WO2016174787A1 - Bone connector - Google Patents

Bone connector Download PDF

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Publication number
WO2016174787A1
WO2016174787A1 PCT/JP2015/079168 JP2015079168W WO2016174787A1 WO 2016174787 A1 WO2016174787 A1 WO 2016174787A1 JP 2015079168 W JP2015079168 W JP 2015079168W WO 2016174787 A1 WO2016174787 A1 WO 2016174787A1
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WO
WIPO (PCT)
Prior art keywords
hole
control member
screw
intramedullary nail
inner peripheral
Prior art date
Application number
PCT/JP2015/079168
Other languages
French (fr)
Japanese (ja)
Inventor
雅規 水上
信夫 松崎
竜太 福豊
康文 椙本
Original Assignee
プロスパー株式会社
ケイ・エヌ・メディカル株式会社
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 プロスパー株式会社, ケイ・エヌ・メディカル株式会社 filed Critical プロスパー株式会社
Priority to JP2016501482A priority Critical patent/JP5961774B1/en
Publication of WO2016174787A1 publication Critical patent/WO2016174787A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72Intramedullary pins, nails or other devices

Definitions

  • the present invention relates to a bone connector. More specifically, the present invention relates to a bone connector that is excellent in handling at the time of use and can sufficiently suppress the rotation of bone fragments at a treatment site.
  • the intramedullary nail is inserted along the longitudinal direction of the bone to be treated, and is used particularly for the treatment of femoral fractures and the like.
  • a bone joint that combines an intramedullary nail and a lag screw is subject to a load due to daily activities after treatment, etc., and may rotate due to the rotational force applied to the bone piece and the lag screw engaged with the bone piece. .
  • cases have been reported in which bone fragments are separated again or the adhesion of fracture sites is delayed.
  • a sub-pin attached to the intramedullary nail in a direction substantially parallel to the lag screw is used in combination.
  • the sub-pin is a sharp rod-like member, and the pointed tip enters the cancellous material in the bone to make it difficult for the bone fragment and the lag screw to rotate.
  • a groove is formed along the longitudinal direction on the outer peripheral surface of the lag screw and rotation is suppressed by using a control member fitted to the groove.
  • the control member has a protrusion that fits into the groove of the lag screw, and is disposed inside the intramedullary nail to fit into the groove of the lag screw.
  • the lag screw is restricted from rotating around the longitudinal direction as the central axis.
  • the degree of fixing by this control member is adjusted using a separate adjustment member.
  • a separate adjustment member For example, there is a configuration in which an adjustment member is attached to the inside of the intramedullary nail and above the control member so as to contact the control member. The penetration depth of the adjusting member into the intramedullary nail is adjusted, and the fixing degree of the control member with respect to the lag screw is varied depending on the penetration depth.
  • the fixing degree by the control member of the lag screw can be adjusted, but the sub-pin is not fixed. Therefore, a structure for controlling the fixing degree of the sub-pin has not been adopted.
  • the bone joint device 100 described in Patent Document 1 includes an intramedullary nail body 101, a control member 102, and a cap 103.
  • a plurality of holes are provided in the intramedullary nail body 101, and the main lag screw 104 and the auxiliary lag screw 105 are inserted therein.
  • the control member 102 has a protruding portion 106 at the tip, and the protruding portion 106 is fitted into the groove 107 of the main lag screw 104 so that rotation is suppressed.
  • the control member 102 is pushed downward by the movement of the cap 103 attached to the inner peripheral surface of the intramedullary nail body 101 with a screw structure.
  • the control member 102 has an overhanging portion 108, and the region of the inner peripheral surface of the intramedullary nail body 101 facing this is a depression 109 whose diameter decreases downward. As the cap 103 moves, the control member 102 is pushed downward while the overhanging portion 108 and the depression 109 generate contact drag. Then, the interval between the cracks 110 of the control member 102 becomes narrower.
  • the insertion passage 111 through which the sub lag screw 105 is inserted becomes narrow, and the inner wall surface of the insertion passage 111 comes into contact with the sub lag screw 105. Finally, the contact pressure of the insertion passage 111 regulates the sliding and rotation of the auxiliary lag screw 105. That is, in the bone fastener 100, the control member 102 fixes the main lag screw 104 and the sub lag screw 105 simultaneously.
  • control member is affected by both the load applied to the main lag screw and the load applied to the sub lag screw. That is, due to the patient's operation after the operation, a load is applied to both the main lag screw and the auxiliary lag screw, and vibrations from both engagement members are transmitted to the control member, so that the control member is more likely to loosen. ing.
  • the fixing of the auxiliary lag screw is gradually generated from the generation of the contact drag between the overhang portion and the depression due to the pressing of the control member to the narrowing of the crack of the control member. Since the movement of the control member does not directly fix the sub-pin, it is expected that the fixing of the sub-pin is insufficient.
  • a member called an end cap that closes the through hole of the intramedullary nail is attached to the upper side of the control member.
  • the control member may fall out from the inside of the intramedullary nail before the end cap is attached.
  • a conventional bone joint has a structure in which a control member is attached to the inner peripheral surface of the intramedullary nail with a screw structure, and the control member is rotated to adjust the advance and retreat in the longitudinal direction of the intramedullary nail.
  • the control member is accommodated in the intramedullary nail and used for use.
  • the control member may enter deep inside the intramedullary nail and reach the end of the screw structure due to the vibration of transportation before use.
  • control member is completely tightened in order to control the movement of the lag screw in the rotational direction and allow the movement to the rear end side in the longitudinal direction to allow “fixing that allows sliding”.
  • the position is set back by a quarter of a turn in the loosening direction. At this time, it is important that the control member does not advance and retract more than necessary in the through-hole of the intramedullary nail and keeps a slightly loosened position.
  • the present invention was devised in view of the above points, and provides an osteosynthesis device that is excellent in handling at the time of use and that can sufficiently suppress rotation of a bone fragment at a treatment site. It is the purpose.
  • the osteosynthesis device of the present invention is a first tubular body in which a first through hole is formed, and a first pin hole communicated with the first through hole.
  • a second pin hole located on the opposite side of the first pin hole of the first cylindrical body and coaxially and communicating with the first through hole, and below the first pin hole.
  • a first screw hole located substantially parallel to the first pin hole and communicating with the first through hole; and a position opposite to and coaxial with the first screw hole of the first cylindrical body.
  • an intramedullary nail in which a second screw hole communicating with the first through hole is formed, and a second cylindrical body that can be accommodated inside the intramedullary nail and has a second through hole formed therein.
  • a first control member formed with a fourth pin hole communicating with the through-hole, and a fitting formed on one end side of the first control member and projecting in one end direction of the first control member
  • a first fixing portion that is located on the other end side of the first control member and that can fix the first control member to the intramedullary nail;
  • the first through hole is closed at the end opposite to the first screw hole and the second screw hole as viewed from the first pin hole and the second pin hole of the inner nail.
  • a second control member, a second fixing member provided on the second control member and capable of fixing the second control member to the intramedullary nail, and protruding from the second control member A protrusion that can be inserted into the second through-hole from the other end side of the first control member, and the first fixing portion on the inner peripheral surface of the intramedullary nail
  • the intramedullary nail is the first cylindrical body in which the first through-hole is formed, it becomes possible to put another member inside the first through-hole. That is, the first control member and the second control member can be accommodated.
  • the intramedullary nail is connected to the first pin hole communicating with the first through hole and the first pin hole of the first cylindrical body opposite to the first pin hole and coaxially.
  • the engaging member to the bone fragment can be inserted through the first pin hole and the second pin hole.
  • the engaging member here includes, for example, known sub-pins and sub-lag screws.
  • the intramedullary nail includes a first screw hole located substantially parallel to the first pin hole below the first pin hole and communicating with the first through hole, and a first cylindrical body first.
  • the main screw is inserted into the first screw hole and the second screw hole by forming a second screw hole which is located on the opposite side of the screw hole and coaxially and communicates with the first through hole. It becomes possible.
  • the first control member can be accommodated inside the intramedullary nail, the first control member can be arranged inside the intramedullary nail.
  • the first control member is a second cylindrical body that can be accommodated inside the intramedullary nail and has a second through-hole formed therein, so that the first control member is arranged inside the intramedullary nail, Furthermore, it becomes possible to put another member inside the first control member. That is, the protruding portion can be inserted.
  • the first control member has a third pin hole communicating with the second through hole, and a second through hole located on the opposite side and coaxial with the third pin hole of the second cylindrical body.
  • the engaging member here includes, for example, known sub-pins and sub-lag screws.
  • the third pin hole corresponds to the first pin hole of the first control member
  • the fourth pin hole corresponds to the second pin hole of the first control member.
  • the linear positions in the third pin hole and the fourth pin hole are those in which a known sub-pin or the like can be inserted straight and the sub-pin or the like can be disposed in a substantially parallel positional relationship with the lag screw. If it is enough.
  • the first control member is positioned on one end side of the first control member, and the first control member is inserted into the first screw hole of the intramedullary nail by a fitting convex portion that protrudes toward the one end of the first control member. And it can be set as the fixing tool of the member inserted in a 2nd screw hole. That is, for example, when the main lag screw is inserted into the first screw hole and the second screw hole, the fitting convex portion is fitted into the groove formed in the longitudinal direction on the outer peripheral surface of the main lag screw.
  • the first control member regulates the rotational movement of the main lag screw.
  • the first control member can be fixed to the intramedullary nail by a first fixing portion that is located on the other end side of the first control member and can fix the first control member to the intramedullary nail.
  • first nail is located on the inner side of the intramedullary nail and at the end opposite to the first screw hole and the second screw hole as viewed from the first pin hole and the second pin hole of the intramedullary nail.
  • the second control member that closes the through hole can prevent foreign matter from entering the first through hole of the intramedullary nail while disposing the first control member inside the intramedullary nail.
  • the second control member can be fixed to the intramedullary nail by a second fixing portion provided on the second control member and capable of fixing the second control member to the intramedullary nail.
  • first inner peripheral region to which the first fixing portion of the inner peripheral surface of the intramedullary nail is fixed, and a second inner peripheral region to which the second fixing portion of the inner peripheral surface of the intramedullary nail is fixed
  • the first control member is not excessively fixed to the intramedullary nail, and the first control member is less likely to be unremovable.
  • the intramedullary nail is made of titanium, if the length of the fixing part such as a screw structure is long, the fixing member may be too bite and cannot be separated.
  • the first fixing portion and the second fixing portion are fixed to the inner peripheral surface of the intramedullary nail with a screw structure, so that the first control member and the second control member are rotated and the intramedullary nail is rotated.
  • the rotation operation in the screw structure at this time can be performed by, for example, a combination of a polygonal driver and a fitting hole fitted therein.
  • the area between the first inner peripheral area and the second inner peripheral area of the intramedullary nail is a first inner diameter formed larger than the inner diameter of the first inner peripheral area and the second inner peripheral area.
  • the first fixing portion has an outer diameter that is substantially the same as the inner diameter of the first inner peripheral region, and is a substantially donut with a cross section viewed from the short direction side of the first control member.
  • the first control member has a first fitting part that can be installed in the first control member, and the first control member has a second fitting part that can be installed in the first fitting part,
  • the outer diameter of at least a part of the first fitting portion is larger than the inner diameter of the corresponding region of the second fitting portion, the first fitting portion and the first fitting portion The tightening margin is generated between the two fitting portions.
  • the first fixing portion and the first control member advance and retract with respect to the first through hole of the intramedullary nail.
  • a frictional resistance force is generated between the first fitting portion and the second fitting portion, and the first fixing portion is difficult to rotate with respect to the intramedullary nail with a weak force such as vibration. . That is, the positions of the first fixing portion and the first control member in the through-hole of the intramedullary nail are easily held. Thereby, it becomes a structure in which excessive insertion and loosening of the first control member are unlikely to occur.
  • the second control member is It is possible to provide a fixture for a member inserted into the pin hole to the fourth pin hole. That is, for example, when the sub pin is inserted into the first pin hole to the fourth pin hole, the projecting portion is brought into contact with the outer peripheral surface of the sub pin and fixed with the pressure, and the second control member slides the sub pin. It regulates the movement and rotation.
  • the protruding portion has a length where the tip is located on the other end side of the first control member from the region sandwiched between the third pin hole and the fourth pin hole of the second through hole.
  • the first fixing portion when the first fixing portion is rotatably mounted with respect to the first control member, the first pin hole and the second pin hole of the intramedullary nail and the first control member It is easy to align the positions of the third pin hole and the fourth pin hole. That is, for example, when the first fixing portion is fitted and rotated with a dedicated driver, the first control member moves forward and backward to the first through hole of the intramedullary nail without rotating.
  • the first control member can be fixed at a predetermined position of the intramedullary nail while the positions of the pin hole and the fourth pin hole are hardly changed.
  • the first fixing portion is rotatably mounted with respect to the first control member, and the first control member includes an inner peripheral surface thereof, the first fixing portion, the third pin hole, and the fourth pin.
  • a thread groove is formed in a region between the holes, only the first control member can be advanced and retracted with respect to the intramedullary nail. That is, for example, even when the first fixing portion and the first control member are separated and cannot be used as they are, a dedicated screwdriver is fitted into the screw groove of the first control member to It can be taken out from the inner nail. As a result, the fixed state of the lag screw by the first control member can be released.
  • six grooves having a substantially hexagonal cross section when viewed from the short direction side of the first control member along the longitudinal direction of the first control member are formed on the inner peripheral surface of the first fixing portion.
  • the rotation operation of the first fixed portion can be performed more reliably, and usability can be improved.
  • a dedicated hexagonal screwdriver that fits into the six grooves is used.
  • the driver is less likely to slip with respect to the first fixed portion than in a case where the screwdriver is fitted on two surfaces. It will be a thing.
  • the first fixing portion has a first fitting portion whose outer diameter is substantially the same as the inner diameter of the first inner peripheral region, and which can be housed in the first control member.
  • the first control member has a second fitting portion that can house the first fitting portion, and the protruding portion can be fitted into the second recess and the protruding portion of the protruding portion. In the case of having a tapered portion whose diameter decreases in the direction, the first control member can be made difficult to loosen.
  • the taper portion of the protruding portion comes into contact with the second recess portion of the first fixing portion, so that the slit portion of the first fixing portion spreads, and the contact pressure is uniformly applied to the first fixing portion. It will be a thing. As a result, the pressure of contact between the first fixing portion and the inner peripheral surface of the intramedullary nail increases, and the first control member can be made difficult to loosen. Further, the lower the second control member is fixed, the more difficult it is to loosen the first control member.
  • the first fixed portion has a first fitting portion whose outer diameter is formed larger than the inner diameter of the first inner peripheral region and has elasticity, and can be installed in the first control member.
  • a slit penetrating from the inner peripheral surface of the second through hole to the outer peripheral surface of the first fixing portion is formed, when the first fixing portion and the first control member are inserted into the intramedullary nail A resistance force is generated between the first fixing portion and the first inner peripheral region, and the positions of the first fixing portion and the first control member in the through-hole of the intramedullary nail are easily maintained.
  • the outer diameter of the first fixing portion is larger than the first inner peripheral region before being inserted into the intramedullary nail, but when inserted into the intramedullary nail, due to the size of the diameter, The distance between the slit portions is reduced by contact with the first inner peripheral region, and the outer diameter of the first fixing portion is reduced. As a result, an urging force is generated in the first fixing portion to return to the original outer diameter due to elasticity, and the first fixing portion pushes the first inner peripheral region of the intramedullary nail and become.
  • region is the screw structure to the intramedullary nail of the 1st fixing
  • the first fitting portion and the first control member advance and retract with respect to the first through hole of the intramedullary nail.
  • a frictional resistance force is generated between the first fitting portion and the second fitting portion, and the first fixing portion is difficult to rotate with respect to the intramedullary nail with a weak force such as vibration. . That is, the positions of the first fixing portion and the first control member in the through-hole of the intramedullary nail are easily held. Thereby, it becomes a structure in which excessive insertion and loosening of the first control member are unlikely to occur.
  • the second control member is moved to the first control member. It is possible to provide a fixture for a member inserted into the pin hole to the fourth pin hole. That is, for example, when the sub pin is inserted into the first pin hole to the fourth pin hole, the projecting portion is brought into contact with the outer peripheral surface of the sub pin and fixed with the pressure, and the second control member slides the sub pin. It regulates the movement and rotation.
  • the protrusion has a length located at the other end side of the first control member from the region sandwiched between the third pin hole and the fourth pin hole of the second through hole.
  • the member constituted by the second control member and the protruding portion can be used when a bone is joined with an intramedullary nail and a lag screw without using a sub-pin together.
  • the osteosynthesis device according to the present invention is excellent in handling at the time of use, and can sufficiently suppress the rotation of the bone fragment at the treatment site.
  • FIG. 2 is a side sectional view and a partially enlarged view of the bone joint device according to the first embodiment of the present invention.
  • It is the schematic front view (b) which shows the schematic front view (a) of an end cap, and the structure of another end cap.
  • It is the schematic sectional view (a) of the intramedullary nail and the schematic view (b) which looked at the intramedullary nail from the near side of the insertion direction of a lag screw.
  • Sectional view seen from the side of the set screw, side schematic view of the set screw and washer (a), schematic view of the washer (b), schematic view of the head side of the set screw (c), and body side of the set screw A schematic diagram (d) is shown. It is sectional drawing (a) of a trunk
  • drum sectional drawing (b) of a head
  • FIG. 1 is a side sectional view and a partially enlarged view of a bone joint device according to an embodiment of the present invention.
  • the structure of this invention is not limited to the content shown below, It can change suitably.
  • an osteosynthesis device 1 as an example of an osteosynthesis device to which the present invention is applied includes an intramedullary nail 2, a set screw 3, and an end cap 4. Moreover, the lag screw 5 and the sub pin 6 are inserted in the intramedullary nail 2 as an engaging member engaged with a bone fragment.
  • Each of the osteosynthesis tools 1 is formed of a metal member that can be used in a surgical operation.
  • the intramedullary nail 2 is a member that connects the bone fragments so that the bone fragments are not displaced and fused or separated before the fractured site is healed. Moreover, it is a member holding engagement members, such as the lag screw 5, in bone.
  • a pin hole 7 and a pin hole 8 In the intramedullary nail 2, a pin hole 7 and a pin hole 8, a screw hole 9 and a screw hole 10 are formed, and a lag screw 5 and a sub pin 6 are inserted respectively.
  • the lag screw 5 bites into the sponge in the bone to be treated (not shown) to generate a resistance force in the anterior-posterior direction, thereby preventing the head from falling off and preventing the rotation.
  • the male screw 11 is formed on the outer peripheral surface of the tip of the lag screw 5, and this male screw 11 is a portion that bites into the intraosseous sponge.
  • a screw groove 12 is formed on the outer peripheral surface of the body portion of the lag screw 5 along the longitudinal direction.
  • the screw groove 12 is a portion that fits into a protruding piece 13 at the tip of the set screw 3 to be described later.
  • a plurality of screw grooves 12 are formed at regular intervals on the circumference of the outer peripheral surface of the body portion of the lag screw 5.
  • the sub-pin 6 is a sharp rod body, and the tip portion easily enters the sponge in the bone to be treated, and is located in the bone without opening a large hole in the bone. It is positioned substantially parallel to the lag screw 5 in the bone, and suppresses the rotation of the bone head.
  • the sub pin 6 is formed shorter than the lag screw 5. Moreover, the trunk
  • a lateral retaining hole (not shown) is formed, and a lateral retaining screw is inserted at the lower end position to fix the intramedullary nail 2 in the bone.
  • a through hole 14 is formed in the axial center of the intramedullary nail 2.
  • a part of the lag screw 5 and the sub pin 6 described above is located in the through hole 14.
  • a set screw 3, a washer 16 and an end cap 4 are attached inside the through hole 14.
  • the set screw 3 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and suppresses the rotation of the lag screw 5.
  • a protruding piece 13 is formed at the tip of the set screw 3 and is fitted to the screw groove 12 of the lag screw 5.
  • the set screw 3 is formed with a pin hole 18 and a pin hole 19, and is located on the same straight line as the pin hole 7 and the pin hole 8 of the intramedullary nail 2 described above, and is a portion into which the sub pin 6 is inserted. ing.
  • the set screw 3 has a large overhanging portion 20, and a screw groove 21 is formed on the outer peripheral surface thereof.
  • the screw groove 21 is fitted to the screw groove 22 on the inner peripheral surface of the intramedullary nail 2, and the set screw 3 is fixed to the intramedullary nail 2 with a screw structure. Further, the overhang portion 20 is fitted to the step 23 of the intramedullary nail 2.
