WO2005092219A1

WO2005092219A1 - Bone connecting tool

Info

Publication number: WO2005092219A1
Application number: PCT/JP2005/005487
Authority: WO
Inventors: Hirotaka Shimizu
Original assignee: Hirotaka Shimizu
Priority date: 2004-03-26
Filing date: 2005-03-25
Publication date: 2005-10-06

Abstract

[PROBLEMS] To provide a bone connecting tool capable of solving problems in a conventional bone connecting tool wherein one end of the base part of a small nail used at the proximal end side of an intramedullary nail is projected from the side face of the intramedullary nail and the intramedullary nail inserted into a cancellius bone is loosened. [MEANS FOR SOLVING PROBLEMS] This bone connecting tool is so formed that a through hole (3) is formed from the end face (2) of the intramedullary nail (1) at the proximal end side in a direction forming a specified angle relative to the centerline of the intramedullary nail (1), a conical part (8) gradually reduced in diameter from the inlet side to the outlet side is formed at the through hole (3), the small nail (4) having a conical part fitted to the conical part (8) of the through hole (3) is inserted into the through hole (3), and the small nail (4) is fixed by pressing from the inlet side of the through hole (3) by a small nail fixing means (12). Also, a soft portion formed of a small diameter part, a plate-like part, or a slit forming part is formed near the center part of the intramedullary nail in the major axis direction.

Description

Specification

Osteosynthesis device

Technical field

The present invention relates to an osteosynthesis device used for treating a fracture of a human body, and particularly to an osteosynthesis device using an intramedullary nail. Background art

[0002] In order to treat fractures in the human body, osteosynthesis devices using an intramedullary nail include a pin inserted from the proximal side of the intramedullary nail, fixed with a set screw, and a screw on the distal side. Inserting and screwing pins and screws into cancellous bone or cortical bone (see, for example, Patent Document 1), and penetrating the nail member from the side on the proximal side of the nail member inserted into the femur The lag screw is inserted and fixed with a set screw, and a locking screw is inserted into the distal side of the nail member so that the lag screw and locking screw are screwed into cancellous bone or cortical bone. (See, for example, Patent Document 2). There is also known an intramedullary nail in which an internal thread is bored to fix the intramedullary nail (for example, see Patent Document 3).

[0003] In this case, when inserting a lag screw or a locking screw at the distal portion penetrating from the side of the proximal portion of the intramedullary nail inserted into the bone, the position and direction of the screw hole can be viewed directly. There is a case where a guide device is used and a case where an X-ray fluoroscope is used. Of these, a guide device, called a target device, is provided with a guide hole for guiding the lock screw on the aiming rail of the aiming strap connected to the head of the intramedullary nail (for example, Patent Document 7) is known.

[0004] Furthermore, when inserting the fixation screw on the distal side of the intramedullary nail inserted into the bone, the position and direction of the screw hole cannot be directly seen, so that the position and direction of the screw hole are determined using an X-ray fluoroscope. There is known a device in which a direction is confirmed and a hole is made in a bone portion corresponding to a screw hole using a radio-lucent drill (for example, see Patent Document 4).

[0005] In addition, as a method of confirming the screw hole of the intramedullary nail using light, a screw hole is observed by observing the lightness on the body surface provided by a light emitter arranged in the intramedullary nail. Position of (See, for example, Patent Document 5) and a method of inserting a light emitter 'element into an intramedullary nail and detecting light from the emitter that shines through a hole in the intramedullary nail with an optical sensor array (for example, see Patent Document 5). Reference 6) is known.

Patent Document 1: Japanese Patent Application Laid-Open No. 2002-253566

Patent Document 2: Japanese Patent Application Laid-Open No. 2002-35000

Patent Document 3: Japanese Patent Publication No. 2001-520071

Patent Document 4: Japanese Patent Laid-Open No. 5-3882

Patent Document 5: U.S. Patent 5,540,691

Patent Document 6: Japanese Patent Publication No. 2002-516690

Patent Document 7: JP-T-2000-513603

Disclosure of the invention

Problems to be solved by the invention

[0007] However, in a conventional osteosynthesis device using an intramedullary nail shown in Patent Documents 1 and 2, when inserting a pin, a lag screw or a screw from the proximal side of the intramedullary nail, Since the pin, lag screw or screw is fixed through the side of the nail, one end of the base of the pin, lag screw or screw protrudes from the side of the bone into which the nail was inserted. There was a problem. For this reason, the range of motion of the joint including the bone into which the intramedullary nail has been inserted may be limited, or the human body may remain damaged. There was also a problem that a new skin incision had to be made to insert the pin, lag screw or screw from the side of the intramedullary nail.

