WO2022038871A1 - End cap used for intramedullary nail, intramedullary nail, end cap insertion instrument, and intramedullary nail insertion instrument - Google Patents

End cap used for intramedullary nail, intramedullary nail, end cap insertion instrument, and intramedullary nail insertion instrument Download PDF

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Publication number
WO2022038871A1
WO2022038871A1 PCT/JP2021/022261 JP2021022261W WO2022038871A1 WO 2022038871 A1 WO2022038871 A1 WO 2022038871A1 JP 2021022261 W JP2021022261 W JP 2021022261W WO 2022038871 A1 WO2022038871 A1 WO 2022038871A1
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WO
WIPO (PCT)
Prior art keywords
intramedullary nail
insertion device
end cap
nail insertion
hole
Prior art date
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PCT/JP2021/022261
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French (fr)
Japanese (ja)
Inventor
タイラー ネフ
Original Assignee
株式会社日本エム・ディ・エム
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Publication of WO2022038871A1 publication Critical patent/WO2022038871A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices

Definitions

  • the cap
  • An end cap that fits into one end of an intramedullary nail after inserting an intramedullary nail, eg, an intramedullary nail as in Patent Document 1, into a fractured bone is usually a female thread on one end of the intramedullary nail. Has a male thread that is adapted to engage the female thread because it is cut.
  • an object of the present invention is to provide an end cap that can be fitted to one end of an intramedullary nail without the need for skill.
  • Another object of the present invention is to provide an intramedullary nail that can be used for the end cap of the present invention.
  • Yet another object of the present invention is to provide an end cap insertion device used for the end cap of the present invention.
  • Yet another object of the present invention is to provide an intramedullary nail insertion device used when inserting the intramedullary nail of the present invention into a bone.
  • an end cap used for an intramedullary nail the end cap extending radially from the surface of the one end to one end.
  • the tip of the one or more protrusions is provided with a first protrusion protruding in the radial direction of the end cap, and is provided at one end of the intramedullary nail.
  • the first protrusion is made to engage with a part of the hole. This makes it possible to easily fit the end cap into the intramedullary nail without the need for skill.
  • the outer periphery of the one end of the end cap is formed so as to fit into one or more outer peripheral grooves provided at the one end of the intramedullary nail. It further comprises one or more second protrusions. This confirms that the end cap and the intramedullary nail are securely connected.
  • the other end of the end cap is further provided with a threaded portion.
  • the end cap can be fitted to the intramedullary nail from a position away from the bone by connecting the longitudinal member to the threaded portion with a screw.
  • the second aspect is to provide an end cap insertion device provided with a threaded portion engaging with a threaded portion of the other end of the end cap at one end. This allows the end cap to be fitted to the intramedullary nail from a position away from the bone.
  • a third aspect is to provide an intramedullary nail having a hole for engaging the end cap of the present invention at one end. This makes it possible to easily fit the end cap into the intramedullary nail without the need for skill.
  • the intramedullary nail insertion device used for an intramedullary nail
  • the intramedullary nail insertion device is one end of the intramedullary nail insertion device from the surface of the one end.
  • the tip of the one or more protrusions comprises a first radial protrusion of the intramedullary nail insertion device.
  • the intramedullary nail insertion device used for this intramedullary nail, is provided on the outer periphery of one end of the intramedullary nail and one or more outer circumferences provided on the one end of the intramedullary nail. It comprises one or more second protrusions formed to fit into the groove. This makes it possible to confirm that the intramedullary nail insertion device and the intramedullary nail are securely connected.
  • the intramedullary nail insertion device In the intramedullary nail insertion device used for this intramedullary nail, the intramedullary nail insertion device further includes a connection portion with the intramedullary nail insertion device handle at the other end. This makes it possible to accurately place the intramedullary nail in the medullary cavity even at a position away from the bone.
  • the intramedullary nail insertion device In the intramedullary nail insertion device used for this intramedullary nail, the intramedullary nail insertion device further includes a through hole extending in the longitudinal direction, and the intramedullary nail insertion device lock is inserted into the through hole. This prevents one or more radially elastic protrusions extending in the axial direction of the intramedullary nail insertion device from elastically deforming in the radial direction, and the intramedullary nail insertion device suddenly moves from the intramedullary nail. It can be prevented from coming off.
  • the intramedullary nail insertion device used for this intramedullary nail, the intramedullary nail insertion device further includes a connection portion with a cross screw drill guide. This makes it possible to insert a cross screw that secures the intramedullary nail to the bone.
  • the end cap and the intramedullary nail in the end cap and the intramedullary nail, first, the end cap can be easily fitted to the intramedullary nail without requiring skill. Furthermore, it can be confirmed that the end cap and the intramedullary nail are securely connected.
  • the end cap insertion device the end cap can be fitted to the intramedullary nail from a position away from the bone.
  • the intramedullary nail insertion device first, the intramedullary nail insertion device can be easily fitted into the intramedullary nail without requiring skill. Furthermore, it can be confirmed that the intramedullary nail insertion device and the intramedullary nail are securely connected.
  • the intramedullary nail can be accurately placed in the medullary cavity even at a position away from the bone.
  • the intramedullary nail insertion device lock can prevent the intramedullary nail insertion device from being accidentally disengaged from the intramedullary nail.
  • the cross-screw drill guide can also be used to insert a cross-screw that secures the intramedullary nail to the bone.
  • FIG. 1 is a simulated perspective view of an intramedullary nail and an end cap according to an embodiment of the present invention.
  • FIG. 2 is a partially enlarged view of the intramedullary nail and the end cap of FIG. 1 according to the embodiment of the present invention when viewed from the front.
  • FIG. 3 is a cross-sectional view of the intramedullary nail and the end cap of FIG. 2 according to the embodiment of the present invention.
  • FIG. 4 is a cross-sectional view of the intramedullary nail and the end cap of FIG. 3 according to the embodiment of the present invention, when the end cap is fitted to the intramedullary nail.
  • FIG. 1 is a simulated perspective view of an intramedullary nail and an end cap according to an embodiment of the present invention.
  • FIG. 2 is a partially enlarged view of the intramedullary nail and the end cap of FIG. 1 according to the embodiment of the present invention when viewed from the front.
  • FIG. 3 is a cross-sectional view
  • FIG. 5 is a simulated perspective view of an intramedullary nail, an end cap, and an end cap insertion device according to an embodiment of the present invention.
  • FIG. 6 is a partially enlarged view of the intramedullary nail, the end cap, and the end cap insertion device of FIG. 5 according to the embodiment of the present invention when viewed from the front.
  • FIG. 7 is a diagram in which the end cap insertion device is connected to the end cap by a screw in the intramedullary nail, the end cap, and the end cap insertion device of FIG. 6 according to the embodiment of the present invention.
  • FIG. 6 is a partially enlarged view of the intramedullary nail, the end cap, and the end cap insertion device of FIG. 5 according to the embodiment of the present invention when viewed from the front.
  • FIG. 7 is a diagram in which the end cap insertion device is connected to the end cap by a screw in the intramedullary nail, the end cap, and the end cap insertion device of FIG. 6 according to
  • FIG. 8 is a view when the end cap connected to the end cap insertion device is fitted to the intramedullary nail in the intramedullary nail, the end cap, and the end cap insertion device of FIG. 7 according to the embodiment of the present invention.
  • FIG. 9 is a diagram showing end caps having different lengths according to the present invention.
  • FIG. 10 is a front view of the intramedullary nail insertion device according to the embodiment of the present invention.
  • FIG. 11 is a cross-sectional view of the intramedullary nail insertion device of FIG. 10 according to the embodiment of the present invention.
  • FIG. 12 is a perspective view of the intramedullary nail insertion device handle used in the intramedullary nail insertion device according to the embodiment of the present invention.
  • FIG. 13 is a plan view of the intramedullary nail insertion device lock used in the intramedullary nail insertion device according to the embodiment of the present invention.
  • FIG. 14 is a perspective view of a cross screw drill guide used in the intramedullary nail insertion device according to the embodiment of the present invention.
  • FIG. 15 is a diagram showing a patient placed in a beach chair position to treat a broken clavicle using an intramedullary nail and an end cap according to an embodiment of the present invention.
  • FIG. 16 is a diagram in which a fractured end of a lateral fragment of a broken clavicle is lifted from an incision at the fracture site.
  • FIG. 17 is a diagram in which a clamp is used at the incision site to reduce crevices and advance a pin with a diameter of 2 mm from the fracture end to the central fragment by at least 15 mm.
  • FIG. 18 is a diagram showing a stage of expanding the medullary cavity.
  • FIG. 19 is a diagram showing the steps of advancing the alignment guide into the widened medullary cavity.
  • FIG. 20 is a diagram showing the steps of advancing the flexible drill guide to the central fragment.
  • FIG. 21 is a diagram showing the steps of advancing the flexible drill to the central fragment.
  • FIG. 22 is a diagram showing a step of advancing the tap to the central fragment.
  • FIG. 23 is a diagram showing a step of removing the tap, the drill guide, and the alignment guide.
  • FIG. 18 is a diagram showing a stage of expanding the medullary cavity.
  • FIG. 19 is a diagram showing the steps of advancing the alignment guide into the widened medullary cavity.
  • FIG. 24 is a diagram showing a stage of assembling an intramedullary nail, an intramedullary nail insertion device, an intramedullary nail insertion device lock, and a compression sleeve.
  • FIG. 25 is a diagram showing a stage of advancing the insertion of an intramedullary nail into the medullary cavity.
  • FIG. 26 is a diagram showing a step of further advancing the insertion of the intramedullary nail into the medullary cavity.
  • FIG. 27 is a diagram showing a stage of attaching a cross screw drill guide to an intramedullary nail insertion device.
  • FIG. 28 is a diagram showing the steps of opening both cortical holes.
  • FIG. 29 is a diagram showing a stage of arranging the cross screw.
  • FIG. 30 is a diagram showing a step of removing the intramedullary nail insertion device from the intramedullary nail.
  • FIG. 31 is a diagram showing a stage of fitting an end cap to
  • FIG. 1 is a simulated perspective view of an intramedullary nail 10 and an end cap 20 according to an embodiment of the present invention.
  • FIG. 2 is a partially enlarged view of the intramedullary nail 10 and the end cap 20 of FIG. 1 according to the embodiment of the present invention when viewed from the front.
  • FIG. 3 is a cross-sectional view of the intramedullary nail 10 and the end cap 20 of FIG. 2 according to the embodiment of the present invention.
  • FIG. 4 is a cross-sectional view of the intramedullary nail 10 and the end cap 20 of FIG. 3 according to the embodiment of the present invention, when the end cap is fitted to the intramedullary nail.
  • FIG. 1 is a simulated perspective view of an intramedullary nail 10 and an end cap 20 according to an embodiment of the present invention.
  • FIG. 2 is a partially enlarged view of the intramedullary nail 10 and the end cap 20 of FIG. 1 according to the embodiment of the present invention when viewed from the front.
  • FIG. 5 is a simulated perspective view of an intramedullary nail 10, an end cap 20, and an end cap insertion device 30 according to an embodiment of the present invention.
  • FIG. 6 is a partially enlarged view of the intramedullary nail 10, the end cap 20, and the end cap insertion device 30 of FIG. 5 according to the embodiment of the present invention when viewed from the front.
  • FIG. 7 is a diagram in which the end cap insertion device 30 is connected to the end cap 20 by a screw in the intramedullary nail 10, the end cap 20, and the end cap insertion device 30 of FIG. 6 according to the embodiment of the present invention.
  • FIG. 8 shows that in the intramedullary nail 10, the end cap 20, and the end cap insertion device 30 of FIG.
  • FIG. 7 is a diagram showing end caps 20 having different lengths according to the present invention.
  • FIG. 10 is a front view of the intramedullary nail insertion device 40 according to the embodiment of the present invention.
  • FIG. 11 is a cross-sectional view of the intramedullary nail insertion device 40 of FIG. 10 according to the embodiment of the present invention.
  • FIG. 12 is a perspective view of the intramedullary nail insertion device handle 50 used in the intramedullary nail insertion device 40 according to the embodiment of the present invention.
  • FIG. 13 is a plan view of the intramedullary nail insertion device lock 60 used in the intramedullary nail insertion device 40 according to the embodiment of the present invention.
  • FIG. 14 is a cross screw drill guide 70 used for the intramedullary nail insertion device 40 according to the embodiment of the present invention.
  • FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115.
  • FIG. 27 is a diagram showing a stage in which the cross screw drill guide 70 is attached to the intramedullary nail insertion device 40.
  • FIG. 28 is a diagram showing the steps of opening both cortical holes.
  • FIG. 29 is a diagram showing a stage of arranging the cross screw 119.
  • FIG. 31 is a diagram showing a stage in which the end cap 20 is fitted to the intramedullary nail 10.
  • the end cap 20 used for the intramedullary nail 10 extends to one end 21 in the axial direction of the end cap 20 from the surface 22 of the one end. It comprises one or more protrusions 23 that are elastic in the radial direction. In the embodiment shown in the figure, there are two protrusions 23.
