WO2023143149A1

WO2023143149A1 - Intramedullary fixing system for fracture end

Info

Publication number: WO2023143149A1
Application number: PCT/CN2023/072224
Authority: WO
Inventors: 陈聚伍
Original assignee: 陈聚伍
Priority date: 2022-01-25
Filing date: 2023-01-14
Publication date: 2023-08-03
Also published as: CN114917006A

Abstract

Provided is an intramedullary fixing system for a fracture end, comprising an intramedullary main nail (1) sleeved at the end portion of a bone cavity, and further comprising a transverse rod piece (2) and longitudinal rod pieces (5). A transverse through hole (3) is formed in the outer end portion of the intramedullary main nail (1), the transverse rod piece (2) mates with and is sleeved and fixed in the transverse through hole (3), a series of longitudinal through holes (4) are formed in the transverse rod piece (2), and at least one said longitudinal rod piece (5) mates with and is sleeved and fixed in the corresponding longitudinal through hole (4). The intramedullary fixing system for a fracture end is used in minimally invasive surgery, can firmly fix the fracture end portion, such as the fracture of distal radius, and is particularly suitable for effectively treating a comminuted fracture at the fracture end portion, and can fix a plurality of bone pieces at the same time.

Description

A fracture end intramedullary fixation system

technical field

The invention belongs to the technical field of fracture end fixation instruments, and in particular relates to a fracture end intramedullary fixation system.

Background technique

Distal radius fractures are very common. Fractures occur within 2 to 3 cm of the distal radius, and are often accompanied by damage to the radiocarpal joint and inferior radioulnar joint. At present, most of the fixation methods for radius fractures are closed reduction and plaster. To prevent the rotation of the patient's wrist from affecting the reduction of the fracture, but the existing fixation devices for distal radius fractures are relatively complicated to operate, which wastes a lot of time and energy for medical staff when fixing, and the patient's palm is often fixed laterally , Long-term horizontal fixation makes the palm of the patient more uncomfortable and increases the pain of the patient.

In addition, distal radius fractures also include the use of external fixation brackets. External fixation brackets are an in vitro medical device widely used in the fields of trauma orthopedics and limb reconstruction. At present, external fixation brackets mostly use screw-rod systems. The way of external fixation rod is fixed by nail clip. The non-movable joint connection of the external fixator brings stiffness in the late stage of the joint, and the mobility disorder and the movable joint connection bring the disadvantages of unstable fracture ends and low mobility, which is very inconvenient for the patient to move.

The publication number is CN203074838U, an elastic radial fracture external fixator, comprising a fracture proximal fixation part and a fracture distal fixation part, and a connecting part for connecting the fracture proximal fixation part and the fracture distal fixation part. This plan includes the fracture distal fixation part, the fracture proximal fixation part and the connection part, in which the connection part is fixed by the elastic method of distal suspension, because this method has little effect on the joint movement in all directions and the fracture stability is good, but In this solution, long screws are required for fixing the nail clip, resulting in long length of screws exposed to the limbs, making it difficult for the patient to move the limbs and wear clothes, which seriously affects the convenience of the patient's carrying, and brings great inconvenience to the patient, especially those who need to carry for a long time. Huge pain; unable to place multiple One nail clip means that multiple external fixation screws cannot be placed within a short distance. When the fracture is located at the distal or proximal end of the diaphysis, multiple screws cannot be placed at the distal or proximal end of the shorter fracture. Joint fixation affects joint function. Publication No. 214342852U discloses an external fixation device for distal radius fractures, which includes an arc-shaped supporting plate. The outer surface of the arc-shaped supporting plate is threadedly connected with a support plate by bolts. The inner wall of the support plate is provided with a limiting groove. The inner wall of the support plate is slidingly connected with a cross bar, one end of the cross bar is fixedly connected with a support column, the bottom of the middle part of the support column is fixedly connected with a limit cylinder, the outer surface of the support plate is movably connected with a pull rod, and one end of the pull rod is fixedly connected with a pull ring, The inner wall of the curved supporting plate is fixedly connected with Velcro. The arc-shaped supporting plate of the external fixation bracket of this solution is bulky, which leads to joint stiffness and mobility impairment. This movable joint connection method brings the shortcomings of unstable fracture ends and low mobility, which is very inconvenient for the patient to move.