[0008] Further, when inserting a screw or a locking screw into an intramedullary nail, since there is no female screw on the side of the intramedullary nail, the screw or the screw part of the locking screw that protrudes to the opposite side after passing through the intramedullary nail is used. Screws are inserted into bone or cortical bone to generate fixation force, so that not only can elderly people with osteoporosis have insufficient fixation force on fragile bones with osteoporosis, but the inserted screws etc. There was also a problem of getting out.

[0009] Further, in the conventional osteosynthesis device, even when a female screw is drilled in an intramedullary nail, a plurality of bone fragments are formed only in a fracture part which is used only for fixing the intramedullary nail. There was no idea that the bone fragments would be fixed to the intramedullary nail in some cases. [0010] In drilling a hole in the bone in accordance with the screw hole of the intramedullary nail inserted in the bone, and in inserting a fixing screw into the screw hole, a screw hole is used using an X-ray fluoroscope. When checking the position and direction of the patient, there was a problem that the amount of X-ray exposure would increase for both operators and patients. Furthermore, there is a problem that this technique is technically difficult and requires a long time for the treatment.

[0011] Further, conventional intramedullary nails have a cylindrical shape and have poor flexibility against bending. However, if an intramedullary nail with poor flexibility is used, for example, in the case of a fracture of the upper limb, especially in the case of a fracture of the proximal humerus, if the cancellous bone is weak, the area around the pin or screw inserted into the cancellous bone Stress is concentrated in the area, and bone around the pin or screw may be destroyed. Therefore, there is a problem that the pin or the screw is loosened. In addition, if the cancellous bone has sufficient strength, there is also a problem that a pin or a screw is broken by a stress caused by a movement of a human body.

[0012] On the other hand, when a drill guide device is used to insert a locking screw at a distal portion of an intramedullary nail inserted into the bone, when the intramedullary nail becomes longer, the intramedullary nail is inserted into the bone. When inserted, the bending in the longitudinal direction causes deflection and changes in the screw hole position, and the sleeve of the drill guide device cannot follow, so the locking screw must be passed accurately through the screw hole of the intramedullary nail. Can not. The conventional guide device shown in Patent Document 7 does not consider the bending of the intramedullary nail, and therefore, when trying to push the locking screw into the screw hole of the intramedullary nail, the long axis of the screw hole and the sleeve are not There was a problem that the locking screw could not be inserted after all because the long axis did not match.

[0013] In addition, the method using a radio-lucent drill disclosed in Patent Document 4 involves technical difficulties and may require a long time, and furthermore, the amount of X-ray exposure is limited to the operator and the patient. Also increased.

[0014] Further, in the devices using the conventional light emitters shown in Patent Documents 5 and 6, since the light emitter composed of the light emitter is arranged in the intramedullary nail, after confirming the screw hole, the light emitter is checked. If you do not take out the luminous body out of the intramedullary nail, you will not be able to drill. At that time, if the position of the screw hole was lost for some reason, it was necessary to insert the luminous body into the intramedullary nail again. In addition, since light is scattered when passing through bones, the light detection position must be In some cases, it may not be the same as the screw hole. It did not address such light scattering. Further, if the intramedullary nail is not hollow, the luminous body cannot be inserted into the intramedullary nail. Therefore, it could not be used for such a solid intramedullary nail. When drilling a screw hole, it is not enough to simply check the position of the screw hole, and the force that must match the direction of the drill with the long axis direction of the screw hole could not cope with this. .

