CN101778604B - 高度多功能可变角骨板系统 - Google Patents

高度多功能可变角骨板系统 Download PDF

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CN101778604B
CN101778604B CN200880103402.7A CN200880103402A CN101778604B CN 101778604 B CN101778604 B CN 101778604B CN 200880103402 A CN200880103402 A CN 200880103402A CN 101778604 B CN101778604 B CN 101778604B
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詹森·S·陈
阿尔伯特·A·费尔南德斯·戴尔奥卡
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
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    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
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    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/864—Pins or screws or threaded wires; nuts therefor hollow, e.g. with socket or cannulated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/067—Measuring instruments not otherwise provided for for measuring angles

Abstract

一种用于骨折内固定的骨板系统包括具有多个骨板孔的骨板。所述孔被构造成容纳非锁定、锁定接骨螺钉、或可变角锁定接骨螺钉。所述孔具有绕所述孔的内表面布置的分离的螺纹片段的纵列，用于啮合锁定和可变角锁定接骨螺钉的头部上的螺纹。传统锁定接骨螺钉与所述骨板孔的中心轴同轴地啮合所述骨板。可变角锁定接骨螺钉可以以相对于所述骨板的角度范围内的可选角度啮合所述骨板。所述可变角锁定螺钉的头部至少部分呈球形，其上的螺纹具有沿着所述螺钉头球形部分的弧形曲率半径的剖面。

Description

高度多功能可变角骨板系统
相关申请的交叉引用
本申请要求2007年8月13日递交的美国临时申请No.60/955,506以及2008年1月9日递交的美国专利申请No.11/971,358的权益。这两个申请的全部内容通过引用而明确包含在本申请中。 
技术领域
本发明涉及用于内部骨折固定的骨板系统。更特别地，本发明涉及一种骨板系统，该骨板系统包括具有骨板孔的骨板，所述骨板孔被构造用于容纳非锁定的、锁定的或者可变角锁定的接骨螺钉。 
背景技术
用于骨折的内部固定的骨板系统是众所周知的。传统的骨板系统特别适合于促进骨折的愈合。接骨螺钉(也称为骨锚)穿过骨板孔(也称为锚栓孔)并拧入骨骼中，以将骨折端压紧、压制、加固、拉紧弯曲(tension bend)和/或桥接在一起并将骨骼靠向该板。这些没有固定到骨板的螺钉(以下称为“未锁定螺钉”)能够被以相对于该骨板的各种角度拧入骨骼。然而，由于所述螺钉没有固定到该骨板，因此该板与螺钉之间的角度关系不固定且可能在手术时和/或手术后改变。也就是说，来自生理条件的在骨骼和骨板上的动态负荷能够引起螺钉相对于该板松动或倒退出去。这能够导致差的校准和差的临床结果。 
将螺钉固定到板上提供了螺钉和板之间固定的角度关系并降低松动的发生率。能够固定到骨板上的螺钉的一个已知实施例在螺钉头的外表面上具有螺纹。该螺钉头上的螺纹与骨板孔的内表面上的相应螺纹紧密结合，以将该螺钉锁定到该板上。通常将这些螺钉(以下称为“锁定螺钉”)与该孔的中心轴同轴地插入。由于锁定螺钉与该板之间的关系固定，因此锁定螺钉对切变应力、扭力以 及弯曲力提供了高阻力。然而，锁定螺钉压紧骨碎片的能力有限，这会影响愈合。 
因此，总而言之，由锁定螺钉和骨板形成的接合对切变应力具有高阻力，以在螺钉/板接合处维持稳定性，但是具有有限的压紧骨碎片的能力，而由非锁定接骨螺钉和骨板形成的接合有效地压紧骨碎片，但是对切变应力具有低阻力，这会导致螺钉松动或倒退出去。因此，在许多临床情况下需要结合非锁定螺钉和锁定螺钉的骨板系统。 
一种已知的能够容纳锁定和非锁定螺钉的骨板系统包括具有多个螺纹板孔和多个无螺纹板孔的骨板，所述螺纹板孔用于容纳锁定螺钉，所述无螺纹板孔用于容纳非锁定螺钉。然而，在该已知系统中的非锁定螺钉仅临时用于在插入锁定螺钉时将板保持在适当的位置。在插入锁定螺钉后，将非锁定螺钉移除。因此，并未获得结合非锁定螺钉和锁定螺钉的长期利益。 
另一种已知的容纳两种螺钉的骨板系统包括具有部分螺纹板孔的骨板。所述部分螺纹孔容纳锁定或非锁定螺钉。然而，由于所述板孔仅部分具有螺纹，因此锁定螺钉在生理负担下可能不能维持所述螺钉和板之间的固定角度关系。特别地，在板内的锁定螺钉只有部分被螺纹环绕，因而只有部分被固定。在高应力和负担条件下，锁定板孔可能变形并允许锁定螺钉和板之间的固定角度关系改变。这能够导致固定或板方向的丧失。另外，由于板孔的几何结构，具有非锁定螺钉的板的平移仅限于一个方向。这可能不利于骨折复位和手法复位。 
又一种已知的容纳两种螺钉的骨板系统包括具有螺纹和无螺纹板孔的骨板。螺纹板孔容纳锁定螺钉，无螺纹板孔容纳非锁定螺钉，每种板孔都意图在植入该板时保持插入。然而，由于锁定螺钉仅在与螺纹孔一起使用时才有效，因此该系统的缺点在于该板中螺纹孔的数量和位置不能根据需要用于特定外科程序。例如，在外科医生更希望有一个用于插入锁定螺钉的螺纹孔的位置可能有一个或多个无螺纹孔。 