  • a through hole 24 is formed in the center of the set screw 3 in the longitudinal direction.
  • the through hole 24 is a part into which a part of the end cap 4 is inserted.
  • a slit substantially parallel to the through hole 24 is formed on the inner peripheral surface of the overhang portion 20 of the set screw 3. The shape of the slit will be described later.
  • the shapes of the pin hole 18 and the pin hole 19 of the set screw 3 are not particularly limited, and it is sufficient if the sub pin 6 can be inserted straight and is positioned substantially parallel to the lag screw 5. is there.
  • the washer 16 is disposed above the set screw 3.
  • the washer 16 serves as a member that prevents the set screw 3 from falling out of the through hole 14.
  • the washer 16 is a ring-shaped member having a cut, and has a diameter capable of surrounding a part of the end cap 4.
  • the washer 16 is disposed in the recess 25 on the inner peripheral surface of the intramedullary nail 2.
  • the depression 25 is formed slightly larger than the washer 16, and the washer 16 is fitted with a margin.
  • a recess 25 is positioned between a screw groove 22 for fixing the set screw 3 and a screw groove 26 for fixing an end cap, which will be described later. That is, on the inner peripheral surface of the intramedullary nail 2, screw grooves are formed discontinuously.
  • the end cap 4 is attached above the set screw 3 and the washer 16.
  • the end cap 4 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and closes the through hole 14. Further, the protruding portion 27 of the end cap 4 is a portion for fixing the sub-pin 6 inserted into the intramedullary nail 2.
  • the end cap 4 has a protruding portion 27, a tapered portion 28, a thread groove portion 29, and a head portion 30.
  • the protruding portion 27 has a diameter that can be inserted into the through hole 24 of the set screw 3, and the tip thereof is formed in a hemispherical shape. This hemispherical portion comes into contact with the cylindrical outer peripheral surface of the sub-pin 6 and fixes the sub-pin 6.
  • the screw groove portion 29 has a screw groove formed on the outer peripheral surface thereof, and is fitted to the screw groove 26 on the inner peripheral surface of the intramedullary nail 2, and the end cap 4 is fixed to the intramedullary nail 2 by a screw structure. Further, the head 30 is formed with a driver hole on the inner side, and becomes a portion where the driver is fitted when the end cap 4 is attached. A hole that fits with the driver is also formed on the inner periphery of the overhang portion 20 of the set screw 3.
  • the screw groove 22 is formed longer than the screw groove 26. More specifically, the screw groove 22 has a length of 5.8 mm and the screw groove 26 has a length of 4 mm.
  • the tip of the projecting portion 27 of the end cap 4 does not necessarily have to be hemispherical.
  • the tip of the protruding portion 27 of the end cap 4 can be a protruding piece that fits into the screw groove.
  • the screw groove 22 and the screw groove 26 of the intramedullary nail 2 do not necessarily need to be formed longer than the screw groove 26.
  • the length of the screw groove 22 is not limited to 5.8 mm, and the length of the screw groove 26 is not limited to 4 mm.
  • FIG. 2 is a schematic front view (a) of the end cap and a schematic front view (b) showing other end cap structures.
  • the end cap 4 has the protruding portion 27, the tapered portion 28, the screw groove portion 29, and the head portion 30.
  • the area of the thread groove 29 has the largest diameter, and is fixed to the inner peripheral surface of the intramedullary nail 2 at this position and closes the through hole 14.
  • an end cap 31 as shown in FIG. 2B may be used.
  • the end cap 31 is formed with a short protrusion 32 and is attached to the intramedullary nail 2 when the sub-pin is not used together or when the sub-pin is not fixed.
  • the structure of the bone fastener using the end cap 31 shown in FIG. 2B will be described later.
  • FIG. 3 is a schematic cross-sectional view (a) of the intramedullary nail and a schematic view (b) of the intramedullary nail viewed from the front side in the insertion direction of the lag screw.
  • FIG. 4 is a schematic cross-sectional view showing the shape of another intramedullary nail.
  • the intramedullary nail 2 has a through hole 14 formed in the longitudinal direction, and each hole for insertion of the lag screw 5 and the sub pin 6 is formed in communication therewith.
  • a lateral stop hole 33 and a lateral stop hole 34 are formed at the lower end of the intramedullary nail 2, and a lateral stop screw is inserted.
  • a screw groove 22 for fixing the set screw 3 and a screw groove 26 for fixing the end cap are formed on the inner peripheral surface of the intramedullary nail 2.
  • the pin hole 7 and the pin hole 8 for inserting the sub-pin, and the screw hole 9 and the screw hole 10 for inserting the lag screw have a shape in a range in which the sub-pin and the lag screw can be inserted. It has become a thing.
  • the intramedullary nail 41 shown in FIG. 4 has a shape in which the lower side is bent about 4 ° with respect to the central axis on the upper side. More specifically, it may be difficult to insert an intramedullary nail straight along the central axis of the femur, which may cause a new fracture. Therefore, the above-described shape is employed so that the intramedullary nail can be inserted from the top of the greater trochanter of the femur rather than on the central axis of the femur.
  • the set screw 3 and the end cap 4 described above can also be used for such an intramedullary nail 41.
  • FIG. 5 shows a schematic diagram (a) of the sub-pin and a schematic diagram (b) of the lag screw.
  • the sub-pin 6 is a sharp rod-like body, and a hole used for insertion into the intramedullary nail is formed at the opposite end.
  • the lag screw 5 has the external thread 11 formed in the outer peripheral surface of the front-end
  • a screw groove 12 is formed on the outer peripheral surface.
  • 5A and 5B are diagrams in which each engagement member is viewed from the end opposite to the insertion direction.
  • FIG. 6 is a cross-sectional view of the set screw viewed from the side, a schematic side view of the set screw and washer (a), a schematic view of the washer (b), a schematic view of the head side of the set screw (c), and a set.
  • a schematic diagram (d) of the body side of the screw is shown.
  • the set screw 3 includes a head portion 35 and a body portion 36.
  • the head portion 35 has a fitting piece 37, and the fitting piece 37 is attached to the fitting groove 38 of the body portion 36 so as not to be separated with respect to a certain force.
  • the head portion 35 is attached to the body portion 36 so as to be rotatable. That is, although the separation in the longitudinal direction is restricted by the fitting piece 37 and the fitting groove 38, rotation about the longitudinal direction is possible.
  • the head portion 35 is rotatable with respect to the body portion 36, when the set screw 3 is inserted into the through hole 14 of the intramedullary nail 2, the positions of the pin hole 18 and the pin hole 19 are changed. Instead, only the head 35 can be rotated and screwed to the inner peripheral surface of the intramedullary nail 2.
  • the head 35 is formed with a slit 39 and a slit 40.
  • the slit 39 is obtained by partially cutting the head 35 from the inner peripheral surface side to the outer peripheral surface side of the head 35.
  • the slit 40 is narrower than the slit 39 and is formed so as to penetrate from the inner peripheral surface of the head 35 to the outer peripheral surface.
  • the outer diameter of the head portion 35 is processed so as to change before and after the head portion 35 and the body portion 36 are integrated. Specifically, the slit 40 is slightly expanded to increase the outer diameter of the head 35.
  • the outer diameter of the head portion 35 is approximately the same as the screw groove 22 of the intramedullary nail 2. That is, the head 35 is rotated with almost no resistance by rotating the head 35 with a dedicated mounting tool, and the outer diameter of the set screw 3 can change the position on the inner peripheral surface of the through hole 14. ing.
  • the head 35 is press-fitted into the body portion 36 with a dedicated tool, and the fitting piece 37 is fitted into the fitting groove 38. After that, a wedge-shaped exclusive tool is inserted into the slit 40 and the slit 40 is slightly expanded. After machining, the slit 40 is expanded with the tool removed, and the outer diameter of the head 35 is increased accordingly.
  • the size of the outer diameter of the head 35 is slightly larger than the size of the inner peripheral surface at the position of the screw groove 22 of the intramedullary nail 2. Since the head portion 35 is formed of an elastic metal, when the external force acts in the direction in which the slit distance of the slit 40 is shortened, that is, in the direction in which the outer diameter of the head portion 35 is reduced, the original outer diameter An urging force is generated to return to the size of.
  • the set screw 3 Since the size of the outer diameter of the head 35 is slightly larger than the size of the inner peripheral surface at the position of the screw groove 22 of the intramedullary nail 2, the set screw 3 is inserted into the through hole 14 of the intramedullary nail 2.
  • the urging force acts as a force in the direction in which the head portion 35 pushes the screw groove 22, and becomes a resistance force generated between the head portion 35 and the inner peripheral surface of the intramedullary nail 2.
  • the head 35 can be made difficult to rotate after the set screw 3 is inserted into the intramedullary nail 2. That is, the position of the set screw 3 on the inner peripheral surface of the intramedullary nail 2 is easily maintained.
  • the frictional resistance between the body 35 and the body portion 36 is different. Since the frictional resistance between the head 35 and the torso 36 is increased, the head 35 is difficult to rotate, and as a result, the position of the set screw 3 on the inner peripheral surface of the intramedullary nail 2 is easily maintained. It will be a thing.
  • the frictional resistance between the head portion 35 and the body portion 36 can be increased.
  • the fitting piece 37 of the head portion 35 has four claw portions 57, but the number and thickness of the claw portions 57 (symbol t1).
  • the elasticity of the claw portion 57 is increased by adjusting the length (symbol h1).
  • both the structure of ⁇ DA> ⁇ DB and the structure of ⁇ DA ⁇ DB can be adopted as the relationship between ⁇ DA and ⁇ DB. From the point of increasing the frictional resistance, A structure of ⁇ DA ⁇ DB is preferably adopted.
  • the concave portions 58 of the fitting groove 38 of the body portion 36 and the tip shapes of the claw portions 57 of the head portion 35 are shaped so as to easily advance only in the direction in which the claw portion 57 is housed in the fitting groove 38. .
  • the movement of the claw portion 57 in the direction in which the claw portion 57 is pulled out from the concave portion 58, that is, the direction in which the head portion 35 is pulled out from the body portion 36 is restricted by the catch of the concave portion 58 and the claw portion 57. Thereby, the fitting state of the head 35 and the trunk
  • the washer 16 has a cut. This cut is provided so that the washer advances along the thread lead angle of the spiral of the screw structure portion on the inner peripheral surface of the intramedullary nail 2.
  • FIG. 8 (a) and 8 (b) show other shapes of washers that can be applied in the present invention.
  • a washer 59 having a substantially circular outer shape and a washer 60 having a substantially flat shape near the cut can be used.
  • Static fixation is to fix both the movement of the lag screw in the rotating direction and the movement toward the rear end side in the longitudinal direction called sliding.
  • the slit 40 is slightly widened to increase the outer diameter of the head 35, and the elastic force of the head 35 is inserted into the intramedullary nail 2.
  • the position of the set screw on the inner peripheral surface of the intramedullary nail 2 can be easily maintained.
  • a frictional force is generated against the rotation of the head 35 between the head 35 and the body portion 36 by adopting a structure having a relationship of ⁇ DA ⁇ DB, the inner peripheral surface of the intramedullary nail 2
  • the position of the set screw in is easy to hold. That is, it is easy to hold the position where the set screw is returned by a quarter of a turn in the direction of loosening, which is in a “fixed state that allows sliding”.
  • the fixing of the end cap 4 by the screw structure can be sufficiently tightened because the washer 16 is fitted in the recess 25 with a margin. Therefore, the fixing force of the sub pin is secured.
  • the end cap 31 is inserted into the inner peripheral surface of the head portion 35 of the set screw 3, and the insertion stops in the middle of the tapered portion 66 of the end cap 31.
  • the tapered portion 66 bites into the slit 39 of the head portion 35.
  • a force is applied in the direction in which the outer diameter of the head 35 expands.
  • the presence of the slit 40 increases the diameter of the head 35 and prevents the set screw 3 from being loosened. Can be. That is, the rotation of the set screw 3 with respect to the intramedullary nail 2 is suppressed.
  • the structure of the set screw is different from that of the first embodiment described above.
  • drum part which comprise a set screw differs from 1st Embodiment.
  • the structure will be described.
  • the osteosynthesis device of the second embodiment of the present invention includes an intramedullary nail 2, a set screw 42, and an end cap 4. Moreover, the lag screw 5 and the sub pin 6 are inserted in the intramedullary nail 2 as an engaging member engaged with a bone fragment.
  • a pin hole 7 and a pin hole 8 In the intramedullary nail 2, a pin hole 7 and a pin hole 8, a screw hole 9 and a screw hole 10 are formed, and a lag screw 5 and a sub pin 6 are inserted respectively.
  • the male screw 11 is formed on the outer peripheral surface of the tip of the lag screw 5, and this male screw 11 is a portion that bites into the intraosseous sponge.
  • a screw groove 12 is formed on the outer peripheral surface of the body portion of the lag screw 5 along the longitudinal direction.
  • the screw groove 12 is a portion that fits into a protruding piece 43 at the tip of a set screw 42 described later.
  • a plurality of screw grooves 12 are formed at regular intervals on the circumference of the outer peripheral surface of the body portion of the lag screw 5.
  • the sub-pin 6 is a sharp rod body, and the tip portion easily enters the sponge in the bone to be treated, and is located in the bone without opening a large hole in the bone. It is positioned substantially parallel to the lag screw 5 in the bone, and suppresses the rotation of the bone head.
  • the sub pin 6 is formed shorter than the lag screw 5. Moreover, the trunk
  • a lateral retaining hole (not shown) is formed, and a lateral retaining screw is inserted at the lower end position to fix the intramedullary nail 2 in the bone.
  • a through hole 14 is formed in the axial center of the intramedullary nail 2. A part of the lag screw 5 and the sub pin 6 described above is located in the through hole 14. A set screw 42, a washer 16, and an end cap 4 are attached inside the through hole 14.
  • the end cap 4 is attached above the set screw 42 and the washer 16.
  • the end cap 4 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and closes the through hole 14. Further, the protruding portion 27 of the end cap 4 is a portion for fixing the sub-pin 6 inserted into the intramedullary nail 2.
  • the end cap 4 has a protruding portion 27, a tapered portion 28, a thread groove portion 29, and a head portion 30.
  • the protruding portion 27 has a diameter that can be inserted into the through hole 24 of the set screw 3, and the tip thereof is formed in a hemispherical shape. This hemispherical portion comes into contact with the cylindrical outer peripheral surface of the sub-pin 6 and fixes the sub-pin 6.
  • the screw groove portion 29 has a screw groove formed on the outer peripheral surface thereof, and is fitted to the screw groove 26 on the inner peripheral surface of the intramedullary nail 2, and the end cap 4 is fixed to the intramedullary nail 2 by a screw structure. Further, the head 30 is formed with a driver hole on the inner side, and becomes a portion where the driver is fitted when the end cap 4 is attached.
  • the screw groove 22 is formed longer than the screw groove 26. More specifically, the screw groove 22 has a length of 5.8 mm and the screw groove 26 has a length of 4 mm.
  • the tip of the projecting portion 27 of the end cap 4 does not necessarily have to be hemispherical.
  • the tip of the protruding portion 27 of the end cap 4 can be a protruding piece that fits into the screw groove.
  • an end cap 31 as shown in FIG. 2B may be used.
  • the end cap 31 is formed with a short protrusion 32 and is attached to the intramedullary nail 2 when the sub-pin is not used together or when the sub-pin is not fixed.
  • the screw groove 22 and the screw groove 26 of the intramedullary nail 2 do not necessarily need to be formed longer than the screw groove 26.
  • the length of the screw groove 22 is not limited to 5.8 mm, and the length of the screw groove 26 is not limited to 4 mm.
  • FIG. 9 is a cross-sectional view seen from the side of a set screw according to the second embodiment of the present invention, a schematic side view of the set screw and washer (a), a schematic view of the washer (b), and a head of the set screw.
  • the schematic diagram (c) of the side and the schematic diagram (d) of the fuselage side of the set screw are shown.
  • the set screw 42 includes a head 44 and a body 45.
  • the head 44 has a fitting piece 46, and the fitting piece 46 is attached to the fitting groove 47 of the body portion 45 so as not to be separated with respect to a certain force.
  • the head 44 is attached to the body 45 so as to be rotatable. That is, the separation in the longitudinal direction is restricted by the fitting piece 46 and the fitting groove 47, but rotation about the longitudinal direction is possible.
  • 9A is a cross-sectional view, and the lower view is a schematic view.
  • the head portion 44 Since the head portion 44 is rotatable with respect to the body portion 45, the positions of the pin hole 48 and the pin hole 49 described later are changed when the set screw 42 is inserted into the through hole 14 of the intramedullary nail 2. Without doing so, only the head 44 can be rotated and screwed to the inner peripheral surface of the intramedullary nail 2.
  • the set screw 42 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and suppresses the rotation of the lag screw 5.
  • a protruding piece 43 is formed at the tip of the set screw 42 and is fitted to the screw groove 12 of the lag screw 5.
  • the set screw 42 is formed with a pin hole 48 and a pin hole 49, which are located on the same straight line as the pin hole 7 and the pin hole 8 of the intramedullary nail 2 described above and into which the sub pin 6 is inserted. ing.
  • the set screw 42 is not necessarily composed of the head portion 44 and the body portion 45, and the head portion 44 is not necessarily attached to the body portion 45 so as to be rotatable.
  • the head portion and the trunk portion are integrated without being separated may be employed.
  • the set screw 42 is attached to a desired position without changing the positions of the pin hole 48 and the pin hole 49, and there is no need to align the pin holes.
  • the body portion 45 is preferably configured such that the head portion 44 is rotatably attached to the body portion 45.
  • the shapes of the pin hole 48 and the pin hole 49 of the set screw 42 are not particularly limited, and it is sufficient if the sub pin 6 can be inserted straight and is positioned substantially parallel to the lag screw 5. .
  • the set screw 42 has an overhanging portion 50 having a large diameter, and a screw groove 51 is formed on the outer peripheral surface thereof.
  • the screw groove 51 is fitted to the screw groove 22 on the inner peripheral surface of the intramedullary nail 2, and the set screw 42 is fixed to the intramedullary nail 2 by a screw structure. Further, the overhanging portion 50 is fitted to the step 23 of the intramedullary nail 2.
  • a through hole 52 is formed at the center of the set screw 42 in the longitudinal direction.
  • the through hole 52 is a portion into which a part of the end cap 4 is inserted.
  • a part of the through hole 52 of the body part 45 is tapped so that a groove part 53 is provided.
  • the groove 53 is a place that can be fitted with a dedicated driver, and when a large external force acts on the head 44 and the body 45 of the set screw 42 and the head 44 and the body 45 are separated, The body part 45 can be removed from the inside of the intramedullary nail 2.
  • a groove 54 is also formed on the inner peripheral surface of the head 44, and this groove 54 is used during normal use. That is, rotation of the set screw 42 in which the head portion 44 and the body portion 45 are integrated with respect to the intramedullary nail 2 is performed by fitting and rotation of the groove portion 54 and the dedicated driver.
  • the washer 16 is disposed above the set screw 42.
  • the washer 16 is a member that prevents the set screw 42 from falling off the through hole 14.
  • the washer 16 is a ring-shaped member having a cut, and is formed to have a diameter that can partially surround the end cap 4.
  • the washer 16 is disposed in the recess 25 on the inner peripheral surface of the intramedullary nail 2 (see FIG. 1).
  • the depression 25 is formed slightly larger than the washer 16, and the washer 16 is fitted with a margin.
  • a recess 25 is located between the screw groove 22 for fixing the set screw 42 and the screw groove 26 for fixing the end cap. That is, on the inner peripheral surface of the intramedullary nail 2, screw grooves are formed discontinuously.
  • the head 44 is formed in a substantially donut shape in a cross-sectional view in the short side direction. That is, unlike the head portion 35 of the first embodiment described above, the head portion 44 is not formed with slits 39 and slits 40 and has a continuous shape.
  • the size of the inner diameter ⁇ DA at the position 61 in the fitting groove 47 of the body 45 shown in FIG. 10A and the outer diameter ⁇ DB at the position 62 of the head 44 shown in FIG. 10B is ⁇ DA ⁇ DB. It is formed to become. As described above, by increasing the outer diameter ⁇ DB, the frictional resistance between the head portion 44 and the body portion 45 is increased, and the head portion 44 can be made difficult to rotate. As a result, the position of the set screw 42 on the inner peripheral surface of the intramedullary nail 2 can be easily maintained.
  • the set screw 42 is different from the set screw 3 described above in the structure of the claw portion 63 of the head 44.
  • the head 44 of the set screw 42 has six claw portions 63.
  • the thickness (reference symbol t2) of the claw portion 63 is formed thinner than the thickness (reference symbol t1) of the claw portion 57 described above.
  • the length of the claw portion 63 (symbol h2) is longer than the length of the claw portion 57 (symbol h1) described above.
  • the claw part 63 has a longer structure than the claw part 57 in which the number of claws is increased and the thickness is reduced. Thereby, the elasticity of the claw part 63 further increases, and the frictional resistance between the head part 44 and the body part 45 can be increased. Further, since the elastic force is improved, the claw portion 63 is unlikely to sag when the head portion 44 and the body portion 45 are integrated, that is, when the claw portion 63 is press-fitted into the fitting groove 47. be able to.
  • the concave portions 64 of the fitting groove 47 of the body portion 45 and the tip shapes of the claw portions 63 of the head portion 44 are shaped so as to easily advance and advance only in the direction in which the claw portion 63 is housed in the fitting groove 47. .
  • the movement of the claw part 63 in the direction in which the claw part 63 is pulled out from the concave part 64, that is, the direction in which the head part 44 comes out of the body part 45 is restricted by the catch of the concave part 64 and the claw part 63. Thereby, the fitting state of the head 44 and the trunk
  • FIG. 11 is a schematic diagram of the head 44, and a diagram on the right side is a cross-sectional view taken along the line CC.
  • the twelve corner portions 65 of the claw 63 of the head 44 shown in the right side of FIG. 11 are chamfered. Thereby, it has the structure which reduces the sliding galling in the contact location of the trunk
  • FIG. 11 is a schematic diagram of the head 44, and a diagram on the right side is a cross-sectional view taken along the line CC.
  • the twelve corner portions 65 of the claw 63 of the head 44 shown in the right side of FIG. 11 are chamfered. Thereby, it has the structure which reduces the sliding galling in the contact location of the trunk
  • the groove portion 54 of the head portion 44 has a substantially hexagonal shape in cross section, and is formed in the longitudinal direction along the through hole 52 of the head portion 44.
  • This part is a part that fits with a dedicated hexagon driver, and is a part that causes the set screw 42 to rotate.
  • the groove 54 has a substantially hexagonal cross section, and it is sufficient if the set screw 42 can be rotated.
  • the groove portion 54 is composed of six grooves having a substantially hexagonal cross section because the set screw can be more reliably rotated with less difficulty in sliding with the driver.
  • FIG. 9D shows the structure of the body portion 45. As described above, the groove portion 53 is formed in the body portion 45.
  • the present invention can also employ the structure of the second embodiment as described above.
  • a frictional resistance force is more easily generated between the head and the body of the set screw, and the set on the inner peripheral surface of the intramedullary nail is performed.
  • the position of the screw is easier to hold.
  • the position of the set screw is more easily held.
  • the osteosynthesis device of the present invention is excellent in handleability at the time of use, and can sufficiently suppress the rotation of the bone fragment at the treatment site.