  • the tip of one or more protruding portions 23 includes a first convex portion 24 protruding in the radial direction of the end cap 20.
  • the hole portion 12 is provided by, for example, boring, and the diameter of a part 13 of the hole portion in the direction perpendicular to the axial direction of the hole is formed to be one step larger than the diameter of the other portion.
  • the first convex portion 24 is engaged.
  • the structure of a part 13 of the hole portion may be any structure as long as it is a structure in which the first convex portion 24 is engaged.
  • the material of the end cap 20 is usually a titanium alloy, but any material may be used as long as it is a surgical grade material containing a metal or a polymer.
  • the tip of one or more protrusions 23 and the first protrusion 24 may be a biocompatible material containing a metal or polymer.
  • the outer circumference of one end 21 of the end cap 20 has one or more second convex portions 26 formed so as to fit into one or more outer peripheral groove portions 14 provided on one end 11 of the intramedullary nail 10. Further prepare.
  • the outer peripheral groove portion 14 has two locations, and the second convex portion 26 also has two locations.
  • the two second convex portions 26 are fitted into the corresponding two outer peripheral groove portions 14, it is sensuously that the end cap 20 and the intramedullary nail 10 are securely connected by the click feeling. You can check it.
  • variations of the end cap 20 are shown. Select an end cap 20 of appropriate length according to the intramedullary nail 10 used.
  • the other end portion 27 of the end cap 20 further includes a threaded portion 28.
  • the end cap 20 can be fitted to the intramedullary nail 10 from a position away from the fractured portion.
  • the longitudinal member 30 may be an end cap insertion device 30 having a threaded portion 31 engaged with a threaded portion 28 of the other end 27 of the end cap 20 at one end. If the threaded portion 28 is a female thread, the threaded portion 31 is a male thread, and if the threaded portion 28 is a male thread, the threaded portion 31 is a female thread.
  • the material of the end cap insertion device 30 is usually stainless steel 465, but it may be a biocompatible material containing other metals or polymers.
  • an intramedullary nail 10 having a hole 12 with which the end cap 20 can be engaged at one end 11. This makes it possible to easily fit the end cap into the intramedullary nail without the need for skill. This is most appropriately achievable with the combination of the end cap 20 and the intramedullary nail 10.
  • the intramedullary nail 10 may be provided with a partial portion 13 of the hole portion or one or more outer peripheral groove portions 14 as described above.
  • FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115.
  • the intramedullary nail insertion device 40 used for the intramedullary nail 10 is attached to one end 41 and the axis of the intramedullary nail insertion device 40 from the surface 42 of one end. It comprises one or more projecting portions 43 that extend in the direction and are elastic in the radial direction. In the embodiment shown in the figure, there are two protrusions 43.
  • the tip of one or more protrusions 43 includes a first protrusion 44 that protrudes in the radial direction of the intramedullary nail insertion device 40.
  • the intramedullary nail insertion device 40 When the intramedullary nail insertion device 40 is inserted into the hole 12 provided at one end 11 of the intramedullary nail 10, the first convex portion 44 is made to engage with a part 13 of the hole. Thereby, the intramedullary nail insertion device 40 can be easily fitted to the intramedullary nail 10 without requiring skill. When engaged, it is also possible to make a clicking sound to recognize the engagement by hearing.
  • the hole portion 12 is provided by, for example, boring, and the diameter of a part 13 of the hole portion in the direction perpendicular to the axial direction of the hole is formed to be one step larger than the diameter of the other portion.
  • the first convex portion 44 is engaged.
  • the structure of a part 13 of the hole portion may be any structure as long as it is a structure in which the first convex portion 44 is engaged.
  • the material of the intramedullary nail insertion instrument 40 is usually stainless steel 465, but any material may be used as long as it is a surgical grade material containing a metal or a polymer.
  • the shape of one end 41, the surface 42 of one end 42, one or more protrusions 43, the first convex portion 44, and the outer circumference 45, respectively, is the shape of one end 21 of the end cap 20 and one end, respectively. It is convenient to have the same shape as the surface 22, one or more protrusions 23, the first convex portion 24, and the outer peripheral 25 because they are used for the same intramedullary nail 10.
  • the intramedullary nail insertion device 40 has one or more second convex portions formed on the outer peripheral 45 of one end 41 so as to fit into the outer peripheral groove 14 provided on the one end 11 of the intramedullary nail 10. 46 is provided. In the embodiment of the figure, one or more outer peripheral groove portions 14 are at two locations, and the second convex portion 46 is also at two locations. When the two second convex portions 46 are fitted into the corresponding two outer peripheral groove portions 14, the intramedullary nail insertion device 40 and the intramedullary nail 10 are sensuously and securely connected by the click feeling. You can confirm that. If the shape of the second convex portion 46 is the same as the shape of the second convex portion 26 of the end cap 20, it is convenient because they are used for the same intramedullary nail 10.
  • the intramedullary nail insertion device 40 further includes a connection portion 48 with the intramedullary nail insertion device handle at the other end 47.
  • the intramedullary nail insertion device handle 50 includes an engagement portion 52 between the through hole 51 and the intramedullary nail insertion device lock, and the connection portion 48 between the through hole 51 and the intramedullary nail insertion device handle of the intramedullary nail insertion device 40.
  • the intramedullary nail insertion device handle 50 can be connected to the intramedullary nail insertion device 40 by inserting.
  • the engagement portion 52 with the intramedullary nail insertion device lock will be described later.
  • the intramedullary nail insertion device 40 further includes a through hole 49 extending in the longitudinal direction, and the intramedullary nail insertion device lock 60 is inserted into the through hole 49.
  • the end portion of the intramedullary nail insertion device lock 60 opposite to the knob 61 has one or more protrusions that are elastic in the radial direction.
  • the intramedullary nail insertion device lock 60 has a first convex portion 44 and a portion 13 of the hole portion of the intramedullary nail 10 in order to prevent radial deformation of the protruding portion 43. The engagement remains held.
  • the intramedullary nail insertion device lock 60 includes an engagement point 62 with the intramedullary nail insertion device handle, and the engagement point 62 with the intramedullary nail insertion device handle is engaged with the intramedullary nail insertion device lock.
  • the intramedullary nail insertion device 40 is kept fitted to the intramedullary nail 10 by inserting it into the slit of the joint portion 52 and rotating it clockwise to engage with the intramedullary nail insertion device 40.
  • FIG. 27 is a diagram showing a stage of attaching the cross screw drill guide 70 to the intramedullary nail insertion device 40
  • FIG. 28 is a diagram showing a stage of opening both cortical holes
  • FIG. 29 is a diagram showing a stage of opening both cortical holes
  • FIG. 29 is a diagram showing a stage of opening both cortical holes. It is a figure which shows the stage which arranges.
  • the intramedullary nail insertion device 40 further comprises a connection 49a with a cross screw drill guide, thereby inserting a cross screw 119 that secures the intramedullary nail 10 to the bone.
  • connection portion 71 of the cross screw drill guide 70 with the intramedullary nail insertion device is attached to the connection portion 49a with the cross screw drill guide.
  • the screw sleeve 116 and the drill sleeve 117 are screwed into the screw sleeve and the drill sleeve connection portion 72, a hole is made in the bone with the drill 118, and then the intramedullary nail 10 is fixed with the cross screw 119.
  • FIG. 15 shows a patient placed in a beach chair position to treat a broken clavicle using an intramedullary nail 10 and an end cap 20 according to an embodiment of the present invention. It is a figure which shows the state.
  • FIG. 16 is a diagram in which the fracture end 102 of the lateral fragment 101 of the broken clavicle is lifted from the incision at the fracture site.
  • FIG. 17 is a diagram in which a clamp 104 is used at the incision site to reduce cracks and a pin (guide wire) 103 having a diameter of 2 mm is advanced by at least 15 mm from the fracture end 102 to the central fragment 100.
  • FIG. 18 is a diagram showing a stage of expanding the medullary cavity 103a.
  • FIG. 19 is a diagram showing a step of advancing the alignment guide 107 into the widened medullary cavity 103a.
  • FIG. 20 is a diagram showing a step of advancing the flexible drill guide 111 to the central fragment 100.
  • FIG. 21 is a diagram showing a step of advancing the flexible drill 113 to the central fragment 100.
  • FIG. 22 is a diagram showing a step of advancing the tap 114 to the central fragment 100.
  • FIG. 23 is a diagram showing a step of removing the tap 114, the drill guide 114a, and the alignment guide 107.
  • FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115.
  • FIG. 25 is a diagram showing a step of advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a.
  • FIG. 26 is a diagram showing a step of further advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a.
  • FIG. 27 is a diagram showing a stage in which the cross screw drill guide 70 is attached to the intramedullary nail insertion device 40.
  • FIG. 28 is a diagram showing the steps of opening both cortical holes.
  • FIG. 29 is a diagram showing a stage of arranging the cross screw 119.
  • FIG. 30 is a diagram showing a step of removing the intramedullary nail insertion device 40 from the intramedullary nail 10.
  • FIG. 31 is a diagram showing a stage in which the end cap 20 is fitted to the intramedullary nail 10.
  • FIG. 15 shows a state in which a patient is placed in a beach chair position to treat a broken clavicle using an intramedullary nail 10 and an end cap 20 according to an embodiment of the present invention. ..
  • a C-arm is placed to allow observation of the anterior-posterior (AP) and head of the surgical site.
  • AP anterior-posterior
  • a 2-3 cm incision is made at the fracture site.
  • FIG. 16 is a diagram in which the fracture end 102 of the lateral fragment 101 of the broken clavicle is lifted from the incision at the fracture site.
  • a hole is made in the medullary cavity 103a of the lateral fragment 101 with a pin having a diameter of 2.0 mm, and the medullary cavity 103a is advanced through the lateral dorsal cortex.
  • a clamp 104 is used at the incision site to reduce crevices and advance a pin with a diameter of 2 mm to at least 15 mm from the fracture end 102 to the central fragment 100.
  • FIG. 18 is a diagram showing a stage of expanding the medullary cavity 103a with reference to FIG.
  • a hard drill 106 with a diameter of 4.5 mm
  • the medullary cavity is gradually widened through the tissue protector 105 to advance the hard drill 106 to the central fragment 100 by at least 10 mm.
  • the groove of the hard drill 106 is at least parallel to the mid-boundary of the fracture. If you do not feel the cortical bone, use a drill of the following sizes to widen the medullary cavity 103a.
  • FIG. 19 is a diagram showing a step of advancing the alignment guide 107 into the widened medullary cavity 103a with reference to FIG. After expanding the medullary cavity 103a to the correct diameter, push the alignment guide 107 forward. The alignment guide 107 is rotated until the parallel hole 108 catches the bone, and then the K wire 109 having a diameter of 2 mm is placed in the parallel hole 108. If necessary, a second K-wire 110 with a diameter of 2 mm is placed in the vertical slot and placed in the cortical bone.
  • FIG. 20 is a diagram showing a step of advancing the flexible drill guide 111 to the central fragment 100 with reference to FIG.
  • the hard drill 106 is removed.
  • a flexible drill guide 111 suitable for the size of the hard drill 106 is inserted.
  • the medullary cavity 103a with a hole is completely installed at the bottom.
  • the pin (guide wire) 103 having a diameter of 2 mm is removed, and the curved wire 112 having a diameter of 1.1 mm is inserted through the flexible drill guide 111 into the central fragment 100.
  • FIG. 21 is a diagram showing a step of advancing the flexible drill 113 to the central fragment 100 with reference to FIG. 21.
  • a 3.2 mm diameter flexible drill 113 drill a hole over the 1.1 mm diameter curved wire 112 until the desired depth is reached (short thread (ST), medium thread (MT)). , Long thread (LT)).
  • FIG. 22 is a diagram showing a stage of advancing the tap 114 to the central fragment 100 with reference to FIG. 22.
  • the tap 114 corresponding to the hard drill 106 used is selected, inserted into the medullary cavity 103a, and the tap 114 is advanced to the total length of the intramedullary nail 10.
  • FIG. 23 is a diagram showing a stage of removing the tap 114, the drill guide 114a, and the alignment guide 107 with reference to FIG. 23. Remove the flexible tap 114, the vertical second K-wire 110, the drill guide 114a, and the alignment guide 107. And only the clamp 104 is left. If desired, a parallel K-wire 109 can be left in place to guide the intramedullary nail 10.
  • FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115 with reference to FIG. 24. Cover the desired portion of the intramedullary nail insertion device 40 with the compression sleeve 115.
  • the connection portion 48 of the intramedullary nail insertion device 40 with the intramedullary nail insertion device handle is inserted into the through hole 51 of the intramedullary nail insertion device handle 50.
  • the first convex portion 44 of the intramedullary nail insertion device 40 is inserted into the hole 12 of the intramedullary nail 10 and connected.
  • the intramedullary nail insertion device handle 50 is rotated so that the first convex portion 44 is fitted to the outer peripheral groove portion 14 of the intramedullary nail 10 and completely installed.