进一步对于上述已知的骨板系统，外科医生经常希望能够将锁定接骨螺钉以外科医生选择的相对于骨板的角度插入穿过骨板孔。已知一些所谓的“多轴” 骨板系统。许多系统使用位于板孔中的衬套来锁定相对于该板的螺钉角度的度数。在一个这样的系统中，该衬套可在板孔中旋转。通过该衬套和板孔将所谓的“可变角锁定”螺钉拧入骨骼。当该螺钉被拧入骨骼时，该螺钉的螺纹锥形头部啮合该衬套的螺纹内部表面，以扩展该衬套倚靠板孔的内表面或内壁，从而摩擦力将螺钉锁定在期望的相对于骨板的角度上。 
在另一个已知的多轴骨板系统中，衬套以期望的角度位于板孔中。具有带有螺纹凹进的可扩展头部的紧固螺钉被插入穿过该衬套并被拧入骨骼中。然后，锁定螺钉被拧入螺钉头的凹进中，以向外扩展该头部倚靠该衬套，从而锁定所选择的螺钉相对于骨板的角度。 
在又一个已知的多轴骨板系统中，可扩展环被定位于板孔中。当具有锥形头部的接骨螺钉啮合该环并被拧入骨骼中时，该环扩展倚靠该孔的内表面或内壁，以锁定所选择的螺钉相对于骨板的角度。 
然而，这些多轴骨板系统具有多个部件，这在外科手术期间对于正骨可能是复杂的和笨重的，更特别地，例如，该衬套或可扩展环可能在外科手术期间突出来。 
鉴于前述内容，希望能够提供一种克服已知骨板系统的不足和缺点的改进的骨板系统。 
发明内容
本发明提供了一种高度多功能的可变角骨板系统，用于固定骨折。该系统包括具有多个骨板孔的骨板，所述骨板孔从该板的上表面至该板的下骨接触表面完全通过该骨板。所述孔被有利地构造成容纳非锁定、锁定接骨螺钉、或可变角锁定接骨螺钉。替代在传统骨板孔中已知的螺钉螺纹，所述板孔的内表面具有分离的齿或螺纹片段的纵列，用于啮合锁定和可变角锁定接骨螺钉的合适尺寸和构造的螺纹头部。 
本发明有利地允许具有合适尺寸和螺钉头形状的传统非锁定接骨螺钉用于所述骨板孔中。非锁定接骨螺钉具有用于啮合骨骼的螺纹杆轴以及其上不具有 用于固定或锁定到所述骨板的装置或结构(例如，螺纹)的螺钉头。非锁定螺钉可以以任何期望的角度被容纳在所述骨板孔中，然后该螺钉的杆轴被推进骨骼中，直至该螺钉的头部如所期望的一样位于所述骨板孔中。 
本发明还有利地允许具有合适尺寸、螺钉头形状、和螺钉头螺纹的传统锁定接骨螺钉用于所述骨板孔中。这些锁定接骨螺钉具有用于啮合骨骼的螺纹杆轴以及在螺钉头外表面上的螺钉螺纹，所述螺钉螺纹能够有利地啮合所述骨板孔中螺纹片段的纵列。锁定接骨螺钉与所述孔的中心轴同轴地被容纳在所述骨板孔中。也就是说，例如，如果所述孔的中心轴垂直于所述骨板的上表面，则锁定接骨螺钉以相对于该上表面约90度的角度被容纳在本发明的骨板孔中。锁定螺钉的杆轴被推进骨骼中，直至螺钉头啮合所述骨板孔，然后螺钉头螺纹啮合骨板孔中螺纹片段的纵列。然后推进该螺钉直至螺钉头如所期望的一样被拧入骨板孔中，所述骨板孔将螺钉固定到所述板上。 
根据本发明的可变角锁定接骨螺钉被插入通过骨板孔并以可选角度范围内的可选角度被锁定到该骨板上。在一个实施例中，可变角度范围形成绕孔的中心轴约30度的圆锥体。换句话说，螺钉的角度可以在任何方向上远离该孔的中心轴从0度到约15度变化。本发明的可变角锁定螺钉有利地不需要衬套、压缩冠、扩扩展环或可扩展头部来锁定螺钉相对于骨板的角度位置。 
本发明的可变角锁定螺钉有利地具有至少部分呈球形的头部。该头部的球形部分在其外表面上具有外螺钉螺纹。该螺钉螺纹的轮廓沿着该球形部分的弧形(非直线)外曲率半径。每个螺纹峰和每个螺纹谷(或者分别为螺纹术语中的冠部和根部)位于各曲率半径上，所述半径与螺钉头球形部分的曲率半径一致或平行/同心(即，具有相同的圆心)。换句话说，所述峰可以位于“主”曲率半径，该“主”半径与球形部分的曲率半径一致；而所述谷位于“次”曲率半径，其中，所述主曲率半径和次曲率半径具有相同的圆心，因此形成同心圆。应注意，该曲率半径的圆心不一定是螺钉头的圆心。在一个实施例中，螺纹剖面具有相交于所述螺钉头曲率半径的圆心的剖面线。剖面线表示在螺纹切刀的切刀头接触在其中切割螺纹的表面时该切刀头纵轴的延伸。相反地，传统锁定 螺钉头具有位于大体上直的、平行的线上的螺纹峰和谷(从断面上看)，而且这些峰和谷的剖面线彼此平行延伸而不相交于螺纹头部曲率半径的圆心(除了可能一个峰或谷的剖面线恰好与该圆心成一直线)。 
为为了方便拧入骨骼，每个接骨螺钉可以为自攻型和/或自钻型。每个接骨螺钉还可以为管状的，用于插入导丝，以引导螺钉安置。 
本发明的骨板不限于任何特定形状、尺寸、或构造。例如，在一个实施例中，该骨板具有头部部分和杆轴部分。所述头部部分的构造和尺寸符合骨骼的骨骺端，而所述杆轴部分的构造和尺寸符合骨骼的骨体。在另一个示例性实施例中，所述头部部分具有弧形表面并包括前部分支和后部分支，所述前部分支大体上平行于杆轴部分的前侧，而所述后部分支从杆轴部分的后侧延伸出去。在又一个示例性实施例中，所述头部部分从杆轴部分向外展开并弯曲、呈锥形、且扭曲。 
本发明的骨板孔不限于任何特定数量或布置。任选地，本发明的骨板孔可以具有长形无螺纹部分，以增强安置非锁定螺钉的多功能性。本发明的骨板还可以任选地具有缝合孔以及传统螺纹和/或无螺纹螺钉孔，但是任何类型的传统孔既不必要也不推荐。 
本发明还提供一种骨折固定方法。该方法包括：倚靠骨骼定位骨板；选择骨板孔，用以穿过该骨板孔插入接骨螺钉；选择非锁定接骨螺钉、锁定接骨螺钉，或者可变角锁定接骨螺钉；将所选的接骨螺钉插入穿过所选的骨板孔，并且如果可以，则选择相对于该孔的中心轴的插入角度；以及将该螺钉推入所述骨骼中，直至螺钉头位于或固定至所述骨板孔，以倚靠所述骨骼压紧所述骨板或固定所述螺钉和所述骨板之间的关系。大体上只要该骨板被植入，所述接骨螺钉就保持在该骨骼中。 
附图说明
本发明的上述和其他优点在考虑以下结合附图提供详细描述时会很清楚，在附图中，相同的参考符号始终指向相同的部分，其中： 
图1为传统非锁定接骨螺钉的正视图； 
图2为传统锁定接骨螺钉的立视图； 
图3A和图3B为传统锁定接骨螺钉的头部的立视图和截面图； 
图3C为图3A和图3B的锁定接骨螺钉的放大的局部截面图； 
图4A为齿条和齿轮的立体图； 
图4B为图4A的齿轮正立视图； 
图4C为图4B的齿轮的放大截面图； 
图5A为根据本发明的可变角锁定螺钉的立体图； 
图5B和图5C分别为图5A的可变角锁定螺钉的头部的正立视图和截面图； 
图6为根据本发明的可变角锁定螺钉的另一个实施例的截面图； 
图7为根据本发明的可变角锁定螺钉头的又一个实施例的截面图； 
图8为具有传统的锁定、非锁定以及结合锁定/非锁定骨板孔的骨板的一部分的立体图； 
图9A和图9B为根据本发明的骨板孔的一个实施例的立体图； 