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Abstract

A bone connector 1 that is one example of a bone connector according to an embodiment of the present invention is provided with an intramedullary nail 2, a set screw 3, and an end cap 4. In addition, a lag screw 5 and a sub-pin 6 are inserted in the intramedullary nail 2 as an engagement member for engagement with a bone fragment. The end cap 4 comprises a protruding section 27, a tapered section 28, a screw groove section 29, and a head section 30. The protruding section 27 has a diameter that enables insertion thereof into a through hole 24 in the set screw 3. The tip of said protruding section 27 is formed in a hemispherical shape. The part having a hemispherical shape is in contact with the cylindrical outer circumferential surface of the sub-pin 6 and fixes the sub-pin.

Description

骨接合具Osteosynthesis
 本発明は、骨接合具に関する。詳しくは、使用時の取扱い性に優れ、かつ、施術部位における骨片の回旋を充分に抑えることが可能な骨接合具に係るものである。 The present invention relates to a bone connector. More specifically, the present invention relates to a bone connector that is excellent in handling at the time of use and can sufficiently suppress the rotation of bone fragments at a treatment site.
 従来から、骨折治療の現場において、髄内釘とラグスクリューを組み合わせた骨接合具が使用されている。髄内釘は、施術対象骨の長手方向に沿って挿入されるものであり、特に大腿部の骨折などの治療のために用いられる。 Traditionally, bone joints that combine intramedullary nails and lag screws have been used in the field of fracture treatment. The intramedullary nail is inserted along the longitudinal direction of the bone to be treated, and is used particularly for the treatment of femoral fractures and the like.
 髄内釘及びラグスクリューを組み合わせた骨接合具に、施術後の日常生活動作等により荷重がかかり、骨片及び骨片に係合したラグスクリューに対する回転方向の力が加わって回旋することがある。この結果、骨片が再度分離したり、骨折部位の癒着が遅れたりする症例が報告されている。 A bone joint that combines an intramedullary nail and a lag screw is subject to a load due to daily activities after treatment, etc., and may rotate due to the rotational force applied to the bone piece and the lag screw engaged with the bone piece. . As a result, cases have been reported in which bone fragments are separated again or the adhesion of fracture sites is delayed.
 このような症状を回避するための一案として、ラグスクリューと略平行な向きに髄内釘に取付けられるサブピンが併用されている。サブピンは尖鋭の棒状部材であり、尖った先端が骨内の海綿質に進入することで、骨片及びラグスクリューの回旋を生じにくくする。 As a proposal for avoiding such symptoms, a sub-pin attached to the intramedullary nail in a direction substantially parallel to the lag screw is used in combination. The sub-pin is a sharp rod-like member, and the pointed tip enters the cancellous material in the bone to make it difficult for the bone fragment and the lag screw to rotate.
 また、ラグスクリューの外周面上に長手方向に沿って溝を形成し、その溝と嵌合する制御部材を用いて回旋を抑える構造も存在する。制御部材はラグスクリューの溝に嵌合する突出部を有し、髄内釘の内部に配置されてラグスクリューの溝と嵌合する。 Also, there is a structure in which a groove is formed along the longitudinal direction on the outer peripheral surface of the lag screw and rotation is suppressed by using a control member fitted to the groove. The control member has a protrusion that fits into the groove of the lag screw, and is disposed inside the intramedullary nail to fit into the groove of the lag screw.
 制御部材の突出部とラグスクリューの溝が嵌合することで、ラグスクリューは長手方向を中心軸とした回転運動が規制されるものとなる。 When the protrusion of the control member and the groove of the lag screw are fitted, the lag screw is restricted from rotating around the longitudinal direction as the central axis.
 この制御部材による固定度は、別途の調整部材を用いて調整される。例えば、髄内釘の内部かつ制御部材の上方に調整部材を取り付けて制御部材と接触させる構成がある。調整部材の髄内釘への侵入深さを調整し、その侵入深さにより、制御部材のラグスクリューに対する固定度を異ならせるものとなっている。 ¡The degree of fixing by this control member is adjusted using a separate adjustment member. For example, there is a configuration in which an adjustment member is attached to the inside of the intramedullary nail and above the control member so as to contact the control member. The penetration depth of the adjusting member into the intramedullary nail is adjusted, and the fixing degree of the control member with respect to the lag screw is varied depending on the penetration depth.
 しかしながら、前述したような、サブピンを併用する構造体では、ラグスクリューの制御部材による固定度は調整可能であるが、サブピンの固定はなされていなかった。従って、サブピンの固定度を制御する構造も採用されていなかった。 However, in the structure using the sub-pin as described above, the fixing degree by the control member of the lag screw can be adjusted, but the sub-pin is not fixed. Therefore, a structure for controlling the fixing degree of the sub-pin has not been adopted.
 サブピンの固定が不充分であると、骨内に挿入されたサブピンの回旋や長手方向前後への摺動が生じる。特に、先端方向側にサブピンが移動し、骨頭を突き破ってしまう症例が報告されていた。 と If the sub-pin is not fixed enough, the sub-pin inserted into the bone will rotate and slide back and forth in the longitudinal direction. In particular, a case has been reported in which the subpin moves to the distal direction side and breaks through the bone head.
 こうしたなか、ラグスクリューやサブピン等の骨片に係合する複数の係合部材を同時に制御することを試みた骨接合具が存在し、例えば、特許文献1に記載された骨接合具が提案されている。 Under such circumstances, there exists a bone joint device that attempts to simultaneously control a plurality of engaging members that engage with bone fragments such as a lag screw and a sub-pin. For example, a bone joint device described in Patent Document 1 has been proposed. ing.
 図12(a)及び図12(b)に示すように、特許文献1に記載された骨接合具100は、髄内釘本体101、制御部材102、キャップ103を備えている。髄内釘本体101には複数の孔が設けられ、主ラグスクリュー104及び副ラグスクリュー105が挿入される。 12 (a) and 12 (b), the bone joint device 100 described in Patent Document 1 includes an intramedullary nail body 101, a control member 102, and a cap 103. A plurality of holes are provided in the intramedullary nail body 101, and the main lag screw 104 and the auxiliary lag screw 105 are inserted therein.
 制御部材102は先端に突出部106を有し、突出部106が主ラグスクリュー104の溝107に嵌合して回旋が抑えられるものとなっている。制御部材102は、髄内釘本体101の内周面にネジ構造で取り付けられたキャップ103の動きにより、下方に押し込まれるものとなる。 The control member 102 has a protruding portion 106 at the tip, and the protruding portion 106 is fitted into the groove 107 of the main lag screw 104 so that rotation is suppressed. The control member 102 is pushed downward by the movement of the cap 103 attached to the inner peripheral surface of the intramedullary nail body 101 with a screw structure.
 制御部材102は張出部108を有し、これに対向する髄内釘本体101の内周面の領域は下方に向けて径が小さくなる窪み109となっている。キャップ103の動きに伴い、張出部108と窪み109が接触抗力を生じながら、制御部材102が下方に押しこまれていく。すると、制御部材102の割れ目110の間隔が狭くなっていく。 The control member 102 has an overhanging portion 108, and the region of the inner peripheral surface of the intramedullary nail body 101 facing this is a depression 109 whose diameter decreases downward. As the cap 103 moves, the control member 102 is pushed downward while the overhanging portion 108 and the depression 109 generate contact drag. Then, the interval between the cracks 110 of the control member 102 becomes narrower.
 割れ目110の間隔が狭くなると、副ラグスクリュー105が挿通された挿通路111が狭くなり、挿通路111の内壁面が副ラグスクリュー105に接触する。最終的に、挿通路111の接触圧力が副ラグスクリュー105の摺動と回転を規制するものとなる。即ち、骨接合具100では、制御部材102が主ラグスクリュー104及び副ラグスクリュー105を同時に固定するものとなっている。 When the interval between the cracks 110 is narrowed, the insertion passage 111 through which the sub lag screw 105 is inserted becomes narrow, and the inner wall surface of the insertion passage 111 comes into contact with the sub lag screw 105. Finally, the contact pressure of the insertion passage 111 regulates the sliding and rotation of the auxiliary lag screw 105. That is, in the bone fastener 100, the control member 102 fixes the main lag screw 104 and the sub lag screw 105 simultaneously.
特開2009-153939号公報JP 2009-153939 A
 しかしながら、特許文献1に記載された骨接合具では、主ラグスクリュー及び副ラグスクリューの両方が、制御部材とそれを調整するキャップによって固定度の調整がなされている。制御部材の固定に緩みが生じた場合には、両方の係合部材が回旋または摺動するおそれがある。 However, in the osteosynthesis device described in Patent Document 1, the fixing degree of both the main lag screw and the auxiliary lag screw is adjusted by a control member and a cap for adjusting the same. If the control member is loosened, both engaging members may rotate or slide.
 また、制御部材は、主ラグスクリューにかかる荷重と、副ラグスクリューにかかる荷重の両方の影響を受けるものとなる。即ち、施術後の患者の動作等により、主ラグスクリューと副ラグスクリューの両方に荷重がかかり、両方の係合部材からの振動等が制御部材に伝わるため、制御部材がより緩みやすいものとなっている。 Also, the control member is affected by both the load applied to the main lag screw and the load applied to the sub lag screw. That is, due to the patient's operation after the operation, a load is applied to both the main lag screw and the auxiliary lag screw, and vibrations from both engagement members are transmitted to the control member, so that the control member is more likely to loosen. ing.
 また、副ラグスクリューの固定が、制御部材の押し込みに伴う張出部と窪みの接触抗力の発生から制御部材の割れ目の狭小化へと段階的に生じるものとなっている。制御部材の動きが直接サブピンを固定するものではないため、サブピンの固定が不充分になることが予想される。 In addition, the fixing of the auxiliary lag screw is gradually generated from the generation of the contact drag between the overhang portion and the depression due to the pressing of the control member to the narrowing of the crack of the control member. Since the movement of the control member does not directly fix the sub-pin, it is expected that the fixing of the sub-pin is insufficient.
 また、従来の骨接合具では、制御部材の上側に髄内釘の貫通孔を閉塞するエンドキャップと呼ばれる部材が取り付けられる。骨接合具を取り扱う向きによっては、エンドキャップの取り付け前に、制御部材が髄内釘の内側から外部に抜け落ちてしまうおそれもあった。 In the conventional bone joint, a member called an end cap that closes the through hole of the intramedullary nail is attached to the upper side of the control member. Depending on the direction in which the bone fastener is handled, the control member may fall out from the inside of the intramedullary nail before the end cap is attached.
 更に、従来の骨接合具には、ネジ構造で髄内釘の内周面に制御部材を取り付け、制御部材を回転させて髄内釘の長手方向での進退を調整する構造が存在する。制御部材は髄内釘の内部に収容されて使用に供されるが、使用前の輸送の振動等で制御部材が髄内釘の奥深く、ネジ構造の端部にまで入る場合がある。 Furthermore, a conventional bone joint has a structure in which a control member is attached to the inner peripheral surface of the intramedullary nail with a screw structure, and the control member is rotated to adjust the advance and retreat in the longitudinal direction of the intramedullary nail. The control member is accommodated in the intramedullary nail and used for use. However, the control member may enter deep inside the intramedullary nail and reach the end of the screw structure due to the vibration of transportation before use.
 この際、制御部材を回転させる専用のドライバーを用いて、所定の高さ位置まで制御部材を引き上げる作業が生じ、手術時の手間を増やすものとなる。別途、シリコン製のストッパー部材を取り付け、使用前に取り除く対応も行われているが、ストッパー部材の準備が必要となる点や、取り外しの際の手間がかかるものとなっていた。 At this time, an operation of pulling up the control member to a predetermined height position using a dedicated driver for rotating the control member occurs, which increases labor during the operation. Separately, a silicon stopper member is attached and removed before use. However, it is necessary to prepare the stopper member, and it takes time and effort to remove the stopper member.
 また、使用方法によっては、ラグスクリューの回旋方向の動きを制御し、長手方向の後端側への動きは許容する「スライディングを許容する固定」を可能とするために、制御部材を完全に締めた状態から緩める方向に4分の1回転戻した位置とする場合がある。この際、制御部材が髄内釘の貫通孔において必要以上に進退せず、わずかに緩めた位置を保つことが重要となる。 In addition, depending on the method of use, the control member is completely tightened in order to control the movement of the lag screw in the rotational direction and allow the movement to the rear end side in the longitudinal direction to allow “fixing that allows sliding”. In some cases, the position is set back by a quarter of a turn in the loosening direction. At this time, it is important that the control member does not advance and retract more than necessary in the through-hole of the intramedullary nail and keeps a slightly loosened position.
 本発明は、以上の点に鑑みて創案されたものであり、使用時の取扱い性に優れ、かつ、施術部位における骨片の回旋を充分に抑えることが可能な骨接合具を提供することを目的とするものである。 The present invention was devised in view of the above points, and provides an osteosynthesis device that is excellent in handling at the time of use and that can sufficiently suppress rotation of a bone fragment at a treatment site. It is the purpose.
 上記の目的を達成するために、本発明の骨接合具は、第1の貫通孔が形成された第1の筒状体であると共に、前記第1の貫通孔と連通した第1のピン孔と、前記第1の筒状体の前記第1のピン孔の反対側かつ同軸状に位置し前記第1の貫通孔と連通した第2のピン孔と、前記第1のピン孔の下方に同第1のピン孔と略平行に位置し前記第1の貫通孔と連通した第1のスクリュー孔と、前記第1の筒状体の前記第1のスクリュー孔の反対側かつ同軸状に位置し前記第1の貫通孔と連通した第2のスクリュー孔が形成された髄内釘と、該髄内釘の内側に収容可能かつ第2の貫通孔が形成された第2の筒状体であると共に、前記第2の貫通孔と連通した第3のピン孔と、前記第2の筒状体の前記第3のピン孔の反対側かつ同軸状に位置し前記第2の貫通孔と連通した第4のピン孔が形成された第1の制御部材と、該第1の制御部材の一端側に位置し、同第1の制御部材の一端方向に突出して形成された嵌合凸部と、前記第1の制御部材の他端側に位置し、同第1の制御部材を前記髄内釘に固定可能な第1の固定部と、前記髄内釘の内側かつ同髄内釘の前記第1のピン孔及び前記第2のピン孔から見た前記第1のスクリュー孔及び前記第2のスクリュー孔と反対側の端部に位置して前記第1の貫通孔を閉塞する第2の制御部材と、該第2の制御部材に設けられ、同第2の制御部材を前記髄内釘に固定可能な第2の固定部と、前記第2の制御部材から突出して前記第1の制御部材の他端側から前記第2の貫通孔の内部に挿入可能な突出部とを備え、前記髄内釘の内周面の前記第1の固定部が固定される第1の内周領域と、同髄内釘の内周面の前記第2の固定部が固定される第2の内周領域との間に間隙を有し、前記第1の固定部及び前記第2の固定部は、前記髄内釘の内周面とネジ構造で固定され、前記髄内釘の前記第1の内周領域及び前記第2の内周領域の間の領域はその内径が同第1の内周領域及び同第2の内周領域の内径よりも大きく形成された第1の窪み部であり、前記突出部の一部を囲繞可能な切れ目を有するリング状であると共に、前記第1の制御部材との間に所定のクリアランスを有して位置し、前記第1の窪み部を埋めて同第1の窪み部に嵌合する止め輪部を有するものとなっている。 In order to achieve the above object, the osteosynthesis device of the present invention is a first tubular body in which a first through hole is formed, and a first pin hole communicated with the first through hole. A second pin hole located on the opposite side of the first pin hole of the first cylindrical body and coaxially and communicating with the first through hole, and below the first pin hole. A first screw hole located substantially parallel to the first pin hole and communicating with the first through hole; and a position opposite to and coaxial with the first screw hole of the first cylindrical body. And an intramedullary nail in which a second screw hole communicating with the first through hole is formed, and a second cylindrical body that can be accommodated inside the intramedullary nail and has a second through hole formed therein. A third pin hole communicating with the second through-hole, and a second pin located opposite to and coaxially with the third pin hole of the second cylindrical body. A first control member formed with a fourth pin hole communicating with the through-hole, and a fitting formed on one end side of the first control member and projecting in one end direction of the first control member A first fixing portion that is located on the other end side of the first control member and that can fix the first control member to the intramedullary nail; The first through hole is closed at the end opposite to the first screw hole and the second screw hole as viewed from the first pin hole and the second pin hole of the inner nail. A second control member, a second fixing member provided on the second control member and capable of fixing the second control member to the intramedullary nail, and protruding from the second control member A protrusion that can be inserted into the second through-hole from the other end side of the first control member, and the first fixing portion on the inner peripheral surface of the intramedullary nail A first inner peripheral region to be fixed and a second inner peripheral region to which the second fixing portion of the inner peripheral surface of the intramedullary nail is fixed, and the first fixing And the second fixing portion are fixed to the inner peripheral surface of the intramedullary nail with a screw structure, and the region between the first inner peripheral region and the second inner peripheral region of the intramedullary nail is It is the 1st hollow part in which the internal diameter was formed larger than the internal diameter of the said 1st inner periphery area | region and the 2nd inner periphery area | region, and it is a ring shape which has the cut | interruption which can surround a part of said protrusion part. And a retaining ring portion that is positioned with a predetermined clearance between the first control member and fills the first recess portion and fits into the first recess portion. ing.
 ここで、髄内釘が第1の貫通孔が形成された第1の筒状体であることによって、第1の貫通孔の内部に別部材を入れることが可能となる。即ち、第1の制御部材や第2の制御部材を収容可能となる。 Here, since the intramedullary nail is the first cylindrical body in which the first through-hole is formed, it becomes possible to put another member inside the first through-hole. That is, the first control member and the second control member can be accommodated.
 また、髄内釘に、第1の貫通孔と連通した第1のピン孔と、第1の筒状体の第1のピン孔の反対側かつ同軸状に位置し第1の貫通孔と連通した第2のピン孔とが形成されたことによって、第1のピン孔及び第2のピン孔に骨片への係合部材を挿通させることが可能となる。なお、ここでいう係合部材とは、例えば、既知のサブピンや副ラグスクリューを含むものである。 The intramedullary nail is connected to the first pin hole communicating with the first through hole and the first pin hole of the first cylindrical body opposite to the first pin hole and coaxially. By forming the second pin hole, the engaging member to the bone fragment can be inserted through the first pin hole and the second pin hole. The engaging member here includes, for example, known sub-pins and sub-lag screws.
 また、髄内釘に、第1のピン孔の下方に第1のピン孔と略平行に位置し第1の貫通孔と連通した第1のスクリュー孔と、第1の筒状体の第1のスクリュー孔の反対側かつ同軸状に位置し第1の貫通孔と連通した第2のスクリュー孔が形成されたことによって、第1のスクリュー孔及び第2のスクリュー孔に主ラグスクリューを挿通させることが可能となる。 The intramedullary nail includes a first screw hole located substantially parallel to the first pin hole below the first pin hole and communicating with the first through hole, and a first cylindrical body first. The main screw is inserted into the first screw hole and the second screw hole by forming a second screw hole which is located on the opposite side of the screw hole and coaxially and communicates with the first through hole. It becomes possible.
 また、第1の制御部材が、髄内釘の内側に収容可能であることによって、髄内釘の内側に第1の制御部材を配置することができる。 Also, since the first control member can be accommodated inside the intramedullary nail, the first control member can be arranged inside the intramedullary nail.
 また、第1の制御部材が、髄内釘の内側に収容可能かつ第2の貫通孔が形成された第2の筒状体であることによって、髄内釘の内側に配置された状態で、さらに第1の制御部材の内部に別部材を入れることが可能となる。即ち、突出部を挿通させることができる。 Further, the first control member is a second cylindrical body that can be accommodated inside the intramedullary nail and has a second through-hole formed therein, so that the first control member is arranged inside the intramedullary nail, Furthermore, it becomes possible to put another member inside the first control member. That is, the protruding portion can be inserted.
 また、第1の制御部材に、第2の貫通孔と連通した第3のピン孔と、第2の筒状体の第3のピン孔の反対側かつ同軸状に位置し第2の貫通孔と連通した第4のピン孔が形成されたことによって、第3のピン孔及び第4のピン孔に骨片への係合部材を挿通させることが可能となる。なお、ここでいう係合部材とは、例えば、既知のサブピンや副ラグスクリューを含むものである。また、第3のピン孔は第1の制御部材の第1のピン孔に、第4のピン孔は第1の制御部材の第2のピン孔にそれぞれ対応するものとなる。また、第3のピン孔及び第4のピン孔における直線状の位置とは、既知のサブピン等がまっすぐに挿入可能であり、サブピン等がラグスクリューと略平行な位置関係で配置可能となるものであれば充分である。 The first control member has a third pin hole communicating with the second through hole, and a second through hole located on the opposite side and coaxial with the third pin hole of the second cylindrical body. By forming the fourth pin hole communicating with the third pin hole, the engaging member to the bone fragment can be inserted into the third pin hole and the fourth pin hole. The engaging member here includes, for example, known sub-pins and sub-lag screws. The third pin hole corresponds to the first pin hole of the first control member, and the fourth pin hole corresponds to the second pin hole of the first control member. In addition, the linear positions in the third pin hole and the fourth pin hole are those in which a known sub-pin or the like can be inserted straight and the sub-pin or the like can be disposed in a substantially parallel positional relationship with the lag screw. If it is enough.