Fractures at the end of the bone are often accompanied by comminuted fractures, and there will be multiple bone fragments, which are not easy to fix. Currently, fixation with steel plates is an invasive operation, with large trauma and high chance of accidental injury. Infection and nonunion, delayed healing, broken nails and broken plates occur from time to time. The postoperative scar is large and affects the appearance. The inner nail adopts closed and minimally invasive technology, and the interlocking intramedullary nail can prevent fracture rotation deformity and reduce the risk of implant fracture. In addition, the structure of the end of the bone is special, the bone surface is uneven, and the firmness of the single plate and some screws needs to be improved.

Contents of the invention

Aiming at the problem that there is no effective minimally invasive surgical instrument for bone end fractures in the prior art, the present invention provides a fracture end intramedullary fixation system, which is used to effectively treat comminuted fractures, and can treat multiple bone fragments at the same time. fixed.

The solution adopted by the present invention to solve the technical problem is: a fracture end intramedullary fixation system, which includes the main intramedullary nail set on the end of the bone cavity, and also includes a transverse bar and a longitudinal bar. The outer end of the nail is provided with a transverse through hole, and the transverse bar is fitted and fixed in the transverse through hole. A series of longitudinal through holes are distributed on the transverse bar, and at least one longitudinal bar is matched and fixed in the corresponding longitudinal through hole.

The said transverse hole has a rectangular structure, the transverse bar is a strip plate, and the transverse bar is matched and set in the transverse hole.

The sleeve fixing structure between the cross bar and the intramedullary main nail is that there are threaded parts at both ends of the cross bar, and each threaded part is matched with a lock nut.

The set-up structure between the cross-bar part and the intramedullary main nail is that there is a longitudinal positioning hole on the intramedullary main nail, and a central positioning hole is arranged in the center of the cross-bar part, which is connected with the longitudinal positioning hole through a central screw. After connecting with the central positioning hole, fix the cross bar on the upper part of the intramedullary main nail, and the longitudinal positioning hole is located at the corresponding position on the side wall of the transverse hole. And the central positioning hole, so that the crossbar and the main intramedullary nail are fixed together.

The set-up structure between the cross bar and the intramedullary main nail is that there is an axial screw hole at the axis of the outer end of the intramedullary main nail. After being installed in the transversal hole, the axial locking nail presses the middle part of the cross bar from the top, so that the cross bar is fixed together with the main intramedullary nail.

The distal end of the main intramedullary nail can also be provided with a locking hole, and a locking nail can be matched with it.

A series of longitudinal perforations are distributed on the cross member, the inner walls of each longitudinal perforation have internal threads respectively, and the longitudinal members also have external threads respectively, so that each longitudinal member can be threadedly connected to the internal threads of the corresponding longitudinal perforations.

The longitudinal rod adopts a threaded longitudinal rod, one end of which has a cap and the other end is equipped with a lock nut, or both ends of the longitudinal rod are equipped with lock nuts, and the two ends of the fracture end are simultaneously pressurized and fixed by the lock nuts at both ends.

The longitudinal through hole of the cross member is a bar-shaped hole without thread, and the longitudinal bar is plate-shaped, and the plate-shaped longitudinal bar can be matched and inserted into the corresponding bar-shaped hole.

A concave plane is set in the middle part of the upper side of the cross bar, and the inner end plane of the shaft locking nail is inserted into the concave plane to form a locking nail relationship.

The rear portion of some or all of the longitudinal rods is designed as a wedge-shaped structure (28), that is, the width of the front end of the longitudinal rods is smaller than the width of the rear end, and the sides are sloped.

Beneficial effects of the present invention: the present invention belongs to minimally invasive surgery, which can treat fracture ends such as distal radius It is especially suitable for effective treatment of comminuted fractures at the end of the fracture, and can fix multiple bone fragments at the same time.