图10A-C和10D-F为根据本发明的骨板孔的两个相似实施例的俯视图、截面图和立体图； 
图11为根据本发明的骨板孔的截面图； 
图12为图11的骨板孔的一列螺纹片段的放大、局部截面剖面图； 
图13为骨板系统的一个实施例的立体图，示出了根据本发明的可变角锁定螺钉的可选角度的范围； 
图14A和14B分别为骨板系统的一个实施例立体图和正立视图，示出了与根据本发明的骨板一起使用的非锁定螺钉、锁定螺钉和可变角锁定螺钉； 
图15A和15B分别为穿过根据本发明的骨板孔的非锁定螺钉的立体图和正立视图； 
图16A和17B分别为被推入根据本发明的骨板孔中的锁定螺钉的立体图和正立视图； 
图17A和17B分别为被推入根据本发明的骨板孔中的可变角锁定螺钉的立 体图和正立视图； 
图18A、图18B、图18C至图23A、图23B、图23C分别为根据本发明的骨板孔的各种特征的俯视图、截面图和立体图； 
图24A至图24D分别为根据本发明的骨板孔的俯视图、截面图、俯视立体图和仰视立体图； 
图25A-C、图26A-C和图27A-D为与根据本发明的骨板一起使用的钻头引导器的各种立体图； 
图28为根据本发明的骨板的一个实施例的立体图； 
图29A-C分别为根据本发明的骨板的另一个实施例的立体图、正立视图和俯视图； 
图30为根据本发明的骨板的底侧的立体图； 
图31为根据本发明应用于骨折的骨板的立体图； 
图32至图34分别为根据本发明的可变角锁定接骨螺钉的螺钉头的三个实施例的截面图；以及 
图35为根据本发明的可变角锁定接骨螺钉的螺钉头的放大局部截面图。 
具体实施方式
根据本发明的骨板系统包括骨板、可变角锁定螺钉、非锁定螺钉以及任选的锁定螺钉。该骨板优选具有骨板孔，所述骨板孔在孔的内表面周围具有分离的螺纹片段的纵列。该骨板还可以具有结合骨板孔，所述结合骨板孔的一部分具有螺纹片段的纵列，而一部分没有螺纹片段或螺纹。两种骨板孔优选被构造用于容纳非锁定螺钉、锁定螺钉和可变角锁定螺钉。任选地，本发明的骨板还可以具有缝合孔，以及而非必要的传统的螺纹孔、平滑孔(即没有螺纹片段或螺纹的孔)和/或其结合孔。 
图1示出了一种典型的非锁定接骨螺钉100，也称为骨质螺钉。一般来说，带有具有通常是平滑的表面的、对于所选择的板孔具有合适的尺寸和几何形状的无螺纹头部102的任何外科手术接骨螺钉都能够与本发明一起使用。头部102 的形状可以为例如圆锥形、直边形、球形、半球形等。非锁定螺钉100具有杆轴104，杆轴104至少部分地带有螺纹，以便附着至骨骼。杆轴104的长度和杆轴螺纹107的螺纹构造(例如，螺距、轮廓等)可以根据应用变化。如现有技术中已知的那样，尖端106和杆轴螺纹107可以为自攻型和/或自钻型，以方便植入骨骼。头部102和杆轴104还可以具有插管108，该插管108用于容纳导丝(guide wire)，以助于适当安置。 
图2示出了一种典型的锁定螺钉200。一般来说，具有螺纹头部202的任何外科手术接骨螺钉都能够与本发明一起使用，其中头部202具有对于所选择的板孔合适的尺寸和几何形状，并且螺纹203与该板孔中的螺纹片段的纵列紧密配合。头部202的形状通常为圆锥形，但是也可以为例如直边形。锁定螺钉200具有杆轴204，杆轴204至少部分带有螺纹，以便附着至骨骼。杆轴204的长度和杆轴螺纹207的螺纹构造(例如，螺距、轮廓等)可以根据应用变化。如现有技术中已知的那样，尖端206和杆轴螺纹207可以为自攻型和/或自钻型，以方便植入骨骼。头部202和杆轴204也可以为管状的，用于容纳导丝，以助于适当安置。 
图3A和图3B示出了一种典型的锁定螺钉300的头部302。如图3C所示，头部302上螺纹303的剖面包括通过螺纹面311相互连接的螺纹峰310和螺纹谷312。如在已知的锁定螺钉上通常的那样，头部302为圆锥形，通常被定向成使得螺纹峰310位于直线上，例如位于直线313或315上，且螺纹谷312位于另一条直线上，例如位于直线314或316上，其中直线对(313，314)以及(315，316)彼此平行。此外，如图3B中谷剖面线318a-318e所示，每个螺纹峰310和每个螺纹谷312的螺纹剖面线彼此平行延伸并与螺钉的中心轴319垂直或正交。通过当螺纹切刀的切刀头接触头部302的外表面时延伸切刀头305的纵轴301以切割螺纹303，形成剖面线318a-318e。典型的锁定螺钉还具有根据沿着中心轴(例如，319)测量时恒定的螺纹螺距(峰到峰的距离、谷到谷的距离、或剖面线到剖面线的距离)。 
根据本发明的可变角锁定螺钉具有至少部分呈球形的螺钉头。该头部的球 形部分在其外表面上具有螺纹，该螺纹优选为双线螺纹。该螺纹具有沿着该头部的球形部分的弧形(即，非直线)曲率半径的剖面。应注意：在沿着曲率半径测量时，螺纹螺距是恒定的，但是在沿着螺钉的中心轴从该头部的球形部分的一端(例如，顶端)到另一端(例如，底端)测量时，螺纹螺距从窄到宽再到窄变化(参见，例如图32-35及其下文中的描述)。这种螺纹剖面允许可变角锁定螺钉在角度范围内以可选角度啮合本发明的骨板孔，同时有利地维持与该骨板的接触程度相同而与所选角度无关。也就是说，在允许角度范围内螺钉相对于骨板孔的中心轴的角度不影响螺钉头螺纹相对于板孔的内表面的啮合。在螺钉和骨板之间有利地获得紧密的锁定，而与螺钉被插入骨板孔的角度(在角度范围内)无关，由于螺钉头的球形部分上的螺纹以完全相同的方式啮合螺纹片段的纵列，因而保证了良好的安装。 
本发明的骨板系统的一些有利特征可以通过类比齿条和齿轮来说明。虽然骨板系统与齿条和齿轮极不相关(齿条和齿轮用于例如汽车转向机构、以及机车和有轨车驱动机构)，但是本发明的骨板系统共用相似的构思。如图4A至图4C所示，齿条和齿轮400具有带有齿421的齿条420和带有齿423的圆形齿轮422。施加给齿轮422的旋转运动使得齿条420平移，而相反地，齿条420的直线运动或平移使得齿轮422旋转。 
该相似的构思在于在围绕齿轮422的曲率半径425布置齿423。如图4B和图4C中的剖面所示，齿轮的齿423等角分隔且沿着曲率半径425。另外，每个齿423都被定向成使得二等分该齿423的线(如线427所示)与曲率半径425的圆心426相交，从而形成具有半径424的圆。类似地，将相邻齿423之间的任何间隔428二等分的线(如线429所示)也与圆心426相交。根据本发明的可变角锁定螺钉的头部的螺纹剖面(从垂直于该螺钉的中心轴的方向观察)与图4C中的齿轮齿423和间隔428的部分剖面图相似。 