  • the intramedullary nail insertion device lock 60 is inserted into the through hole 51 from the engagement portion 52 side of the intramedullary nail insertion device handle 50 with the intramedullary nail insertion device lock.
  • the engagement portion 62 with the intramedullary nail insertion device handle is inserted into the engagement portion 52 with the intramedullary nail insertion device lock, and the knob 61 is rotated clockwise as shown to lock.
  • the intramedullary nail insertion device lock 60 When locked, the intramedullary nail insertion device lock 60 extends to a position where the first convex portion 44 of the intramedullary nail insertion device 40 does not elastically deform in the radial direction, so that the intramedullary nail insertion device 40 is intramedullary. It will not come off the nail 10 unexpectedly.
  • FIG. 25 is a diagram showing a step of advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a with reference to FIG. 25.
  • the tip of the intramedullary nail 10 is introduced into the perforated medullary cavity 103a using a parallel K-wire 109, if necessary. Once the intramedullary nail 10 crosses the fracture line with the fracture end 102, the clamp 104 that reduces the crevice can be removed.
  • FIG. 26 is a diagram showing a step of further advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a with reference to FIG. 26.
  • the intramedullary nail 10 is advanced into the medullary cavity 103a until the desired compression is achieved. If necessary, adjust the compression sleeve 115 to ensure that at least the body of the intramedullary nail 10 (eg, made of titanium) extends to the fracture end 102, which is the intermediate boundary of the fracture.
  • the body of the intramedullary nail 10 eg, made of titanium
  • FIG. 27 is a diagram showing a stage of attaching the cross screw drill guide 70 to the intramedullary nail insertion device 40 with reference to FIG. 27.
  • the cross-screw drill guide 70 is arranged so as to cover the connection portion 49a of the intramedullary nail insertion device 40 with the cross-screw drill guide. After that, the cross screw drill guide 70 is pushed toward the compression sleeve 115 to lock it. The screw sleeve 116 and the drill sleeve 117 make a small puncture cut so that they can contact the cortical bone.
  • FIG. 28 is a diagram showing a stage of opening both cortical holes.
  • a drill 118 with a diameter of 2.0 mm is passed through a drill sleeve 117 to make both cortical holes, and the depth is measured and recorded. Remove the drill 118 with a diameter of 2.0 mm and the drill sleeve 117.
  • FIG. 29 is a diagram showing a stage of arranging the cross screw 119 with reference to FIG. 29. Check the length of both cortical threads using a depth gauge.
  • the cross screw 119 is arranged via the screw sleeve 116.
  • FIG. 30 is a diagram showing a stage of removing the intramedullary nail insertion device 40 from the intramedullary nail 10 with reference to FIG. 30. If necessary, make a hole and place a second cross screw. Turn the knob 61 of the intramedullary nail insertion device lock 60 counterclockwise to disengage the engagement point 62 with the intramedullary nail insertion device handle from the engagement point 52 with the intramedullary nail insertion device lock, and the intramedullary nail 10 The intramedullary nail insertion device lock 60 is removed in order to unlock the device and the intramedullary nail insertion device 40. In order to remove the intramedullary nail insertion device 40 from the intramedullary nail 10, the intramedullary nail insertion device 40 is pulled out. The required tension is between 15N and 35N, which is about 20N.
  • FIG. 31 is a diagram showing a stage of fitting the end cap 20 to the intramedullary nail 10 with reference to FIG. 31.
  • the end cap inserting device 30 is connected to the threaded portion 28 of the desired end cap 20 by the threaded portion 31 of the end cap inserting device 30.
  • the end cap insertion device 30 is used to push the first convex portion 24 of the end cap 20 into the hole portion 12 of the intramedullary nail 10.
  • the second convex portion 26 of the end cap 20 fits into the outer peripheral groove portion 14 of the intramedullary nail 10 and rotation is hindered.
  • the end cap 20 is continuously pressed until it is completely attached to the intramedullary nail 10.
  • the end cap insertion device 30 is rotated counterclockwise and removed from the end cap 20. This is the end of the explanation of how to install the intramedullary nail 10 at the fracture site.
  • the procedure almost opposite to the above method may be performed.
  • the end cap insertion device 30 is connected to the end cap 20 as described above, and then the end cap insertion device 30 is pulled to pull out the end cap 20.
  • the required tension is between 15N and 35N, which is about 20N.
  • Intramedullary nail 11 One end 12 Hole 13 Part of the hole 14 Outer groove 20 End cap 21 One end 22 Surface of one end 23 1 or more protrusions 24 First convex 25 Outer circumference 26 Second convex part 27 Another end 28 Threaded part 30 End cap insertion device 31 Threaded part 40 Intramedullary nail insertion device 41 One end 42 One end surface 43 One or more protrusions 44 First Convex 45 Outer circumference 46 Second convex 47 Other end 48 Connection with intramedullary nail insertion device handle 49 Through hole 49a Connection with cross screw drill guide 50 Intramedullary nail insertion device handle 51 Through hole 52 Spinal Engagement point with the internal nail insertion device lock 60 Intramedullary nail insertion device lock 61 Knob 62 Engagement point with the intramedullary nail insertion device handle 70 Cross screw drill guide 71 Connection with intramedullary nail insertion device 72 Screw sleeve and Drill sleeve connection 100 Central fragment 101 Lateral fragment 102 Fracture end 103 Pin

Abstract

Provided is an end cap which can be fitted into one end section of an intramedullary nail even without a skill. This end cap has, on one end section thereof, one or more protruding sections which extend in the axial direction of the end cap from the surface of the one end section and have radial elasticity, wherein: the tips of the one or more protruding sections each have a first protruding section protruding in a radial direction of the end cap; and when the end cap is inserted into a hole section provided to the one end section of the intramedullary nail, the first protruding section engages with a part of the hole section.

Description

髄内釘に使用するエンドキャップ、髄内釘、エンドキャップ挿入器具及び髄内釘挿入器具End caps, intramedullary nails, end cap insertion devices and intramedullary nail insertion devices used for intramedullary nails
　髄腔内に髄内釘を設置後、新生骨の髄内釘内部の侵入を防止し、髄内釘を抜去時に抜去器を接続する為の、髄内釘の１つの端部を保護するエンドキャップに関する。 An end that protects one end of the intramedullary nail to prevent invasion of the new bone into the intramedullary nail and to connect the remover when the intramedullary nail is removed after the intramedullary nail is placed in the intramedullary cavity. Regarding the cap.
　髄内釘、例えば特許文献１のような髄内釘を、骨折した骨に挿入した後に、髄内釘の１つの端部に嵌めるエンドキャップは、髄内釘の１つの端部には通常雌ねじが切られているため、その雌ねじに係合するようにされた雄ねじを備えている。 An end cap that fits into one end of an intramedullary nail after inserting an intramedullary nail, eg, an intramedullary nail as in Patent Document 1, into a fractured bone, is usually a female thread on one end of the intramedullary nail. Has a male thread that is adapted to engage the female thread because it is cut.
特表２０１８－５２１８２２Special table 2018-521822
　しかしながら、髄内釘の１つの端部の雌ねじに、エンドキャップを嵌めるためには、雌ねじに嵌るようにエンドキャップの位置を調節する必要があり、エンドキャップを髄内釘に嵌めるのに手間がかかり、熟練を要していた。 However, in order to fit the end cap to the female screw at one end of the intramedullary nail, it is necessary to adjust the position of the end cap so that it fits into the female screw, and it is troublesome to fit the end cap to the intramedullary nail. It took a lot of skill and required skill.
　したがって、本発明の目的は、熟練を要さずとも、髄内釘の１つの端部にエンドキャップを嵌めることが出来る、エンドキャップを提供することにある。本発明の別の目的は、本願発明のエンドキャップに使用可能な髄内釘を提供することにある。本発明のさらに別の目的は、本発明のエンドキャップに使用するエンドキャップ挿入器具を提供することにある。本発明のさらに別の目的は、本発明の髄内釘を骨に挿入する際に使用する髄内釘挿入器具を提供することにある。 Therefore, an object of the present invention is to provide an end cap that can be fitted to one end of an intramedullary nail without the need for skill. Another object of the present invention is to provide an intramedullary nail that can be used for the end cap of the present invention. Yet another object of the present invention is to provide an end cap insertion device used for the end cap of the present invention. Yet another object of the present invention is to provide an intramedullary nail insertion device used when inserting the intramedullary nail of the present invention into a bone.
　第一の観点では、髄内釘に使用するエンドキャップであって、上記エンドキャップは、一方の端部に、上記一方の端部の表面から上記エンドキャップの軸方向に延在する、半径方向に弾性のある１以上の突出部を備え、上記１以上の突出部の先端は、上記エンドキャップの半径方向に突出した第１の凸部を備え、上記髄内釘の一方の端部に設けられた穴部に上記エンドキャップを挿入すると、上記第１の凸部が上記穴部の一部と係合するようにされる。これにより、熟練を要さずとも簡単にエンドキャップを髄内釘に嵌めることが出来る。 From a first aspect, an end cap used for an intramedullary nail, the end cap extending radially from the surface of the one end to one end. The tip of the one or more protrusions is provided with a first protrusion protruding in the radial direction of the end cap, and is provided at one end of the intramedullary nail. When the end cap is inserted into the hole, the first protrusion is made to engage with a part of the hole. This makes it possible to easily fit the end cap into the intramedullary nail without the need for skill.
　この髄内釘に使用するエンドキャップにおいては、上記エンドキャップの上記一方の端部の外周は、上記髄内釘の上記一方の端部に設けられた１以上の外周溝部に嵌るように形成された１以上の第２の凸部をさらに備える。これにより、エンドキャップと髄内釘とが確実に接続されていることを確認できる。 In the end cap used for this intramedullary nail, the outer periphery of the one end of the end cap is formed so as to fit into one or more outer peripheral grooves provided at the one end of the intramedullary nail. It further comprises one or more second protrusions. This confirms that the end cap and the intramedullary nail are securely connected.
　この髄内釘に使用するエンドキャップにおいては、上記エンドキャップの他方の端部はねじ部をさらに備える。これにより、ねじ部に長手部材をねじにより接続することで、骨から離れた位置から、髄内釘にエンドキャップを嵌めることが出来る。 In the end cap used for this intramedullary nail, the other end of the end cap is further provided with a threaded portion. As a result, the end cap can be fitted to the intramedullary nail from a position away from the bone by connecting the longitudinal member to the threaded portion with a screw.
　第二の観点では、エンドキャップの他方の端部のねじ部に係合するねじ部を一方の端部に備える、エンドキャップ挿入器具を提供することにある。これにより、骨から離れた位置から、髄内釘にエンドキャップを嵌めることが出来る。 The second aspect is to provide an end cap insertion device provided with a threaded portion engaging with a threaded portion of the other end of the end cap at one end. This allows the end cap to be fitted to the intramedullary nail from a position away from the bone.
　第三の観点では、本発明のエンドキャップを係合可能な穴部を一方の端部に備える髄内釘を提供することにある。これにより、熟練を要さずとも簡単にエンドキャップを髄内釘に嵌めることが出来る。 A third aspect is to provide an intramedullary nail having a hole for engaging the end cap of the present invention at one end. This makes it possible to easily fit the end cap into the intramedullary nail without the need for skill.
　第四の観点では、髄内釘に使用する髄内釘挿入器具であって、上記髄内釘挿入器具は、一方の端部に、上記一方の端部の表面から上記髄内釘挿入器具の軸方向に延在する、半径方向に弾性のある１以上の突出部を備え、上記１以上の突出部の先端は、上記髄内釘挿入器具の半径方向に突出した第１の凸部を備え、上記髄内釘の一方の端部に設けられた穴部に上記髄内釘挿入器具を挿入すると、上記第１の凸部が上記穴部の一部と係合するようにされる、髄内釘挿入器具を提供することにある。これにより、熟練を要さずとも簡単に髄内釘挿入器具を髄内釘に嵌めることが出来る。 From the fourth aspect, it is an intramedullary nail insertion device used for an intramedullary nail, and the intramedullary nail insertion device is one end of the intramedullary nail insertion device from the surface of the one end. Along with one or more radially elastic protrusions extending axially, the tip of the one or more protrusions comprises a first radial protrusion of the intramedullary nail insertion device. When the intramedullary nail insertion device is inserted into the hole provided at one end of the intramedullary nail, the first convex portion is made to engage with a part of the hole. The purpose is to provide an internal nail insertion device. This makes it possible to easily fit the intramedullary nail insertion device into the intramedullary nail without requiring skill.
　この髄内釘に使用する髄内釘挿入器具においては、上記髄内釘挿入器具は、上記一方の端部の外周に、上記髄内釘の上記一方の端部に設けられた１以上の外周溝部に嵌るように形成された１以上の第２の凸部を備える。これにより、髄内釘挿入器具と髄内釘とが確実に接続されていることを確認出来る。 In the intramedullary nail insertion device used for this intramedullary nail, the intramedullary nail insertion device is provided on the outer periphery of one end of the intramedullary nail and one or more outer circumferences provided on the one end of the intramedullary nail. It comprises one or more second protrusions formed to fit into the groove. This makes it possible to confirm that the intramedullary nail insertion device and the intramedullary nail are securely connected.
