WO2022038871A1 - Capuchon d'extrémité utilisé pour clou intramédullaire, clou intramédullaire, instrument d'insertion de capuchon d'extrémité et instrument d'insertion de clou intramédullaire - Google Patents

Capuchon d'extrémité utilisé pour clou intramédullaire, clou intramédullaire, instrument d'insertion de capuchon d'extrémité et instrument d'insertion de clou intramédullaire 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
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PCT/JP2021/022261
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English (en)
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 date
Application filed by 株式会社日本エム・ディ・エム filed Critical 株式会社日本エム・ディ・エム
Publication of WO2022038871A1 publication Critical patent/WO2022038871A1/fr

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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

L'invention concerne un capuchon d'extrémité qui peut être ajusté dans une section d'extrémité d'un clou intramédullaire même sans compétence. Ce capuchon d'extrémité a, sur une section d'extrémité de celui-ci, une ou plusieurs sections en saillie qui s'étendent dans la direction axiale du capuchon d'extrémité à partir de la surface de la section d'extrémité et ont une élasticité radiale, les pointes de l'au moins une section en saillie ayant chacune une première section en saillie faisant saillie dans une direction radiale du capuchon d'extrémité ; et lorsque le capuchon d'extrémité est inséré dans une section de trou disposée sur la section d'extrémité du clou intramédullaire, la première section en saillie vient en prise avec une partie de la section de trou.
PCT/JP2021/022261 2020-08-18 2021-06-11 Capuchon d'extrémité utilisé pour clou intramédullaire, clou intramédullaire, instrument d'insertion de capuchon d'extrémité et instrument d'insertion de clou intramédullaire WO2022038871A1 (fr)

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JP2020137867A JP2022034191A (ja) 2020-08-18 2020-08-18 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
JP2020-137867 2020-08-18

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005506126A (ja) * 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 骨用固定システム
JP2011521718A (ja) * 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 モジュール式セグメント化髄内システム、装置、および関連方法
CN210697787U (zh) * 2019-05-21 2020-06-09 江苏安格尔医疗器械有限公司 一种交锁髓内钉封帽
JP2020092790A (ja) * 2018-12-11 2020-06-18 株式会社ホムズ技研 骨固定システム

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE69737756T2 (de) * 1995-03-27 2008-01-31 Warsaw Orthopedic, Inc., Minneapolis Wirbelsäulenfusionsimplantat

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005506126A (ja) * 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 骨用固定システム
JP2011521718A (ja) * 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 モジュール式セグメント化髄内システム、装置、および関連方法
JP2020092790A (ja) * 2018-12-11 2020-06-18 株式会社ホムズ技研 骨固定システム
CN210697787U (zh) * 2019-05-21 2020-06-09 江苏安格尔医疗器械有限公司 一种交锁髓内钉封帽

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