图5A至图5C示出了根据本发明的可变角锁定螺钉的一个实施例。可变角锁定螺钉500具有部分呈球形的头部502和杆轴504。头部502具有螺纹503，杆轴504具有螺纹507。头部502优选具有凹进509，用于容纳将螺钉推入骨骼 和从骨骼抽出、以及推入骨板孔和从骨板孔抽出的工具。优选地，尖端506和杆轴螺纹507为自攻型和/或自钻型，以方便植入骨骼。头部502和杆轴504可以为管状，用于容纳导丝，以助于适当安置。图5B和图5C示出了螺纹503的剖面，螺纹503有利地跟随曲率半径525。在一个实施例中，该半径为约2mm。在断面上观察到的螺纹503的各个峰510和谷512优选地隔开相等的角度增量。峰510和谷512由螺纹面511以螺纹角517连接，在本实施例中，所述螺纹角517优选为60度。螺纹剖面线518a-518f延伸穿过谷512且产生与曲率半径525的圆点526相交的一系列线。通过当螺纹切刀的切刀头505接触头部502的外部球形表面时延伸切刀头505的纵轴501以切割螺纹503，形成剖面线518a-518f。在本实施例中，当切割螺纹503时，切刀头505始终与头部502的外部球形表面正交。此外，在本实施例中，曲率半径为使得半径圆心526位于螺钉500的中心轴519上。取决于半径的长度和螺钉的尺寸，圆心526可以位于或不位于螺钉的中心轴上。另外，例如，如图6所示，当半径增大而螺钉的尺寸保持不变时，半径圆心将移到螺钉头的外部。 
图6示出了本发明的可变角锁定螺钉的另一个实施例。在本实施例中，与螺钉500相比，可变角锁定螺钉600的螺钉头602具有更大的曲率半径625。这产生了与曲率半径圆心626相交的谷剖面线618a-618f，圆心626与螺钉600的中心轴619相距距离630(垂直测量)。例如，如果半径624为10mm，则对于2.4mm的螺钉(2.4mm是指杆轴604的大直径)，距离630可以为约8.2mm。然而，应注意：当曲率半径增大时，螺钉头的球形形状变得越来越不明显，导致螺纹剖面变得越来越趋向于如已知锁定螺钉头的直线(例如，线313-316)。 
图7示出了根据本发明的可变角锁定螺钉头的又一个实施例。螺钉头702具有中心轴719、螺纹703以及用于容纳推进/抽出工具的凹进709。如同前述实施例一样，螺纹703的剖面有利地沿着弧形(即，非直线)的曲率半径725，并且包括螺纹峰710、螺纹谷712和螺纹面711。然而，不同于前述实施例，螺纹剖面线不与曲率半径的圆心相交。由谷剖面线718a-718f表示的螺纹剖面线而是彼此平行延伸且垂直于中心轴719。这些线以这种方式延伸，原因在于螺纹切刀 的切刀头705接触头部702的外部球形表面以切割螺纹703的方式，线718a-718f表示该切刀头705的纵轴701的延伸。功能上，这种差异导致不太理想的螺钉头/孔螺纹啮合。然而，螺钉头702目前比螺钉头502更容易制造。 
图8示出了具有传统的骨板孔的骨板800，所述骨板孔包括锁定骨板孔832、非锁定骨板孔834和结合锁定/非锁定骨板孔836。每种孔都从上表面837完全贯穿延伸到底部骨接合表面839。锁定板孔832具有绕该孔的内表面分布的螺纹833，用于啮合围绕锁定接骨螺钉的头部的螺纹。传统的锁定板孔可以如所示出的一样具有从上表面837完全穿过到下表面839的螺纹833，或者也可以具有在骨板的上下表面之间延伸仅一部分垂直距离的螺纹。非锁定板孔834具有无螺纹或平滑的内表面835，用于容纳非锁定接骨螺钉的头部。结合锁定/非锁定板孔836通过允许外科医生使用锁定螺钉或者非锁定螺钉穿过该孔而增强了骨板的多功能性。结合孔836在一端具有绕该孔的内表面的螺纹833，用于容纳锁定接骨螺钉，而在另一端具有平滑或无螺纹的内表面835，用于可替选地容纳非锁定接骨螺钉。 
图9A和图9B示出了根据本发明的具有骨板孔940的骨板900。并非如传统的锁定螺钉骨板孔中绕板孔内表面935的螺旋状的螺纹，本发明的骨板孔具有绕该孔的内表面布置的优选为螺纹片段的分离的、垂直的纵列942。这些螺纹片段纵列如果被扩展成彼此连接(即，如果绕内表面935完全延伸)，则将形成螺旋状的螺纹。所述纵列在从上表面937到下表面939的方向上延伸，并且优选绕该孔的内表面被等距地分隔开。每纵列的螺纹片段921的数量可以根据外科应用以及骨板和接骨螺钉的尺寸(例如，板厚和螺纹螺距)而变化。然而，每纵列应具有至少两个螺纹片段且优选为更多，以确保螺钉和板之间固定的角度关系。 
应注意，纵列942还可以具有多个形成于其上的齿，而非螺纹片段。这些齿的纵列如果扩展至彼此连接(即，如果绕内表面935完全延伸)，则不会形成螺旋状的螺纹，而是形成一系列垂直于骨板孔的中心轴的同轴脊和沟槽。尽管这种齿的纵列也可以容纳非锁定接骨螺钉、锁定接骨螺钉和可变角锁定接骨螺 钉，但是所述齿与锁定和可变角锁定接骨螺钉的螺钉头螺纹的啮合没有螺纹片段与锁定和可变角锁定接骨螺钉的螺钉头螺纹的啮合理想。 
如图9A和图9B所示，本发明的骨板孔优选具有四个螺纹片段的纵列942。然而，本发明的骨板孔也可以具有其他数量的螺纹片段的纵列。 
例如，如图10A-10C和图10D-10F分别示出的两个实施例，各骨板1000A和1000D的骨板孔1040A和1040D具有六个螺纹片段的纵列(应注意：由于是透视图，图10C和10F中仅可看见三个纵列)。螺纹片段纵列1042A和螺纹片段纵列1042D之间的差异在于螺纹片段1042A的列宽1041A约为螺纹片段1042D的列宽1041D的两倍。不推荐多于六个的螺纹片段的纵列，这是因为螺钉头螺纹与螺纹片段纵列的螺纹错扣风险会增大。反过来，也不推荐本发明的骨板孔具有少于三个的螺纹片段的纵列，这是因为在骨骼/板接合处稳定性不足的可能性增大。 
