CN1337863A - 骨板 - Google Patents

骨板 Download PDF

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CN1337863A
CN1337863A CN99816446A CN99816446A CN1337863A CN 1337863 A CN1337863 A CN 1337863A CN 99816446 A CN99816446 A CN 99816446A CN 99816446 A CN99816446 A CN 99816446A CN 1337863 A CN1337863 A CN 1337863A
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hone lamella
hole
female thread
screw
thread
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CN1149056C (zh
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米歇尔·瓦格纳
罗伯特·弗里格
罗伯特·沙瓦恩
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AO Technology AG
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Synthes AG Chur
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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
    • A61B17/80—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
    • A61B17/8057—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 the interlocking form comprising a thread
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
    • A61B17/8014—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones the extension or compression force being caused by interaction of the plate hole and the screws

Abstract

本发明的骨板具有一上面(1)、一为与骨接触的下面(2)以及多个沿板的纵轴线(3)设置的、连接上面与下面(1,2)的孔(4)以便容纳骨螺钉(11)。至少一个孔(4)沿板的纵轴线(3)方向的直径DL大于该孔垂直于板的纵轴线(3)的直径DQ。至少一个孔(4)具有内螺纹(5)。该内螺纹(5)沿由其构成的几何体的至少180°延伸。本发明的骨板可以用作一压缩板和同时用作一所谓内部的固定器,就象两元件单独使用时一样有效。