The main intramedullary nail is used for implanting from the drilled hole at the end of the fracture, keeping its outer end (upper end) at the corresponding position in the cavity of the end of the fracture. The end of the bone is drilled transversely and reamed into an approximately rectangular structure, which matches the shape of the transversal hole, and the crossbar is inserted through, that is, the two ends of the crossbar are inserted into the reamed hole of the bone cavity, and the middle part is inserted into the main intramedullary nail in the transverse hole. The intramedullary main nail is used as the main supporting part, and the cross bar is fixed on the end of the fracture, and the cross bar is used as the supporting part, and multiple longitudinal bars are fixed on the cross bar, thus forming a vertical, horizontal and longitudinal structure. Three-dimensional structure. Yes, the fracture end forms a high-strength support structure, which can fix multiple bone fragments at the same time, and its operation method is relatively simple and standardized. In addition, the locking nuts at both ends cooperate with the longitudinal bar to simultaneously provide pressure to both sides of the fracture end to achieve pressurization and fixation.

The longitudinal member can also be designed as a plate, which can be matched and inserted into the corresponding strip hole. The width direction of the plate shape can be either horizontal, vertical, or oblique, and various models can be selected and used according to the corresponding needs.

There may also be a central positioning hole in the center of the cross bar, and after connecting with the longitudinal positioning hole and the central positioning hole through the central screw, the cross bar is fixed on the upper part of the main intramedullary nail. Alternatively, there is an axial screw hole at the axial center of the outer end of the intramedullary main nail 1 , and an axial locking screw is matched and installed therein. After the cross-bar is installed in the transverse hole, the central locking nail presses the middle part of the cross-bar from the top, so that the cross-bar and the intramedullary main nail are fixed together.

When a strip-shaped cross-through hole is designed in the middle of the cross-bar member, the self-tapping threads with threaded edges can be screwed into corresponding positions in the strip-shaped cross-through hole of the cross-bar member respectively. When a honeycomb porous structure is designed in the middle of the cross bar, the self-tapping threads with threaded edges of the plurality of longitudinal bar parts can be respectively screwed into the corresponding perforations in the honeycomb porous structure of the cross bar. This provides a wide range of fixed environments.

It is also possible to design part or all of the rear part of the longitudinal member as a wedge-shaped structure, after being connected to the transverse hole, as the pressure increases, the connection strength also increases.

Description of drawings

Fig. 1 is a schematic structural diagram of an example of the present invention.

FIG. 2 is a schematic diagram of the assembly relationship in FIG. 1 .

Fig. 3 is a schematic diagram of the side structure of the song in Fig. 1 .

Fig. 4 is a schematic diagram of the structure of the double lock nut of the cross bar.

Fig. 5 is a schematic diagram of the assembly structure of the plate type cross bar.

Fig. 6 is a schematic diagram of the assembly relationship of the central screw.

Fig. 7 is a schematic diagram of the assembly relationship of the shaft locking thread.

Fig. 8 is one of the schematic diagrams of the structure of the bar-shaped hole.

Fig. 9 is the second schematic diagram of the structure of the bar-shaped hole.

Fig. 10 is a structural schematic diagram of a combined cross member.

Fig. 11 is a schematic diagram of the structure of the honeycomb cross bar.

Fig. 12 is a schematic diagram of the structure of the longitudinal rod.

Detailed ways

The present invention will be further described below in conjunction with the accompanying drawings and embodiments.

Embodiment 1: An intramedullary fixation system for a fracture end, as shown in FIG. 1 , the system mainly includes a vertical main intramedullary nail 1 , a transverse cross bar 2 and a longitudinal longitudinal bar 5 . The components are set and fixed together in turn, and the combination is applied to the end of the fracture. This system is mainly designed for the lack of effective minimally invasive surgical instruments for bone end fractures, so as to achieve effective treatment of comminuted fractures and simultaneous treatment of fractures. Multiple bone fragments are used for fixation.

Specifically, it can be seen from Fig. 1 and Fig. 2 that the upper part of the main intramedullary nail 1 is provided with a transverse hole 3, and In this embodiment, the shape of the transverse hole 3 is rectangular, and the shape of the transverse bar 2 is a plate structure, and the shape of the transverse hole 3 matches or approximately matches the shape of the transverse bar 2 .

The main intramedullary nail 1 is used for implanting from the drilled hole at the end of the fracture, keeping its outer end (upper end) at the corresponding position in the cavity of the end of the fracture. The distal end of the main intramedullary nail 1 may also be provided with a locking hole 6, and a locking nail is installed in conjunction with it. That is, the distal end of the main intramedullary nail 1 goes deep into the bone cavity, drills a hole at the corresponding position on the wall of the bone cavity, and inserts the locking nail into the lock hole 6 from the hole drilled on the wall of the bone cavity, so that the main intramedullary nail 1 can be fixed in the bone cavity.