图11示出了根据本发明的骨板孔的横截面。骨板孔1140形成在骨板1100中，并且从上表面1137完全穿过骨板1100至下部骨接合表面1139。孔1040具有内表面1135，内表面1135包括上部分1144、中间部分1146和下部分1148。上部分1144从上表面1137延伸至中间部分1146。中间部分1146从上部分1144延伸至下部分1148并优选具有该孔的最小直径。下部分1148从中间部分延伸至下表面1139。上部分1144无螺纹，优选具有平滑内表面1143，并优选为朝向下表面向内呈圆锥形收缩。骨板孔1140在上部分1144和中间部分1146的相交处具有肩1145(即为每个纵列中第一个螺纹片段的上部)。肩1145可以作为插入穿过孔1140的非锁定接骨螺钉的螺钉头的停止装置，并且，在一个实施例中，肩1145与孔的中心轴形成约60度的角。应注意：内表面1143或上表面1137可以根据头部的尺寸和形状作为非锁定接骨螺钉的螺钉头的停止装置。下部分1148也具有优选为平滑的内表面1149并优选为朝向底切球形式的上表面而向内收缩。在本发明的一个实施例中，该底切球的半径为约1.75mm。对于厚度约为2mm的骨板，例如，该上部分可以延伸约1mm，而该中间部分和底部分分别可以延伸约0.5mm。 
在本实施例中，骨板孔1140的中间部分1146在内表面1135上具有四个分离的螺纹片段的纵列1142。每个纵列1142优选是朝向下表面1139以相对于中心轴1119测量的角1150向内倾斜。在一个实施例中，角1150优选为约15度。每个纵列1142还优选具有四个或五个螺纹片段1121。如上所述，其他实施例可以具有更多或更少的螺纹片段。对于容纳2.4mm可变角锁定螺钉的骨板孔，每个螺纹片段的列宽1141优选为约0.35mm。根据应用，其他实施例可以具有其他列宽。 
图12示出了螺纹片段1221的纵列1242的一部分的横截面剖面(应注意：如上所述的可替选的齿纵列的横截面剖面与所述螺纹片段表现相同)。在图12中，示出了纵列1242的五个螺纹片段1221中的两个。螺纹片段的纵列1242优选以角1250朝向骨板的下表面倾斜。在一个实施例中，角1250为约15度。从断面中可见，螺纹片段1221的纵列1242包括通过螺纹面1211以螺纹角1217彼此连接的峰(或冠部)1210和谷(或根部)1212。峰1210优选具有长度1252，在一个实施例中，该长度1252为约0.04mm。谷1212优选具有半径1254，在一个实施例中，该半径1254为约0.03mm。角1217优选为约60度，由谷剖面线1218表示的谷1212的二等分发生在从螺纹面1211测量的优选为约30度的角1256处。骨板孔螺纹片段纵列的其他实施例也可以具有其他值的纵列倾斜角、峰长度、谷半径、螺纹角以及二等分角(螺纹角的函数)。 
有利地，本发明的可变角锁定接骨螺钉可以以可选角度范围内的可选角度被推入骨骼中并被固定至骨板。图13示出了本发明的一个实施例，其中，骨板1300具有根据本发明构造的骨板孔1340。每个孔1340都可以以角度范围内的可选角度在任何方向上有利地容纳也是根据本发明构造的可变角锁定螺钉1360。角度范围形成了具有角1362的圆锥体，在本实施例中，角1362为约30度。换句话说，可变角锁定螺钉1360可以以相对于骨板1340的中心轴1319的从0度到15度的可选角度在任何方向上被插入孔1340中并被固定至骨板1300。 
图14A至图17B示出了根据本发明构造的骨板孔的有益特征。骨板1400具有至少三个骨板孔1440。每个孔1440具有四个螺纹片段的纵列1542并且可 以有利地容纳非锁定接骨螺钉、锁定接骨螺钉或可变角锁定接骨螺钉中的任何一个。 
如图14A、图14B、图15A和图15B所示，传统的非锁定接骨螺钉14100可以被插入穿过骨板孔1440中的一个。非锁定接骨螺钉14100具有无螺纹螺钉头14102和螺纹杆部14104，二者的尺寸和构造均适于与孔1440一起使用。应注意：如图14B所示，非锁定接骨螺钉14100无需与孔的中心轴同轴地插入穿过孔1440，而是可以以可选角度插入穿过孔1440。图15B示出了螺钉头14102在完全位于孔1440内时不啮合螺纹片段的纵列1542，而是接触孔1440的肩1545。 
图14A、图14B、图16A和图16B示出了插入穿过第二骨板孔1440的传统锁定接骨螺钉14200。锁定接骨螺钉14200具有在其外表面上带有螺纹14203的螺钉头14202。所述螺钉头和螺纹都具有合适的尺寸和尺度，使得螺纹14203能够以螺纹形式与螺纹片段的纵列1542啮合并紧密配合。为了与螺纹片段的纵列1542准确啮合并紧密配合，锁定接骨螺钉14200应该与孔的中心轴1419同轴地插入通过孔1440。螺钉14200还具有用于啮合骨骼的螺纹杆部14204。杆部14204的尺寸和尺度也适合于插入穿过孔1440。 
图14A、图14B、图17A和图17B示出了穿过第三骨板孔1440插入的可变角锁定接骨螺钉1460。根据本发明构造的可变角锁定接骨螺钉1460具有螺纹杆部1404和在其外表面上带有螺纹1403的部分球形的头部1402。螺钉头螺纹1403具有有利地沿着头部1402的球形部分的弧形(即，非直线)曲率半径的剖面。示出了通过螺纹1403牢固地啮合螺纹片段的纵列1542，螺钉1460与中心轴1719非同轴地被插入第三孔1440。 
图18A至图24C示出了根据本发明的骨板孔的一个实施例的各种特征。除了绕孔的内表面形成纵列之外，至少一些特征不需要用于根据本发明的骨板孔的可替选实施例中。还应注意：描述和示出这些特征的顺序并不意味着制造本发明的骨板孔的特定过程的顺序或步骤。本领域普通技术人员容易理解，存在可以制造本发明的孔的多种方式。 
如图18A至图18C所示，本发明的骨板孔通常始于圆形起始孔1865。起始孔1865具有中心轴1819且从上表面1837至下表面1839完全穿过骨板1800延伸。在一个实施例中，该起始孔的直径为约2.2mm。 
图19A至图19C示出了不具有其他特征的骨板孔的内表面轮廓。骨板1900中孔1965的剖面包括向内呈锥形的上部分1944，突出的、向内呈锥形的中间部分1946，以及球形底切的下部分1948。在一个实施例中，该孔的所述中间部分和下部分分别沿中心轴1919延伸约1mm，且球形底切的半径为约1.75mm。 
另一个特征为图20A至图20C所示的任选的“X键”切口2065。该X键切口2065优选关于与起始孔1865相同的中心轴1819完全贯穿该骨板按压、切割或冲压得到。在一个实施例中，“X”的每个支(leg)都具有约1.5mm的宽度并以具有约0.75m半径的弧形终结。在本实施例中，共线的各支的端部之间的跨度为约4.25mm。如下文关于图25A至图27D进一步描述的一样，该X键切口形成了四叶式立体交叉设计，旨在容纳具有互补钻头引导端部设计的钻头引导器。 
