CN1198317A - 用以处理髋部骨折的骨髓腔内钉 - Google Patents

用以处理髋部骨折的骨髓腔内钉 Download PDF

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CN1198317A
CN1198317A CN98105630A CN98105630A CN1198317A CN 1198317 A CN1198317 A CN 1198317A CN 98105630 A CN98105630 A CN 98105630A CN 98105630 A CN98105630 A CN 98105630A CN 1198317 A CN1198317 A CN 1198317A
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nail
intramedullary nail
distal part
hole
femur
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CN1134244C (zh
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焦万尼·法西奥利
达尼埃莱·文图里尼
弗兰科·拉维尼
洛多维科·伦齐·布里维奥
桑德·坦·威尔杜伊斯
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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
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/744—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to an intramedullary nail
    • 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
    • A61B17/68—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
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B17/1721—Guides or aligning means for drills, mills, pins or wires for applying pins along or parallel to the axis of the femoral neck
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • 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
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/725—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with locking pins or screws of special form
    • 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
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • 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
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/863—Shanks, i.e. parts contacting bone tissue with thread interrupted or changing its form along shank, other than constant taper

Abstract

处理股骨骨折的骨髓腔内钉,它包括一实心细长本体,本体有一近部2和一远部3,近部具有接纳固定股骨颈的螺钉9,10的孔,该远部有接纳固定股骨的远侧的骨干螺钉的远部孔16,该钉的特征是:近部的直径Φp基本恒定以稳固锚定在股骨的长度相对有限的腔内,从而减少失血,远部的直径Φd基本恒定且比近部的直径小,从而不用钻骨即可容易地将远部插入股骨的骨髓腔内。近部和远部呈一直线,在水平面上构成预定偏角β。近部有接螺钉9,10的倾斜孔7,8。