　この髄内釘に使用する髄内釘挿入器具においては、上記髄内釘挿入器具は、他方の端部に髄内釘挿入器具ハンドルとの接続部をさらに備える。これにより骨から離れた位置であっても、的確に髄内釘を髄腔に配置することが出来る。 In the intramedullary nail insertion device used for this intramedullary nail, the intramedullary nail insertion device further includes a connection portion with the intramedullary nail insertion device handle at the other end. This makes it possible to accurately place the intramedullary nail in the medullary cavity even at a position away from the bone.
　この髄内釘に使用する髄内釘挿入器具においては、上記髄内釘挿入器具は、長手方向に延在する貫通孔をさらに備え、髄内釘挿入器具ロックが上記貫通孔に挿入される。
これにより、髄内釘挿入器具の軸方向に延在する、半径方向に弾性のある１以上の突出部が半径方向に弾性変形することを防ぎ、髄内釘から髄内釘挿入器具が不意に外れることを防止することが出来る。 In the intramedullary nail insertion device used for this intramedullary nail, the intramedullary nail insertion device further includes a through hole extending in the longitudinal direction, and the intramedullary nail insertion device lock is inserted into the through hole.
This prevents one or more radially elastic protrusions extending in the axial direction of the intramedullary nail insertion device from elastically deforming in the radial direction, and the intramedullary nail insertion device suddenly moves from the intramedullary nail. It can be prevented from coming off.
　この髄内釘に使用する髄内釘挿入器具においては、上記髄内釘挿入器具は、クロススクリュードリルガイドとの接続部をさらに備える。これにより、髄内釘を骨に固定するクロススクリューを挿入することが出来る。 In the intramedullary nail insertion device used for this intramedullary nail, the intramedullary nail insertion device further includes a connection portion with a cross screw drill guide. This makes it possible to insert a cross screw that secures the intramedullary nail to the bone.
　本発明によれば、エンドキャップと髄内釘においては、まず、熟練を要さずとも簡単にエンドキャップを髄内釘に嵌めることが出来る。さらに、エンドキャップと髄内釘とが確実に接続されていることも確認できる。エンドキャップ挿入器具においては、骨から離れた位置から、髄内釘にエンドキャップを嵌めることが出来る。髄内釘挿入器具においては、まず、熟練を要さずとも簡単に髄内釘挿入器具を髄内釘に嵌めることが出来る。さらに、髄内釘挿入器具と髄内釘とが確実に接続されていることも確認出来る。また、挿入器具ハンドルを使用することにより骨から離れた位置であっても、的確に髄内釘を髄腔に配置することも出来る。さらに、髄内釘挿入器具ロックにより髄内釘から髄内釘挿入器具が不意に外れることを防止することも出来る。また、クロススクリュードリルガイドにより、髄内釘を骨に固定するクロススクリューを挿入することも出来る。 According to the present invention, in the end cap and the intramedullary nail, first, the end cap can be easily fitted to the intramedullary nail without requiring skill. Furthermore, it can be confirmed that the end cap and the intramedullary nail are securely connected. In the end cap insertion device, the end cap can be fitted to the intramedullary nail from a position away from the bone. In the intramedullary nail insertion device, first, the intramedullary nail insertion device can be easily fitted into the intramedullary nail without requiring skill. Furthermore, it can be confirmed that the intramedullary nail insertion device and the intramedullary nail are securely connected. In addition, by using the insertion instrument handle, the intramedullary nail can be accurately placed in the medullary cavity even at a position away from the bone. Furthermore, the intramedullary nail insertion device lock can prevent the intramedullary nail insertion device from being accidentally disengaged from the intramedullary nail. The cross-screw drill guide can also be used to insert a cross-screw that secures the intramedullary nail to the bone.
　本発明を用いるさらなる有利性、特徴、及び態様は、非限定的な実例として与えられる以下の本発明の実施例の詳細な説明から明らかになるであろう。 Further advantages, features, and aspects of using the invention will become apparent from the following detailed description of the embodiments of the invention given as non-limiting examples.
図１は、本発明の一の実施形態に係る髄内釘とエンドキャップの模擬斜視図である。FIG. 1 is a simulated perspective view of an intramedullary nail and an end cap according to an embodiment of the present invention. 図２は、本発明の一の実施形態に係る図１の髄内釘とエンドキャップを正面から見た際の部分拡大図である。FIG. 2 is a partially enlarged view of the intramedullary nail and the end cap of FIG. 1 according to the embodiment of the present invention when viewed from the front. 図３は、本発明の一の実施形態に係る図２の髄内釘とエンドキャップの断面図である。FIG. 3 is a cross-sectional view of the intramedullary nail and the end cap of FIG. 2 according to the embodiment of the present invention. 図４は、本発明の一の実施形態に係る図３の髄内釘とエンドキャップの断面図において、エンドキャップを髄内釘に嵌めた際の断面図である。FIG. 4 is a cross-sectional view of the intramedullary nail and the end cap of FIG. 3 according to the embodiment of the present invention, when the end cap is fitted to the intramedullary nail. 図５は、本発明の一の実施形態に係る髄内釘とエンドキャップとエンドキャップ挿入器具の模擬斜視図である。FIG. 5 is a simulated perspective view of an intramedullary nail, an end cap, and an end cap insertion device according to an embodiment of the present invention. 図６は、本発明の一の実施形態に係る図５の髄内釘とエンドキャップとエンドキャップ挿入器具を正面から見た際の部分拡大図である。FIG. 6 is a partially enlarged view of the intramedullary nail, the end cap, and the end cap insertion device of FIG. 5 according to the embodiment of the present invention when viewed from the front. 図７は、本発明の一の実施形態に係る図６の髄内釘とエンドキャップとエンドキャップ挿入器具において、エンドキャップ挿入器具をエンドキャップにねじにより接続した図である。FIG. 7 is a diagram in which the end cap insertion device is connected to the end cap by a screw in the intramedullary nail, the end cap, and the end cap insertion device of FIG. 6 according to the embodiment of the present invention. 図８は、本発明の一の実施形態に係る図７の髄内釘とエンドキャップとエンドキャップ挿入器具において、エンドキャップ挿入器具に接続されたエンドキャップを髄内釘に嵌めた際の図である。FIG. 8 is a view when the end cap connected to the end cap insertion device is fitted to the intramedullary nail in the intramedullary nail, the end cap, and the end cap insertion device of FIG. 7 according to the embodiment of the present invention. be. 図９は、本発明に係る長さの異なるエンドキャップを示す図である。FIG. 9 is a diagram showing end caps having different lengths according to the present invention. 図１０は、本発明に係る一の実施形態の髄内釘挿入器具の正面図である。FIG. 10 is a front view of the intramedullary nail insertion device according to the embodiment of the present invention. 図１１は、本発明に係る一の実施形態に係る図１０の髄内釘挿入器具の断面図である。FIG. 11 is a cross-sectional view of the intramedullary nail insertion device of FIG. 10 according to the embodiment of the present invention. 図１２は、本願発明に係る一の実施形態の髄内釘挿入器具に使用する髄内釘挿入器具ハンドルの斜視図である。FIG. 12 is a perspective view of the intramedullary nail insertion device handle used in the intramedullary nail insertion device according to the embodiment of the present invention. 図１３は、本願発明に係る一の実施形態の髄内釘挿入器具に使用する髄内釘挿入器具ロックの平面図である。FIG. 13 is a plan view of the intramedullary nail insertion device lock used in the intramedullary nail insertion device according to the embodiment of the present invention. 図１４は、本願発明に係る一の実施形態の髄内釘挿入器具に使用するクロススクリュードリルガイドの斜視図である。FIG. 14 is a perspective view of a cross screw drill guide used in the intramedullary nail insertion device according to the embodiment of the present invention. 図１５は、本願発明の一の実施形態に係る髄内釘とエンドキャップを用いて折れた鎖骨を治療するために患者がビーチチェアポジションに置かれた状態を示す図である。FIG. 15 is a diagram showing a patient placed in a beach chair position to treat a broken clavicle using an intramedullary nail and an end cap according to an embodiment of the present invention. 図１６は、折れた鎖骨の側方断片の骨折端部を骨折部位の切開部から持ち上げる図である。FIG. 16 is a diagram in which a fractured end of a lateral fragment of a broken clavicle is lifted from an incision at the fracture site. 図１７は、クランプを切開部位に用いて、割れ目を減らして、直径２ｍｍのピンを少なくとも１５ｍｍ骨折端部から中央断片に進めた図である。FIG. 17 is a diagram in which a clamp is used at the incision site to reduce crevices and advance a pin with a diameter of 2 mm from the fracture end to the central fragment by at least 15 mm. 図１８は、髄腔を広げる段階を示す図である。FIG. 18 is a diagram showing a stage of expanding the medullary cavity. 図１９は、広げられた髄腔内にアライメントガイドを進める段階を示す図である。FIG. 19 is a diagram showing the steps of advancing the alignment guide into the widened medullary cavity. 図２０は、中央断片へ可撓性ドリルガイドを進める段階を示す図である。FIG. 20 is a diagram showing the steps of advancing the flexible drill guide to the central fragment. 図２１は、中央断片へ可撓性ドリルを進める段階を示す図である。FIG. 21 is a diagram showing the steps of advancing the flexible drill to the central fragment. 図２２は、中央断片へタップを進める段階を示す図である。FIG. 22 is a diagram showing a step of advancing the tap to the central fragment. 図２３は、タップ、ドリルガイド、アライメントガイドを取り除く段階を示す図である。FIG. 23 is a diagram showing a step of removing the tap, the drill guide, and the alignment guide. 図２４は、髄内釘、髄内釘挿入器具、髄内釘挿入器具ロック、コンプレッションスリーブを組み立てる段階を示す図である。FIG. 24 is a diagram showing a stage of assembling an intramedullary nail, an intramedullary nail insertion device, an intramedullary nail insertion device lock, and a compression sleeve. 図２５は、髄内釘の髄腔内への挿入を進める段階を示す図である。FIG. 25 is a diagram showing a stage of advancing the insertion of an intramedullary nail into the medullary cavity. 図２６は、髄内釘の髄腔内への挿入をさらに進める段階を示す図である。FIG. 26 is a diagram showing a step of further advancing the insertion of the intramedullary nail into the medullary cavity. 図２７は、髄内釘挿入器具にクロススクリュードリルガイドを装着する段階を示した図である。FIG. 27 is a diagram showing a stage of attaching a cross screw drill guide to an intramedullary nail insertion device. 図２８は、両皮質孔を開ける段階を示す図である。FIG. 28 is a diagram showing the steps of opening both cortical holes. 図２９は、クロススクリューを配置する段階を示す図である。FIG. 29 is a diagram showing a stage of arranging the cross screw. 図３０は、髄内釘挿入器具を髄内釘から取り外す段階を示す図である。FIG. 30 is a diagram showing a step of removing the intramedullary nail insertion device from the intramedullary nail. 図３１は、髄内釘にエンドキャップを嵌める段階を示す図である。FIG. 31 is a diagram showing a stage of fitting an end cap to an intramedullary nail.