The present invention has been made in view of such a problem, and has solved the problem that one end of the base of a nail used proximally of an intramedullary nail protrudes from the side surface of the intramedullary nail. Provide an osteosynthesis device. In addition, the present invention provides an osteosynthesis device that is easy to insert a fixing screw into an intramedullary nail, is flexible, and exhibits a sufficient fixing force. Still further, the present invention provides an osteosynthesis device capable of fixing a plurality of bone fragments. Further, it is possible to provide an osteosynthesis device that can easily detect the position of the insertion portion of the fixing screw and can further control the insertion direction. It is still another object of the present invention to provide an osteosynthesis device that can easily and accurately drill a hole in accordance with the position and orientation of a screw hole of an intramedullary nail.

[0016] As used herein, the "proximal portion" of an intramedullary nail refers to a portion of the intramedullary nail close to a bone hole where the intramedullary nail is inserted into a bone. The “distal part” refers to the tip part when an intramedullary nail is inserted into a bone. Further, in this specification, the term “fixing screw” refers to a fixing screw for fixing a distal portion of an intramedullary nail, and has the same meaning as a locking screw described in a prior document.

Means for solving the problem

[0017] In order to solve the above-mentioned problems, the osteosynthesis device according to claim 1 of the present invention comprises:

A nail insertion portion for inserting a nail for fixing an intramedullary nail is provided at an end of a proximal portion of the intramedullary nail in a direction intersecting the longitudinal direction of the intramedullary nail. .

According to this feature, a pin or lug for fixing the proximal portion of the conventional intramedullary nail is provided by providing a nail insert portion for inserting the nail into the end of the proximal portion of the intramedullary nail. It makes it possible to fix the proximal part of the nail without using a screw or a technique in which the screw penetrates the side of the nail.

[0018] The osteosynthesis device according to claim 2 of the present invention is the osteosynthesis device according to claim 1, A through-hole is provided from the proximal end surface of the intramedullary nail in a direction having a certain angle with respect to the center line of the intramedullary nail, and the through-hole is formed with a conical portion whose diameter decreases from the entrance side to the exit side. A nail having a conical portion fitted into the conical portion of the through hole is inserted into the through hole, and the nail is pressed and fixed from the entrance side of the through hole by the nail fixing means. .

According to this feature, the nail can be freely rotated in the through-hole of the intramedullary nail. For example, when a curved nail is used, the nail can be fixed in a desired direction, and The gripping force can be assured. In addition, since one end of the base of the nail does not protrude from the side of the intramedullary nail, it is possible to prevent pain from remaining in the human body, and it is necessary to make a new skin incision for inserting the nail. Absent.

An osteosynthesis device according to claim 3 of the present invention is the osteosynthesis device according to claim 1 or 2,

It is characterized in that the shape of the nail is formed in an arc shape or a spiral shape having a twist. According to this feature, it is possible to employ a nail having an optimal shape according to the fracture site, and it is possible to secure the gripping force even when the nail is inserted into the cancellous bone.

[0020] An osteosynthesis device according to claim 4 of the present invention is the osteosynthesis device according to any one of claims 1 to 3,

A through hole is provided inside the nail insertion portion, and a partition wall is provided on the exit side of the through hole so as to divide the through hole into two or three parts, and a nail is fixed on the entrance side of the through hole. A female screw portion into which a small nail fixing screw is screwed is provided, and the small nail is provided with a hook which is expanded and extended in a bifurcated shape or a trifurcated shape from the base portion to the front. According to this feature, the bone is a locomotor and it is assumed that it moves, so the intramedullary nail placed in the bone is subjected to fluctuating force, but it is placed in the through hole. The nails are fixed together by being pushed into the bulkhead by the nail fixing screws, so that even if the nails are subjected to fluctuating stress, the nails will not be loosened.

[0021] An osteosynthesis device according to claim 5 of the present invention is the osteosynthesis device according to claim 1, A receiving hole for receiving the head of a screw for fixing an intramedullary nail is provided on the entrance side inside the small nail fitting portion, and a female screw portion for screwing the screw is provided following the receiving hole. The feature is that screws are used as nails.

According to this feature, since the head of the screw of the screw configured as a peg is housed in the accommodation hole, the problem that one end of the peg protrudes from the side surface of the intramedullary nail is eliminated. It does not limit the range of motion of the joint, including the inserted bone, or contribute to remaining human damage.