Description

用以处理髋部骨折的骨髓腔内钉
本发明涉及一种用以处理股骨近侧骨折型的骨髓腔内钉，该骨髓腔内钉包括一个实心的、细长的本体，该本体的近部有至少一个接纳用以固定股骨颈的相应的螺钉的孔，本体的远部有至少一个接纳用以固定股骨远侧的至少一个骨干螺钉的远部孔。
本发明还涉及一种将钉装入股骨的骨髓腔内的装置。
众所周知，经大转子的骨折在老年科病人中往往出现在骨颈处。实际上，这些病人的高龄和面临病变危险需要及时地对骨的损伤进行固定，以便通过尽可能地在手术中减少失血和减少手术伤害而使卧床和康复时间减到最少。事实上，必需防止由固定术综合征引起的并发症，因为这些并发症可能导致在虚弱的代谢补偿中的病人死亡，同时还必须使与手术有关的失血降低到最小。
同时，所采用的综合手段必需是稳定的，以便允许病人非常及时地采取坐姿，而在手术后的两到三天以后就能随着过牵引机砝码的递增而重新呈直立的姿势。
现有的用以固定转子间的、经大转子的和转子下的骨折的技术是采用一杆状的骨髓腔内钉，该钉的近部在相对于骨干部分较小直径的中间水平平面内弯曲成一定的角度以便适应股骨的生理弯曲。有时所述弯曲位于两个相互正交的平面内，以便有利于进一步适应骨的髓腔。
现有的杆状钉一般靠两个骨干钉固定，从而阻止钉旋转用于压住骨折点处的海绵状组织的一个或两个头侧螺钉。
上面所述类型的现有骨髓腔内钉的结构上的一个弊端在于下述的事实，即它们都有直径相对增加的近部和远部，一般直径增加10mm以上，因此它们需要更复杂地钻骨，以便将整个钉的长度装入，同时可能会产生骨内应力。
进一步说，骨干螺钉与钉的远端如此接近，从而可能会在钉的基部引起应力集中而使股骨断裂。
最后，头侧螺钉一般是相互平行的，因此钉的头部可能会发生滑动，这就必然导致骨折的固定的不稳定。
本发明的总的目的是提供一种骨髓腔内钉，以便消除或至少是减少上述弊端。该骨髓腔内钉的特征是增加了强度、增加了可靠性和生物相容性并且基本无伤害。
本发明的一个具体的目的是提供一种骨髓腔内钉，该钉的装入需要最少的钻骨操作和皮肤切口，这样减少了失血和手术伤害并且减少了康复时间。
本发明的进一步的目的是提供一种增加了生物相容性并减少了花费的骨髓腔内钉。
本发明的更进一步的目的是提供一种骨髓腔内钉，该钉易于用非常简单有效的装置装入骨髓腔中。
按照本发明的上述提供的骨髓腔内钉的类型中的一个优选方案的特征在于，所述近部有一个基本恒定的直径以适于锚在股骨的有限长度腔内，从而减少失血，同时所述远部有一个基本恒定的、比近部小一些的直径，从而可容易地将钉的远部插入股骨的骨髓腔内而不必钻骨。
本发明的特征之处和优点从下面对本发明骨髓腔内钉的一些优选的(但非限定的)实施例描述中将变得更加清楚，附图仅用于帮助描述而不具有限定的目的。其中：
图1为按照本发明的优选方案的骨髓腔内钉的侧视图；
图2为按图1所示箭头II看的钉的局部图；
图3为按图2所示箭头III看的钉的局部图；
图4为插入到股骨的骨髓腔内的图1所示骨髓腔内钉的侧视图；
图5为图4所示钉的一个部件的侧视图；
图6为图4所示钉的另一个部件的侧视图；
图7为按照本发明的一个优选方案的用以将骨髓腔内钉固定到骨中的装置的侧视图；
图8为图1所示骨髓腔内钉与用以将钉插入骨髓腔内的装置装配在一起的侧视图。
参照附图，按照本发明优选方案的一个骨髓腔内钉(用参考符号1表示整个钉)一般为由生物相容的金属构成的和实心的细长本体。生物相容的金属如钛或AISI316LVM型不锈钢。钉的本体基本上由一个近部2通过一基本上为斜锥体的中间部4接合一个远部3构成。
远部2和近部3两者基本上是直的，它们的轴线构成一个限定的偏角β，该偏角β例如在4°和5°之间。
近部2的长度Lp例如在70mm和80mm之间。近部2的相对均匀的直径φp基本为一恒定值，例如在12mm和16mm之间，最好等于约14mm，比如可以使近部2稳固地锚固于在骨的有限长度的转子区域上钻的孔中。这样便以更多的成功机会减少在切割组织的手术中失血和简化外科手术的伤害。
朝向近部2的自由端形成一个端边上有一个径向的凹槽6的螺纹座5。
在近部2上至少为头侧螺钉9，10设有一对横向过孔7，8以固定股骨头，并且孔7，8相对于近部2的轴ap倾斜。
孔7，8相对于近部的轴倾斜的角度平均约为115°，而相互之间可倾斜约成10°以便逐渐会聚，从而阻止股骨头的移位和螺钉从股骨头中脱落出来。
头侧螺钉9，10的相应的近端部分11，12的直径最好是递增的(但不是必需的)以稳固地与钉1的孔7，8接合，而远端部分13，14的直径较小些或不变，并且远端部分的尖端具有自攻螺纹以拧入到股骨头内。
如果需要，可以在近部2上为基本上与股骨头同轴的中间的Kirschner钢丝设有第三过孔15，该孔相对于轴ap倾斜的平均角度例如为115°。Kirschner钢丝的直径比前面的两个螺钉小，且在图中未示出。
远部3的长度Ld例如在100mm和120mm之间，其平均直径φd小于近部的直径φp，例如在8mm和10mm之间，最好为约9mm，这样远部3可以容易地插入股骨的骨髓腔内而不用如前所述钻骨。
远部3上仅为固定骨干和扭转阻滞销17设有一个过孔16，该孔基本上垂直于轴ad。孔16最好设置在远部3的整个长度Ld的一半的位置上，以便使远部3的自由尖端和销之间有足够的距离，从而减少钉的端部断裂的危险。
骨干销17最好是有一个光滑部分18和一个有螺纹的近端部分19，所述光滑部分的基本恒定的直径适于稳固地与孔16接合，而有螺纹的近端部分与骨的海绵状组织接合。
由于具有上述结构，钉1具有最佳的稳固性，并且可以在几乎没有手术损伤和失血很有限的情况下稳定、快速地拼接骨。
所有头侧螺钉和骨干销都可以采用与钉相同的材料，显然该材料应是生物相容的。
根据本发明的另一个方面，本发明还提供一种放置上述骨髓腔内钉和完成必需的钻骨的装置。
这种装置最好包括一个在一主平面上延伸的钻防护罩20，该装置由一个供外科医生握持的柄21和柄部横向附加段22构成，该附加段延伸出一端孔23。导向套筒24嵌在孔23上，该孔在它的低端有径向凸起或端齿25，该凸起或端齿穿过沿防护罩扩展的主平面并与钉1的座5上的径向凹槽6接合，从而确保在操作中对位。
具有一个机动手柄27的销26可穿过套筒24的内腔，并且销有一个螺纹端28与钉1上的螺纹座5啮合以确保销与防护罩20的连接。
在防护罩20的柄21的下部设有用于分别能与钉的孔7，8，15和16相应的骨上的孔所产生的碎骨导出的孔。
在使用中，外科医生在股骨的转子区域上大约钻10cm深，然后小心地将钉插入，使沿钉的螺纹座边缘上的凹槽6位于零件的水平面上。接下来小心地将钉与钻防护罩20相连，使导向套筒24上的凸起或端齿25与凹槽6接合。最后，将销26插入套筒24并将销的螺纹端28拧入钉的螺纹座26中，这样使它们稳固连接。此时，可以在相应于钉的孔7，8，15，16处钻骨，最后可以将螺钉9，10，17插入相应的孔中，以快速、可靠的方式使股骨固定。
为了插入和紧固这些螺钉，避免意外脱落，可以使用一个如图7清楚显示的、整个用参考符号29来表示的特殊的T形工具。该工具有一个机动杆30，该杆有一个头部31，该头部的中心有一个截面为六边形的锁定附加物32，外边有一个杆状部分33，附加物32用来与螺钉的六角接头相接合；有一个径向的纵凹槽34的杆状部分33形成两个半柱面的弹性翼以握持住螺钉的头部。