　図１～図１４、図２３、図２８、及び図３１を参照しながら本発明の実施形態を説明する。図１は、本発明の一の実施形態に係る髄内釘１０とエンドキャップ２０の模擬斜視図である。図２は、本発明の一の実施形態に係る図１の髄内釘１０とエンドキャップ２０を正面から見た際の部分拡大図である。図３は、本発明の一の実施形態に係る図２の髄内釘１０とエンドキャップ２０の断面図である。図４は、本発明の一の実施形態に係る図３の髄内釘１０とエンドキャップ２０の断面図において、エンドキャップを髄内釘に嵌めた際の断面図である。図５は、本発明の一の実施形態に係る髄内釘１０とエンドキャップ２０とエンドキャップ挿入器具３０の模擬斜視図である。図６は、本発明の一の実施形態に係る図５の髄内釘１０とエンドキャップ２０とエンドキャップ挿入器具３０を正面から見た際の部分拡大図である。図７は、本発明の一の実施形態に係る図６の髄内釘１０とエンドキャップ２０とエンドキャップ挿入器具３０において、エンドキャップ挿入器具３０をエンドキャップ２０にねじにより接続した図である。図８は、本発明の一の実施形態に係る図７の髄内釘１０とエンドキャップ２０とエンドキャップ挿入器具３０において、エンドキャップ挿入器具３０に接続されたエンドキャップ２０を髄内釘１０に嵌めた際の図である。図９は、本発明に係る長さの異なるエンドキャップ２０を示す図である。図１０は、本発明に係る一の実施形態の髄内釘挿入器具４０の正面図である。図１１は、本発明に係る一の実施形態に係る図１０の髄内釘挿入器具４０の断面図である。図１２は、本願発明に係る一の実施形態の髄内釘挿入器具４０に使用する髄内釘挿入器具ハンドル５０の斜視図である。図１３は、本願発明に係る一の実施形態の髄内釘挿入器具４０に使用する髄内釘挿入器具ロック６０の平面図である。図１４は、本願発明に係る一の実施形態の髄内釘挿入器具４０に使用するクロススクリュードリルガイド７０である。図２４は、髄内釘１０、髄内釘挿入器具４０、髄内釘挿入器具ロック６０、コンプレッションスリーブ１１５を組み立てる段階を示す図である。図２７は、髄内釘挿入器具４０にクロススクリュードリルガイド７０を装着する段階を示した図である。図２８は、両皮質孔を開ける段階を示す図である。図２９は、クロススクリュー１１９を配置する段階を示す図である。図３１は、髄内釘１０にエンドキャップ２０を嵌める段階を示す図である。 An embodiment of the present invention will be described with reference to FIGS. 1 to 14, 23, 28, and 31. FIG. 1 is a simulated perspective view of an intramedullary nail 10 and an end cap 20 according to an embodiment of the present invention. FIG. 2 is a partially enlarged view of the intramedullary nail 10 and the end cap 20 of FIG. 1 according to the embodiment of the present invention when viewed from the front. FIG. 3 is a cross-sectional view of the intramedullary nail 10 and the end cap 20 of FIG. 2 according to the embodiment of the present invention. FIG. 4 is a cross-sectional view of the intramedullary nail 10 and the end cap 20 of FIG. 3 according to the embodiment of the present invention, when the end cap is fitted to the intramedullary nail. FIG. 5 is a simulated perspective view of an intramedullary nail 10, an end cap 20, and an end cap insertion device 30 according to an embodiment of the present invention. FIG. 6 is a partially enlarged view of the intramedullary nail 10, the end cap 20, and the end cap insertion device 30 of FIG. 5 according to the embodiment of the present invention when viewed from the front. FIG. 7 is a diagram in which the end cap insertion device 30 is connected to the end cap 20 by a screw in the intramedullary nail 10, the end cap 20, and the end cap insertion device 30 of FIG. 6 according to the embodiment of the present invention. FIG. 8 shows that in the intramedullary nail 10, the end cap 20, and the end cap insertion device 30 of FIG. 7 according to the embodiment of the present invention, the end cap 20 connected to the end cap insertion device 30 is attached to the intramedullary nail 10. It is a figure at the time of fitting. FIG. 9 is a diagram showing end caps 20 having different lengths according to the present invention. FIG. 10 is a front view of the intramedullary nail insertion device 40 according to the embodiment of the present invention. FIG. 11 is a cross-sectional view of the intramedullary nail insertion device 40 of FIG. 10 according to the embodiment of the present invention. FIG. 12 is a perspective view of the intramedullary nail insertion device handle 50 used in the intramedullary nail insertion device 40 according to the embodiment of the present invention. FIG. 13 is a plan view of the intramedullary nail insertion device lock 60 used in the intramedullary nail insertion device 40 according to the embodiment of the present invention. FIG. 14 is a cross screw drill guide 70 used for the intramedullary nail insertion device 40 according to the embodiment of the present invention. FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115. FIG. 27 is a diagram showing a stage in which the cross screw drill guide 70 is attached to the intramedullary nail insertion device 40. FIG. 28 is a diagram showing the steps of opening both cortical holes. FIG. 29 is a diagram showing a stage of arranging the cross screw 119. FIG. 31 is a diagram showing a stage in which the end cap 20 is fitted to the intramedullary nail 10.
　図３１に示すように、髄腔１０３ａに設置された髄内釘１０には、新生骨の髄内釘内部の侵入を防止し、髄内釘を抜去時に抜去器を接続する為のエンドキャップ２０が嵌められる。まず、図１～図４を参照して、髄内釘１０に使用するエンドキャップ２０は、一方の端部２１に、一方の端部の表面２２からエンドキャップ２０の軸方向に延在する、半径方向に弾性のある１以上の突出部２３を備える。図の実施形態では突出部２３は２箇所である。１以上の突出部２３の先端は、エンドキャップ２０の半径方向に突出した第１の凸部２４を備える。図の実施形態では、第１の凸部２４は２箇所である。髄内釘１０の一方の端部１１に設けられた穴部１２にエンドキャップ２０を挿入すると、第１の凸部２４が穴部の一部１３と係合するようにされる。これにより、熟練を要さずとも簡単にエンドキャップ２０を髄内釘１０に嵌めることが出来る。係合した際に、パチッというような音を生じさせて聴覚で係合したことを認識させることもできる。図の実施形態では、穴部１２は例えば中ぐり加工で設けられており、穴部の一部１３は穴の軸方向に垂直方向の直径が他の部分の直径より一段と大きく形成されており、ここに、第１の凸部２４が係合することになる。穴部の一部１３の構造は、第１の凸部２４が係合する構造であれば、どのような構造であってもよい。ここで、エンドキャップ２０の材質は、通常チタン合金であるが、金属やポリマーを含む手術用グレードの材料であればどのような材料でもよい。１以上の突出部２３の先端及び第１の凸部２４は、金属やポリマーを含む生体適合性材料であってもよい。 As shown in FIG. 31, the end cap 20 for preventing the invasion of the inside of the intramedullary nail of the new bone into the intramedullary nail 10 installed in the medullary cavity 103a and connecting the remover when the intramedullary nail is removed. Is fitted. First, referring to FIGS. 1 to 4, the end cap 20 used for the intramedullary nail 10 extends to one end 21 in the axial direction of the end cap 20 from the surface 22 of the one end. It comprises one or more protrusions 23 that are elastic in the radial direction. In the embodiment shown in the figure, there are two protrusions 23. The tip of one or more protruding portions 23 includes a first convex portion 24 protruding in the radial direction of the end cap 20. In the embodiment of the figure, there are two first convex portions 24. When the end cap 20 is inserted into the hole 12 provided in one end 11 of the intramedullary nail 10, the first convex portion 24 is made to engage with a part 13 of the hole. As a result, the end cap 20 can be easily fitted to the intramedullary nail 10 without requiring skill. When engaged, it is also possible to make a clicking sound to recognize the engagement by hearing. In the embodiment of the figure, the hole portion 12 is provided by, for example, boring, and the diameter of a part 13 of the hole portion in the direction perpendicular to the axial direction of the hole is formed to be one step larger than the diameter of the other portion. Here, the first convex portion 24 is engaged. The structure of a part 13 of the hole portion may be any structure as long as it is a structure in which the first convex portion 24 is engaged. Here, the material of the end cap 20 is usually a titanium alloy, but any material may be used as long as it is a surgical grade material containing a metal or a polymer. The tip of one or more protrusions 23 and the first protrusion 24 may be a biocompatible material containing a metal or polymer.
　エンドキャップ２０の一方の端部２１の外周は、髄内釘１０の一方の端部１１に設けられた１以上の外周溝部１４に嵌るように形成された１以上の第２の凸部２６をさらに備える。図の実施形態では、外周溝部１４は２箇所であり、第２の凸部２６も２箇所である。２箇所の第２の凸部２６が、対応する２箇所の外周溝部１４に嵌ると、そのクリック感で、感覚的に、エンドキャップ２０と髄内釘１０とが確実に接続されていることを確認できる。次に、図９を参照すると、エンドキャップ２０のバリエーションが示されている。使用する髄内釘１０に応じて適切な長さのエンドキャップ２０を選択する。 The outer circumference of one end 21 of the end cap 20 has one or more second convex portions 26 formed so as to fit into one or more outer peripheral groove portions 14 provided on one end 11 of the intramedullary nail 10. Further prepare. In the embodiment shown in the figure, the outer peripheral groove portion 14 has two locations, and the second convex portion 26 also has two locations. When the two second convex portions 26 are fitted into the corresponding two outer peripheral groove portions 14, it is sensuously that the end cap 20 and the intramedullary nail 10 are securely connected by the click feeling. You can check it. Next, with reference to FIG. 9, variations of the end cap 20 are shown. Select an end cap 20 of appropriate length according to the intramedullary nail 10 used.
　さらに、図５～図８を参照して、エンドキャップ２０の他方の端部２７はねじ部２８をさらに備える。これにより、ねじ部に長手部材３０をねじにより接続するで、骨折部位から離れた位置から、髄内釘１０にエンドキャップ２０を嵌めることが出来る。 Further, referring to FIGS. 5 to 8, the other end portion 27 of the end cap 20 further includes a threaded portion 28. As a result, by connecting the longitudinal member 30 to the threaded portion with a screw, the end cap 20 can be fitted to the intramedullary nail 10 from a position away from the fractured portion.
　この長手部材３０は、エンドキャップ２０の他方の端部２７のねじ部２８に係合するねじ部３１を一方の端部に備える、エンドキャップ挿入器具３０であってもよい。ねじ部２８が雌ねじであれば、ねじ部３１は雄ねじとなり、ねじ部２８が雄ねじであれば、ねじ部３１は雌ねじとなる。エンドキャップ挿入器具３０の材質は、通常ステンレススチール４６５であるが、これ以外の金属やポリマーを含む生体適合性材料であってもよい。 The longitudinal member 30 may be an end cap insertion device 30 having a threaded portion 31 engaged with a threaded portion 28 of the other end 27 of the end cap 20 at one end. If the threaded portion 28 is a female thread, the threaded portion 31 is a male thread, and if the threaded portion 28 is a male thread, the threaded portion 31 is a female thread. The material of the end cap insertion device 30 is usually stainless steel 465, but it may be a biocompatible material containing other metals or polymers.
　また、エンドキャップ２０を係合可能な穴部１２を一方の端部１１に備える髄内釘１０を提供する。これにより、熟練を要さずとも簡単にエンドキャップを髄内釘に嵌めることが出来る。このことは、エンドキャップ２０と髄内釘１０との組み合わせにより、最も適切に達成可能である。もちろん、髄内釘１０には、上述したような穴部の一部１３や１以上の外周溝部１４を備えてもよい。 Also provided is an intramedullary nail 10 having a hole 12 with which the end cap 20 can be engaged at one end 11. This makes it possible to easily fit the end cap into the intramedullary nail without the need for skill. This is most appropriately achievable with the combination of the end cap 20 and the intramedullary nail 10. Of course, the intramedullary nail 10 may be provided with a partial portion 13 of the hole portion or one or more outer peripheral groove portions 14 as described above.
　図２４は、髄内釘１０、髄内釘挿入器具４０、髄内釘挿入器具ロック６０、コンプレッションスリーブ１１５を組み立てる段階を示す図である。まず、図１０、図１１を参照して、髄内釘１０に使用する髄内釘挿入器具４０は、一方の端部４１に、一方の端部の表面４２から髄内釘挿入器具４０の軸方向に延在する、半径方向に弾性のある１以上の突出部４３を備える。図の実施形態では突出部４３は２箇所である。１以上の突出部４３の先端は、髄内釘挿入器具４０の半径方向に突出した第１の凸部４４を備える。図の実施形態では、第１の凸部４４は２箇所である。髄内釘１０の一方の端部１１に設けられた穴部１２に髄内釘挿入器具４０を挿入すると、第１の凸部４４が穴部の一部１３と係合するようにされる。これにより、熟練を要さずとも簡単に髄内釘挿入器具４０を髄内釘１０に嵌めることが出来る。係合した際に、パチッというような音を生じさせて聴覚で係合したことを認識させることもできる。図の実施形態では、穴部１２は例えば中ぐり加工で設けられており、穴部の一部１３は穴の軸方向に垂直方向の直径が他の部分の直径より一段と大きく形成されており、ここに、第１の凸部４４が係合することになる。穴部の一部１３の構造は、第１の凸部４４が係合する構造であれば、どのような構造であってもよい。ここで、髄内釘挿入器具４０の材質は、通常ステンレススチール４６５であるが、金属やポリマーを含む手術用グレードの材料であればどのような材料でもよい。一方の端部４１、一方の端部の表面４２、１以上の突出部４３、第１の凸部４４、外周４５の形状を、それぞれ、エンドキャップ２０の一方の端部２１、一方の端部の表面２２、１以上の突出部２３、第１の凸部２４、外周２５の形状と同じ形状にすると、これらは同じ髄内釘１０に使用するので、都合がよい。 FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115. First, referring to FIGS. 10 and 11, the intramedullary nail insertion device 40 used for the intramedullary nail 10 is attached to one end 41 and the axis of the intramedullary nail insertion device 40 from the surface 42 of one end. It comprises one or more projecting portions 43 that extend in the direction and are elastic in the radial direction. In the embodiment shown in the figure, there are two protrusions 43. The tip of one or more protrusions 43 includes a first protrusion 44 that protrudes in the radial direction of the intramedullary nail insertion device 40. In the embodiment of the figure, there are two first convex portions 44. When the intramedullary nail insertion device 40 is inserted into the hole 12 provided at one end 11 of the intramedullary nail 10, the first convex portion 44 is made to engage with a part 13 of the hole. Thereby, the intramedullary nail insertion device 40 can be easily fitted to the intramedullary nail 10 without requiring skill. When engaged, it is also possible to make a clicking sound to recognize the engagement by hearing. In the embodiment of the figure, the hole portion 12 is provided by, for example, boring, and the diameter of a part 13 of the hole portion in the direction perpendicular to the axial direction of the hole is formed to be one step larger than the diameter of the other portion. Here, the first convex portion 44 is engaged. The structure of a part 13 of the hole portion may be any structure as long as it is a structure in which the first convex portion 44 is engaged. Here, the material of the intramedullary nail insertion instrument 40 is usually stainless steel 465, but any material may be used as long as it is a surgical grade material containing a metal or a polymer. The shape of one end 41, the surface 42 of one end 42, one or more protrusions 43, the first convex portion 44, and the outer circumference 45, respectively, is the shape of one end 21 of the end cap 20 and one end, respectively. It is convenient to have the same shape as the surface 22, one or more protrusions 23, the first convex portion 24, and the outer peripheral 25 because they are used for the same intramedullary nail 10.