Description

骨板
本发明涉及按照权利要求1的前序部分的骨板和按照权利要求15的前序部分的具有该骨板的固定装置。
基本上人们知道两类用骨板实现的接骨术。
其一涉及“刚性接骨术”。刚性接骨术在护理关节骨折、简单的骨干骨折(如果不可能用插钉术)时以及在切骨术中应用。除解剖学上的复位可能性之外骨本身支持接骨术的稳定性，这使得肢体可较早地和不痛地负重。稳定的骨折护理的优点也可以在由于创伤引起的骨血液流通大大地减少了的部位观察到。当护理“骨不连合”时或存在感染时，必须稳定地护理骨折，以便能使骨愈合并且不因不稳定性在骨折缝隙中另外引起感染。
其二涉及“柔性接骨术”。在护理管状骨的骨干区域中的粉碎性骨折时看出柔性(生物学的)接骨术的最大优点。对这种骨折其目的是保持骨的长度以及各骨端(接头)处于相互间正确的位置。其中骨折区不被直接固定和处理，这并不另外阻止该区域的血液流通。骨板的作用类似于一固定骨髓钉，其只在干骺端固定。
现在如果考察骨板接骨术的这两个极端，人们会发现它们彼此相离有多么远。由于不总是可以将所有的骨折分为上述两类接骨术中之一类，外科医生常常必须采取折衷办法，因为没有可供他使用的植入物使其可以将两类方法不折衷地组合起来。如果一关节骨折可以借助拉紧螺钉通过骨板被压缩并且全关节部分经过一内部的固定器借助角度不变的螺钉连接于骨干，则这样的组合是例如有意义的。另一应用情况是例如关于多孔的骨，这时可以借助轴向的和角度不变的螺钉将骨板固定于干骺端的断片中，其中可以在骨干区域围上一稳定的护板，并借助通过骨折的板拉紧螺钉给以支持。通过这种护理可以达到骨折的初步稳定。
这种情况已导致人们开发了用于两类接骨术的骨植入物并已投入市场。为两类方法最佳地设计了两组植入物。因此该两组系统的缺点在于其没有组合的可能性。
由TALOS等人的US5709686已知一种这样的组合板，其中在长孔的中部设有圆柱形螺纹。该已知的骨板的缺点如下：
1)螺纹在板的长孔中的居中位置将螺纹限制在60°至179°的范围内。
2)螺纹在板的长孔(夹紧孔)中的居中位置具有长孔的侧面的板可能扩大的危险。
3)由于螺纹的圆柱形式必须采用特别构成的螺钉头，以便在拧紧时其可以支承在板的外表面上。
在这里本发明将消除所述弊端。本发明的目的在于，提供一种骨板，其组合两类接骨术，但对两类单纯的骨板护理方法并不产生限制。因此本发明的骨板应该不折衷地用作压缩板和用作所谓内部的固定器。
本发明借助于具有权利要求1的特征的骨板来达到所设定的目的。
骨板作为内部的固定器的应用导致板和螺钉的界面的大大提高的机械应力，因为骨板不被压在骨上并因此借助于骨板与骨之间的摩擦固定骨折。估计这样的机械超负荷是由于长孔中的螺纹沿至少180°的范围延伸并因此绕至少这个角度范围包围螺钉头的螺纹。这种情况对薄的骨板来说是特别重要的。
一优选的进一步发展在于，其长孔中的内螺纹向骨板的下面成锥形缩小。其优点是，螺钉的固定通过板孔的锥螺纹和所采用的螺钉头的相配的锥螺纹来实现。当采用自钻孔的螺钉时，这种固定方式是特别重要的。由于螺钉的钉头部分中的锥螺纹，螺钉拧入骨中的过程可以独立地完成而与骨板无关。只有在螺钉头的螺纹锥体穿入骨板的长孔中的内螺纹时，螺钉才被锁定。虽然在板孔锥体和骨中的螺纹起点不同，但锥形螺钉头螺纹定心于骨板的螺纹锥体中。
当紧固锥螺纹时在板孔中产生径向力，为了充分地吸收这些力，锥形板孔必须具有足够的稳固性。向骨板的下面成锥形逐渐缩小的内螺纹适当地具有5°～20°的锥角，典型地为10°。
在另一优选的实施形式中按照特征A和B的各孔相互是同样的，因此在一孔内设置内螺纹，孔沿板纵轴线方向测定的直径DL大于该孔垂直于板纵轴线测定的直径DQ。
在本发明的另一优选的结构中，沿板纵轴线方向观察，内螺纹设置在长孔两端部之一端部上。这个位置使其在结构上可以实现加大的螺纹范围，例如由其构成的几何体从190°至280°，优选从200°至250°延伸。
只要长孔构成为锥形的，则内螺纹在骨板的下面或上面的延伸量具有不同的值。对在下面的延伸量。螺纹的范围应该优选延伸180°至230°；而在对上面的延伸量应该延伸200°至270°。
在另一优选的实施形式中，长孔(夹紧孔)中的端部的锥螺纹设置在长孔接近板中心的那一端部。这种实施形式的优点是并不损害板夹紧孔的夹紧作用。
在另一优选的实施形式中，至少一个按照特征A的孔在其面向上面的上部具有一凹面的、优选球面的扩大部以便容纳带有球形头的骨螺钉。传统的骨螺钉的球形螺钉头在该凹面的、球面的扩大部中处于其最佳的位置。这特别在为达到骨折压缩需要将骨螺钉偏心地拧入时是这样。
在另一优选的实施形式中，骨板的下面构成凹面的。由于板的凹面式下面，其可更好地配合胫骨、股骨、肱骨和下臂骨等的圆形骨横截面。由于板下面的凹面实施形式，可以将传统的骨螺钉倾斜地通过板孔插入。这特别对于嵌入一小的骨断片是重要的，骨断片必须被拉向骨板。
在又一优选的实施形式中，内螺纹沿骨板的全厚从下面延伸到上面，以便达到尽可能高的稳定性。
在另一优选的实施形式中，长孔在其无螺纹的扇形部分的面向下面的下部扩展，以便骨螺钉可以偏移。
在另一优选的实施形式中，DL/DQ比值处于1.01～3.00的范围内，优选在1.1～1.5的范围内。该比值由压缩孔和螺纹孔的组合产生，其中压缩孔需要一定的螺钉用的夹紧通路。所确定的比值DL/DQ表示在夹紧可能性与由于组合孔引起的板的最小削弱之间的一个最佳的折衷。
另一实施形式除本发明的骨板外还包括至少一个骨螺钉，其具有与内螺纹相配合、设置在螺钉头上的外螺纹，其优选构成为自钻孔的。
当将骨板用作压缩板时，板钻孔的夹紧孔几何尺寸不受端部的锥形螺纹孔4的不利影响。螺纹孔的锥形结构的优点是可以将螺钉独立地拧入骨中而与骨板无关，其中只有在固紧时螺钉才通过一相配的成锥形构成的、有螺纹的螺钉头与骨板相连接。这特别在采用自钻孔和自攻丝的螺钉时是有利的。
本发明及其进一步发展以下借助于多个实施例的部分示意表示的附图更详细地加以说明。附图中：
图1示出本发明的骨板的俯视图，其具有一无螺纹的长孔和一分离的螺纹孔；
图2示出本发明的具有带成一体的螺纹的长孔之骨板；
图3示出通过图1的螺纹孔取的纵剖面图；
图4示出通过图2的带螺纹的长孔取的纵剖面图；以及
图5示出本发明的骨板与一插入带成一体的螺纹的长孔中的骨螺钉的透视图。
图1中所示本发明的骨板具有一上面1、一为与骨接触确定的下面2以及两个连接上面1与下面2的、沿板纵轴线3设置的长孔4用以容纳骨螺钉。
箭头7表示向骨板的一端的方向而箭头8指向板中心的方向。
接近于板中心的孔4沿板纵轴线3的方向测定的直径DL大于该孔垂直于板纵轴线3测定的直径DQ。直径DL为5.2mm而直径DQ为3mm。
在这个长孔的面向上面1的上部其具有一凹面的、优选球面的扩大部6以便容纳具有球形头的骨螺钉。
接近于板端部的孔4具有内螺纹5，其沿由其构成的几何体的360°延伸。在该附图所示的实施形式中该板孔具有向下面2逐渐缩的锥体形式，从而内螺纹5同样向骨板的下面2成锥形缩小并且具有10°的锥角。内螺纹5优选构成为双线螺纹。
如图3中所示，图1中接近板端部的孔4的内螺纹5沿骨板的全厚从上面1延伸至下面2。
在图2和4中所示本发明的优选实施形式中，按图1的骨板的两孔4组合在一起，因此在两长孔4内设置内螺纹5。其中螺纹5设置在长孔接近于板中心的那一端部。
此外，同按图1的结构一样地构成所述两长孔。
内螺纹5在下面2测定时为沿223°的范围延伸，如通过圆弧9所表示的，而在上面1测定时为沿256°的范围延伸，如通过圆弧10所表示的。
按照内螺纹5的直径得到以下优选的参数：
螺纹直径              3.0mm       4.0mm     5.0mm
双线螺纹              是          是        是
螺纹螺距              0.7         0.9       1.0
螺纹深度(＝外、内     0.2025      0.2575    0.2810
螺纹直径差的一半)
张角范围(在上面)      200°       200°     190°
张角范围(在下面)      260°       240°     250°
图5中示出具有按图4的骨板的固定装置，其中骨螺钉11包括有与骨板的内螺纹5相配合的、设置在螺钉头13上的外螺纹12。骨螺钉11合适地构成为自钻孔和自攻丝的。