 また、第1の制御部材の一端側に位置し、第1の制御部材の一端方向に突出して形成された嵌合凸部によって、第1の制御部材を、髄内釘の第1のスクリュー孔及び第2のスクリュー孔に挿入される部材の固定具とすることができる。即ち、例えば、第1のスクリュー孔及び第2のスクリュー孔に主ラグスクリューが挿入された際に、主ラグスクリューの外周面上の長手方向に形成された溝部に嵌合凸部を嵌合させ、第1の制御部材によって主ラグスクリューの回旋の動きを規制するものとなる。 Further, the first control member is positioned on one end side of the first control member, and the first control member is inserted into the first screw hole of the intramedullary nail by a fitting convex portion that protrudes toward the one end of the first control member. And it can be set as the fixing tool of the member inserted in a 2nd screw hole. That is, for example, when the main lag screw is inserted into the first screw hole and the second screw hole, the fitting convex portion is fitted into the groove formed in the longitudinal direction on the outer peripheral surface of the main lag screw. The first control member regulates the rotational movement of the main lag screw.
 また、第1の制御部材の他端側に位置し、第1の制御部材を髄内釘に固定可能な第1の固定部によって、第1の制御部材を髄内釘に固定することができる。 In addition, the first control member can be fixed to the intramedullary nail by a first fixing portion that is located on the other end side of the first control member and can fix the first control member to the intramedullary nail. .
 また、髄内釘の内側かつ髄内釘の第1のピン孔及び第2のピン孔から見た第1のスクリュー孔及び第2のスクリュー孔と反対側の端部に位置して第1の貫通孔を閉塞する第2の制御部材によって、髄内釘の内側に第1の制御部材を配置しながら、髄内釘の第1の貫通孔への異物の混入を防ぐことができる。 In addition, the first nail is located on the inner side of the intramedullary nail and at the end opposite to the first screw hole and the second screw hole as viewed from the first pin hole and the second pin hole of the intramedullary nail. The second control member that closes the through hole can prevent foreign matter from entering the first through hole of the intramedullary nail while disposing the first control member inside the intramedullary nail.
 また、第2の制御部材に設けられ、第2の制御部材を髄内釘に固定可能な第2の固定部によって、第2の制御部材を髄内釘に固定することができる。 Also, the second control member can be fixed to the intramedullary nail by a second fixing portion provided on the second control member and capable of fixing the second control member to the intramedullary nail.
 また、髄内釘の内周面の第1の固定部が固定される第1の内周領域と、髄内釘の内周面の第2の固定部が固定される第2の内周領域との間に間隙を有することによって、第1の制御部材が髄内釘に対して過度に固定されず、第1の制御部材が抜去不能になりにくくなる。例えば、髄内釘がチタンで形成された際には、ネジ構造等の固定部の長さが長いと、固定する部材がかみこみ過ぎて分離不可能となることがあるが、前述したように、第1の内周領域と第2の内周領域の間に間隙があり非連続な固定部とすることで、過度なかみこみが生じにくくすることができる。 In addition, a first inner peripheral region to which the first fixing portion of the inner peripheral surface of the intramedullary nail is fixed, and a second inner peripheral region to which the second fixing portion of the inner peripheral surface of the intramedullary nail is fixed The first control member is not excessively fixed to the intramedullary nail, and the first control member is less likely to be unremovable. For example, when the intramedullary nail is made of titanium, if the length of the fixing part such as a screw structure is long, the fixing member may be too bite and cannot be separated. By setting a discontinuous fixing portion with a gap between the first inner peripheral region and the second inner peripheral region, it is possible to prevent excessive entrapment.
 また、第1の固定部及び第2の固定部が髄内釘の内周面とネジ構造で固定されることによって、第1の制御部材及び第2の制御部材を回転させて、髄内釘に固定することができる。なお、この際のネジ構造における回転動作は、例えば、多角形のドライバーと、それに嵌合する嵌合孔との組み合わせによって行いうるものとなる。 The first fixing portion and the second fixing portion are fixed to the inner peripheral surface of the intramedullary nail with a screw structure, so that the first control member and the second control member are rotated and the intramedullary nail is rotated. Can be fixed to. In addition, the rotation operation in the screw structure at this time can be performed by, for example, a combination of a polygonal driver and a fitting hole fitted therein.
 また、髄内釘の第1の内周領域及び第2の内周領域の間の領域はその内径が第1の内周領域及び第2の内周領域の内径よりも大きく形成された第1の窪み部であり、突出部の一部を囲繞可能な切れ目を有するリング状であると共に、第1の制御部材との間に所定のクリアランスを有して位置し、第1の窪み部を埋めて窪み部に嵌合する止め輪部を備えることによって、止め輪部を介して第1の制御部材の抜け落ちを防ぐことができる。即ち、髄内釘に第1の制御部材及び止め輪部が収容され、第2の制御部材が取り付けられていない状態の際に、第1の制御部材が回転して第1の貫通孔から抜ける方向に移動しても、第1の窪み部に位置する止め輪部に接触して、その先には移動できないものとなる。また、止め輪部で第1の制御部材の抜け落ちを防止しながら、第2の制御部材を第1の制御部材の方向にネジ構造で充分に締めていくことが可能となる。即ち、第1の窪み部の位置で髄内釘の内周面のネジ溝が一旦途切れ、窪み部に止め輪部が配置されていることから、連続したネジ溝上に止め輪部を配置する構造では不充分となる第2の制御部材のネジ締めが、充分に行えるものとなる。この結果、髄内釘に対する第2の制御部材の固定、第2の制御部材と突出部によるサブピンの固定及び第1の制御部材の緩み防止が確実なものとなる。 In addition, the area between the first inner peripheral area and the second inner peripheral area of the intramedullary nail is a first inner diameter formed larger than the inner diameter of the first inner peripheral area and the second inner peripheral area. And is a ring shape having a slit that can surround a part of the projecting portion, and is located with a predetermined clearance between the first control member, and fills the first recess. By providing the retaining ring portion that fits into the recessed portion, it is possible to prevent the first control member from falling off via the retaining ring portion. That is, when the first control member and the retaining ring portion are accommodated in the intramedullary nail and the second control member is not attached, the first control member rotates and comes out of the first through hole. Even if it moves in the direction, it will come into contact with the retaining ring portion located in the first recess and cannot move beyond that. In addition, it is possible to sufficiently tighten the second control member with the screw structure in the direction of the first control member while preventing the first control member from falling off at the retaining ring portion. That is, since the thread groove on the inner peripheral surface of the intramedullary nail is temporarily interrupted at the position of the first recess portion, and the retaining ring portion is disposed in the recess portion, the retaining ring portion is disposed on the continuous thread groove. Then, the screwing of the second control member, which is insufficient, can be sufficiently performed. As a result, the fixing of the second control member to the intramedullary nail, the fixing of the sub-pin by the second control member and the protrusion, and the prevention of the loosening of the first control member are ensured.
 また、第1の固定部は、その外径が第1の内周領域の内径と略同等の大きさであり、第1の制御部材の短手方向側から見た断面が切れ目のない略ドーナツ状であると共に、第1の制御部材に内装可能な第1の嵌合部を有し、第1の制御部材は第1の嵌合部を内装可能な第2の嵌合部を有し、第1の嵌合部の少なくとも一部の外径の大きさが、第2の嵌合部の対応する領域の内径の大きさよりも大きく形成された場合には、第1の嵌合部と第2の嵌合部との間で締め代が生じるものとなる。この結果、第1の固定部が第1の内周領域に対して回転する際、即ち、第1の固定部及び第1の制御部材が髄内釘の第1の貫通孔に対して進退動作する際に第1の嵌合部と第2の嵌合部との間で摩擦抵抗力が生じ、振動等の弱い力では第1の固定部が髄内釘に対して回転しにくいものとなる。つまり、第1の固定部及び第1の制御部材の髄内釘の貫通孔における位置が保持されやすいものとなる。これにより、第1の制御部材の過度な挿入や緩みが生じにくい構造となる。 The first fixing portion has an outer diameter that is substantially the same as the inner diameter of the first inner peripheral region, and is a substantially donut with a cross section viewed from the short direction side of the first control member. And the first control member has a first fitting part that can be installed in the first control member, and the first control member has a second fitting part that can be installed in the first fitting part, When the outer diameter of at least a part of the first fitting portion is larger than the inner diameter of the corresponding region of the second fitting portion, the first fitting portion and the first fitting portion The tightening margin is generated between the two fitting portions. As a result, when the first fixing portion rotates with respect to the first inner peripheral region, that is, the first fixing portion and the first control member advance and retract with respect to the first through hole of the intramedullary nail. In this case, a frictional resistance force is generated between the first fitting portion and the second fitting portion, and the first fixing portion is difficult to rotate with respect to the intramedullary nail with a weak force such as vibration. . That is, the positions of the first fixing portion and the first control member in the through-hole of the intramedullary nail are easily held. Thereby, it becomes a structure in which excessive insertion and loosening of the first control member are unlikely to occur.
 また、突出部が、その先端が第2の貫通孔の第3のピン孔及び第4のピン孔で挟まれた領域まで届く長さを有する場合には、第2の制御部材を、第1のピン孔乃至第4のピン孔に挿入される部材の固定具とすることができる。即ち、例えば、第1のピン孔乃至第4のピン孔にサブピンが挿入された際に、サブピンの外周面に突出部を接触させ、その圧力で固定し、第2の制御部材によってサブピンの摺動及び回旋の動きを規制するものとなる。 Further, when the protruding portion has a length that reaches the region between the tip end of the second through hole and the third pin hole and the fourth pin hole, the second control member is It is possible to provide a fixture for a member inserted into the pin hole to the fourth pin hole. That is, for example, when the sub pin is inserted into the first pin hole to the fourth pin hole, the projecting portion is brought into contact with the outer peripheral surface of the sub pin and fixed with the pressure, and the second control member slides the sub pin. It regulates the movement and rotation.
 また、突出部が、その先端が第2の貫通孔の第3のピン孔及び第4のピン孔で挟まれた領域より第1の制御部材の他端側に位置する長さを有する場合には、第2の制御部材及び突出部で構成される部材をコンパクトなものにすることができる。即ち、例えば、サブピンを併用せずに、髄内釘とラグスクリューで骨を接合する際に用いることができる。 Further, when the protruding portion has a length where the tip is located on the other end side of the first control member from the region sandwiched between the third pin hole and the fourth pin hole of the second through hole. Can make the member constituted by the second control member and the protruding portion compact. That is, for example, it can be used when a bone is joined with an intramedullary nail and a lag screw without using a sub-pin together.
 また、第1の固定部は第1の制御部材に対して回転自在に内装される場合には、髄内釘の第1のピン孔及び第2のピン孔と、第1の制御部材の第3のピン孔及び第4のピン孔との位置を合わせやすいものとなる。即ち、例えば、第1の固定部を専用ドライバーと嵌合させて回転させることで、第1の制御部材は回転することなく髄内釘の第1の貫通孔に進退動作するものとなり、第3のピン孔及び第4のピン孔の位置が変わりにくくしながら、第1の制御部材を髄内釘の所定位置に固定することが可能となる。 Further, when the first fixing portion is rotatably mounted with respect to the first control member, the first pin hole and the second pin hole of the intramedullary nail and the first control member It is easy to align the positions of the third pin hole and the fourth pin hole. That is, for example, when the first fixing portion is fitted and rotated with a dedicated driver, the first control member moves forward and backward to the first through hole of the intramedullary nail without rotating. The first control member can be fixed at a predetermined position of the intramedullary nail while the positions of the pin hole and the fourth pin hole are hardly changed.
 また、第1の固定部は第1の制御部材に対して回転自在に内装され、第1の制御部材は、その内周面かつ第1の固定部と第3のピン孔及び第4のピン孔との間の領域にネジ溝が形成された場合には、第1の制御部材のみを髄内釘に対して進退動作させることが可能となる。即ち、例えば、第1の固定部と第1の制御部材が分離し、そのままの使用が不可能になった際にも、第1の制御部材のネジ溝に専用のドライバーを嵌合させ、髄内釘から取り出すことが可能となる。この結果、第1の制御部材によるラグスクリューの固定状態を解除可能なものとなる。 The first fixing portion is rotatably mounted with respect to the first control member, and the first control member includes an inner peripheral surface thereof, the first fixing portion, the third pin hole, and the fourth pin. When a thread groove is formed in a region between the holes, only the first control member can be advanced and retracted with respect to the intramedullary nail. That is, for example, even when the first fixing portion and the first control member are separated and cannot be used as they are, a dedicated screwdriver is fitted into the screw groove of the first control member to It can be taken out from the inner nail. As a result, the fixed state of the lag screw by the first control member can be released.
 また、第1の固定部に、その内周面に第1の制御部材の長手方向に沿って第1の制御部材の短手方向側から見た断面が略六角形となる6つの溝が形成された場合には、第1の固定部の回転動作をより確実に行えるものとなり、使い勝手を向上させることができる。ここでは、6つの溝に嵌合する専用の六角ドライバーを使用するものとなるが、例えば、ドライバーの嵌合箇所が二面のものなどに比べ、ドライバーが第1の固定部に対して滑りにくいものとなる。 In addition, six grooves having a substantially hexagonal cross section when viewed from the short direction side of the first control member along the longitudinal direction of the first control member are formed on the inner peripheral surface of the first fixing portion. In such a case, the rotation operation of the first fixed portion can be performed more reliably, and usability can be improved. Here, a dedicated hexagonal screwdriver that fits into the six grooves is used. For example, the driver is less likely to slip with respect to the first fixed portion than in a case where the screwdriver is fitted on two surfaces. It will be a thing.
 また、第1の固定部は、その外径が第1の内周領域の内径と略同等の大きさであり、第1の制御部材に内装可能な第1の嵌合部を有すると共に、第2の貫通孔の内周面から第1の固定部の外周面に貫通したスリットと、第2の貫通孔の内周面から第1の固定部の外周面に向けて位置する第2の窪み部とが形成され、第1の制御部材は第1の嵌合部を内装可能な第2の嵌合部を有し、突出部は、第2の窪み部に嵌合可能かつ突出部の突出方向にかけて径が小さくなるテーパ部を有する場合には、第1の制御部材が緩みにくいものとすることができる。即ち、第1の固定部の第2の窪み部に突出部のテーパ部が接触して食い込むことで、第1の固定部のスリット部分が広がり、接触圧が第1の固定部に均一にかかるものとなる。この結果、第1の固定部と髄内釘の内周面との接触する圧力が増し、第1の制御部材を緩みにくくすることができる。また、第2の制御部材を下方に下げて固定するほど、第1の制御部材は緩みにくいものとなる。 The first fixing portion has a first fitting portion whose outer diameter is substantially the same as the inner diameter of the first inner peripheral region, and which can be housed in the first control member. A slit penetrating from the inner peripheral surface of the two through holes to the outer peripheral surface of the first fixing portion, and a second recess positioned from the inner peripheral surface of the second through hole toward the outer peripheral surface of the first fixing portion. And the first control member has a second fitting portion that can house the first fitting portion, and the protruding portion can be fitted into the second recess and the protruding portion of the protruding portion. In the case of having a tapered portion whose diameter decreases in the direction, the first control member can be made difficult to loosen. That is, the taper portion of the protruding portion comes into contact with the second recess portion of the first fixing portion, so that the slit portion of the first fixing portion spreads, and the contact pressure is uniformly applied to the first fixing portion. It will be a thing. As a result, the pressure of contact between the first fixing portion and the inner peripheral surface of the intramedullary nail increases, and the first control member can be made difficult to loosen. Further, the lower the second control member is fixed, the more difficult it is to loosen the first control member.
 また、第1の固定部は、その外径が第1の内周領域の内径より大きく形成されかつ弾性を有し、第1の制御部材に内装可能な第1の嵌合部を有すると共に、第2の貫通孔の内周面から第1の固定部の外周面に貫通したスリットが形成された場合には、髄内釘に第1の固定部及び第1の制御部材を挿入した際に、第1の固定部と第1の内周領域との間に抵抗力が生じ、第1の固定部及び第1の制御部材の髄内釘の貫通孔における位置が保持されやすいものとなる。より詳細には、第1の固定部の外径は、髄内釘に挿入される前は第1の内周領域より大きいが、髄内釘への挿入時には、径の大きさの関係により、第1の内周領域との接触でスリット部分の距離が縮まり、第1の固定部の外径が小さくなる。この結果、弾性により第1の固定部には元の外径の大きさに戻ろうとする付勢力が生じ、第1の固定部が髄内釘の第1の内周領域を押す方向の力となる。なお、第1の固定部と第1の内周領域との間に生じる抵抗力の大きさは、別途の取り付け器具による第1の固定部及び第1の制御部材の髄内釘へのネジ構造による挿入や抜去を妨げるような大きな力ではない。例えば、外部からの振動等の軽微な外力に対して第1の固定部が勝手に回転しない程度の抵抗力を生むものであればよい。 In addition, the first fixed portion has a first fitting portion whose outer diameter is formed larger than the inner diameter of the first inner peripheral region and has elasticity, and can be installed in the first control member. When a slit penetrating from the inner peripheral surface of the second through hole to the outer peripheral surface of the first fixing portion is formed, when the first fixing portion and the first control member are inserted into the intramedullary nail A resistance force is generated between the first fixing portion and the first inner peripheral region, and the positions of the first fixing portion and the first control member in the through-hole of the intramedullary nail are easily maintained. More specifically, the outer diameter of the first fixing portion is larger than the first inner peripheral region before being inserted into the intramedullary nail, but when inserted into the intramedullary nail, due to the size of the diameter, The distance between the slit portions is reduced by contact with the first inner peripheral region, and the outer diameter of the first fixing portion is reduced. As a result, an urging force is generated in the first fixing portion to return to the original outer diameter due to elasticity, and the first fixing portion pushes the first inner peripheral region of the intramedullary nail and Become. In addition, the magnitude | size of the resistance force produced between a 1st fixing | fixed part and a 1st inner peripheral area | region is the screw structure to the intramedullary nail of the 1st fixing | fixed part and 1st control member by a separate attachment tool. It is not a big force that prevents insertion and removal by For example, what is necessary is just to produce the resistance force of the grade which the 1st fixing | fixed part does not rotate arbitrarily with respect to slight external forces, such as an external vibration.
 上記の観点からは、例えば、髄内釘への第1の固定部及び第1の制御部材の挿入前に、第1の固定部のスリットを専用治工具で広げる加工を行って、第1の固定部の外径を第1の内周領域よりもわずかに大きくする方法が採用し得る。 From the above viewpoint, for example, before inserting the first fixing portion and the first control member into the intramedullary nail, a process of expanding the slit of the first fixing portion with a dedicated jig is performed. A method in which the outer diameter of the fixing portion is slightly larger than that of the first inner peripheral region can be employed.
 また、第1の嵌合部の少なくとも一部の外径の大きさが、第2の嵌合部の対応する領域の内径の大きさよりも大きく形成された場合には、第1の嵌合部と第2の嵌合部との間で締め代が生じるものとなる。この結果、第1の固定部が第1の内周領域に対して回転する際、即ち、第1の固定部及び第1の制御部材が髄内釘の第1の貫通孔に対して進退動作する際に第1の嵌合部と第2の嵌合部との間で摩擦抵抗力が生じ、振動等の弱い力では第1の固定部が髄内釘に対して回転しにくいものとなる。つまり、第1の固定部及び第1の制御部材の髄内釘の貫通孔における位置が保持されやすいものとなる。これにより、第1の制御部材の過度な挿入や緩みが生じにくい構造となる。 In addition, when the outer diameter of at least a part of the first fitting portion is larger than the inner diameter of the corresponding region of the second fitting portion, the first fitting portion And a second fitting part are tightened. As a result, when the first fixing portion rotates with respect to the first inner peripheral region, that is, the first fixing portion and the first control member advance and retract with respect to the first through hole of the intramedullary nail. In this case, a frictional resistance force is generated between the first fitting portion and the second fitting portion, and the first fixing portion is difficult to rotate with respect to the intramedullary nail with a weak force such as vibration. . That is, the positions of the first fixing portion and the first control member in the through-hole of the intramedullary nail are easily held. Thereby, it becomes a structure in which excessive insertion and loosening of the first control member are unlikely to occur.