The end of the bone is drilled transversely and reamed into an approximately rectangular structure, which matches the shape of the transverse hole 3, and is inserted through the crossbar part 2, that is, the two ends of the crossbar part are inserted into the reamed hole of the bone cavity, and the middle part is inserted into the marrow In the transverse hole 3 of the main nail 1.

It can be seen from FIG. 2 that there are threaded parts at both ends of the cross bar member 2, and each threaded part is matched with a lock nut 7 installed. The lock nut and the cross bar are installed, and the lock nuts on both sides are fixedly pressed on the reaming holes on the outside of the bone wall respectively. The lock nut can be designed to include a spacer, or a spacer can be set inside the lock nut, and the spacer should preferably match the outer surface of the bone wall.

As shown in FIG. 2 , a series of longitudinal through holes 4 are distributed on the cross member. In this embodiment, the inner walls of each of the longitudinal through holes 4 have internal threads respectively. There are also external threads on each longitudinal rod member, so that each longitudinal rod member can be screwed into the corresponding longitudinal through hole internal thread.

Specifically, drill holes longitudinally at the end of the fracture, including drilling longitudinally along the bone fragments, inserting the longitudinal rod through the bone segment or the drill hole of the bone fragment, and screwing the inner end of the longitudinal rod to the cross rod In the longitudinal perforation, a stable structure is formed.

Based on the above structural features, as shown in Figure 3, the intramedullary main nail 1 is used as the main supporting part to fix the cross bar at the end of the fracture, and the cross bar is used as the supporting part to fix multiple longitudinal bar parts to the cross bar Components, thus forming a vertical, horizontal and vertical three-dimensional structure. Yes, the fracture end forms a high-strength support structure, which can fix multiple bone fragments at the same time, and its operation method is relatively simple and standardized. The system can effectively treat comminuted fractures and fix multiple bone fragments at the same time.

Embodiment 2: Based on the structural scheme of Embodiment 1 above, the longitudinal rod adopts the structural form shown in Figure 4, that is, a threaded longitudinal rod is used, one end of which contains a cap, and the other end is a lock nut 8. Or both ends are lock nuts 8. Therefore, by using the lock nuts at both ends to cooperate with the longitudinal rod member, pressure can be provided on both sides of the fracture end at the same time, so as to realize pressurization and fixation.

Embodiment 3: On the basis of Embodiment 1, the longitudinal through hole of the cross member 2 is designed to be a bar-shaped hole 10, which does not contain threads, that is, a through hole. The longitudinal rod is in the shape of a plate 9 , and the plate-shaped longitudinal rod can be matched and inserted into the corresponding strip-shaped hole 10 . It can be seen from FIG. 5 that the two ends of the plate-shaped longitudinal rod have threaded sections respectively, and are respectively connected with lock nuts. There is no possibility of rotation in the plate-shaped longitudinal bar member in this embodiment. The width direction of the plate shape can be either horizontal (as shown in Figure 5), vertical or oblique, and various models can be selected and used according to corresponding requirements. That is, the corresponding longitudinal perforations can be flat, vertical or oblique.

Embodiment 4: On the basis of Embodiment 2, a plane 12 is provided on the side of the longitudinal rod. As shown in Figure 6, a plane 11 is provided on the inner wall of the longitudinal perforation. possible.

Embodiment 5: On the basis of Embodiment 1, the main intramedullary nail 1 is designed to have a longitudinal positioning hole 13, and a central positioning hole in the center of the cross member 2, through which the central screw 14 is connected to the longitudinal positioning hole 13 and the center. After the hole is positioned, the cross bar member 2 is fixed on the upper part of the main intramedullary nail 1 . As shown in Figure 6, the longitudinal positioning hole 13 is located at the corresponding position on the side wall of the transverse hole 3. When the cross bar member 2 is penetrated and installed in the transverse hole 3, the central screw 14 penetrates the longitudinal positioning hole 13 and the central positioning hole at the same time, so that The cross bar is fixed together with the main intramedullary nail 1 .