另一个特征为优选的12度浮凸切口2165，如图21A至图21C所示(没有任何其他的孔特征)。浮凸切口2165包括八个对称切割部分2166(每四分之一圆两个切割部分)，其中，每个部分从骨板的上表面2137以约12度向内倾斜。使该浮凸切口完全穿过骨板。在一个实施例中，每个凹槽切割轴2119距骨板孔的中心轴1819约1.1mm。 
图22A至图22C示出的孔剖面具有上部分1944、中间部分1946、下部分1948、X键切口2065、浮凸切口2165、以及其中形成的四个纵列2242，所述四个纵列2242中还没有切割齿或螺纹片段。通过从该孔的中间部分的内表面移除轴向部分来形成纵列2242。 
螺纹切割工艺在纵列2242中形成螺纹片段。应注意：如果在中间部分1946中未形成纵列，则如图23A至图23C所示，螺纹切割过程将在孔2365的中间部分2346的内表面中切割出完全绕该内表面的螺旋状螺纹2367。螺纹片段的螺纹剖面优选与以上针对图11和图12所示的螺纹片段的纵列所描述的剖面相同。 
如上所述，还可以在纵列2242中形成齿，而非在纵列2242中形成螺纹片 段。所述齿通过在纵列中切割沟槽而形成，且垂直于或至少大体上垂直于孔的中心轴。应注意：如果中间部分1946中还未形成纵列，则沟槽切割工艺将形成一系列同心的、平行的可替选的沟槽和脊。 
图24A至图24D示出了根据本发明的骨板孔的一个完整实施例。孔2440包括螺纹片段的纵列2442、X键切口2065以及浮凸切口2165。图24C示出了孔2440的上表面2437，而图24D示出了孔2440的用于与骨骼接触。相邻或面向骨骼的下表面2439。 
图25A至图27D示出了本发明的与钻头引导器有关的另一个有益特征。根据本发明构造的钻头引导器的一个实施例在图25A至图26C中示出，另一个实施例在图27A至图27D中示出。 
图25A示出了具有端部2571和柄2573的钻头引导器2570。如图25B所示，端部2571具有形成四叶式立体交叉设计的四个等距分隔的弧形的翼或部分2572，所述翼或部分2572被布置在钻头杆轴的周围，用于引导钻头、接骨螺钉、和/或推进/抽出工具以可选角度穿过骨板2500并进入骨骼。翼2572的尺寸和构造使其紧贴地安装在骨板孔2540的X键切口1965内。这允许钻头引导器2570被同轴地插入骨板孔2540中(即与骨板孔的中心轴同轴)且在骨骼中钻孔和/或将接骨螺钉推入骨骼中时容易保持在适当的位置。应注意：端部2571和孔2540还可以分别采用除了四叶式立体交叉设计和X键切口以外的构造。如图25C所示，柄2573可以绕端部2571和其中插入端部2571的孔2540的中心轴旋转360度。 
图26A示出了具有缝2675的钻头引导器2570，通过缝2675，可以进行可选角度范围内的钻动。在本实施例中，可选角度范围从0度到15度。柄2573可以旋转360度的能力于是绕孔的中心轴提供了30度的成角的角锥体。钻头引导器2570沿着缝2675具有标记2674a-2674d，在本实施例中，这些标记分别表示相对于孔的中心轴为0、5、10和15度。其他实施例可以具有其他角度范围和/或其他可选角度的标记。图26A和图26B示出了通过钻头引导器2570以最上面的角度设置2674a引导通过骨板2500并进入骨骼2678的钻头2676，在本 实施例中，所述最上面的角度设置2674a相对于骨板孔的中心轴为0度(即，同轴)。图26C示出了通过钻头引导器2570以最下面的角度设置2674d引导通过骨板2500并进入骨骼2678的钻头2676，在本实施例中，所述最下面的角度设置2674d相对于骨板孔的中心轴为15度或者相对于骨板2500的上表面2673为75度。 
图27A至图27D示出了根据本发明的钻头引导器的另一个实施例。钻头引导器2770在一端具有带有端部2771A的漏斗形引导器2777，在另一端具有带有端部2771B的同轴引导器2779，并且在它们之间具有柄2773。端部2771A和2771B分别具有形成四叶式立体交叉设计的四个等距分隔的弧形的翼或部分2772，所述翼或部分2772围绕钻头杆轴，用于引导钻头、接骨螺钉、和/或推进/抽出工具2776穿过骨板并进入骨骼。翼2772的尺寸和构造使其紧贴地安装在本发明的骨板孔(例如，骨板孔2540)的X键切口1965内。这允许钻头引导器2770的任一端被同轴地插入骨板孔中(即与骨板孔的中心轴同轴)且当在骨骼中钻孔和/或将接骨螺钉推入骨骼中时容易被保持在适当的位置。应注意：可替选地，本发明的端部2771A和2771B以及孔还可以分别采用除了四叶式立体交叉设计和X键切口以外的构造。与钻头引导器2570的柄2573不同，柄2773不绕端部2771A或2771B旋转。漏斗形引导器2777具有延伸穿过漏斗形引导器自身并关于插入端部2771A的骨板孔的中心轴收缩的漏斗形钻孔2775。钻孔2775提供了成角的圆锥体，在本实施例中，该角为30度。通过将漏斗形引导器2777插入本发明的骨板孔中，进而将漏斗形引导器2777锁定在固定的位置，则可以以相对于孔的中心轴从0度到15度范围内的在任何方向上的可选角度有利地进行钻动。在钻头引导器2770的另一端，同轴引导器2779具有延伸穿过它的钻孔2778。通过将同轴引导器2779插入本发明的骨板孔中，钻孔2778可以用于与孔的中心轴同轴地引导钻头或推进/抽出工具2776。同轴引导器2779还具有任选的测量尺2774，以帮助确定穿透深度。 
图28示出了根据本发明的骨板构造。骨板2800被成形并构造用于但不限于侧面近端胫骨平台骨折。骨板2800具有头部部分2880以及杆轴部分2882， 头部部分2880的构造和尺寸符合侧面近端胫骨的骨骺端，而杆轴部分2882的构造和尺寸符合侧面近端胫骨的骨体。骨板2800还具有上表面2837以及多个骨板孔2840，骨板孔2840从上表面2837至下表面完全穿过该骨板延伸。每个孔2840都具有四个螺纹片段的纵列2842且能够有利地容纳非锁定接骨螺钉、锁定接骨螺钉或根据本发明的可变角锁定接骨螺钉。杆轴部分2882还具有增强多功能性的多个8字形的结合孔2884，其中，该8字的一部分2885优选具有四个螺纹片段的纵列，而另一部分2886优选为平滑、无螺纹的。部分2886可以容纳非锁定接骨螺钉，而部分2885可以有利地容纳非锁定接骨螺钉、锁定接骨螺钉，或者可变角锁定接骨螺钉。当骨体部分的远端皮层缺失或严重损伤时，由于远端皮层的状况原因而使得通过非锁定螺钉进行固定是有问题的，所以在杆轴部分2882中使用可变角锁定螺钉的能力特别有用。骨板孔的特定类型和安置当然可以变化。 