[0022] The osteosynthesis device according to claim 6 of the present invention comprises:

The intramedullary nail is characterized in that a soft portion consisting of a small-diameter portion, a plate-shaped portion, or a slit-formed portion is formed near the central portion in the longitudinal direction of the intramedullary nail.

According to this feature, by making the intramedullary nail main body flexible, it is possible to prevent loosening and breakage of the nail or the fixing screw for fixing the intramedullary nail at the proximal and distal portions of the nail. .

[0023] An osteosynthesis device according to claim 7 of the present invention is the osteosynthesis device according to claim 6,

The reinforcing member for temporarily reinforcing the flexible portion of the intramedullary nail is detachably attachable via a hollow portion formed in the intramedullary nail.

According to this feature, the reinforcing member that temporarily reinforces the flexible portion of the intramedullary nail can be detachably attached via the hollow portion formed in the intramedullary nail, so that it can be inserted into the bone of the intramedullary nail. At the time of insertion, the reinforcing member is attached to the intramedullary nail, and the fixing screw can be inserted into the intramedullary nail in a state where the flexibility of the intramedullary nail is suppressed and the intramedullary nail is prevented from bending.

[0024] The osteosynthesis device according to claim 8 of the present invention comprises:

One or more screw holes having at least one thread are formed between the proximal end and the distal end of the intramedullary nail, and a conical expanding portion is formed on at least one side of the screw hole. Osteosynthesis device, provided with a shaft rotation cap to be attached to the base of the intramedullary nail, and attaching a rail formed in an arc shape centering on the screw hole of the intramedullary nail to the shaft rotation cap. A drill guide member slidably provided along a guide groove provided in the rail; The member is provided so as to extend in a direction perpendicular to the tangent to the arc of the arc-shaped rail, and the drill guide member is provided with a guide hole for guiding a drill. According to this feature, the fixing screw can be easily inserted into the intramedullary nail, a sufficient fixing force can be exerted, and a plurality of bone fragments can be fixed. Bone can be easily and accurately drilled according to position and orientation.

[0025] The osteosynthesis device according to claim 9 of the present invention comprises:

At least one nut member having a screw hole is pivotally mounted between the proximal end and the distal end of the intramedullary nail, and at least one side of the nut member is conically expanded on at least one side. An osteosynthesis device having a guide portion formed on an intramedullary nail, comprising a shaft rotation cap attached to the base of the intramedullary nail, wherein the shaft rotation cap has an arc shape centered on a screw hole of a nut member. And a drill guide member is slidably provided along a guide groove provided in the rail, and the drill guide member extends in a direction perpendicular to a tangent to the arc of the arc-shaped rail. The drill guide member is provided with a guide hole for guiding a drill.

According to this feature, the fixing screw can be easily and flexibly inserted into the intramedullary nail, a sufficient fixing force can be exerted, and a plurality of bone fragments can be fixed. It is possible to easily and accurately make a hole in a bone according to the position and orientation of the hole.

[0026] An osteosynthesis device according to claim 10 of the present invention is the osteosynthesis device according to claim 9, wherein

External magnets are opposed to each other so that the polarity is opposite to the magnets mounted on both sides of the screw hole of the nut member, and the direction of the screw hole of the nut member can be controlled by using the attractive force of the facing magnet. It is characterized by doing.

According to this feature, in addition to the effect of the invention described in claim 9, the direction of the screw can be controlled to a desired direction.

[0027] The osteosynthesis device according to claim 11 of the present invention comprises:

At the base of the intramedullary nail, a drill guide device equipped with an arm extending at a certain distance from the intramedullary nail and extending parallel to the longitudinal axis of the intramedullary nail and a counterforce sleeve in the screw hole, The arm has a hinge parallel to the long axis of the sleeve and can be extended and contracted in the long axis of the intramedullary nail. It is characterized by providing a flexible telescopic device.

According to this feature, the drill guide has a structure capable of responding to bending caused by bending in the longitudinal direction of the intramedullary nail, so that the same direction as the axial direction of the screw hole provided at the distal portion of the intramedullary nail is provided. It is possible to drill while keeping it.