 また、突出部は、その先端が第2の貫通孔の第3のピン孔及び第4のピン孔で挟まれた領域まで届く長さを有する場合には、第2の制御部材を、第1のピン孔乃至第4のピン孔に挿入される部材の固定具とすることができる。即ち、例えば、第1のピン孔乃至第4のピン孔にサブピンが挿入された際に、サブピンの外周面に突出部を接触させ、その圧力で固定し、第2の制御部材によってサブピンの摺動及び回旋の動きを規制するものとなる。 Further, when the protruding portion has a length that reaches the region sandwiched between the third pin hole and the fourth pin hole of the second through hole, the second control member is moved to the first control member. It is possible to provide a fixture for a member inserted into the pin hole to the fourth pin hole. That is, for example, when the sub pin is inserted into the first pin hole to the fourth pin hole, the projecting portion is brought into contact with the outer peripheral surface of the sub pin and fixed with the pressure, and the second control member slides the sub pin. It regulates the movement and rotation.
 また、突出部は、その先端が第2の貫通孔の第3のピン孔及び第4のピン孔で挟まれた領域より第1の制御部材の他端側に位置する長さを有する場合には、第2の制御部材及び突出部で構成される部材をコンパクトなものにすることができる。即ち、例えば、サブピンを併用せずに、髄内釘とラグスクリューで骨を接合する際に用いることができる。 Further, when the protrusion has a length located at the other end side of the first control member from the region sandwiched between the third pin hole and the fourth pin hole of the second through hole. Can make the member constituted by the second control member and the protruding portion compact. That is, for example, it can be used when a bone is joined with an intramedullary nail and a lag screw without using a sub-pin together.
 本発明に係る骨接合具は、使用時の取扱い性に優れ、かつ、施術部位における骨片の回旋を充分に抑えることが可能なものとなっている。 The osteosynthesis device according to the present invention is excellent in handling at the time of use, and can sufficiently suppress the rotation of the bone fragment at the treatment site.
本発明の第1の実施の形態に係る骨接合具の側面視断面図およびその部分拡大図である。FIG. 2 is a side sectional view and a partially enlarged view of the bone joint device according to the first embodiment of the present invention. エンドキャップの概略正面図(a)及びその他のエンドキャップの構造を示す概略正面図(b)である。It is the schematic front view (b) which shows the schematic front view (a) of an end cap, and the structure of another end cap. 髄内釘の概略断面図(a)及び髄内釘をラグスクリューの挿入方向の手前側から見た概略図(b)である。It is the schematic sectional view (a) of the intramedullary nail and the schematic view (b) which looked at the intramedullary nail from the near side of the insertion direction of a lag screw. その他の髄内釘の形状を示す概略断面図である。It is a schematic sectional drawing which shows the shape of the other intramedullary nail. サブピンの概略図(a)及びラグスクリューの概略図(b)である。It is the schematic (a) of a subpin, and the schematic (b) of a lag screw. セットスクリューの側面側から見た断面図及びセットスクリュー及びワッシャーの側面概略図(a)、ワッシャーの概略図(b)、セットスクリューの頭部側の概略図(c)及びセットスクリューの胴体側の概略図(d)を示している。Sectional view seen from the side of the set screw, side schematic view of the set screw and washer (a), schematic view of the washer (b), schematic view of the head side of the set screw (c), and body side of the set screw A schematic diagram (d) is shown. 胴体部の断面図(a)、頭部の断面図(b)及び頭部の概略図(c)である。It is sectional drawing (a) of a trunk | drum, sectional drawing (b) of a head, and schematic (c) of a head. ワッシャーのその他の形状を示す概略図である。It is the schematic which shows the other shape of a washer. 本発明の第2の実施の形態におけるセットスクリューの側面側から見た断面図及びセットスクリュー及びワッシャーの側面概略図(a)、ワッシャーの概略図(b)、セットスクリューの頭部側の概略図(c)及びセットスクリューの胴体側の概略図(d)を示している。Sectional view and side schematic view of set screw and washer (a), schematic view of washer (b), schematic view of head side of set screw in the second embodiment of the present invention (C) and the schematic view (d) of the fuselage side of the set screw are shown. 胴体部の断面図(a)、頭部の断面図(b)及び頭部の概略図(c)である。It is sectional drawing (a) of a trunk | drum, sectional drawing (b) of a head, and schematic (c) of a head. 頭部及びC-C線における爪部の構造を示す概略図である。It is the schematic which shows the structure of the nail | claw part in a head and CC line. 従来の骨接合具の断面形状を示した図(a)及びその図を側面から見た状態の断面形状を示した図(b)である。It is the figure (a) which showed the cross-sectional shape of the conventional bone joint tool, and the figure (b) which showed the cross-sectional shape of the state which looked at the figure from the side surface.
 以下、本発明の第1の実施の形態について図面を参照しながら説明し、本発明の理解に供する。
 図1は、本発明の実施の形態に係る骨接合具の側面視断面図およびその部分拡大図である。なお、本発明の構成は以下に示す内容に限定されるものではなく、適宜変更することができる。
Hereinafter, a first embodiment of the present invention will be described with reference to the drawings for understanding of the present invention.
FIG. 1 is a side sectional view and a partially enlarged view of a bone joint device according to an embodiment of the present invention. In addition, the structure of this invention is not limited to the content shown below, It can change suitably.
 図1に示すように、本発明を適用した骨接合具の一例である骨接合具1は、髄内釘2と、セットスクリュー3と、エンドキャップ4を備えている。また、髄内釘2には、骨片に係合する係合部材として、ラグスクリュー5と、サブピン6が挿入されている。骨接合具1はいずれも外科手術に利用可能な金属部材で形成されている。 As shown in FIG. 1, an osteosynthesis device 1 as an example of an osteosynthesis device to which the present invention is applied includes an intramedullary nail 2, a set screw 3, and an end cap 4. Moreover, the lag screw 5 and the sub pin 6 are inserted in the intramedullary nail 2 as an engaging member engaged with a bone fragment. Each of the osteosynthesis tools 1 is formed of a metal member that can be used in a surgical operation.
 髄内釘2は、骨折した部位が治癒するまでに骨片がずれて癒着したり、あるいは、分離したりしないように骨片間を連結する部材である。また、骨内でラグスクリュー5等の係合部材を保持する部材である。 The intramedullary nail 2 is a member that connects the bone fragments so that the bone fragments are not displaced and fused or separated before the fractured site is healed. Moreover, it is a member holding engagement members, such as the lag screw 5, in bone.
 髄内釘2には、ピン孔7及びピン孔8と、スクリュー孔9及びスクリュー孔10が形成され、ラグスクリュー5と、サブピン6がそれぞれ挿入される。ラグスクリュー5は、図示しない施術対象骨内の海綿質に食い込んで先後方向への抵抗力を生じさせ、骨頭の脱落防止及び回旋防止効果を生じさせる。 In the intramedullary nail 2, a pin hole 7 and a pin hole 8, a screw hole 9 and a screw hole 10 are formed, and a lag screw 5 and a sub pin 6 are inserted respectively. The lag screw 5 bites into the sponge in the bone to be treated (not shown) to generate a resistance force in the anterior-posterior direction, thereby preventing the head from falling off and preventing the rotation.
 ラグスクリュー5の先端は外周面に雄ネジ11が形成され、この雄ネジ11が骨内海綿質に食い込む部分となる。また、ラグスクリュー5の胴部外周面には、長手方向に沿って、スクリュー溝12が形成されている。 The male screw 11 is formed on the outer peripheral surface of the tip of the lag screw 5, and this male screw 11 is a portion that bites into the intraosseous sponge. A screw groove 12 is formed on the outer peripheral surface of the body portion of the lag screw 5 along the longitudinal direction.
 スクリュー溝12は、後述するセットスクリュー3の先端の突出片13と嵌合する部分である。また、スクリュー溝12は、ラグスクリュー5の胴部外周面の円周上に一定間隔で複数形成されている。 The screw groove 12 is a portion that fits into a protruding piece 13 at the tip of the set screw 3 to be described later. A plurality of screw grooves 12 are formed at regular intervals on the circumference of the outer peripheral surface of the body portion of the lag screw 5.
 サブピン6は、尖鋭な棒体であり、先端部分が施術対象骨内の海綿質に容易に進入し、骨に大きな孔を開けることなく、骨内に位置するものとなる。骨内でラグスクリュー5と略平行に位置し、骨頭の回旋を抑えるものとなる。 The sub-pin 6 is a sharp rod body, and the tip portion easily enters the sponge in the bone to be treated, and is located in the bone without opening a large hole in the bone. It is positioned substantially parallel to the lag screw 5 in the bone, and suppresses the rotation of the bone head.
 サブピン6は、ラグスクリュー5よりも短く形成されている。また、その胴体部分は円柱状に形成されている。 The sub pin 6 is formed shorter than the lag screw 5. Moreover, the trunk | drum part is formed in the column shape.
 髄内釘2の下端には、図示しない横止め孔が形成され、下端位置において横止めスクリューが挿入され、髄内釘2が骨内に固定されている。 At the lower end of the intramedullary nail 2, a lateral retaining hole (not shown) is formed, and a lateral retaining screw is inserted at the lower end position to fix the intramedullary nail 2 in the bone.
 図1に示すように、髄内釘2の軸心には貫通孔14が形成されている。貫通孔14には、前述したラグスクリュー5及びサブピン6の一部が位置する。また、貫通孔14の内部には、セットスクリュー3、ワッシャー16及びエンドキャップ4が取り付けられる。 As shown in FIG. 1, a through hole 14 is formed in the axial center of the intramedullary nail 2. A part of the lag screw 5 and the sub pin 6 described above is located in the through hole 14. A set screw 3, a washer 16 and an end cap 4 are attached inside the through hole 14.
 セットスクリュー3は髄内釘2の内周面に固定され、ラグスクリュー5の回旋を抑える部材である。セットスクリュー3の先端には突出片13が形成され、ラグスクリュー5のスクリュー溝12と嵌合する。 The set screw 3 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and suppresses the rotation of the lag screw 5. A protruding piece 13 is formed at the tip of the set screw 3 and is fitted to the screw groove 12 of the lag screw 5.
 また、セットスクリュー3にはピン孔18及びピン孔19が形成され、前述した髄内釘2のピン孔7及びピン孔8と同一直線上に位置して、サブピン6が挿入される部分となっている。 Further, the set screw 3 is formed with a pin hole 18 and a pin hole 19, and is located on the same straight line as the pin hole 7 and the pin hole 8 of the intramedullary nail 2 described above, and is a portion into which the sub pin 6 is inserted. ing.
 セットスクリュー3は径大な張出部20を有し、その外周面上にネジ溝21が形成されている。ネジ溝21は、髄内釘2の内周面のネジ溝22と嵌合し、セットスクリュー3はネジ構造にて髄内釘2に固定される。また、張出部20は、髄内釘2の段差23に嵌合する。 The set screw 3 has a large overhanging portion 20, and a screw groove 21 is formed on the outer peripheral surface thereof. The screw groove 21 is fitted to the screw groove 22 on the inner peripheral surface of the intramedullary nail 2, and the set screw 3 is fixed to the intramedullary nail 2 with a screw structure. Further, the overhang portion 20 is fitted to the step 23 of the intramedullary nail 2.
 また、セットスクリュー3の中心には、長手方向にかけて貫通孔24が形成されている。貫通孔24は、エンドキャップ4の一部が挿入される部分となる。 Further, a through hole 24 is formed in the center of the set screw 3 in the longitudinal direction. The through hole 24 is a part into which a part of the end cap 4 is inserted.
 セットスクリュー3の張出部20の内周面には、貫通孔24と略平行なスリットが形成されている。スリットの形状については後述する。 A slit substantially parallel to the through hole 24 is formed on the inner peripheral surface of the overhang portion 20 of the set screw 3. The shape of the slit will be described later.
 ここで、セットスクリュー3のピン孔18及びピン孔19の形状は特に限定されるものではなく、サブピン6がまっすぐ挿入可能かつラグスクリュー5と略平行な位置にくるものとなっていれば充分である。 Here, the shapes of the pin hole 18 and the pin hole 19 of the set screw 3 are not particularly limited, and it is sufficient if the sub pin 6 can be inserted straight and is positioned substantially parallel to the lag screw 5. is there.
 セットスクリュー3の上方にワッシャー16が配置される。ワッシャー16は、セットスクリュー3の貫通孔14の外側への抜け落ちを抑える部材となる。ワッシャー16は切れ目を有するリング状の部材で、エンドキャップ4の一部を囲繞可能な径に形成されている。 The washer 16 is disposed above the set screw 3. The washer 16 serves as a member that prevents the set screw 3 from falling out of the through hole 14. The washer 16 is a ring-shaped member having a cut, and has a diameter capable of surrounding a part of the end cap 4.
 また、ワッシャー16は髄内釘2の内周面の窪み25に配置されている。窪み25はワッシャー16よりもやや大きめに形成され、ワッシャー16は余裕をもって嵌合するものとなる。 Further, the washer 16 is disposed in the recess 25 on the inner peripheral surface of the intramedullary nail 2. The depression 25 is formed slightly larger than the washer 16, and the washer 16 is fitted with a margin.
 髄内釘2の内周面において、セットスクリュー3固定用のネジ溝22と後述するエンドキャップ固定用のネジ溝26との間に窪み25が位置している。即ち、髄内釘2の内周面では、ネジ溝が非連続に形成されたものとなっている。 On the inner peripheral surface of the intramedullary nail 2, a recess 25 is positioned between a screw groove 22 for fixing the set screw 3 and a screw groove 26 for fixing an end cap, which will be described later. That is, on the inner peripheral surface of the intramedullary nail 2, screw grooves are formed discontinuously.
 セットスクリュー3及びワッシャー16の上方にエンドキャップ4が取り付けられている。エンドキャップ4は、髄内釘2の内周面に固定され、貫通孔14を閉塞する部材である。また、エンドキャップ4の突出部27が髄内釘2に挿入されたサブピン6を固定する部分となる。 The end cap 4 is attached above the set screw 3 and the washer 16. The end cap 4 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and closes the through hole 14. Further, the protruding portion 27 of the end cap 4 is a portion for fixing the sub-pin 6 inserted into the intramedullary nail 2.
 エンドキャップ4は、突出部27と、テーパ部28と、ネジ溝部29と、頭部30を有している。突出部27は、セットスクリュー3の貫通孔24に挿入可能な径であり、その先端は半球状に形成されている。この半球状の部分が、サブピン6の円柱状の外周面に接触し、サブピン6を固定する。 The end cap 4 has a protruding portion 27, a tapered portion 28, a thread groove portion 29, and a head portion 30. The protruding portion 27 has a diameter that can be inserted into the through hole 24 of the set screw 3, and the tip thereof is formed in a hemispherical shape. This hemispherical portion comes into contact with the cylindrical outer peripheral surface of the sub-pin 6 and fixes the sub-pin 6.
 ネジ溝部29は、外周面にネジ溝が形成され、髄内釘2の内周面のネジ溝26と嵌合し、エンドキャップ4はネジ構造にて髄内釘2に固定される。また、頭部30は内側にドライバー孔が形成され、エンドキャップ4の取り付け時に、ドライバーが嵌合する部分となる。なお、セットスクリュー3の張出部20の内周にも、ドライバーと嵌合する孔が形成されている。 The screw groove portion 29 has a screw groove formed on the outer peripheral surface thereof, and is fitted to the screw groove 26 on the inner peripheral surface of the intramedullary nail 2, and the end cap 4 is fixed to the intramedullary nail 2 by a screw structure. Further, the head 30 is formed with a driver hole on the inner side, and becomes a portion where the driver is fitted when the end cap 4 is attached. A hole that fits with the driver is also formed on the inner periphery of the overhang portion 20 of the set screw 3.
 髄内釘2のネジ溝22とネジ溝26では、ネジ溝22がネジ溝26よりも長く形成されている。より具体的には、ネジ溝22が5.8mm、ネジ溝26が4mmの長さとなっている。 In the screw groove 22 and the screw groove 26 of the intramedullary nail 2, the screw groove 22 is formed longer than the screw groove 26. More specifically, the screw groove 22 has a length of 5.8 mm and the screw groove 26 has a length of 4 mm.
 ここで、必ずしも、エンドキャップ4の突出部27の先端が半球状に形成される必要はない。例えば、サブピンの外周面上に、ラグスクリューと同様のスクリュー溝を形成した場合には、エンドキャップ4の突出部27の先端をスクリュー溝に嵌合する突出片とすることも可能である。 Here, the tip of the projecting portion 27 of the end cap 4 does not necessarily have to be hemispherical. For example, when a screw groove similar to a lag screw is formed on the outer peripheral surface of the sub-pin, the tip of the protruding portion 27 of the end cap 4 can be a protruding piece that fits into the screw groove.
 また、必ずしも、髄内釘2のネジ溝22とネジ溝26では、ネジ溝22がネジ溝26よりも長く形成される必要はない。また、ネジ溝22が5.8mm、ネジ溝26が4mmの長さに限定されるものではない。但し、セットスクリューの固定度を高めることができる点から、髄内釘2のネジ溝22とネジ溝26では、ネジ溝22がネジ溝26よりも長く形成されることが好ましい。 Also, the screw groove 22 and the screw groove 26 of the intramedullary nail 2 do not necessarily need to be formed longer than the screw groove 26. Further, the length of the screw groove 22 is not limited to 5.8 mm, and the length of the screw groove 26 is not limited to 4 mm. However, it is preferable that the screw groove 22 is formed longer than the screw groove 26 in the screw groove 22 and the screw groove 26 of the intramedullary nail 2 because the fixing degree of the set screw can be increased.
 上述した骨接合具1の各構成部材をそれぞれの図面で説明する。 Each component of the above-described bone connector 1 will be described with reference to the drawings.
 図2は、エンドキャップの概略正面図(a)及びその他のエンドキャップの構造を示す概略正面図(b)である。 FIG. 2 is a schematic front view (a) of the end cap and a schematic front view (b) showing other end cap structures.
 前述したように、エンドキャップ4は、突出部27と、テーパ部28と、ネジ溝部29と、頭部30を有している。ネジ溝部29の領域が最も径が大きく、この位置で髄内釘2の内周面に固定されると共に、貫通孔14を閉塞する。 As described above, the end cap 4 has the protruding portion 27, the tapered portion 28, the screw groove portion 29, and the head portion 30. The area of the thread groove 29 has the largest diameter, and is fixed to the inner peripheral surface of the intramedullary nail 2 at this position and closes the through hole 14.
 また、図2(b)に示すようなエンドキャップ31が使用されることもある。エンドキャップ31は突出部32が短く形成され、サブピンを併用しない場合や、サブピンを固定しない場合の髄内釘2に取付けられる。図2(b)の示すエンドキャップ31を用いる骨接合具の構造については、後述する。 Also, an end cap 31 as shown in FIG. 2B may be used. The end cap 31 is formed with a short protrusion 32 and is attached to the intramedullary nail 2 when the sub-pin is not used together or when the sub-pin is not fixed. The structure of the bone fastener using the end cap 31 shown in FIG. 2B will be described later.
 図3は、髄内釘の概略断面図(a)及び髄内釘をラグスクリューの挿入方向の手前側から見た概略図(b)である。また、図4は、その他の髄内釘の形状を示す概略断面図である。 FIG. 3 is a schematic cross-sectional view (a) of the intramedullary nail and a schematic view (b) of the intramedullary nail viewed from the front side in the insertion direction of the lag screw. FIG. 4 is a schematic cross-sectional view showing the shape of another intramedullary nail.
 図3(a)に示すように、髄内釘2は長手方向に貫通孔14が形成され、それに連通してラグスクリュー5及びサブピン6の挿入用の各孔が形成されている。また、髄内釘2の下端には、横止め孔33及び横止め孔34が形成され、横止めスクリューが挿入される。 As shown in FIG. 3 (a), the intramedullary nail 2 has a through hole 14 formed in the longitudinal direction, and each hole for insertion of the lag screw 5 and the sub pin 6 is formed in communication therewith. In addition, a lateral stop hole 33 and a lateral stop hole 34 are formed at the lower end of the intramedullary nail 2, and a lateral stop screw is inserted.
 また、髄内釘2の内周面の上部には、セットスクリュー3を固定するためのネジ溝22と、エンドキャップを固定するためのネジ溝26が形成されている。 Further, a screw groove 22 for fixing the set screw 3 and a screw groove 26 for fixing the end cap are formed on the inner peripheral surface of the intramedullary nail 2.
 図3(b)に示すように、サブピン挿入用のピン孔7及びピン孔8や、ラグスクリュー挿入用のスクリュー孔9及びスクリュー孔10は、サブピンやラグスクリューが挿入可能な範囲の形状を有するものとなっている。 As shown in FIG. 3B, the pin hole 7 and the pin hole 8 for inserting the sub-pin, and the screw hole 9 and the screw hole 10 for inserting the lag screw have a shape in a range in which the sub-pin and the lag screw can be inserted. It has become a thing.
 図4に示す髄内釘41は、上部側の中心軸に対して下部側が4°程曲げられた形状となっている。より具体的には、大腿骨の中心軸線上に沿って髄内釘を真っ直ぐ挿入することが難しい場合があり、挿入により新たな骨折の原因となることがある。そのため、大腿骨の中心軸線上ではなく、大腿骨の大転子頂部から髄内釘を挿入可能とすべく、上記の形状が採用される。このような髄内釘41にも、前述したセットスクリュー3及びエンドキャップ4を使用することができる。 The intramedullary nail 41 shown in FIG. 4 has a shape in which the lower side is bent about 4 ° with respect to the central axis on the upper side. More specifically, it may be difficult to insert an intramedullary nail straight along the central axis of the femur, which may cause a new fracture. Therefore, the above-described shape is employed so that the intramedullary nail can be inserted from the top of the greater trochanter of the femur rather than on the central axis of the femur. The set screw 3 and the end cap 4 described above can also be used for such an intramedullary nail 41.
 図5には、サブピンの概略図(a)及びラグスクリューの概略図(b)を示している。 FIG. 5 shows a schematic diagram (a) of the sub-pin and a schematic diagram (b) of the lag screw.