图29A至图29C示出了根据本发明的另一种骨板构造(与图25至图27中示出的骨板相同)。骨板2900被成形并构造用于但不限于远端桡骨骨折。骨板2900具有头部部分2980和杆轴部分2982，头部部分2980的构造和尺寸符合远端桡骨的骨骺端，而杆轴部分2982的构造和尺寸符合远端桡骨的骨体。骨板2900还具有上表面2937、下表面2939以及多个骨板孔2940，骨板孔2940从上表面2937至下表面2939完全穿过该骨板延伸。每个孔2940优选具有四个螺纹片段的纵列2942且可以有利地容纳非锁定骨螺钉、锁定接骨螺钉，或者根据本发明的可变角锁定接骨螺钉。杆轴部分2982还具有增强多功能性的多个结合孔2984和2989。所述结合孔的孔部分2985优选具有四个螺纹片段的纵列2942，而其他部分2886和2887优选为平滑、无螺纹的。部分2886和2887可以容纳非锁定接骨螺钉，而部分2885可以有利地容纳非锁定骨螺钉、锁定接骨螺钉，或者可变角锁定接骨螺钉。在一个实施例中，骨板2900的长度2990为约65mm，头部部分2980的宽度2992为约22.2mm，头部部分2980相对于杆轴部分2982向上倾斜的角2994为约25度。 
如图30所示，本发明的骨板优选可以成形为限制和/或最小化骨板的下表面 或底侧与骨骼之间的接触。限制和/或最小化骨板和骨骼之间的接触具有很多生物学的和化学的优点，包括降低对供血的损伤以及更易于板的移除。限制和/或最小化骨板3000和骨骼之间的接触的一种方式为在骨板孔之间在下表面3039上为板3000设置圆弧形或圆齿形的切口3099。其他方式在美国专利号为5,151,103、5,053,036、5,002,544和4,838,252中被公开。通过引用而将这些专利的内容合并到本文中。 
图31示出了应用于骨折的本发明的骨板系统的一个实施例。如图所示，骨板2900被示为通过四个可变角锁定螺钉3160附着到骨折的骨骼3178上，所述四个可变角锁定螺钉3160被以各种可选角度插入穿过头部部分2980的骨板孔2940并通过孔2940中螺纹片段的纵列被附着到骨板2900上。骨板孔2940的内表面上的螺纹片段的纵列与可变角锁定螺钉3160的球形头部上的螺纹对接并紧密配合，所述可变角锁定螺钉3160通常与齿条和齿轮相似，允许可变角螺钉3160以各种角度固定在板孔2940中。可变角锁定螺钉3160根据本发明被构造并可以例如为可变角锁定螺钉500、600和/或700。骨板2900还通过插入穿过骨板孔2989的部分2987的非锁定接骨螺钉31100附着到骨骼3178。骨板2900还通过一对传统锁定接骨螺钉31200附着到骨骼3178上，所述传统锁定接骨螺钉31200被插入穿过骨板孔2984的各部分2985并通过部分2985中螺纹片段的纵列被固定至该骨板。骨板孔中螺纹片段的纵列与锁定螺钉的螺纹头部紧密配合，以将锁定螺钉固定至该骨板。应注意：本发明的可变角锁定螺钉也可以用在锁定螺钉31200的位置。还应注意：并不是所有的骨板孔都需要在每个应用中使用。可变角锁定螺钉3160、非锁定螺钉31100和锁定螺钉31200为了保持板2900植入而保持插入穿过骨板2900并进入骨骼3178。 
返回到根据本发明构造的可变角锁定接骨螺钉的螺钉头螺纹特征，图32至图34示出了可变角锁定螺钉的螺钉头的三个实施例，这三个实施例示出了在沿着每个螺钉的中心轴测量时变化的螺距(例如，峰到峰的距离)。下表列出了所示出的螺钉头所属的可变角螺钉的尺寸和所述变化的螺距(所有尺寸都以毫米为单位)。 
                图32          图33           图34
杆轴直径：      5.0           3.5            2.4 
螺钉头直径：    6.5           4.5            3.0 
螺距：         32P01＝0.90    33P01＝0.76    34P01＝0.56 
               32P02＝0.95    33P02＝0.79    34P02＝0.59 
               32P03＝0.99    33P03＝0.80    34P03＝0.60 
               32P04＝1.00    33P04＝0.79    34P04＝0.58 
               32P05＝0.99    33P05＝0.75    34P05＝0.55 
               32P06＝0.95    33P06＝0.68    34P06＝0.49 
               32P07＝0.90    33P07＝0.60    34P07＝0.41 
               32P08＝0.82 
               32P09＝0.72 
本发明的可变角锁定接骨螺钉的其他实施例可以具有其他变化的螺纹螺距。 
应注意：如图35所示，在每种情况下，在沿着曲率半径测量时，相邻螺纹峰之间的角距离是恒定的。也就是说，在沿着曲率半径3525测量时，相邻螺纹峰3510之间的每个角距离35AD相同——与如图32至图34所示的在沿着或平行于中心轴3519测量时变化的螺纹螺距35P01-35P05形成对比。 
通过在采用相同类型的骨板孔的同一骨板上结合可变角锁定螺钉、锁定螺钉以及非锁定螺钉，本发明提供了一种新的混合固定方式。通过非锁定螺钉，通过骨板和骨骼之间的摩擦力保持骨折复位。该摩擦力通过在骨骼中拉紧非锁定螺钉而产生。然而，非锁定螺钉和骨骼之间的微动导致骨吸收并因此导致无法复位。此外，非锁定螺钉的插入需要骨骼承受螺钉拉紧的应力，所述螺钉拉紧在非锁定螺钉周围的骨骼中产生高应力。通常，高应力能够导致非锁定螺钉螺纹脱落(即，骨骼中的螺纹不能切变)和/或在骨骼中缓慢移动(因为骨骼是粘弹性材料)。这些现象中的任何一个都导致无法复位。 