Claims (16)

1、一种用以处理股骨骨折的骨髓腔内钉，该钉包括一实心的细长本体，该本体有一个近部(2)和与该近部相连的远部(3)，所述近部(2)具有至少一个孔以便接纳用来固定股骨颈的相应的螺钉(9，10)，所述远部(3)有至少一个接纳用来固定股骨的远侧的至少一个骨干螺钉的远部孔(16)，所述骨髓腔内钉的特征在于：所述近部(2)的直径(φp)基本恒定以便适于稳固地锚定在股骨的长度相对有限的腔内，从而减少失血，同时所述远部(3)的直径(φd)基本恒定并且比所述近部的直径小，从而不用钻骨即可容易地将远部插入股骨的骨髓腔内。
2、如权利要求1所述的骨髓腔内钉，其特征在于：所述近部和远部(2；3)基本上是呈一直线的，它们之间在水平面上构成一预定的偏角(β)。
3、如权利要求2所述的骨髓腔内钉，其特征在于：所述偏角(β)在3°至10°之间，最好是约等于5°。
4、如权利要求1所述的骨髓腔内钉，其特征在于：所述近部(2)的直径(φp)在12mm至16mm之间，最好是约等于14mm。
5、如权利要求1所述的骨髓腔内钉，其特征在于：所述远部(3)的直径(φd)在7mm至11mm之间，最好是约等于9mm。
6、如权利要求1所述的骨髓腔内钉，其特征在于：所述近部(2)有一对适于接纳相应的紧固股骨头的头侧螺钉(9，10)的倾斜孔(7，8) 。
7、如权利要求6所述的骨髓腔内钉，其特征在于：所述头侧螺钉(9，10)有一个明显比所述近部(2)小的直径，并且头侧螺钉相互之间以及相对于股骨头的中间轴逐渐会聚，从而在后来的纵向元件上产生一个反作用力以抵抗它的移位和/或轴向穿透。
8、如权利要求7所述的骨髓腔内钉，其特征在于：所述头侧螺钉(9，10)具有与相应的所述近部(2)上的孔(7，8)接合的各自最大直径部分(11，12)，最大直径在3mm到8mm之间，最好约为7mm。
9、如权利要求1所述的骨髓腔内钉，其特征在于：所述钉仅提供一个用以抵抗钉的扭转力的骨干螺钉(17)，与之相应的单个孔(16)基本上与远部(3)的轴(ad)正交，并位于距离所述远部(3)的端部较远处。
10、如权利要求9所述的骨髓腔内钉，其特征在于：所述骨干钉(17)有一个与所述远部的所述单个孔(16)相应的直径基本恒定的主部(18)和一个直径增大的螺纹部分(19)。
11、如权利要求10所述的骨髓腔内钉，其特征在于：所述骨干钉(17)位于所述远部总长度(Ld)大约一半的位置上以避免钉的自由端断裂。
12、如权利要求1所述的骨髓腔内钉，其特征在于：所述近部(2)相对于它的自由端有一个接纳连接销(26)的螺纹座(5)，从而与配置在钉的主平面上的钻防护罩(20)连接。
13、如权利要求12所述的骨髓腔内钉，其特征在于：在所述螺纹座(5)的边缘上有一个与钉的主平面共面的径向凹槽(6)以便在钉和防护罩(20)之间的对位凸起(25)的插入。
14、如权利要求12所述的骨髓腔内钉，其特征在于：所述钻防护罩(20)有一个柄(21)，该柄有一横向附加段(22)，该附加段在它的自由端有一个用以使所述连接销(26)通过的轴向孔(23)。
15、如权利要求14所述的骨髓腔内钉，其特征在于：所述柄(21)有一系列用于钻头的导向孔，在钻骨时，该导向孔与头侧的和骨干螺钉的孔(7，8，15)对准。
16、如权利要求14所述的骨髓腔内钉，其特征在于：所述装置包括一个有一纵杆(30)的特殊工具(29)，所述杆上有一头部(31)，该头部有中心锁定装置(32)和螺钉头部的横向握持装置(33)以避免螺钉的意外脱落。
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PT853923E (pt) 2003-07-31
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ES2195077T3 (es) 2003-12-01
EP0853923A1 (en) 1998-07-22
JP3630214B2 (ja) 2005-03-16
ZA9711353B (en) 1998-06-23
DE69720177T2 (de) 2004-02-12
US6126661A (en) 2000-10-03
TR199800083A2 (xx) 1998-08-21
CA2227290A1 (en) 1998-07-21
IT1293934B1 (it) 1999-03-11
DE69720177D1 (de) 2003-04-30
CN1134244C (zh) 2004-01-14
ATE235191T1 (de) 2003-04-15

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