 図5(a)に示すように、サブピン6は、尖鋭な棒状体であり、反対側の端部には、髄内釘への挿入時に使用される孔が形成されている。また、図5(b)に示すように、ラグスクリュー5は、先端の外周面に雄ネジ11が形成されている。また、外周面にはスクリュー溝12が形成されている。なお、図5(a)及び図5(b)の左側の図は、各係合部材を挿入方向と反対側の端部から見た図である。 As shown in FIG. 5 (a), the sub-pin 6 is a sharp rod-like body, and a hole used for insertion into the intramedullary nail is formed at the opposite end. Moreover, as shown in FIG.5 (b), the lag screw 5 has the external thread 11 formed in the outer peripheral surface of the front-end | tip. A screw groove 12 is formed on the outer peripheral surface. 5A and 5B are diagrams in which each engagement member is viewed from the end opposite to the insertion direction.
 図6には、セットスクリューの側面側から見た断面図及びセットスクリュー及びワッシャーの側面概略図(a)、ワッシャーの概略図(b)、セットスクリューの頭部側の概略図(c)及びセットスクリューの胴体側の概略図(d)を示している。 FIG. 6 is a cross-sectional view of the set screw viewed from the side, a schematic side view of the set screw and washer (a), a schematic view of the washer (b), a schematic view of the head side of the set screw (c), and a set. A schematic diagram (d) of the body side of the screw is shown.
 図6(a)~図6(d)から明らかなように、セットスクリュー3は頭部35と、胴体部36から構成されている。頭部35は嵌合片37を有し、嵌合片37が胴部36の嵌合溝38に、一定の力に対して分離不可能に取り付けられている。また、頭部35は胴体部36に対して回転自在に取り付けられている。即ち、嵌合片37及び嵌合溝38で長手方向への分離が規制されるが、長手方向を軸心とする回転は可能となっている。 As is apparent from FIGS. 6A to 6D, the set screw 3 includes a head portion 35 and a body portion 36. The head portion 35 has a fitting piece 37, and the fitting piece 37 is attached to the fitting groove 38 of the body portion 36 so as not to be separated with respect to a certain force. The head portion 35 is attached to the body portion 36 so as to be rotatable. That is, although the separation in the longitudinal direction is restricted by the fitting piece 37 and the fitting groove 38, rotation about the longitudinal direction is possible.
 頭部35が胴体部36に対して回転自在となっていることから、髄内釘2の貫通孔14にセットスクリュー3を入れた際に、ピン孔18及びピン孔19の位置を変更することなく、頭部35のみを回転させて、髄内釘2の内周面にネジ固定することが可能となる。 Since the head portion 35 is rotatable with respect to the body portion 36, when the set screw 3 is inserted into the through hole 14 of the intramedullary nail 2, the positions of the pin hole 18 and the pin hole 19 are changed. Instead, only the head 35 can be rotated and screwed to the inner peripheral surface of the intramedullary nail 2.
 また、図6(c)から明らかなように、頭部35には、スリット39及びスリット40が形成されている。スリット39は、頭部35の内周面側から外周面側に向けて頭部35を部分的に削ったものである。スリット40はスリット39より細く、頭部35の内周面から外周面にかけて貫通して形成されている。 As is clear from FIG. 6C, the head 35 is formed with a slit 39 and a slit 40. The slit 39 is obtained by partially cutting the head 35 from the inner peripheral surface side to the outer peripheral surface side of the head 35. The slit 40 is narrower than the slit 39 and is formed so as to penetrate from the inner peripheral surface of the head 35 to the outer peripheral surface.
 また、頭部35の外径の大きさは、頭部35と胴体部36を一体化させる前後で変わるように加工が施されている。具体的には、スリット40をわずかに広げ、頭部35の外径を大きくする加工が施されている。 Further, the outer diameter of the head portion 35 is processed so as to change before and after the head portion 35 and the body portion 36 are integrated. Specifically, the slit 40 is slightly expanded to increase the outer diameter of the head 35.
 まず、頭部35と胴体部36を一体化させる前は、頭部35の外径の大きさは、髄内釘2のネジ溝22とほぼ同程度の大きさとなっている。即ち、頭部35を専用の取り付け工具で回転させてほぼ抵抗なく頭部35が回転し、セットスクリュー3が貫通孔14の内周面上の位置を変えることが可能な外径の大きさとなっている。 First, before the head portion 35 and the body portion 36 are integrated, the outer diameter of the head portion 35 is approximately the same as the screw groove 22 of the intramedullary nail 2. That is, the head 35 is rotated with almost no resistance by rotating the head 35 with a dedicated mounting tool, and the outer diameter of the set screw 3 can change the position on the inner peripheral surface of the through hole 14. ing.
 頭部35を胴体部36に対して専用の工具で圧入し、嵌合片37を嵌合溝38に嵌合させる。その後、スリット40の箇所に楔状の専用治工具を入れ、スリット40をわずかに広げる加工を行う。加工後は工具を取り除いた状態でスリット40が広がり、これに伴って頭部35の外径が大きくなる。 The head 35 is press-fitted into the body portion 36 with a dedicated tool, and the fitting piece 37 is fitted into the fitting groove 38. After that, a wedge-shaped exclusive tool is inserted into the slit 40 and the slit 40 is slightly expanded. After machining, the slit 40 is expanded with the tool removed, and the outer diameter of the head 35 is increased accordingly.
 加工の後、頭部35の外径の大きさは、髄内釘2のネジ溝22の位置の内周面の大きさよりもわずかに大きいものとなる。そして、頭部35は弾性を有する金属で形成されているため、スリット40のスリット距離を縮める方向の外力、即ち、頭部35の外径が小さくなる方向に外力が働くと、元の外径の大きさに戻ろうとする付勢力が生じる。 After processing, the size of the outer diameter of the head 35 is slightly larger than the size of the inner peripheral surface at the position of the screw groove 22 of the intramedullary nail 2. Since the head portion 35 is formed of an elastic metal, when the external force acts in the direction in which the slit distance of the slit 40 is shortened, that is, in the direction in which the outer diameter of the head portion 35 is reduced, the original outer diameter An urging force is generated to return to the size of.
 頭部35の外径の大きさは、髄内釘2のネジ溝22の位置の内周面の大きさよりもわずかに大きくなっているため、セットスクリュー3を髄内釘2の貫通孔14に挿入する際に上述の付勢力が生じる。付勢力は、頭部35がネジ溝22を押す方向の力として働き、頭部35と髄内釘2の内周面との間に生じる抵抗力となる。この結果、髄内釘2にセットスクリュー3を挿入した後に、頭部35が回転しにくいものとすることができる。つまり、セットスクリュー3の髄内釘2の内周面における位置が保持しやすいものとなる。 Since the size of the outer diameter of the head 35 is slightly larger than the size of the inner peripheral surface at the position of the screw groove 22 of the intramedullary nail 2, the set screw 3 is inserted into the through hole 14 of the intramedullary nail 2. When inserting, the above-mentioned urging force is generated. The urging force acts as a force in the direction in which the head portion 35 pushes the screw groove 22, and becomes a resistance force generated between the head portion 35 and the inner peripheral surface of the intramedullary nail 2. As a result, the head 35 can be made difficult to rotate after the set screw 3 is inserted into the intramedullary nail 2. That is, the position of the set screw 3 on the inner peripheral surface of the intramedullary nail 2 is easily maintained.
 図7(a)~(c)を用いて、更に詳細な構造を説明する。図7(a)に示す胴体部36の嵌合溝38における位置55の内径φDAと、図7(b)に示す頭部35の位置56における外径φDBとの大きさの関係で、頭部35と胴体部36との間の摩擦抵抗力が異なるものとなる。頭部35と胴体部36との間の摩擦抵抗力が大きくなることで、頭部35が回転しにくくなり、この結果、セットスクリュー3の髄内釘2の内周面における位置が保持しやすいものとなる。 A more detailed structure will be described with reference to FIGS. 7 (a) to (c). 7 (a), the relationship between the inner diameter φDA at the position 55 in the fitting groove 38 of the body portion 36 and the outer diameter φDB at the position 56 of the head 35 shown in FIG. The frictional resistance between the body 35 and the body portion 36 is different. Since the frictional resistance between the head 35 and the torso 36 is increased, the head 35 is difficult to rotate, and as a result, the position of the set screw 3 on the inner peripheral surface of the intramedullary nail 2 is easily maintained. It will be a thing.
 上述したように位置56における外径φDBを大きくすることで頭部35と胴体部36との間の摩擦抵抗力を高めることができる。例えば、図7(b)や図7(c)に示すように、頭部35の嵌合片37は4つの爪部57を有しているが、爪部57の枚数や厚み(符号t1)、長さ(符号h1)を調整することで爪部57の弾性が高まるものとなる。爪部57の弾性が高まることで、頭部35の胴体部36と接触する箇所の外径φDBがより大きくなり、摩擦抵抗力を高めることができる。爪部の調整については後述する。 As described above, by increasing the outer diameter φDB at the position 56, the frictional resistance between the head portion 35 and the body portion 36 can be increased. For example, as shown in FIGS. 7B and 7C, the fitting piece 37 of the head portion 35 has four claw portions 57, but the number and thickness of the claw portions 57 (symbol t1). The elasticity of the claw portion 57 is increased by adjusting the length (symbol h1). By increasing the elasticity of the claw portion 57, the outer diameter φDB of the portion of the head 35 that contacts the body portion 36 becomes larger, and the frictional resistance can be increased. The adjustment of the claw portion will be described later.
 なお、本発明の第1の実施の形態では、φDAとφDBの関係について、φDA>φDBの構造と、φDA<φDBの構造のいずれもが採用しうるが、摩擦抵抗力を高める点からは、φDA<φDBの構造が採用されることが好ましい。 In the first embodiment of the present invention, both the structure of φDA> φDB and the structure of φDA <φDB can be adopted as the relationship between φDA and φDB. From the point of increasing the frictional resistance, A structure of φDA <φDB is preferably adopted.
 また、胴体部36の嵌合溝38の凹部58と、頭部35の爪部57の先端形状は、爪部57が嵌合溝38に内装される方向にのみ進み進みやすい形状となっている。換言すれば、爪部57が凹部58から引き抜かれる方向、即ち、頭部35が胴体部36から抜け出る方向への動きが凹部58と爪部57の引っ掛かりにより規制されるものとなる。これにより、頭部35と胴体部36の嵌合状態が保持されるものとなる。 Further, the concave portions 58 of the fitting groove 38 of the body portion 36 and the tip shapes of the claw portions 57 of the head portion 35 are shaped so as to easily advance only in the direction in which the claw portion 57 is housed in the fitting groove 38. . In other words, the movement of the claw portion 57 in the direction in which the claw portion 57 is pulled out from the concave portion 58, that is, the direction in which the head portion 35 is pulled out from the body portion 36 is restricted by the catch of the concave portion 58 and the claw portion 57. Thereby, the fitting state of the head 35 and the trunk | drum 36 will be hold | maintained.
 図6(b)に示すように、ワッシャー16には切れ目が形成されている。この切れ目は、髄内釘2の内周面のネジ構造部分の螺旋のスレッドリード角に沿ってワッシャーが進めるように設けたものである。 As shown in FIG. 6B, the washer 16 has a cut. This cut is provided so that the washer advances along the thread lead angle of the spiral of the screw structure portion on the inner peripheral surface of the intramedullary nail 2.
 図8(a)及び図8(b)には、本発明で適用しうるワッシャーのその他の形状を示している。図6(b)に示すワッシャー16以外にも、ほぼ円形の外形を有するワッシャー59や、切れ目の近傍に略平坦な形状を有するワッシャー60が利用可能である。 8 (a) and 8 (b) show other shapes of washers that can be applied in the present invention. In addition to the washer 16 shown in FIG. 6B, a washer 59 having a substantially circular outer shape and a washer 60 having a substantially flat shape near the cut can be used.
 以上までで説明した骨接合具におけるラグスクリューとサブピンを挿入した状態での具体的な機能を説明する。 Specific functions of the bone joint described above with the lag screw and sub-pin inserted are described.
 まず、ラグスクリューに対する2種類の固定態様について触れる。ラグスクリューの固定態様としては、「スタティックな固定」と、「スライディングを許容する固定」の2種類が存在する。いずれも、ラグスクリューの回旋を抑える点では共通しているが、骨折の症例によって、2つの異なる固定態様が使い分けられている。 First, I will touch on two types of fixing to the lag screw. There are two types of fixing of the lag screw: “static fixing” and “fixing that allows sliding”. Both are common in that the rotation of the lag screw is suppressed, but two different fixation modes are used properly depending on the fracture case.
 「スタティックな固定」とは、ラグスクリューの回旋方向の動きと、スライディングと呼ばれる長手方向の後端側への動きの両方を固定するものである。 "Static fixation" is to fix both the movement of the lag screw in the rotating direction and the movement toward the rear end side in the longitudinal direction called sliding.
 「スライディングを許容する固定」とは、ラグスクリューの回旋方向の動きは制御し、長手方向の後端側への動きは許容するものである。 ”“ Fixing that allows sliding ”means that the movement of the lag screw in the rotating direction is controlled and the movement toward the rear end side in the longitudinal direction is allowed.
 通常のセットスクリューによるラグスクリューの固定では、ネジ構造でセットスクリューを回転不能となるまで締めた後に、ラグスクリューの長手方向への移動を許容するために、セットスクリューを緩める方向に4分の1回転戻し、「スライディングを許容する固定」とする。緩めることで、セットスクリューの先端とラグスクリューのスクリュー溝との間にわずかにクリアランスが生じて、ラグスクリューの回旋は規制されるが、長手方向への移動は許容するものとなる。 In fixing a lag screw with a normal set screw, after tightening the set screw until it becomes non-rotatable in the screw structure, in order to allow the lag screw to move in the longitudinal direction, the set screw is loosened by a quarter. Rotate back and “fixed to allow sliding”. By loosening, a slight clearance is generated between the tip of the set screw and the screw groove of the lag screw, and the rotation of the lag screw is restricted, but the movement in the longitudinal direction is allowed.
 ネジ構造でセットスクリューを回転不能となるまで締めたままにすると、ラグスクリューの回旋方向の動きと、スライディングが制御され、ラグスクリューは強固に固定された「スタティックな固定」となる。 If the set screw is tightened until it becomes unrotatable due to the screw structure, the movement of the lag screw in the rotating direction and sliding are controlled, and the lag screw becomes a “static fixation” that is firmly fixed.
 「スライディングを許容する固定」を行うと、骨頭に係合したラグスクリューが動き、骨折の隙間を埋めて、骨癒合を促進させることができるため、本固定も重要な固定態様となっている。 ”When“ fixing that allows sliding ”is performed, the lag screw engaged with the head of the bone moves and fills the gap between the fractures to promote bone fusion, so this fixing is also an important fixing mode.
 このように、ラグスクリューを併用する骨接合具では、「スタティックな固定」及び「スライディングを許容する固定」の両方が行えることが望ましい。しかし、「スライディングを許容する固定」では、セットスクリューを緩める作業を伴うため、外力等が作用することで、ラグスクリューの回旋も規制できないほどのセットスクリューの緩みにつながることがある。 As described above, it is desirable that both “static fixation” and “fixation that allows sliding” can be performed in a bone joint using a lag screw. However, since “fixing that allows sliding” involves an operation of loosening the set screw, an external force or the like may act to loosen the set screw so that the rotation of the lag screw cannot be regulated.
 本発明の第1の実施の形態では、セットスクリュー3の構造で、スリット40をわずかに広げて頭部35の外径を大きくして、髄内釘2への挿入時に頭部35の弾性力を利用することにより、髄内釘2の内周面におけるセットスクリューの位置が保持しやすいものとなっている。また、φDA<φDBの関係となる構造にすることで、頭部35と胴体部36との間で、頭部35の回転に対して摩擦抵抗力が生じるため、髄内釘2の内周面におけるセットスクリューの位置が保持しやすいものとなっている。即ち、「スライディングを許容する固定」の状態とする、セットスクリューを緩める方向に4分の1回転戻した位置が保持しやすいものとなっている。 In the first embodiment of the present invention, with the structure of the set screw 3, the slit 40 is slightly widened to increase the outer diameter of the head 35, and the elastic force of the head 35 is inserted into the intramedullary nail 2. By using this, the position of the set screw on the inner peripheral surface of the intramedullary nail 2 can be easily maintained. In addition, since a frictional force is generated against the rotation of the head 35 between the head 35 and the body portion 36 by adopting a structure having a relationship of φDA <φDB, the inner peripheral surface of the intramedullary nail 2 The position of the set screw in is easy to hold. That is, it is easy to hold the position where the set screw is returned by a quarter of a turn in the direction of loosening, which is in a “fixed state that allows sliding”.
 また、エンドキャップ4のネジ構造による固定は、ワッシャー16が窪み25に余裕をもって嵌合しているため、充分に締めることが可能となる。そのため、サブピンの固定力が担保される。 Further, the fixing of the end cap 4 by the screw structure can be sufficiently tightened because the washer 16 is fitted in the recess 25 with a margin. Therefore, the fixing force of the sub pin is secured.
 ここで、本発明を適用した骨接合具のその他の実施の形態として、図2(b)に示すようなエンドキャップ31でセットスクリュー3の緩みを抑える構造も採用しうる。この場合、サブピンは使用しない状態、またはサブピンは固定されない状態でエンドキャップによりセットスクリューの回転が抑えられる構造となる。また、ラグスクリューの回転の規制は第1の実施の形態と同様である。 Here, as another embodiment of the bone connector to which the present invention is applied, a structure in which loosening of the set screw 3 is suppressed by an end cap 31 as shown in FIG. In this case, the rotation of the set screw is suppressed by the end cap when the sub pin is not used or the sub pin is not fixed. Further, the regulation of the rotation of the lag screw is the same as that of the first embodiment.
 詳細には、エンドキャップ31がセットスクリュー3の頭部35の内周面に挿入され、エンドキャップ31のテーパ部66の途中で挿入が止まる。この際、頭部35のスリット39にテーパ部66が食い込むものとなる。テーパ部66がスリット39に食い込むと、頭部35の外径が広がる方向に力がかかるが、スリット40があることで、頭部35の径が大きくなり、セットスクリュー3の固定状態が緩みにくいものとすることができる。即ち、セットスクリュー3の髄内釘2に対する回転が抑えられるものとなる。 Specifically, the end cap 31 is inserted into the inner peripheral surface of the head portion 35 of the set screw 3, and the insertion stops in the middle of the tapered portion 66 of the end cap 31. At this time, the tapered portion 66 bites into the slit 39 of the head portion 35. When the taper portion 66 bites into the slit 39, a force is applied in the direction in which the outer diameter of the head 35 expands. However, the presence of the slit 40 increases the diameter of the head 35 and prevents the set screw 3 from being loosened. Can be. That is, the rotation of the set screw 3 with respect to the intramedullary nail 2 is suppressed.
 続いて、本発明の第2の実施の形態について説明する。なお、以後の本発明の実施の形態については、上述した構造と同様の部材については同一の符号を用いて説明を行うものとする。 Subsequently, a second embodiment of the present invention will be described. In the following embodiments of the present invention, members similar to those described above will be described using the same reference numerals.
 本発明の第2の実施の形態では、上述した第1の実施の形態とは、セットスクリューの構造が異なるものとなる。より詳細には、セットスクリューを構成する頭部及び胴体部の構造が第1の実施の形態と異なる。以下、構造について説明する。 In the second embodiment of the present invention, the structure of the set screw is different from that of the first embodiment described above. In more detail, the structure of the head part and the trunk | drum part which comprise a set screw differs from 1st Embodiment. Hereinafter, the structure will be described.
 本発明の第2の実施の形態の骨接合具は、髄内釘2と、セットスクリュー42と、エンドキャップ4を備えている。また、髄内釘2には、骨片に係合する係合部材として、ラグスクリュー5と、サブピン6が挿入されている。 The osteosynthesis device of the second embodiment of the present invention includes an intramedullary nail 2, a set screw 42, and an end cap 4. Moreover, the lag screw 5 and the sub pin 6 are inserted in the intramedullary nail 2 as an engaging member engaged with a bone fragment.
 髄内釘2には、ピン孔7及びピン孔8と、スクリュー孔9及びスクリュー孔10が形成され、ラグスクリュー5と、サブピン6がそれぞれ挿入される。 In the intramedullary nail 2, a pin hole 7 and a pin hole 8, a screw hole 9 and a screw hole 10 are formed, and a lag screw 5 and a sub pin 6 are inserted respectively.
 ラグスクリュー5の先端は外周面に雄ネジ11が形成され、この雄ネジ11が骨内海綿質に食い込む部分となる。また、ラグスクリュー5の胴部外周面には、長手方向に沿って、スクリュー溝12が形成されている。 The male screw 11 is formed on the outer peripheral surface of the tip of the lag screw 5, and this male screw 11 is a portion that bites into the intraosseous sponge. A screw groove 12 is formed on the outer peripheral surface of the body portion of the lag screw 5 along the longitudinal direction.
 スクリュー溝12は、後述するセットスクリュー42の先端の突出片43と嵌合する部分である。また、スクリュー溝12は、ラグスクリュー5の胴部外周面の円周上に一定間隔で複数形成されている。 The screw groove 12 is a portion that fits into a protruding piece 43 at the tip of a set screw 42 described later. A plurality of screw grooves 12 are formed at regular intervals on the circumference of the outer peripheral surface of the body portion of the lag screw 5.
 サブピン6は、尖鋭な棒体であり、先端部分が施術対象骨内の海綿質に容易に進入し、骨に大きな孔を開けることなく、骨内に位置するものとなる。骨内でラグスクリュー5と略平行に位置し、骨頭の回旋を抑えるものとなる。 The sub-pin 6 is a sharp rod body, and the tip portion easily enters the sponge in the bone to be treated, and is located in the bone without opening a large hole in the bone. It is positioned substantially parallel to the lag screw 5 in the bone, and suppresses the rotation of the bone head.
 サブピン6は、ラグスクリュー5よりも短く形成されている。また、その胴体部分は円柱状に形成されている。 The sub pin 6 is formed shorter than the lag screw 5. Moreover, the trunk | drum part is formed in the column shape.
 髄内釘2の下端には、図示しない横止め孔が形成され、下端位置において横止めスクリューが挿入され、髄内釘2が骨内に固定されている。 At the lower end of the intramedullary nail 2, a lateral retaining hole (not shown) is formed, and a lateral retaining screw is inserted at the lower end position to fix the intramedullary nail 2 in the bone.