[0028] The osteosynthesis device according to claim 12 of the present invention comprises:

A hollow drill guide for guiding a drill is provided with a plurality of light emitters for emitting light and a plurality of light detectors for detecting reflected light, and the light emitted from the plurality of light emitters is set to have different wavelengths. It is characterized by becoming.

According to this feature, by providing the drill guide with the light emitter and the photodetector, the position of the screw hole can be visually recognized until the drill operation is completed.

[0029] An osteosynthesis device according to claim 13 of the present invention is the osteosynthesis device according to claim 12, wherein

A plurality of light emitters are characterized in that the emitted light is emitted in a pulse shape and the emission timing of each emitted light is set to be shifted.

According to this feature, even if the light passing through the bone is scattered, the position S of the screw hole can be accurately specified.

Brief Description of Drawings

FIG. 1 is a schematic front view for explaining an example in which a fracture called a 3 part in a proximal humerus fracture is reduced using an intramedullary nail to reduce the fracture site. .

FIG. 2 is a front view showing details for fixing a small nail in a through-hole provided in a base portion on a proximal side of the intramedullary nail.

FIG. 3 is a view showing a modification of the shape of a nail.

FIG. 4 is a schematic front view for explaining a connection relationship between a bone fragment fixing screw and an intramedullary nail.

FIG. 5 shows a modification of FIG.

FIG. 6 is a schematic view for explaining an example in which a nut member rotatable relative to the intramedullary nail is provided.

FIG. 7 is a schematic diagram for explaining a state in which a magnet is embedded in a nut member and a magnetic force is applied to the nut member from the outside to control the direction of a screw hole. FIG. 8 is a schematic diagram illustrating a state in which a magnet is embedded around a screw hole of a nut member.

FIG. 9 is a schematic explanatory view showing a guide device for passing a drill through a screw hole of an intramedullary nail.

FIG. 10 is a front view illustrating an example in which an intramedullary nail is used for a distal fracture of a radius.

FIG. 11 is a front view illustrating an example in which an intramedullary nail is used for a fracture of a calcaneus.

FIG. 12 is a diagram illustrating a case where a small nail is used to fix the proximal end of the intramedullary nail.

FIG. 13 is a cross-sectional view taken along the line AA of the nail insertion portion in FIG. 12.

FIG. 14 is a view showing a modified example of the nail shown in FIG. 12.

FIG. 15 is an explanatory view showing a modified example of a nail for fixing an end of a proximal portion of an intramedullary nail.

[FIG. 16] (a) is a front view of a flexible intramedullary nail, and (b) is a side view of the intramedullary nail.

[FIG. 17] (a) is a front view of a flexible intramedullary nail, and (b) is a side view of the intramedullary nail.

[FIG. 18] (a) is a front view of a flexible intramedullary nail, and (b) is a side view of the intramedullary nail.

FIG. 19 is a view showing a reinforcing member for preventing a flexible intramedullary nail from bending when inserted into a bone.

FIG. 20 is a view showing a reinforcing member for preventing a flexible intramedullary nail from bending when inserted into a bone.

FIG. 21 is a view showing a conventional general drill guide device.

FIG. 22 is a diagram illustrating a drill guide device of the present invention.

FIG. 23 is an explanatory view showing an overall image of a screw hole guide device.

FIG. 24 is a schematic view showing a case where an intramedullary nail is applied to a fracture of a proximal humerus.

FIG. 25 is a schematic view showing a case in which an intramedullary nail is applied to a metaphyseal fracture of the radius.

Explanation of symbols

1 Intramedullary nail (osteosynthesis device)

2 End face

3 Through hole (Peg insertion area) Nail

Intramedullary nail fixing screw

Bone fragment fixing screw

Cone

Former part

Conical hole

Nail fixing screw (Nail fixing means) Conical projection

Screw hole

a Screw hole

a Guide section

b Screw hole

Nut member

External magnetic force device

Magnet (external magnet)

Drill equipment

Humerus

a cortical bone

b spongy bone

Bone fragment

Bone

Guide device

Shaft rotation cap

Lenore

Guide groove

Drill guide member

Guide hole

Intramedullary nail edge

Nail

Small nail fitting

Through hole

Partition

hook

Nail

b Screw head

Accommodation hole

c Small diameter part

f Small diameter part

d plate

e Slit hole (slit forming part) g Slit hole (slit forming part) i Drill guide device (osteosynthesis device) h Mounting device

i arm

i sleeve

i hinge

i Telescopic device

Drill guide (osteosynthesis device)

Photo detector

Screw hole guide device

Bone

Reinforcement members

Mating recess

Reinforcement members BEST MODE FOR CARRYING OUT THE INVENTION

The best mode for carrying out the osteosynthesis device according to the present invention will be described below based on embodiments with reference to the drawings.