　髄内釘挿入器具４０は、一方の端部４１の外周４５に、髄内釘１０の一方の端部１１に設けられた外周溝部１４に嵌るように形成された１以上の第２の凸部４６を備える。図の実施形態では、１以上の外周溝部１４は２箇所であり、第２の凸部４６も２箇所である。２つの第２の凸部４６が、対応する２箇所の外周溝部１４に嵌ると、そのクリック感で、感覚的に、髄内釘挿入器具４０と髄内釘１０とが確実に接続されていることを確認できる。第２の凸部４６の形状を、エンドキャップ２０の第２の凸部２６の形状と同じ形状にすると、これらは同じ髄内釘１０に使用するので都合がよい。 The intramedullary nail insertion device 40 has one or more second convex portions formed on the outer peripheral 45 of one end 41 so as to fit into the outer peripheral groove 14 provided on the one end 11 of the intramedullary nail 10. 46 is provided. In the embodiment of the figure, one or more outer peripheral groove portions 14 are at two locations, and the second convex portion 46 is also at two locations. When the two second convex portions 46 are fitted into the corresponding two outer peripheral groove portions 14, the intramedullary nail insertion device 40 and the intramedullary nail 10 are sensuously and securely connected by the click feeling. You can confirm that. If the shape of the second convex portion 46 is the same as the shape of the second convex portion 26 of the end cap 20, it is convenient because they are used for the same intramedullary nail 10.
　次に、図１２を参照して、髄内釘挿入器具４０は、他方の端部４７に髄内釘挿入器具ハンドルとの接続部４８をさらに備える。これにより骨折部位から離れた位置であっても、的確に髄内釘１０を髄腔１０３ａに配置することが出来る。髄内釘挿入器具ハンドル５０は、貫通孔５１と髄内釘挿入器具ロックとの係合箇所５２を備え、貫通孔５１に髄内釘挿入器具４０の髄内釘挿入器具ハンドルとの接続部４８を挿入することにより髄内釘挿入器具ハンドル５０を髄内釘挿入器具４０に接続可能である。髄内釘挿入器具ロックとの係合箇所５２については後述する。 Next, referring to FIG. 12, the intramedullary nail insertion device 40 further includes a connection portion 48 with the intramedullary nail insertion device handle at the other end 47. As a result, the intramedullary nail 10 can be accurately placed in the medullary cavity 103a even at a position away from the fracture site. The intramedullary nail insertion device handle 50 includes an engagement portion 52 between the through hole 51 and the intramedullary nail insertion device lock, and the connection portion 48 between the through hole 51 and the intramedullary nail insertion device handle of the intramedullary nail insertion device 40. The intramedullary nail insertion device handle 50 can be connected to the intramedullary nail insertion device 40 by inserting. The engagement portion 52 with the intramedullary nail insertion device lock will be described later.
　さらに、図１３を参照して、髄内釘挿入器具４０は、長手方向に延在する貫通孔４９をさらに備え、髄内釘挿入器具ロック６０が貫通孔４９に挿入される。これにより、髄内釘挿入器具４０の軸方向に延在する、半径方向に弾性のある１以上の突出部４３が半径方向に弾性変形することを防ぎ、髄内釘１０から髄内釘挿入器具４０が不意に外れることを防止することが出来る。すなわち、髄内釘挿入器具ロック６０が貫通孔４９を延在することにより、髄内釘挿入器具ロック６０のつまみ６１とは反対側の端部が、半径方向に弾性のある１以上の突出部４３を越えて延在することにより、髄内釘挿入器具ロック６０が、突出部４３の半径方向の変形を防ぐため、第１の凸部４４と髄内釘１０の穴部の一部１３との係合が保持されたままとなる。髄内釘挿入器具ロック６０は、髄内釘挿入器具ハンドルとの係合箇所６２を備えており、この髄内釘挿入器具ハンドルとの係合箇所６２を、髄内釘挿入器具ロックとの係合箇所５２のスリットに入れて、時計回りに回転させて、髄内釘挿入器具４０と係合させることにより、髄内釘挿入器具４０が、髄内釘１０に嵌った状態が保たれる。 Further, referring to FIG. 13, the intramedullary nail insertion device 40 further includes a through hole 49 extending in the longitudinal direction, and the intramedullary nail insertion device lock 60 is inserted into the through hole 49. This prevents one or more radially elastic protrusions 43 extending in the axial direction of the intramedullary nail insertion device 40 from elastically deforming in the radial direction, and prevents the intramedullary nail insertion device 10 from being elastically deformed. It is possible to prevent the 40 from coming off unexpectedly. That is, because the intramedullary nail insertion device lock 60 extends through the through hole 49, the end portion of the intramedullary nail insertion device lock 60 opposite to the knob 61 has one or more protrusions that are elastic in the radial direction. By extending beyond 43, the intramedullary nail insertion device lock 60 has a first convex portion 44 and a portion 13 of the hole portion of the intramedullary nail 10 in order to prevent radial deformation of the protruding portion 43. The engagement remains held. The intramedullary nail insertion device lock 60 includes an engagement point 62 with the intramedullary nail insertion device handle, and the engagement point 62 with the intramedullary nail insertion device handle is engaged with the intramedullary nail insertion device lock. The intramedullary nail insertion device 40 is kept fitted to the intramedullary nail 10 by inserting it into the slit of the joint portion 52 and rotating it clockwise to engage with the intramedullary nail insertion device 40.
　図２７は、髄内釘挿入器具４０にクロススクリュードリルガイド７０を装着する段階を示した図であり、図２８は、両皮質孔を開ける段階を示す図であり、図２９は、クロススクリュー１１９を配置する段階を示す図である。図１０及び図１４を参照して、髄内釘挿入器具４０は、クロススクリュードリルガイドとの接続部４９ａをさらに備える、これにより、髄内釘１０を骨に固定するクロススクリュー１１９を挿入することが出来るクロススクリュードリルガイド７０の髄内釘挿入器具との接続部７１をクロススクリュードリルガイドとの接続部４９ａに取り付ける。スクリュースリーブ及びドリルスリーブ接続部７２にスクリュースリーブ１１６とドリルスリーブ１１７をねじ込んで、ドリル１１８で骨に穴を空けてから、クロススクリュー１１９で髄内釘１０を固定する。 27 is a diagram showing a stage of attaching the cross screw drill guide 70 to the intramedullary nail insertion device 40, FIG. 28 is a diagram showing a stage of opening both cortical holes, and FIG. 29 is a diagram showing a stage of opening both cortical holes, and FIG. 29 is a diagram showing a stage of opening both cortical holes. It is a figure which shows the stage which arranges. With reference to FIGS. 10 and 14, the intramedullary nail insertion device 40 further comprises a connection 49a with a cross screw drill guide, thereby inserting a cross screw 119 that secures the intramedullary nail 10 to the bone. The connection portion 71 of the cross screw drill guide 70 with the intramedullary nail insertion device is attached to the connection portion 49a with the cross screw drill guide. The screw sleeve 116 and the drill sleeve 117 are screwed into the screw sleeve and the drill sleeve connection portion 72, a hole is made in the bone with the drill 118, and then the intramedullary nail 10 is fixed with the cross screw 119.
　次に、本願発明の実施形態に係る髄内釘１０の骨折部位への設置方法を説明する。
図１５～３１を参照して、図１５は、本願発明の一の実施形態に係る髄内釘１０とエンドキャップ２０を用いて折れた鎖骨を治療するために患者がビーチチェアポジションに置かれた状態を示す図である。図１６は、折れた鎖骨の側方断片１０１の骨折端部１０２を骨折部位の切開部から持ち上げる図である。図１７は、クランプ１０４を切開部位に用いて、割れ目を減らして、直径２ｍｍのピン（ガイドワイヤー）１０３を少なくとも１５ｍｍ、骨折端部１０２から中央断片１００に進めた図である。図１８は、髄腔１０３ａを広げる段階を示す図である。図１９は、広げられた髄腔１０３ａ内にアライメントガイド１０７を進める段階を示す図である。図２０は、中央断片１００へ可撓性ドリルガイド１１１を進める段階を示す図である。図２１は、中央断片１００へ可撓性ドリル１１３を進める段階を示す図である。図２２は、中央断片１００へタップ１１４を進める段階を示す図である。図２３は、タップ１１４、ドリルガイド１１４ａ、アライメントガイド１０７を取り除く段階を示す図である。図２４は、髄内釘１０、髄内釘挿入器具４０、髄内釘挿入器具ロック６０、コンプレッションスリーブ１１５を組み立てる段階を示す図である。図２５は、髄内釘１０の髄腔１０３ａ内への挿入を進める段階を示す図である。図２６は、髄内釘１０の髄腔１０３ａ内への挿入をさらに進める段階を示す図である。図２７は、髄内釘挿入器具４０にクロススクリュードリルガイド７０を装着する段階を示した図である。図２８は、両皮質孔を開ける段階を示す図である。図２９は、クロススクリュー１１９を配置する段階を示す図である。図３０は、髄内釘挿入器具４０を髄内釘１０から取り外す段階を示す図である。図３１は、髄内釘１０にエンドキャップ２０を嵌める段階を示す図である。 Next, a method of installing the intramedullary nail 10 according to the embodiment of the present invention at the fracture site will be described.
With reference to FIGS. 15-31, FIG. 15 shows a patient placed in a beach chair position to treat a broken clavicle using an intramedullary nail 10 and an end cap 20 according to an embodiment of the present invention. It is a figure which shows the state. FIG. 16 is a diagram in which the fracture end 102 of the lateral fragment 101 of the broken clavicle is lifted from the incision at the fracture site. FIG. 17 is a diagram in which a clamp 104 is used at the incision site to reduce cracks and a pin (guide wire) 103 having a diameter of 2 mm is advanced by at least 15 mm from the fracture end 102 to the central fragment 100. FIG. 18 is a diagram showing a stage of expanding the medullary cavity 103a. FIG. 19 is a diagram showing a step of advancing the alignment guide 107 into the widened medullary cavity 103a. FIG. 20 is a diagram showing a step of advancing the flexible drill guide 111 to the central fragment 100. FIG. 21 is a diagram showing a step of advancing the flexible drill 113 to the central fragment 100. FIG. 22 is a diagram showing a step of advancing the tap 114 to the central fragment 100. FIG. 23 is a diagram showing a step of removing the tap 114, the drill guide 114a, and the alignment guide 107. FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115. FIG. 25 is a diagram showing a step of advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a. FIG. 26 is a diagram showing a step of further advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a. FIG. 27 is a diagram showing a stage in which the cross screw drill guide 70 is attached to the intramedullary nail insertion device 40. FIG. 28 is a diagram showing the steps of opening both cortical holes. FIG. 29 is a diagram showing a stage of arranging the cross screw 119. FIG. 30 is a diagram showing a step of removing the intramedullary nail insertion device 40 from the intramedullary nail 10. FIG. 31 is a diagram showing a stage in which the end cap 20 is fitted to the intramedullary nail 10.
　図１５を参照して、本願発明の一の実施形態に係る髄内釘１０とエンドキャップ２０を用いて折れた鎖骨を治療するために患者がビーチチェアポジションに置かれた状態を示す図である。Ｃアームが手術部位の前後（ＡＰ）及び頭部の観察を可能にするために配置される。骨折部位で２～３ｃｍの切開がなされる。鎖骨上の中間枝を確認して後退させる。 FIG. 15 shows a state in which a patient is placed in a beach chair position to treat a broken clavicle using an intramedullary nail 10 and an end cap 20 according to an embodiment of the present invention. .. A C-arm is placed to allow observation of the anterior-posterior (AP) and head of the surgical site. A 2-3 cm incision is made at the fracture site. Check the middle branch on the clavicle and retract it.
　図１６を参照して、折れた鎖骨の側方断片１０１の骨折端部１０２を骨折部位の切開部から持ち上げる図である。側方断片１０１の髄腔１０３ａに直径２．０ｍｍのピンで穴を空けて、側背皮質を通して進める。皮膚を張るようにして、ピンの先端を覆っている部分を小さく１ｃｍ切開して、出口ポイントに露出させる。 FIG. 16 is a diagram in which the fracture end 102 of the lateral fragment 101 of the broken clavicle is lifted from the incision at the fracture site. A hole is made in the medullary cavity 103a of the lateral fragment 101 with a pin having a diameter of 2.0 mm, and the medullary cavity 103a is advanced through the lateral dorsal cortex. Make a small 1 cm incision in the area covering the tip of the pin so that the skin is stretched, and expose it to the exit point.