 髄内釘2の軸心には貫通孔14が形成されている。貫通孔14には、前述したラグスクリュー5及びサブピン6の一部が位置する。また、貫通孔14の内部には、セットスクリュー42、ワッシャー16及びエンドキャップ4が取り付けられる。 A through hole 14 is formed in the axial center of the intramedullary nail 2. A part of the lag screw 5 and the sub pin 6 described above is located in the through hole 14. A set screw 42, a washer 16, and an end cap 4 are attached inside the through hole 14.
 セットスクリュー42及びワッシャー16の上方にエンドキャップ4が取り付けられている。エンドキャップ4は、髄内釘2の内周面に固定され、貫通孔14を閉塞する部材である。また、エンドキャップ4の突出部27が髄内釘2に挿入されたサブピン6を固定する部分となる。 The end cap 4 is attached above the set screw 42 and the washer 16. The end cap 4 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and closes the through hole 14. Further, the protruding portion 27 of the end cap 4 is a portion for fixing the sub-pin 6 inserted into the intramedullary nail 2.
 エンドキャップ4は、突出部27と、テーパ部28と、ネジ溝部29と、頭部30を有している。突出部27は、セットスクリュー3の貫通孔24に挿入可能な径であり、その先端は半球状に形成されている。この半球状の部分が、サブピン6の円柱状の外周面に接触し、サブピン6を固定する。 The end cap 4 has a protruding portion 27, a tapered portion 28, a thread groove portion 29, and a head portion 30. The protruding portion 27 has a diameter that can be inserted into the through hole 24 of the set screw 3, and the tip thereof is formed in a hemispherical shape. This hemispherical portion comes into contact with the cylindrical outer peripheral surface of the sub-pin 6 and fixes the sub-pin 6.
 ネジ溝部29は、外周面にネジ溝が形成され、髄内釘2の内周面のネジ溝26と嵌合し、エンドキャップ4はネジ構造にて髄内釘2に固定される。また、頭部30は内側にドライバー孔が形成され、エンドキャップ4の取り付け時に、ドライバーが嵌合する部分となる。 The screw groove portion 29 has a screw groove formed on the outer peripheral surface thereof, and is fitted to the screw groove 26 on the inner peripheral surface of the intramedullary nail 2, and the end cap 4 is fixed to the intramedullary nail 2 by a screw structure. Further, the head 30 is formed with a driver hole on the inner side, and becomes a portion where the driver is fitted when the end cap 4 is attached.
 髄内釘2のネジ溝22とネジ溝26では、ネジ溝22がネジ溝26よりも長く形成されている。より具体的には、ネジ溝22が5.8mm、ネジ溝26が4mmの長さとなっている。 In the screw groove 22 and the screw groove 26 of the intramedullary nail 2, the screw groove 22 is formed longer than the screw groove 26. More specifically, the screw groove 22 has a length of 5.8 mm and the screw groove 26 has a length of 4 mm.
 ここで、必ずしも、エンドキャップ4の突出部27の先端が半球状に形成される必要はない。例えば、サブピンの外周面上に、ラグスクリューと同様のスクリュー溝を形成した場合には、エンドキャップ4の突出部27の先端をスクリュー溝に嵌合する突出片とすることも可能である。 Here, the tip of the projecting portion 27 of the end cap 4 does not necessarily have to be hemispherical. For example, when a screw groove similar to a lag screw is formed on the outer peripheral surface of the sub-pin, the tip of the protruding portion 27 of the end cap 4 can be a protruding piece that fits into the screw groove.
 また、必ずしも、図2(a)に示すようなエンドキャップ4が用いられる必要はない。例えば、図2(b)に示すようなエンドキャップ31が使用されることもある。エンドキャップ31は突出部32が短く形成され、サブピンを併用しない場合や、サブピンを固定しない場合の髄内釘2に取付けられる。 Also, it is not always necessary to use the end cap 4 as shown in FIG. For example, an end cap 31 as shown in FIG. 2B may be used. The end cap 31 is formed with a short protrusion 32 and is attached to the intramedullary nail 2 when the sub-pin is not used together or when the sub-pin is not fixed.
 また、必ずしも、髄内釘2のネジ溝22とネジ溝26では、ネジ溝22がネジ溝26よりも長く形成される必要はない。また、ネジ溝22が5.8mm、ネジ溝26が4mmの長さに限定されるものではない。但し、セットスクリューの固定度を高めることができる点から、髄内釘2のネジ溝22とネジ溝26では、ネジ溝22がネジ溝26よりも長く形成されることが好ましい。 Also, the screw groove 22 and the screw groove 26 of the intramedullary nail 2 do not necessarily need to be formed longer than the screw groove 26. Further, the length of the screw groove 22 is not limited to 5.8 mm, and the length of the screw groove 26 is not limited to 4 mm. However, it is preferable that the screw groove 22 is formed longer than the screw groove 26 in the screw groove 22 and the screw groove 26 of the intramedullary nail 2 because the fixing degree of the set screw can be increased.
 図9を用いてセットスクリュー42の構造について説明する。
 図9は、本発明の第2の実施の形態におけるセットスクリューの側面側から見た断面図及びセットスクリュー及びワッシャーの側面概略図(a)、ワッシャーの概略図(b)、セットスクリューの頭部側の概略図(c)及びセットスクリューの胴体側の概略図(d)を示している。
The structure of the set screw 42 will be described with reference to FIG.
FIG. 9 is a cross-sectional view seen from the side of a set screw according to the second embodiment of the present invention, a schematic side view of the set screw and washer (a), a schematic view of the washer (b), and a head of the set screw. The schematic diagram (c) of the side and the schematic diagram (d) of the fuselage side of the set screw are shown.
 図9(a)~図9(d)に示すように、セットスクリュー42は頭部44と、胴体部45から構成されている。頭部44は嵌合片46を有し、嵌合片46が胴体部45の嵌合溝47に、一定の力に対して分離不可能に取り付けられている。また、頭部44は胴体部45に対して回転自在に取り付けられている。即ち、嵌合片46及び嵌合溝47で長手方向への分離が規制されるが、長手方向を軸心とする回転は可能となっている。図9(a)の上の図は断面図、下の図は概略図である。 As shown in FIGS. 9A to 9D, the set screw 42 includes a head 44 and a body 45. The head 44 has a fitting piece 46, and the fitting piece 46 is attached to the fitting groove 47 of the body portion 45 so as not to be separated with respect to a certain force. The head 44 is attached to the body 45 so as to be rotatable. That is, the separation in the longitudinal direction is restricted by the fitting piece 46 and the fitting groove 47, but rotation about the longitudinal direction is possible. 9A is a cross-sectional view, and the lower view is a schematic view.
 頭部44が胴体部45に対して回転自在となっていることから、髄内釘2の貫通孔14にセットスクリュー42を入れた際に、後述するピン孔48及びピン孔49の位置を変更することなく、頭部44のみを回転させて、髄内釘2の内周面にネジ固定することが可能となる。 Since the head portion 44 is rotatable with respect to the body portion 45, the positions of the pin hole 48 and the pin hole 49 described later are changed when the set screw 42 is inserted into the through hole 14 of the intramedullary nail 2. Without doing so, only the head 44 can be rotated and screwed to the inner peripheral surface of the intramedullary nail 2.
 セットスクリュー42は髄内釘2の内周面に固定され、ラグスクリュー5の回旋を抑える部材である。セットスクリュー42の先端には突出片43が形成され、ラグスクリュー5のスクリュー溝12と嵌合する。 The set screw 42 is a member that is fixed to the inner peripheral surface of the intramedullary nail 2 and suppresses the rotation of the lag screw 5. A protruding piece 43 is formed at the tip of the set screw 42 and is fitted to the screw groove 12 of the lag screw 5.
 また、セットスクリュー42にはピン孔48及びピン孔49が形成され、前述した髄内釘2のピン孔7及びピン孔8と同一直線上に位置して、サブピン6が挿入される部分となっている。 Further, the set screw 42 is formed with a pin hole 48 and a pin hole 49, which are located on the same straight line as the pin hole 7 and the pin hole 8 of the intramedullary nail 2 described above and into which the sub pin 6 is inserted. ing.
 ここで、必ずしも、セットスクリュー42が頭部44と、胴体部45から構成され、頭部44が胴体部45に対して回転自在に取り付けられる必要はない。例えば、頭部と胴体部を分離せずに一体化した構造も採用しうる。但し、上述したように、ピン孔48及びピン孔49の位置を変更することなくセットスクリュー42を所望の位置に取り付け、ピン孔同士を合わせる手間がなくなることから、セットスクリュー42が頭部44と、胴体部45から構成され、頭部44が胴体部45に対して回転自在に取り付けられることが好ましい。 Here, the set screw 42 is not necessarily composed of the head portion 44 and the body portion 45, and the head portion 44 is not necessarily attached to the body portion 45 so as to be rotatable. For example, a structure in which the head portion and the trunk portion are integrated without being separated may be employed. However, as described above, the set screw 42 is attached to a desired position without changing the positions of the pin hole 48 and the pin hole 49, and there is no need to align the pin holes. The body portion 45 is preferably configured such that the head portion 44 is rotatably attached to the body portion 45.
 また、セットスクリュー42のピン孔48及びピン孔49の形状は特に限定されるものではなく、サブピン6がまっすぐ挿入可能かつラグスクリュー5と略平行な位置にくるものとなっていれば充分である。 Further, the shapes of the pin hole 48 and the pin hole 49 of the set screw 42 are not particularly limited, and it is sufficient if the sub pin 6 can be inserted straight and is positioned substantially parallel to the lag screw 5. .
 セットスクリュー42は径大な張出部50を有し、その外周面上にネジ溝51が形成されている。ネジ溝51は、髄内釘2の内周面のネジ溝22と嵌合し、セットスクリュー42はネジ構造にて髄内釘2に固定される。また、張出部50は、髄内釘2の段差23に嵌合する。 The set screw 42 has an overhanging portion 50 having a large diameter, and a screw groove 51 is formed on the outer peripheral surface thereof. The screw groove 51 is fitted to the screw groove 22 on the inner peripheral surface of the intramedullary nail 2, and the set screw 42 is fixed to the intramedullary nail 2 by a screw structure. Further, the overhanging portion 50 is fitted to the step 23 of the intramedullary nail 2.
 また、セットスクリュー42の中心には、長手方向にかけて貫通孔52が形成されている。貫通孔52は、エンドキャップ4の一部が挿入される部分となる。 Further, a through hole 52 is formed at the center of the set screw 42 in the longitudinal direction. The through hole 52 is a portion into which a part of the end cap 4 is inserted.
 また、胴体部45の貫通孔52の一部にはタップ加工が施され、溝部53が設けられた構造となっている。この溝部53は専用のドライバーと嵌合可能な箇所であり、セットスクリュー42の頭部44と胴体部45に大きな外力が働き、頭部44及び胴体部45が分離してしまった場合にも、胴体部45を髄内釘2の内部から取り外すことが可能となる。 Further, a part of the through hole 52 of the body part 45 is tapped so that a groove part 53 is provided. The groove 53 is a place that can be fitted with a dedicated driver, and when a large external force acts on the head 44 and the body 45 of the set screw 42 and the head 44 and the body 45 are separated, The body part 45 can be removed from the inside of the intramedullary nail 2.
 即ち、セットスクリュー42によるラグスクリュー5の固定状態を解除できるものとなる。頭部44の内周面にも溝部54が形成され、通常の使用時は、この溝部54が用いられる。つまり、頭部44及び胴体部45が一体化したセットスクリュー42の髄内釘2に対する回転は、この溝部54と専用ドライバーとの嵌合及び回転によって行われる。 That is, the fixed state of the lag screw 5 by the set screw 42 can be released. A groove 54 is also formed on the inner peripheral surface of the head 44, and this groove 54 is used during normal use. That is, rotation of the set screw 42 in which the head portion 44 and the body portion 45 are integrated with respect to the intramedullary nail 2 is performed by fitting and rotation of the groove portion 54 and the dedicated driver.
 図9(a)の下の図に示すように、セットスクリュー42の上方にワッシャー16が配置される。ワッシャー16は、セットスクリュー42の貫通孔14の外側への抜け落ちを抑える部材となる。図9(b)に示すように、ワッシャー16は切れ目を有するリング状の部材で、エンドキャップ4の一部を囲繞可能な径に形成されている。 As shown in the lower figure of FIG. 9A, the washer 16 is disposed above the set screw 42. The washer 16 is a member that prevents the set screw 42 from falling off the through hole 14. As shown in FIG. 9B, the washer 16 is a ring-shaped member having a cut, and is formed to have a diameter that can partially surround the end cap 4.
 また、ワッシャー16は髄内釘2の内周面の窪み25に配置されている(図1参照)。窪み25はワッシャー16よりもやや大きめに形成され、ワッシャー16は余裕をもって嵌合するものとなる。 Further, the washer 16 is disposed in the recess 25 on the inner peripheral surface of the intramedullary nail 2 (see FIG. 1). The depression 25 is formed slightly larger than the washer 16, and the washer 16 is fitted with a margin.
 髄内釘2の内周面において、セットスクリュー42固定用のネジ溝22とエンドキャップ固定用のネジ溝26との間に窪み25が位置している。即ち、髄内釘2の内周面では、ネジ溝が非連続に形成されたものとなっている。 On the inner peripheral surface of the intramedullary nail 2, a recess 25 is located between the screw groove 22 for fixing the set screw 42 and the screw groove 26 for fixing the end cap. That is, on the inner peripheral surface of the intramedullary nail 2, screw grooves are formed discontinuously.
 また、図9(c)に示すように、頭部44は、短手方向の断面視で略ドーナツ状に形成されている。即ち、頭部44には、前述した第1の実施の形態の頭部35とは異なり、スリット39及びスリット40は形成されず、切れ目のない形状となっている。 Further, as shown in FIG. 9C, the head 44 is formed in a substantially donut shape in a cross-sectional view in the short side direction. That is, unlike the head portion 35 of the first embodiment described above, the head portion 44 is not formed with slits 39 and slits 40 and has a continuous shape.
 図10(a)~(c)及び図11を用いて、更に詳細な構造を説明する。図10(a)に示す胴体部45の嵌合溝47における位置61の内径φDAと、図10(b)に示す頭部44の位置62における外径φDBとの大きさは、φDA<φDBとなるように形成されている。上述したように、外径φDBを大きくすることで頭部44と胴体部45との間の摩擦抵抗力が高まり、頭部44が回転しにくいものとすることができる。この結果、セットスクリュー42の髄内釘2の内周面における位置が保持しやすいものとなる。 A more detailed structure will be described with reference to FIGS. 10 (a) to 10 (c) and FIG. The size of the inner diameter φDA at the position 61 in the fitting groove 47 of the body 45 shown in FIG. 10A and the outer diameter φDB at the position 62 of the head 44 shown in FIG. 10B is φDA <φDB. It is formed to become. As described above, by increasing the outer diameter φDB, the frictional resistance between the head portion 44 and the body portion 45 is increased, and the head portion 44 can be made difficult to rotate. As a result, the position of the set screw 42 on the inner peripheral surface of the intramedullary nail 2 can be easily maintained.
 また、セットスクリュー42は、頭部44の爪部63の構造が、上述したセットスクリュー3と異なっている。まず、セットスクリュー42の頭部44は6つの爪部63を有している。また、爪部63の厚み(符号t2)は上述した爪部57の厚み(符号t1)よりも薄く形成されている。更に、爪部63の長さ(符号h2)は上述した爪部57の長さ(符号h1)よりも長く形成されている。 Also, the set screw 42 is different from the set screw 3 described above in the structure of the claw portion 63 of the head 44. First, the head 44 of the set screw 42 has six claw portions 63. Further, the thickness (reference symbol t2) of the claw portion 63 is formed thinner than the thickness (reference symbol t1) of the claw portion 57 described above. Further, the length of the claw portion 63 (symbol h2) is longer than the length of the claw portion 57 (symbol h1) described above.
 即ち、爪部63は爪部57と比べて、爪の枚数が増え、厚みが薄くなり、より長い構造となっている。これにより、爪部63の弾性がより一層高まり、頭部44と胴体部45との摩擦抵抗力を高めることができる。また、弾性力が向上したことで、頭部44と胴体部45を一体化した状態、即ち、爪部63を嵌合溝47に圧入した際に爪部63がへたりが生じにくいものとすることができる。 That is, the claw part 63 has a longer structure than the claw part 57 in which the number of claws is increased and the thickness is reduced. Thereby, the elasticity of the claw part 63 further increases, and the frictional resistance between the head part 44 and the body part 45 can be increased. Further, since the elastic force is improved, the claw portion 63 is unlikely to sag when the head portion 44 and the body portion 45 are integrated, that is, when the claw portion 63 is press-fitted into the fitting groove 47. be able to.
 また、胴体部45の嵌合溝47の凹部64と、頭部44の爪部63の先端形状は、爪部63が嵌合溝47に内装される方向にのみ進み進みやすい形状となっている。換言すれば、爪部63が凹部64から引き抜かれる方向、即ち、頭部44が胴体部45から抜け出る方向への動きが凹部64と爪部63の引っ掛かりにより規制されるものとなる。これにより、頭部44と胴体部45の嵌合状態が保持されるものとなる。 Further, the concave portions 64 of the fitting groove 47 of the body portion 45 and the tip shapes of the claw portions 63 of the head portion 44 are shaped so as to easily advance and advance only in the direction in which the claw portion 63 is housed in the fitting groove 47. . In other words, the movement of the claw part 63 in the direction in which the claw part 63 is pulled out from the concave part 64, that is, the direction in which the head part 44 comes out of the body part 45 is restricted by the catch of the concave part 64 and the claw part 63. Thereby, the fitting state of the head 44 and the trunk | drum 45 will be hold | maintained.
 図11に左側の図は頭部44の概略図、右側の図はC-C線における断面図である。図11の右側の図に示す、頭部44の爪部63の角65の部分12箇所は面取りがなされている。これにより、胴体部45と爪部63の接触箇所における摺動かじりを低減する構造となっている。 11 is a schematic diagram of the head 44, and a diagram on the right side is a cross-sectional view taken along the line CC. The twelve corner portions 65 of the claw 63 of the head 44 shown in the right side of FIG. 11 are chamfered. Thereby, it has the structure which reduces the sliding galling in the contact location of the trunk | drum 45 and the nail | claw part 63. FIG.
 また、頭部44の溝部54は断面で略六角形の形状であり、頭部44の貫通孔52に沿って長手方向に形成されている。本部分が専用の六角ドライバーと嵌合する箇所であり、セットスクリュー42に回転動作を生じる部分となる。 Further, the groove portion 54 of the head portion 44 has a substantially hexagonal shape in cross section, and is formed in the longitudinal direction along the through hole 52 of the head portion 44. This part is a part that fits with a dedicated hexagon driver, and is a part that causes the set screw 42 to rotate.
 ここで、必ずしも、溝部54の断面が略六角形となる6本の溝で構成される必要はなく、セットスクリュー42を回転可能な構造となっていれば充分である。但し、ドライバーとの間で滑りが生じにくく、より確実にセットスクリューを回転させることができる点から、溝部54の断面が略六角形となる6本の溝で構成されることが好ましい。 Here, it is not always necessary that the groove 54 has a substantially hexagonal cross section, and it is sufficient if the set screw 42 can be rotated. However, it is preferable that the groove portion 54 is composed of six grooves having a substantially hexagonal cross section because the set screw can be more reliably rotated with less difficulty in sliding with the driver.
 図9(d)には、胴体部45の構造を示している。前述したように、胴体部45には、溝部53が形成されている。本発明は上述したような第2の実施の形態の構造も採用しうる。 FIG. 9D shows the structure of the body portion 45. As described above, the groove portion 53 is formed in the body portion 45. The present invention can also employ the structure of the second embodiment as described above.
 上述したように、本発明の第2の実施の形態では、セットスクリューの頭部及び胴体部との間に摩擦抵抗力がより生じやすい構造となっており、髄内釘の内周面におけるセットスクリューの位置がより一層保持しやすいものとなっている。また、「スライディングを許容する固定」のセットスクリューを4分の1回転戻した状態において、セットスクリューの位置がより一層保持しやすくなっている。 As described above, in the second embodiment of the present invention, a frictional resistance force is more easily generated between the head and the body of the set screw, and the set on the inner peripheral surface of the intramedullary nail is performed. The position of the screw is easier to hold. In addition, in the state where the "fixing that allows sliding" set screw is returned by a quarter of a turn, the position of the set screw is more easily held.
 以上のように、本発明の骨接合具は、使用時の取扱い性に優れ、かつ、施術部位における骨片の回旋を充分に抑えることが可能なものとなっている。 As described above, the osteosynthesis device of the present invention is excellent in handleability at the time of use, and can sufficiently suppress the rotation of the bone fragment at the treatment site.
   1   骨接合具
   2   髄内釘
   3   セットスクリュー
   4   エンドキャップ
   5   ラグスクリュー
   6   サブピン
   7   ピン孔
   8   ピン孔
   9   スクリュー孔
  10   スクリュー孔
  11   雄ネジ
  12   スクリュー溝
  13   突出片
  14   貫通孔
  16   ワッシャー
  18   ピン孔
  19   ピン孔
  20   張出部
  21   ネジ溝
  22   ネジ溝
  23   段差
  24   貫通孔
  25   窪み
  26   ネジ溝
  27   突出部
  28   テーパ部
  29   ネジ溝部
  30   頭部
  31   エンドキャップ
  32   突出部
  33   横止め孔
  34   横止め孔
  35   頭部
  36   胴体部
  37   嵌合片
  38   嵌合溝
  39   スリット
  40   スリット
  41   髄内釘
  42   セットスクリュー
  43   突出片
  44   頭部
  45   胴体部
  46   嵌合片
  47   嵌合溝
  48   ピン孔
  49   ピン孔
  50   張出部
  51   ネジ溝
  52   貫通孔
  53   溝部
  54   溝部
  55   位置
  56   位置
  57   爪部
  58   凹部
  59   ワッシャー
  60   ワッシャー
  61   位置
  62   位置
  63   爪部
  64   凹部
  65   角
  66   テーパ部
DESCRIPTION OF SYMBOLS 1 Bone joint tool 2 Intramedullary nail 3 Set screw 4 End cap 5 Lag screw 6 Sub pin 7 Pin hole 8 Pin hole 9 Screw hole 10 Screw hole 11 Male screw 12 Screw groove 13 Projection piece 14 Through hole 16 Washer 18 Pin hole 19 Pin Hole 20 Overhang portion 21 Screw groove 22 Screw groove 23 Step 24 Through hole 25 Depression 26 Screw groove 27 Projection portion 28 Taper portion 29 Screw groove portion 30 Head portion 31 End cap 32 Projection portion 33 Side stop hole 34 Side stop hole 35 Head portion 36 body part 37 fitting piece 38 fitting groove 39 slit 40 slit 41 intramedullary nail 42 set screw 43 projecting piece 44 head 45 body part 46 fitting piece 47 fitting groove 48 Emission hole 49 pin hole 50 extending portion 51 the screw groove 52 through hole 53 groove 54 groove 55 located 56 position 57 claw portion 58 recess 59 Washer 60 Washer 61 position 62 position 63 the claw portion 64 recess 65 corner 66 tapered portion