Claims (17)

1.骨板，其具有一上面(1)、一为与骨接触确定的下面(2)以及多个连接上面与下面(1，2)、沿板纵轴线(3)设置的孔(4)以便容纳骨螺钉(11)，其中
A)至少一个这样的孔(4)沿板纵轴线(3)方向测定的直径DL大于该孔垂直于板纵轴线(3)测定的直径DQ；以及
B)至少一个这样的孔(4)具有内螺纹(5)，其特征在于，
C)内螺纹(5)沿由其构成的几何体的至少180°延伸。
2.按照权利要求1所述的骨板，其特征在于内螺纹(5)向骨板的下面(2)成锥形缩小。
3.按照权利要求1或2所述的骨板，其特征在于内螺纹(5)沿由其构成的几何体的190°至280°延伸。
4.按照权利要求3所述的骨板，其特征在于内螺纹(5)沿由其构成的几何体的200°至250°延伸。
5.按照权利要求1至4之一项所述的骨板，其特征在于，内螺纹(5)在下面(2)测定时延伸180°至230°，而在上面(1)测定时延伸200°至270°。
6.按照权利要求1至5之一项所述的骨板，其特征在于，按照特征A)和B)的各孔(4)相互是同样的，因此在一孔(4)内设置内螺纹(5)，孔沿板纵轴线(3)方向测定的直径DL大于该孔(4)垂直于板纵轴线(3)测定的直径DQ。
7.按照权利要求6所述的骨板，其特征在于，沿板纵轴线(3)方向观察，内螺纹(5)设置在按特征A的长孔(4)的两端部之一端部上，优选接近于板中心(8)的那一端部上。
8.按照权利要求1至7之一项所述的骨板，其特征在于，至少一个按照特征A的孔(4)在其面向上面(1)的上部具有一凹面的、优选球面的扩大部(6)用以容纳具有球形头(13)的骨螺钉(11)。
9.按照权利要求1至8之一项所述的骨板，其特征在于下面(1)构成凹面的。
10.按照权利要求1至9之一项所述的骨板，其特征在于内螺纹(5)沿骨板的全厚从上面(1)延伸至下面(2)。
11.按照权利要求1至10之一项所述的骨板，其特征在于，孔(4)在其无螺纹扇形部分的面向下面(2)的下部扩展。
12.按照权利要求1至11之一项所述的骨板，其特征在于比值DL/DQ处于1.01～3.00的范围内。
13.按照权利要求12所述的骨板，其特征在于比值DL/DQ处于1.1～1.5的范围内。
14.按照权利要求2至13之一项所述的骨板，其特征在于，向骨板的下面(2)成锥形逐渐缩小的内螺纹(5)具有5°～20°的锥角。
15.具有按照权利要求2至14的骨板的固定装置，其特征在于，其还包括至少一个骨螺钉(11)，其具有与内螺纹(5)相配合、设置在螺钉头(13)上的外螺纹(12)。
16.按照权利要求15所述的固定装置，其特征在于骨螺钉(11)构成为自钻孔的。
17.按照权利要求15或16所述的固定装置，其特征在于骨螺钉(11)构成为自攻丝的。
CNB998164461A 1999-03-09 1999-03-09 骨板 Expired - Lifetime CN1149056C (zh)

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US (3) US6719759B2 (zh)
EP (1) EP1158915B1 (zh)
JP (1) JP4121141B2 (zh)
KR (1) KR100604452B1 (zh)
CN (1) CN1149056C (zh)
AT (1) ATE274856T1 (zh)
AU (1) AU756487B2 (zh)
CA (1) CA2367085C (zh)
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US20020045901A1 (en) 2002-04-18
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US7976570B2 (en) 2011-07-12

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