　図１７を参照して、クランプ１０４を切開部位に用いて、割れ目を減らして、直径２ｍｍのピンを少なくとも１５ｍｍ、骨折端部１０２から中央断片１００に進めた図である。 With reference to FIG. 17, a clamp 104 is used at the incision site to reduce crevices and advance a pin with a diameter of 2 mm to at least 15 mm from the fracture end 102 to the central fragment 100.
　図１８を参照して、髄腔１０３ａを広げる段階を示す図である。直径４．５ｍｍの硬質ドリル１０６で始めて、組織プロテクター１０５を介して徐々に髄腔を広げて、中央断片１００に、少なくとも１０ｍｍ、硬質ドリル１０６を進める。硬質ドリル１０６の溝は骨折の中間境界に少なくとも平行である。皮質骨を感じない場合には、次の大きさの直径のドリルを使用して髄腔１０３ａを広げる。 FIG. 18 is a diagram showing a stage of expanding the medullary cavity 103a with reference to FIG. Starting with a hard drill 106 with a diameter of 4.5 mm, the medullary cavity is gradually widened through the tissue protector 105 to advance the hard drill 106 to the central fragment 100 by at least 10 mm. The groove of the hard drill 106 is at least parallel to the mid-boundary of the fracture. If you do not feel the cortical bone, use a drill of the following sizes to widen the medullary cavity 103a.
　図１９を参照して、広げられた髄腔１０３ａ内にアライメントガイド１０７を進める段階を示す図である。正しい直径に髄腔１０３ａを広げた後で、アライメントガイド１０７を前方に押す。平行孔１０８が骨を捉えるまでアライメントガイド１０７を回転し、その後、直径２ｍｍのＫワイヤー１０９を平行孔１０８に配置する。必要とあれば、直径２ｍｍの第２のＫワイヤー１１０を垂直スロットに配置し、皮質骨に入れる。 FIG. 19 is a diagram showing a step of advancing the alignment guide 107 into the widened medullary cavity 103a with reference to FIG. After expanding the medullary cavity 103a to the correct diameter, push the alignment guide 107 forward. The alignment guide 107 is rotated until the parallel hole 108 catches the bone, and then the K wire 109 having a diameter of 2 mm is placed in the parallel hole 108. If necessary, a second K-wire 110 with a diameter of 2 mm is placed in the vertical slot and placed in the cortical bone.
　図２０を参照して、中央断片１００へ可撓性ドリルガイド１１１を進める段階を示す図である。まず、硬質ドリル１０６を外す。次に、硬質ドリル１０６の大きさに合った可撓性ドリルガイド１１１を挿入する。そして、穴を空けられた髄腔１０３ａの底部に完全に据え付けられていることを確認する。直径２ｍｍのピン（ガイドワイヤー）１０３を外して、直径１．１ｍｍの湾曲ワイヤー１１２を、可撓性ドリルガイド１１１を介して挿入して、中央断片１００に入れる。 FIG. 20 is a diagram showing a step of advancing the flexible drill guide 111 to the central fragment 100 with reference to FIG. First, the hard drill 106 is removed. Next, a flexible drill guide 111 suitable for the size of the hard drill 106 is inserted. Then, it is confirmed that the medullary cavity 103a with a hole is completely installed at the bottom. The pin (guide wire) 103 having a diameter of 2 mm is removed, and the curved wire 112 having a diameter of 1.1 mm is inserted through the flexible drill guide 111 into the central fragment 100.
　図２１を参照して、中央断片１００へ可撓性ドリル１１３を進める段階を示す図である。直径３．２ｍｍの可撓性ドリル１１３を使用して、所望の深さに到達するまで、直径１．１ｍｍの湾曲ワイヤー１１２を覆って穴をあける（ショートスレッド（ＳＴ）、ミディアムスレッド（ＭＴ）、ロングスレッド（ＬＴ））。 FIG. 21 is a diagram showing a step of advancing the flexible drill 113 to the central fragment 100 with reference to FIG. 21. Using a 3.2 mm diameter flexible drill 113, drill a hole over the 1.1 mm diameter curved wire 112 until the desired depth is reached (short thread (ST), medium thread (MT)). , Long thread (LT)).
　硬質ドリル１０６、及び可撓性ドリル１１３の穴開による計測を使用して、適切な深さの髄内釘１０及びタップ１１４を選択する。 Select the intramedullary nail 10 and tap 114 of appropriate depth using the measurement by drilling the hard drill 106 and the flexible drill 113.
　図２２を参照して、中央断片１００へタップ１１４を進める段階を示す図である。可撓性ドリル１１３、１．１ｍｍの直径の案内となる湾曲ワイヤー１１２、及び可撓性ドリルガイド１１１を外す。使用した硬質ドリル１０６に対応するタップ１１４を選択し、髄腔１０３ａへ入れて、髄内釘１０の全長までタップ１１４を進める。 FIG. 22 is a diagram showing a stage of advancing the tap 114 to the central fragment 100 with reference to FIG. 22. Remove the flexible drill 113, the curved wire 112 that guides the diameter of 1.1 mm, and the flexible drill guide 111. The tap 114 corresponding to the hard drill 106 used is selected, inserted into the medullary cavity 103a, and the tap 114 is advanced to the total length of the intramedullary nail 10.
　図２３を参照して、タップ１１４、ドリルガイド１１４ａ、アライメントガイド１０７を取り外す段階を示す図である。可撓性のタップ１１４、垂直の第２のＫワイヤー１１０、ドリルガイド１１４ａ、アライメントガイド１０７を取り外す。そしてクランプ１０４のみを残す。必要であれば、髄内釘１０を案内するために平行のＫワイヤー１０９をその場に残すことも出来る。 FIG. 23 is a diagram showing a stage of removing the tap 114, the drill guide 114a, and the alignment guide 107 with reference to FIG. 23. Remove the flexible tap 114, the vertical second K-wire 110, the drill guide 114a, and the alignment guide 107. And only the clamp 104 is left. If desired, a parallel K-wire 109 can be left in place to guide the intramedullary nail 10.
　図２４を参照して、髄内釘１０、髄内釘挿入器具４０、髄内釘挿入器具ロック６０、コンプレッションスリーブ１１５を組み立てる段階を示す図である。コンプレッションスリーブ１１５で髄内釘挿入器具４０の所望の部分を覆う。髄内釘挿入器具４０の髄内釘挿入器具４０の髄内釘挿入器具ハンドルとの接続部４８を髄内釘挿入器具ハンドル５０の貫通孔５１に挿入する。髄内釘１０の穴部１２に髄内釘挿入器具４０の第１の凸部４４を挿入して接続する。必要に応じて髄内釘挿入器具ハンドル５０を回転させて、第１の凸部４４を髄内釘１０の外周溝部１４に合わせて嵌めて、完全に据え付ける。髄内釘挿入器具ロック６０を、髄内釘挿入器具ハンドル５０の髄内釘挿入器具ロックとの係合箇所５２側から貫通孔５１に挿入する。髄内釘挿入器具ハンドルとの係合箇所６２を髄内釘挿入器具ロックとの係合箇所５２に挿入して、つまみ６１を図のように時計回りに回転してロックする。ロックすると髄内釘挿入器具ロック６０が、髄内釘挿入器具４０の第１の凸部４４が半径方向に弾性変形しない位置まで延在しているため、髄内釘挿入器具４０が、髄内釘１０から不意に外れることはない。 FIG. 24 is a diagram showing a stage of assembling an intramedullary nail 10, an intramedullary nail insertion device 40, an intramedullary nail insertion device lock 60, and a compression sleeve 115 with reference to FIG. 24. Cover the desired portion of the intramedullary nail insertion device 40 with the compression sleeve 115. The connection portion 48 of the intramedullary nail insertion device 40 with the intramedullary nail insertion device handle is inserted into the through hole 51 of the intramedullary nail insertion device handle 50. The first convex portion 44 of the intramedullary nail insertion device 40 is inserted into the hole 12 of the intramedullary nail 10 and connected. If necessary, the intramedullary nail insertion device handle 50 is rotated so that the first convex portion 44 is fitted to the outer peripheral groove portion 14 of the intramedullary nail 10 and completely installed. The intramedullary nail insertion device lock 60 is inserted into the through hole 51 from the engagement portion 52 side of the intramedullary nail insertion device handle 50 with the intramedullary nail insertion device lock. The engagement portion 62 with the intramedullary nail insertion device handle is inserted into the engagement portion 52 with the intramedullary nail insertion device lock, and the knob 61 is rotated clockwise as shown to lock. When locked, the intramedullary nail insertion device lock 60 extends to a position where the first convex portion 44 of the intramedullary nail insertion device 40 does not elastically deform in the radial direction, so that the intramedullary nail insertion device 40 is intramedullary. It will not come off the nail 10 unexpectedly.
　図２５を参照して、髄内釘１０の髄腔１０３ａ内への挿入を進める段階を示す図である。髄内釘１０の先端を、必要であれば、平行のＫワイヤー１０９を使用して、穴を空けられた髄腔１０３ａに導入する。髄内釘１０が骨折端部１０２のある骨折線を越えたら、割れ目を減らすクランプ１０４を取り外すことが出来る。 FIG. 25 is a diagram showing a step of advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a with reference to FIG. 25. The tip of the intramedullary nail 10 is introduced into the perforated medullary cavity 103a using a parallel K-wire 109, if necessary. Once the intramedullary nail 10 crosses the fracture line with the fracture end 102, the clamp 104 that reduces the crevice can be removed.
　図２６を参照して、髄内釘１０の髄腔１０３ａ内への挿入をさらに進める段階を示す図である。所望の圧縮が達成されるまで、髄内釘１０を髄腔１０３ａの中に進める。骨折の中間境界である骨折端部１０２に少なくとも髄内釘１０の本体（例えばチタニウム製）が延在することを確実にするために、必要であれば、コンプレッションスリーブ１１５を調整する。 FIG. 26 is a diagram showing a step of further advancing the insertion of the intramedullary nail 10 into the medullary cavity 103a with reference to FIG. 26. The intramedullary nail 10 is advanced into the medullary cavity 103a until the desired compression is achieved. If necessary, adjust the compression sleeve 115 to ensure that at least the body of the intramedullary nail 10 (eg, made of titanium) extends to the fracture end 102, which is the intermediate boundary of the fracture.
　図２７を参照して、髄内釘挿入器具４０にクロススクリュードリルガイド７０を装着する段階を示した図である。クロススクリュードリルガイド７０を髄内釘挿入器具４０のクロススクリュードリルガイドとの接続部４９ａを覆うように配置する。その後、クロススクリュードリルガイド７０をコンプレッションスリーブ１１５側に押してロックする。スクリュースリーブ１１６及びドリルスリーブ１１７が、皮質骨に接触できるように小さい刺切創を作る。 FIG. 27 is a diagram showing a stage of attaching the cross screw drill guide 70 to the intramedullary nail insertion device 40 with reference to FIG. 27. The cross-screw drill guide 70 is arranged so as to cover the connection portion 49a of the intramedullary nail insertion device 40 with the cross-screw drill guide. After that, the cross screw drill guide 70 is pushed toward the compression sleeve 115 to lock it. The screw sleeve 116 and the drill sleeve 117 make a small puncture cut so that they can contact the cortical bone.
　図２８を参照して、両皮質孔を開ける段階を示す図である。直径２．０ｍｍのドリル１１８をドリルスリーブ１１７に通して、両皮質孔を開けて、深さを測定して記録する。直径２．０ｍｍのドリル１１８とドリルスリーブ１１７を取り外す。 With reference to FIG. 28, it is a diagram showing a stage of opening both cortical holes. A drill 118 with a diameter of 2.0 mm is passed through a drill sleeve 117 to make both cortical holes, and the depth is measured and recorded. Remove the drill 118 with a diameter of 2.0 mm and the drill sleeve 117.
　図２９を参照して、クロススクリュー１１９を配置する段階を示す図である。深さゲージを使用して両皮質ねじ長を確認する。スクリュースリーブ１１６を介してクロススクリュー１１９を配置する。 FIG. 29 is a diagram showing a stage of arranging the cross screw 119 with reference to FIG. 29. Check the length of both cortical threads using a depth gauge. The cross screw 119 is arranged via the screw sleeve 116.