Claims (11)

  1.  第1の貫通孔が形成された第1の筒状体であると共に、前記第1の貫通孔と連通した第1のピン孔と、前記第1の筒状体の前記第1のピン孔の反対側かつ同軸状に位置し前記第1の貫通孔と連通した第2のピン孔と、前記第1のピン孔の下方に同第1のピン孔と略平行に位置し前記第1の貫通孔と連通した第1のスクリュー孔と、前記第1の筒状体の前記第1のスクリュー孔の反対側かつ同軸状に位置し前記第1の貫通孔と連通した第2のスクリュー孔が形成された髄内釘と、
     該髄内釘の内側に収容可能かつ第2の貫通孔が形成された第2の筒状体であると共に、前記第2の貫通孔と連通した第3のピン孔と、前記第2の筒状体の前記第3のピン孔の反対側かつ同軸状に位置し前記第2の貫通孔と連通した第4のピン孔が形成された第1の制御部材と、
     該第1の制御部材の一端側に位置し、同第1の制御部材の一端方向に突出して形成された嵌合凸部と、
     前記第1の制御部材の他端側に位置し、同第1の制御部材を前記髄内釘に固定可能な第1の固定部と、
     前記髄内釘の内側かつ同髄内釘の前記第1のピン孔及び前記第2のピン孔から見た前記第1のスクリュー孔及び前記第2のスクリュー孔と反対側の端部に位置して前記第1の貫通孔を閉塞する第2の制御部材と、
     該第2の制御部材に設けられ、同第2の制御部材を前記髄内釘に固定可能な第2の固定部と、
     前記第2の制御部材から突出して前記第1の制御部材の他端側から前記第2の貫通孔の内部に挿入可能な突出部とを備え、
     前記髄内釘の内周面の前記第1の固定部が固定される第1の内周領域と、同髄内釘の内周面の前記第2の固定部が固定される第2の内周領域との間に間隙を有し、
     前記第1の固定部及び前記第2の固定部は、前記髄内釘の内周面とネジ構造で固定され、
     前記髄内釘の前記第1の内周領域及び前記第2の内周領域の間の領域はその内径が同第1の内周領域及び同第2の内周領域の内径よりも大きく形成された第1の窪み部であり、
     前記突出部の一部を囲繞可能な切れ目を有するリング状であると共に、前記第1の制御部材との間に所定のクリアランスを有して位置し、前記第1の窪み部を埋めて同第1の窪み部に嵌合する止め輪部を有する
     骨接合具。
    A first cylindrical body having a first through hole, a first pin hole communicating with the first through hole, and the first pin hole of the first cylindrical body. A second pin hole located on the opposite side and coaxially and communicating with the first through hole, and below the first pin hole and positioned substantially parallel to the first pin hole and the first through hole. A first screw hole that communicates with the hole and a second screw hole that communicates with the first through hole and is located on the opposite side of the first cylindrical body and coaxially with the first screw hole are formed. An intramedullary nail,
    A second cylindrical body that can be accommodated inside the intramedullary nail and has a second through hole, a third pin hole that communicates with the second through hole, and the second cylinder A first control member having a fourth pin hole formed on the opposite side of the third pin hole of the rod-like body and coaxially and communicating with the second through hole;
    A fitting projection formed on one end side of the first control member and projecting in the one end direction of the first control member;
    A first fixing portion located on the other end side of the first control member and capable of fixing the first control member to the intramedullary nail;
    It is located inside the intramedullary nail and at the end opposite to the first screw hole and the second screw hole as viewed from the first pin hole and the second pin hole of the intramedullary nail. A second control member for closing the first through hole;
    A second fixing portion provided on the second control member and capable of fixing the second control member to the intramedullary nail;
    A protrusion that protrudes from the second control member and can be inserted into the second through-hole from the other end of the first control member;
    A first inner peripheral region to which the first fixing portion of the inner peripheral surface of the intramedullary nail is fixed, and a second inner portion to which the second fixing portion of the inner peripheral surface of the intramedullary nail is fixed. With a gap between the surrounding area,
    The first fixing portion and the second fixing portion are fixed to the inner peripheral surface of the intramedullary nail with a screw structure,
    A region between the first inner peripheral region and the second inner peripheral region of the intramedullary nail is formed so that an inner diameter thereof is larger than inner diameters of the first inner peripheral region and the second inner peripheral region. A first indentation,
    It has a ring shape having a cut that can surround a part of the protruding portion, and is located with a predetermined clearance between the first control member, and the first depression is filled to the same extent. A bone joint having a retaining ring portion that fits into the hollow portion of 1.
  2.  前記第1の固定部は、その外径が前記第1の内周領域の内径と略同等の大きさであり、前記第1の制御部材の短手方向側から見た断面が切れ目のない略ドーナツ状であると共に、前記第1の制御部材に内装可能な第1の嵌合部を有し、
     前記第1の制御部材は前記第1の嵌合部を内装可能な第2の嵌合部を有し、
     前記第1の嵌合部の少なくとも一部の外径の大きさが、前記第2の嵌合部の対応する領域の内径の大きさよりも大きく形成された
     請求項1に記載の骨接合具。
    The first fixed portion has an outer diameter that is substantially the same as the inner diameter of the first inner peripheral region, and the cross section viewed from the short direction side of the first control member is substantially continuous. A donut-shaped and having a first fitting portion that can be installed in the first control member;
    The first control member has a second fitting portion that can house the first fitting portion,
    The osteosynthesis tool according to claim 1, wherein an outer diameter of at least a part of the first fitting portion is formed larger than an inner diameter of a corresponding region of the second fitting portion.
  3.  前記突出部は、その先端が前記第2の貫通孔の前記第3のピン孔及び前記第4のピン孔で挟まれた領域まで届く長さを有する
     請求項1または請求項2に記載の骨接合具。
    3. The bone according to claim 1, wherein the protrusion has a length so that a tip thereof reaches a region sandwiched between the third pin hole and the fourth pin hole of the second through hole. Joiner.
  4.  前記突出部は、その先端が前記第2の貫通孔の前記第3のピン孔及び前記第4のピン孔で挟まれた領域より前記第1の制御部材の他端側に位置する長さを有する
     請求項1または請求項2に記載の骨接合具。
    The protrusion has a length at which the tip is positioned on the other end side of the first control member from a region sandwiched between the third pin hole and the fourth pin hole of the second through hole. The osteosynthesis device according to claim 1 or 2.
  5.  前記第1の固定部は前記第1の制御部材に対して回転自在に内装され、
     前記第1の制御部材は、その内周面かつ前記第1の固定部と前記第3のピン孔及び前記第4のピン孔との間の領域にネジ溝が形成された
     請求項1、請求項2、請求項3または請求項4に記載の骨接合具。
    The first fixing portion is rotatably mounted with respect to the first control member,
    The first control member has a thread groove formed in an inner peripheral surface thereof and a region between the first fixing portion and the third pin hole and the fourth pin hole. The bone joint device according to claim 2, claim 3 or claim 4.
  6.  前記第1の固定部は、その内周面に前記第1の制御部材の長手方向に沿って同第1の制御部材の短手方向側から見た断面が略六角形となる6つの溝が形成された
     請求項1、請求項2、請求項3、請求項4または請求項5に記載の骨接合具。
    The first fixing portion has six grooves having a substantially hexagonal cross section as viewed from the short direction side of the first control member along the longitudinal direction of the first control member on the inner peripheral surface thereof. The osteosynthesis tool according to claim 1, claim 2, claim 3, claim 4 or claim 5.
  7.  前記第1の固定部は、その外径が前記第1の内周領域の内径と略同等の大きさであり、前記第1の制御部材に内装可能な第1の嵌合部を有すると共に、前記第2の貫通孔の内周面から前記第1の固定部の外周面に貫通したスリットと、同第2の貫通孔の内周面から同第1の固定部の外周面に向けて位置する第2の窪み部とが形成され、
     前記第1の制御部材は前記第1の嵌合部を内装可能な第2の嵌合部を有し、
     前記突出部は、前記第2の窪み部に嵌合可能かつ同突出部の突出方向にかけて径が小さくなるテーパ部を有する
     請求項1に記載の骨接合具。
    The first fixed portion has a first fitting portion whose outer diameter is substantially the same as the inner diameter of the first inner peripheral region, and can be installed in the first control member. A slit penetrating from the inner peripheral surface of the second through hole to the outer peripheral surface of the first fixing portion, and positioned from the inner peripheral surface of the second through hole toward the outer peripheral surface of the first fixing portion. A second depression is formed,
    The first control member has a second fitting portion that can house the first fitting portion,
    The bone connector according to claim 1, wherein the protrusion includes a tapered portion that can be fitted into the second depression and has a diameter that decreases in a protrusion direction of the protrusion.
  8.  前記第1の固定部は、その外径が前記第1の内周領域の内径より大きく形成されかつ弾性を有し、前記第1の制御部材に内装可能な第1の嵌合部を有すると共に、前記第2の貫通孔の内周面から前記第1の固定部の外周面に貫通したスリットと、同第2の貫通孔の内周面から同第1の固定部の外周面に向けて位置する第2の窪み部とが形成され、
     前記第1の制御部材は前記第1の嵌合部を内装可能な第2の嵌合部を有し、
     前記突出部は、前記第2の窪み部に嵌合可能かつ同突出部の突出方向にかけて径が小さくなるテーパ部を有する
     請求項1に記載の骨接合具。
    The first fixing portion has a first fitting portion that has an outer diameter larger than an inner diameter of the first inner peripheral region and has elasticity, and can be fitted in the first control member. A slit penetrating from the inner peripheral surface of the second through hole to the outer peripheral surface of the first fixing portion, and from the inner peripheral surface of the second through hole toward the outer peripheral surface of the first fixing portion. A second indentation located is formed,
    The first control member has a second fitting portion that can house the first fitting portion,
    The bone connector according to claim 1, wherein the protrusion includes a tapered portion that can be fitted into the second depression and has a diameter that decreases in a protrusion direction of the protrusion.
  9.  前記第1の嵌合部の少なくとも一部の外径の大きさが、前記第2の嵌合部の対応する領域の内径の大きさよりも大きく形成された
     請求項7または請求項8に記載の骨接合具。
    The magnitude | size of the outer diameter of at least one part of the said 1st fitting part was formed more largely than the magnitude | size of the internal diameter of the area | region corresponding to a said 2nd fitting part. Bone joint.
  10.  前記突出部は、その先端が前記第2の貫通孔の前記第3のピン孔及び前記第4のピン孔で挟まれた領域まで届く長さを有する
     請求項7、請求項8または請求項9に記載の骨接合具。
    The projecting portion has a length such that a tip thereof reaches a region sandwiched between the third pin hole and the fourth pin hole of the second through hole. The bone joint device according to 1.
  11.  前記突出部は、その先端が前記第2の貫通孔の前記第3のピン孔及び前記第4のピン孔で挟まれた領域より前記第1の制御部材の他端側に位置する長さを有する
     請求項7、請求項8または請求項9に記載の骨接合具。
    The protrusion has a length at which the tip is positioned on the other end side of the first control member from a region sandwiched between the third pin hole and the fourth pin hole of the second through hole. The bone joint device according to claim 7, claim 8 or claim 9.
PCT/JP2015/079168 2015-04-27 2015-10-15 Bone connector WO2016174787A1 (en)

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JP2022113859A (en) * 2017-06-16 2022-08-04 株式会社ホムズ技研 Bone fixing device
JP7512506B1 (en) 2023-12-05 2024-07-08 株式会社イーピーメディック Adjustment device

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JP2024032295A (en) * 2022-08-29 2024-03-12 HOYA Technosurgical株式会社 Intramedullary nail and osteosynthesis tool

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US20120157997A1 (en) * 2004-03-11 2012-06-21 Sohngen Gary W Fixation Instrument for Treating a Bone Fracture
JP2014124451A (en) * 2012-12-27 2014-07-07 Homuzu Giken:Kk Intramedullary fixation system
WO2015052841A1 (en) * 2013-10-11 2015-04-16 プロスパー株式会社 Device for osteosynthesis and osteosynthesis

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JP2022113859A (en) * 2017-06-16 2022-08-04 株式会社ホムズ技研 Bone fixing device
JP7424668B2 (en) 2017-06-16 2024-01-30 株式会社ホムズ技研 bone fixation device
JP7512506B1 (en) 2023-12-05 2024-07-08 株式会社イーピーメディック Adjustment device

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