Embodiment 6: On the basis of Embodiment 1, an axial screw hole 15 is designed at the axial center of the outer end of the main intramedullary nail 1 , and an axial locking nail 16 is matched and installed therein. After the cross bar 2 is installed in the cross hole 3 , the axial locking nail 16 presses the middle part of the cross bar from the top, so that the cross bar and the main intramedullary nail 1 are fixed together. It can be seen from Fig. 7 that a concave plane 17 can be further set in the middle of the upper side of the cross member, which is the axis locking nail The inner end plane of 16 is inserted into the concave plane 17 to form a locking nail relationship.

Embodiment 7: On the basis of Embodiment 1, design a cross bar as shown in FIG. 8 , that is, a strip-shaped transverse hole 18 is designed in the middle of the cross bar. Correspondingly, the plurality of longitudinal rods are respectively self-tapping threads 19 containing threaded edges, and the outer diameter of the thread of the self-tapping thread is slightly larger than the width of the transverse hole, so that each automatic wire can be screwed into the strip-shaped transverse hole of the transverse member respectively. Corresponding positions within 18.

This implementation is mainly designed for the irregular distribution of fracture fragments or a large number of fragments. The longitudinal rod can penetrate and fix along the center of the bone fragments, and the strip-shaped transverse holes 18 provide a wide range of fixing environments.

Embodiment 8: On the basis of Embodiment 7, as shown in FIG. 9, a series of protrusions 21 are arranged at equal intervals in the strip-shaped transverse holes 18, and grooves 20 are formed between adjacent protrusions. The solution is Multiple grooves are distributed side by side, and any groove can be selected to fit the corresponding bone piece. The protrusion and the inner wall of the groove can have more contact area with the self-tapping thread 19 .

Embodiment 9: On the basis of Embodiment 7, the cross bar is composed of two U-shaped rods, as shown in Figure 10. The right U-shaped rod 23 is set on the outside of the left U-shaped rod 22. The fork distribution of the U-shaped bar is elastic and has a certain deformation capacity. The contact surfaces of the fork rods of the two U-shaped rods are designed as a convex-concave joint structure 24 . An annular outer pressure plate 26 is distributed on the outer ends of the two U-shaped bars. A convex-concave engagement structure 25 is provided between the outer surface of the fork bar of the right (outer) U-shaped bar and the inner wall of the transverse hole. The clearance of the left U-shaped rod 22 is equal to the implementation of the strip-shaped cross-cutting hole 18 in 8. The multiple longitudinal rods are self-tapping threads 19 with threaded edges, and the outer diameter of the thread of the self-tapping thread is slightly larger than that of the left U-shaped thread. The width of the gap of the type bar 22, so that each automatic wire can be screwed into the corresponding position in the gap of the left side U-shaped bar 22 respectively.

When installing, insert the right U-shaped bar first, make it fit in place with the transverse hole, and then insert the left bar, make it match with the right bar in place. Simultaneously press the annular outer pressure plates 26 of the U-shaped rods on both sides inwardly to increase the pressurization on both sides of the fracture end.

It can be seen that the combined cross bar used in this embodiment can not only be firmly connected with the transverse hole of the main intramedullary nail 1 Connection, and the assembly can be firmly connected, and the convex-concave joint structure can maintain a certain inward pressure without loosening.

Embodiment 10: On the basis of Embodiment 1, design a cross bar as shown in FIG. 11 , that is, a honeycomb porous structure 27 is designed in the middle of the cross bar. Specifically, the cross member includes a rectangular frame on the outside, and a honeycomb porous structure 27 on the inside of the rectangular frame. Correspondingly, the plurality of longitudinal rods are respectively self-tapping threads 19 containing threaded edges, and the outer diameter of the self-tapping thread is slightly larger than the inner diameter of the honeycomb perforation, so that each automatic thread can be screwed into the honeycomb porous structure of the horizontal rod. 27 in the corresponding perforation.

Implementation 11: On the basis of the above implementation, a wedge-shaped structure 28 is designed at the rear of part or all of the longitudinal rods, that is, the width of the front end of the longitudinal rods is smaller than the width of the rear end, and the sides are sloped. As shown in FIG. 12 , after the longitudinal rod is connected to the transverse hole 3 , as the pressure increases, the connection strength also increases. It is not excluded to provide a convex-concave engagement structure or a sawtooth structure in the transverse hole or on the side of the wedge-shaped structure.