　図３０を参照して、髄内釘挿入器具４０を髄内釘１０から取り外す段階を示す図である。必要があれば、穴を空けて、第２のクロススクリューを配置する。髄内釘挿入器具ロック６０のつまみ６１を半時計周りに回して髄内釘挿入器具ハンドルとの係合箇所６２を髄内釘挿入器具ロックとの係合箇所５２から外して、髄内釘１０と髄内釘挿入器具４０とのロックを解除するために、髄内釘挿入器具ロック６０を取り外す。髄内釘１０から髄内釘挿入器具４０を取り外すために、髄内釘挿入器具４０を引き出す。必要な張力は、１５Ｎ～３５Ｎの間であり、大体２０Ｎ位である。 FIG. 30 is a diagram showing a stage of removing the intramedullary nail insertion device 40 from the intramedullary nail 10 with reference to FIG. 30. If necessary, make a hole and place a second cross screw. Turn the knob 61 of the intramedullary nail insertion device lock 60 counterclockwise to disengage the engagement point 62 with the intramedullary nail insertion device handle from the engagement point 52 with the intramedullary nail insertion device lock, and the intramedullary nail 10 The intramedullary nail insertion device lock 60 is removed in order to unlock the device and the intramedullary nail insertion device 40. In order to remove the intramedullary nail insertion device 40 from the intramedullary nail 10, the intramedullary nail insertion device 40 is pulled out. The required tension is between 15N and 35N, which is about 20N.
　図３１を参照して、髄内釘１０にエンドキャップ２０を嵌める段階を示す図である。所望のエンドキャップ２０のねじ部２８にエンドキャップ挿入器具３０のねじ部３１によりエンドキャップ挿入器具３０を接続する。エンドキャップ挿入器具３０を使用して、エンドキャップ２０の第１の凸部２４を髄内釘１０の穴部１２に押し入れる。エンドキャップ２０を時計回りもしくは半時計回りに回すことにより、エンドキャップ２０の第２の凸部２６が髄内釘１０の外周溝部１４に嵌り回転が妨げられる。その後、完全にエンドキャップ２０が、髄内釘１０に据え付けられるまで連続して押圧する。据付後、エンドキャップ挿入器具３０を半時計回りに回転して、エンドキャップ２０から取り外す。以上で、髄内釘１０の骨折部位への設置方法の説明は終了である。 FIG. 31 is a diagram showing a stage of fitting the end cap 20 to the intramedullary nail 10 with reference to FIG. 31. The end cap inserting device 30 is connected to the threaded portion 28 of the desired end cap 20 by the threaded portion 31 of the end cap inserting device 30. The end cap insertion device 30 is used to push the first convex portion 24 of the end cap 20 into the hole portion 12 of the intramedullary nail 10. By turning the end cap 20 clockwise or counterclockwise, the second convex portion 26 of the end cap 20 fits into the outer peripheral groove portion 14 of the intramedullary nail 10 and rotation is hindered. Then, the end cap 20 is continuously pressed until it is completely attached to the intramedullary nail 10. After installation, the end cap insertion device 30 is rotated counterclockwise and removed from the end cap 20. This is the end of the explanation of how to install the intramedullary nail 10 at the fracture site.
　なお、髄内釘１０を体内から取り外すには、上記の方法とほぼ逆の手順を行えばよい。この際、エンドキャップ２０を髄内釘１０から取り外すときは、エンドキャップ挿入器具３０を上述したようにエンドキャップ２０に接続してから、エンドキャップ挿入器具３０を引いて、エンドキャップ２０を引き出す。必要な張力は、１５Ｎ～３５Ｎの間であり、大体２０Ｎ位である。 To remove the intramedullary nail 10 from the body, the procedure almost opposite to the above method may be performed. At this time, when the end cap 20 is removed from the intramedullary nail 10, the end cap insertion device 30 is connected to the end cap 20 as described above, and then the end cap insertion device 30 is pulled to pull out the end cap 20. The required tension is between 15N and 35N, which is about 20N.
　以上、図面を参照して、本発明の実施例を詳述してきたが、具体的な構成は、この実施例に限らず、本発明の要旨を逸脱しない程度の設計的変更は、本発明に含まれる。 Although the embodiments of the present invention have been described in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design changes to the extent that the gist of the present invention is not deviated are made in the present invention. included.
１０　髄内釘
１１　一方の端部
１２　穴部
１３　穴部の一部
１４　外周溝部
２０　エンドキャップ
２１　一方の端部
２２　一方の端部の表面
２３　１以上の突出部
２４　第１の凸部
２５　外周
２６　第２の凸部
２７　他方の端部
２８　ねじ部
３０　エンドキャップ挿入器具
３１　ねじ部
４０　髄内釘挿入器具
４１　一方の端部
４２　一方の端部の表面
４３　１以上の突出部
４４　第１の凸部
４５　外周
４６　第２の凸部
４７　他方の端部
４８　髄内釘挿入器具ハンドルとの接続部
４９　貫通孔
４９ａ　クロススクリュードリルガイドとの接続部
５０　髄内釘挿入器具ハンドル
５１　貫通孔
５２　髄内釘挿入器具ロックとの係合箇所
６０　髄内釘挿入器具ロック
６１　つまみ
６２　髄内釘挿入器具ハンドルとの係合箇所
７０　クロススクリュードリルガイド
７１　髄内釘挿入器具との接続部
７２　スクリュースリーブ及びドリルスリーブ接続部
１００　中央断片
１０１　側方断片
１０２　骨折端部
１０３　ピン（ガイドワイヤー）
１０３ａ　髄腔
１０４　クランプ
１０５　組織プロテクター
１０６　硬質ドリル
１０７　アライメントガイド
１０８　平行孔
１０９　Ｋワイヤー
１１０　第２のＫワイヤー
１１１　可撓性ドリルガイド
１１２　湾曲ワイヤー
１１３　可撓性ドリル
１１４　タップ
１１４ａドリルガイド
１１５　コンプレッションスリーブ
１１６　スクリュースリーブ
１１７　ドリルスリーブ
１１８　ドリル
１１９　クロススクリュー
  10 Intramedullary nail 11 One end 12 Hole 13 Part of the hole 14 Outer groove 20 End cap 21 One end 22 Surface of one end 23 1 or more protrusions 24 First convex 25 Outer circumference 26 Second convex part 27 Another end 28 Threaded part 30 End cap insertion device 31 Threaded part 40 Intramedullary nail insertion device 41 One end 42 One end surface 43 One or more protrusions 44 First Convex 45 Outer circumference 46 Second convex 47 Other end 48 Connection with intramedullary nail insertion device handle 49 Through hole 49a Connection with cross screw drill guide 50 Intramedullary nail insertion device handle 51 Through hole 52 Spinal Engagement point with the internal nail insertion device lock 60 Intramedullary nail insertion device lock 61 Knob 62 Engagement point with the intramedullary nail insertion device handle 70 Cross screw drill guide 71 Connection with intramedullary nail insertion device 72 Screw sleeve and Drill sleeve connection 100 Central fragment 101 Lateral fragment 102 Fracture end 103 Pin (guide wire)
103a medullary cavity 104 clamp 105 tissue protector 106 hard drill 107 alignment guide 108 parallel hole 109 K wire 110 second K wire 111 flexible drill guide 112 curved wire 113 flexible drill 114 tap 114a drill guide 115 compression sleeve 116 screw Sleeve 117 Drill Sleeve 118 Drill 119 Cross Screw

Claims (10)

  1. 　髄内釘に使用するエンドキャップであって、
    　前記エンドキャップは、一方の端部に、前記一方の端部の表面から前記エンドキャップの軸方向に延在する、半径方向に弾性のある１以上の突出部を備え、
    　前記１以上の突出部の先端は、前記エンドキャップの半径方向に突出した第１の凸部を備え、
    　前記髄内釘の一方の端部に設けられた穴部に前記エンドキャップを挿入すると、前記第１の凸部が前記穴部の一部と係合するようにされる、エンドキャップ。     An end cap used for intramedullary nails
    The end cap comprises one or more radialally elastic protrusions at one end that extend axially from the surface of the one end.
    The tip of the one or more protrusions comprises a first protrusion protruding in the radial direction of the end cap.
    An end cap in which when the end cap is inserted into a hole provided at one end of the intramedullary nail, the first convex portion engages with a part of the hole.
  2. 　前記エンドキャップの前記一方の端部の外周は、前記髄内釘の前記一方の端部に設けられた１以上の外周溝部に嵌るように形成された１以上の第２の凸部をさらに備える、請求項１に記載のエンドキャップ。 The outer circumference of the one end of the end cap further comprises one or more second protrusions formed to fit into the one or more outer peripheral grooves provided at the one end of the intramedullary nail. , The end cap according to claim 1.
  3. 　前記エンドキャップの他方の端部はねじ部をさらに備える、請求項１又は２に記載のエンドキャップ。 The end cap according to claim 1 or 2, wherein the other end of the end cap further includes a threaded portion.
  4. 　請求項３に記載のエンドキャップの他方の端部のねじ部に係合するねじ部を一方の端部に備える、エンドキャップ挿入器具。 An end cap insertion device having a threaded portion engaged with a threaded portion at the other end of the end cap according to claim 3 at one end.
  5. 　請求項１～３のいずれか一項に記載のエンドキャップを係合可能な穴部を一方の端部に備える髄内釘。 An intramedullary nail having a hole in one end to which the end cap according to any one of claims 1 to 3 can be engaged.
  6. 　髄内釘に使用する髄内釘挿入器具であって、
    　前記髄内釘挿入器具は、一方の端部に、前記一方の端部の表面から前記髄内釘挿入器具の軸方向に延在する、半径方向に弾性のある１以上の突出部を備え、
    　前記１以上の突出部の先端は、前記髄内釘挿入器具の半径方向に突出した第１の凸部を備え、
    　前記髄内釘の一方の端部に設けられた穴部に前記髄内釘挿入器具を挿入すると、前記第１の凸部が前記穴部の一部と係合するようにされる、髄内釘挿入器具。     An intramedullary nail insertion device used for intramedullary nails.
    The intramedullary nail insertion device comprises one or more radialally elastic protrusions at one end that extend axially from the surface of the one end.
    The tip of the one or more protrusions comprises a first radial protrusion of the intramedullary nail insertion device.
    When the intramedullary nail insertion device is inserted into a hole provided at one end of the intramedullary nail, the first convex portion is made to engage with a part of the hole. Nail insertion device.
  7. 　前記髄内釘挿入器具は、前記一方の端部の外周に、前記髄内釘の前記一方の端部に設けられた１以上の外周溝部に嵌るように形成された１以上の第２の凸部を備える、請求項６に記載の髄内釘挿入器具。 The intramedullary nail insertion device has one or more second protrusions formed on the outer periphery of the one end so as to fit into one or more outer peripheral grooves provided at the one end of the intramedullary nail. The intramedullary nail insertion device according to claim 6, further comprising a portion.
  8. 　前記髄内釘挿入器具は、他方の端部に髄内釘挿入器具ハンドルとの接続部をさらに備える、請求項６又は７に記載の髄内釘挿入器具。 The intramedullary nail insertion device according to claim 6 or 7, wherein the intramedullary nail insertion device further includes a connection portion with an intramedullary nail insertion device handle at the other end.
  9. 　前記髄内釘挿入器具は、長手方向に延在する貫通孔をさらに備え、髄内釘挿入器具ロックが前記貫通孔に挿入される、請求項６～８のいずれか一項に記載の髄内釘挿入器具。 The intramedullary nail insertion device according to any one of claims 6 to 8, further comprising a through hole extending in the longitudinal direction, and the intramedullary nail insertion device lock is inserted into the through hole. Nail insertion device.
  10. 　前記髄内釘挿入器具は、クロススクリュードリルガイドとの接続部をさらに備える、請求項６～９のいずれか一項に記載の髄内釘挿入器具。
          The intramedullary nail insertion device according to any one of claims 6 to 9, further comprising a connection portion with a cross screw drill guide.
PCT/JP2021/022261 2020-08-18 2021-06-11 End cap used for intramedullary nail, intramedullary nail, end cap insertion instrument, and intramedullary nail insertion instrument WO2022038871A1 (en)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005506126A (en) * 2001-10-17 2005-03-03 ジンテーズ　アクチエンゲゼルシャフト　クール Bone fixation system
JP2011521718A (en) * 2008-05-23 2011-07-28 ノヴァリン・オルソペディクス・インコーポレーテッド Modular segmented intramedullary system, apparatus, and related methods
CN210697787U (en) * 2019-05-21 2020-06-09 江苏安格尔医疗器械有限公司 Interlocking intramedullary nail sealing cap
JP2020092790A (en) * 2018-12-11 2020-06-18 株式会社ホムズ技研 Bone fixation system

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE69732226T2 (en) * 1995-03-27 2005-12-22 SDGI Holdings, Inc., Wilmington SPIN-FUSION IMPLANT AND INTRODUCTION AND INSPECTION TOOLS

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005506126A (en) * 2001-10-17 2005-03-03 ジンテーズ　アクチエンゲゼルシャフト　クール Bone fixation system
JP2011521718A (en) * 2008-05-23 2011-07-28 ノヴァリン・オルソペディクス・インコーポレーテッド Modular segmented intramedullary system, apparatus, and related methods
JP2020092790A (en) * 2018-12-11 2020-06-18 株式会社ホムズ技研 Bone fixation system
CN210697787U (en) * 2019-05-21 2020-06-09 江苏安格尔医疗器械有限公司 Interlocking intramedullary nail sealing cap

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