通过添加至少一个锁定或可变角锁定螺钉，复位失败被最小化或消除。特 别地，通过将锁定螺钉固定到骨板而非骨骼上，降低了骨骼的粘弹性性能的效果，螺纹不脱落，且阻止了微动。锁定螺钉和骨板之间的附着是固定角构造的高强度连接，其中，锁定螺钉必须侧面切割穿过骨骼才失效。 
因为可变角螺钉可以以比锁定螺钉更多的期望角度被固定，所以使用可变角螺钉提供了比锁定螺钉更大的优势。 
另外，由于对某些关节周围骨折的处理通常涉及螺钉以相对于骨板的各种角度插入，且考虑到维持各螺钉和骨板之间初始角度关系的重要性，因此本发明的高度多功能骨板系统特别适用于这些临床应用。 
应注意：本文描述和示出的特征可以单独或者与骨板系统的其他特征和实施例结合使用。 
这样，结合优选实施例已描述了本发明。然而，本发明并不限于这些实施例，这些实施例只是本发明的示例。本领域技术人员能够意识到，可以在本发明的范围内作出各种改变，而本发明仅由权利要求来限定。 

Claims (27)

1.一种用于将骨板固定至骨骼的骨板系统，该系统包括骨板，该骨板具有上表面、下骨骼接合表面以及从上表面至下表面延伸穿过该骨板的孔，该孔具有内表面，该内表面限定所述孔的周围，所述孔限定中心轴并且被构造成容纳非锁定接骨螺钉或锁定接骨螺钉；
所述孔的内表面包括上部分、中间部分和下部分，所述上部分从所述上表面延伸至所述中间部分，所述中间部分在所述上部分和所述下部分之间延伸，所述下部分从所述中间部分延伸至所述下表面，以及所述内表面限定用于所述非锁定接骨螺钉的头部的停止装置，
所述骨板具有多个分离的纵列，所述多个分离的纵列布置在所述孔的内表面上并且绕该孔的周围彼此分隔开，每个纵列在从所述上表面至所述下表面的方向上延伸；
其中，所述纵列被构造并确定尺寸用于啮合所述锁定接骨螺钉的头部上的螺纹，其中当所述锁定接骨螺钉被插入到所述孔中时，所述纵列以相对于所述中心轴的在可选角度范围内的可选角度锁定所述锁定接骨螺钉，所述可选角度范围形成围绕所述孔的中心轴的具有角度的圆锥体。
2.如权利要求1所述的骨板系统，其中，所述锁定接骨螺钉是可变角锁定接骨螺钉。
3.如权利要求1所述的骨板系统，其中，所述纵列是齿或螺纹片段的纵列。
4.如权利要求1所述的骨板系统，其中，所述骨板具有在所述孔的内表面上绕所述孔的周围布置的四个分离的纵列。
5.如权利要求1所述的骨板系统，其中，所述多个分离的纵列在所述孔的内表面上被等距分隔开。
6.如权利要求1所述的骨板系统，其中，每个纵列朝向所述下表面以约15度的角度向内倾斜。
7.如权利要求1所述的骨板系统，其中，所述孔的上部分和下部分具有平滑内表面。
8.如权利要求1所述的骨板系统，其中，所述孔的上部分和下部分为朝向所述中间部分向内圆锥形收缩。
9.如权利要求1所述的骨板系统，其中，所述分离的纵列各限定有肩，该肩是所述上部分和所述中间部分的相交部，其中所述停止装置是每个所述分离的纵列的所述肩。
10.如权利要求1所述的骨板系统，其中，所述锁定接骨螺钉包括头部和螺纹杆轴，所述螺纹杆轴被构造并确定其尺寸以通过所述孔安装并啮合所述骨骼，其中，所述头部具有在所述头部的外表面上的螺纹，所述头部被构造并确定尺寸以与所述中心轴共轴地啮合所述多个纵列。
11.如权利要求10所述的骨板系统，其中，所述锁定接骨螺钉是可变角锁定接骨螺钉，所述可变角锁定接骨螺钉的头部具有球形部分，该球形部分具有曲率半径，所述头部还在所述球形部分的外表面上具有螺纹，该螺纹被构造并确定尺寸以啮合所述多个纵列，该螺纹具有包括峰、谷和螺纹面的剖面，所述螺纹面连接所述峰和谷，其中，所述峰和谷位于与曲率半径平行以及同心中的一种的相应的非直线的曲线上。
12.根据权利要求1所述的骨板系统，其中，所述非锁定接骨螺钉具有无螺纹头部和螺纹杆部，所述头部被构造成接合所述停止装置，所述螺纹杆部被构造并确定其尺寸以安装到所述孔中以啮合所述多个纵列和所述骨骼。
13.根据权利要求9所述的骨板系统，其中，所述肩邻接插入到所述孔中的非锁定接骨螺钉的头部。
14.根据权利要求13所述的骨板系统，其中，所述肩相对于所述孔的中心轴形成60度的角。
15.根据权利要求1所述的骨板系统，其中，所述下部分为底切球的形式。
16.根据权利要求15所述的骨板系统，其中，所述底切球具有1.75mm的半径。
17.根据权利要求1所述的骨板系统，其中，所述可选角度范围形成围绕所述孔的中心轴的具有30度的角的圆锥体。
18.根据权利要求1所述的骨板系统，所述骨板系统还包括浮凸切口，所述浮凸切口包括各个从所述骨板的上表面向内倾斜的部分。
19.根据权利要求18所述的骨板系统，其中，所述浮凸切口完全延伸穿过所述骨板。
20.根据权利要求18所述的骨板系统，其中，每个所述从所述骨板的上表面向内倾斜的部分从所述骨板的上表面以约12度向内倾斜。
21.一种在用于内部骨折固定的骨板系统的骨板中制造孔的方法，包括：
从骨板的上表面至下表面完全穿过该骨板钻出起始孔，该起始孔具有中心轴，并且所述骨板具有绕所述孔的周围的内表面；
在绕所述孔的内表面中形成上部分、中间部分、下部分以及在上部分和中间部分的相交处的停止装置，所述上部分从所述上表面延伸至所述中间部分，所述中间部分从所述上部分延伸至所述下部分，所述下部分从所述中间部分延伸至所述下表面，所述中间部分形成比所述上部分和下部分小的所述孔的直径，其中所述停止装置被构造成接合接骨螺钉的头部；
从所述孔的中间部分的内表面移除多个轴向部分，以在所述中间部分的内表面上形成多个分离的纵列；以及
在每个纵列中形成多个沟槽。
22.根据权利要求21所述的方法，其中，所述移除的步骤还包括形成每个纵列，使得每个纵列以一角度朝着所述下表面倾斜。
23.根据权利要求21所述的方法，其中，所述方法还包括在所述上部分和所述中间部分的相交处形成作为肩的停止装置。
24.根据权利要求23所述的方法，其中，所述方法还包括形成相对于所述孔的所述中心轴成60度的所述肩。
25.根据权利要求21所述的方法，还包括在所述孔的内表面中形成浮凸切口的步骤，以形成八个对称切割部分，其中每个对称切割部分从所述骨板的所述上表面向内倾斜。
26.根据权利要求25所述的方法，其中，所述形成浮凸切口的步骤还包括形成从所述骨板的所述上表面以12度向内倾斜的每个对称切割部分。
27.根据权利要求26所述的方法，其中，所述形成浮凸切口的步骤包括形成完全穿过所述骨板的所述浮凸切口。
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