On this basis, a threaded segment is provided at the distal end of a longitudinal rod member with a wedge structure for installing the lock nut 8 .

It can be seen that this implementation is mainly designed for the irregular distribution of fracture fragments or a large number of fragments. Different self-tapping screws can choose to move horizontally or vertically, and finally select the best screw-in position to connect to the honeycomb porous structure. 27, so that the honeycomb porous structure 27 is used in this implementation to provide a wider fixed environment.

Claims

An intramedullary fixation system for a fracture end, comprising an intramedullary main nail (1) sleeved at the end of a bone cavity, characterized in that it also includes a transverse bar (2) and a longitudinal bar (5), the intramedullary The outer end of the main nail (1) is provided with a transverse through hole (3), the cross bar (2) is matched and fixed in the transverse through hole (3), and a series of longitudinal through holes (4) are distributed on the cross bar (2), at least A longitudinal rod (5) is matched with the suit and fixed in the corresponding longitudinal through hole (4).
The fracture end intramedullary fixation system according to claim 1, characterized in that, the transverse hole (3) is a rectangular structure, the transverse bar (2) is a strip plate, and the transverse bar (2) is matched and sleeved on the transverse inside the perforation (3).
The fracture end intramedullary fixation system according to claim 1 or (2), characterized in that the set-up structure between the cross bar and the main intramedullary nail is at the two ends of the cross bar (2) There are threaded parts respectively, and each threaded part is matched with a lock nut (7) installed.
The fracture end intramedullary fixation system according to claim 1 or 2, characterized in that, the set-up structure between the cross member and the main intramedullary nail is longitudinally positioned on the main intramedullary nail (1). The hole (13) has a central positioning hole in the center of the cross bar (2), and after connecting the longitudinal positioning hole (13) and the central positioning hole through the central screw (14), the cross bar (2) is fixed on the On the upper part of the intramedullary main nail (1), the longitudinal positioning hole (13) is located at the corresponding position on the side wall of the transverse hole (3). At the same time, it runs through the longitudinal positioning hole (13) and the central positioning hole, so that the cross bar is fixed together with the intramedullary main nail (1).
The fracture end intramedullary fixation system according to claim 1 or 2, characterized in that, the set-up structure between the cross member and the intramedullary main nail is the shaft at the outer end of the intramedullary main nail (1). There is an axial screw hole (15) at the center, and an axial locking nail (16) is matched and installed in it. When the cross member (2) penetrates and is installed in the transverse hole (3), the axial locking nail (16) is installed from the top Constantly press the middle part of the cross bar, so that the cross bar is fixed together with the intramedullary main nail (1), and a concave plane (17) is set on the upper middle part of the cross bar, which is the inner part of the axial locking nail (16). The end plane is inserted into the concave plane (17) to form a locking nail relationship.
The fracture end intramedullary fixation system according to claim 1, characterized in that the main intramedullary nail (1) The far end of the lock hole (6) can also be provided with a locking nail.
The fracture end intramedullary fixation system according to claim 1, characterized in that a series of longitudinal perforations (4) are distributed on the cross bar, and the inner walls of each longitudinal perforation (4) have internal threads respectively, and the longitudinal bar also has Each has an external thread, so that each longitudinal member can be screwed into a corresponding internal thread of the longitudinal bore.
The fracture end intramedullary fixation system according to claim 1, wherein the longitudinal rod is a threaded longitudinal rod, one end of which has a cap, and the other end is equipped with a lock nut (8), or both ends of the longitudinal rod are A lock nut (8) is installed, and both sides of the fracture end are simultaneously pressurized and fixed by using the lock nuts at both ends.
The fracture end intramedullary fixation system according to claim 1, characterized in that, the longitudinal perforation of the cross member (2) is a bar-shaped hole (10) without thread, the longitudinal member is a plate (9), the The plate-shaped longitudinal rods can be matched and inserted in the corresponding strip-shaped holes (10).
The fracture end intramedullary fixation system according to claim 5, characterized in that, the rear portion of part or all of the longitudinal rods is designed as a wedge-shaped structure (28), that is, the width of the front end of the longitudinal rods is smaller than the width of the rear end, and the side is inclined plane.