Example

An embodiment of the present invention will be described with reference to the drawings. First, FIG. 1 shows the use of an intramedullary nail to reduce a fracture site called a 3 part in a proximal humerus fracture. FIG. 2 is a schematic front view for explaining an example of the case in which the nail is fixed. It is. Hereinafter, the upper side of FIGS. 1 and 2 will be described as the proximal side (base side) of the intramedullary nail, and the lower side will be described as the distal side (tip side) of the intramedullary nail.

[0034] Reference numeral 1 in Fig. 1 denotes an intramedullary nail constituting an osteosynthesis device to which the present invention is applied. In Fig. 1, first, a fracture site H is placed in the humerus 30 from the outside of the rotator cuff. The intramedullary nail 1 is inserted so as to straddle. The humerus 30 is composed of a hard and dense cortical bone 30a forming a peripheral part of the bone and a cancellous bone 30b forming a sponge structure forming the inside of the bone. As shown in FIG. 1, the intramedullary nail 1 is designed to be inserted into the cancellous bone 30b in the humerus 30.

[0035] Further, a penetration as a small nail insertion portion in the present embodiment provided so as to be directed from the proximal end surface 2 of the intramedullary nail 1 to a direction having a certain angle with respect to the center line of the intramedullary nail 1 Hole 3 is formed. The through hole 3 penetrates the side surface of the nail 1. The nail 4 is inserted into the through hole 3 from the end face 2 side, and is fixed to the intramedullary nail 1 in a state where the tip of the nail 4 projects from the side surface of the intramedullary nail 1. Since the small nail 4 grips the cancellous bone 30b, an intramedullary nail without using a method in which a pin, a lag screw or a screw for fixing the proximal portion of the conventional intramedullary nail penetrates the side surface of the intramedullary nail is used. One proximal portion can be fixed within the humerus 30. Further, an intramedullary nail fixing screw 5 is screwed into the screw hole 5a formed on the distal side of the intramedullary nail 1 from the side, so that the intramedullary nail 1 is fixed to the cortical bone 30a. .

Next, for example, when fixing the bone fragment 31 of the large nodule, a screw hole 16 in which the bone fragment fixing screw 6 can be formed before the operation is formed in the intramedullary nail 1. After inserting the humerus 30 into the humerus 30, pass the bone fragment fixing screw 6 through the large nodular bone fragment 31, and insert the Into. Thereby, the bone fragments 31 are drawn to the intramedullary nail 1 and are fixed in the reduced position.

[0037] As shown in FIG. 2, the approximate center line of the through-hole 3 extends from the end face 2 of the nail 1 to the length of the nail.

1

The nail is oriented so as to have a certain angle と with respect to the center line / 3 of the direction, and penetrates from the end face 2 to the side face 7 of the intramedullary nail 1. The approximate center line of the through hole 3 intersects the approximate center line j3 in the longitudinal direction of the intramedullary nail.

1

[0038] In the through hole 3, there is formed a conical portion 8 whose diameter decreases from the inlet side to the outlet side, and a female screw 9 is provided in a large diameter portion on the end face 2 side from the conical portion 8. I have. The outer surface of the base 10 of the peg 4 inserted into the through-hole 3 is formed in a conical shape so as to fit with the conical part 8 of the through-hole 3, and the base 10 is free in the through-hole 3. It has a structure that can rotate. Therefore, the nail 4 can be arranged in a desired direction, and the gripping force of the nail 4 on the cancellous bone 30b can be ensured. A conical hole 11 is formed at the center of the base 10 of the peg 4.

Further, in order to fix the nail 4 inserted in the through hole 3, a nail fixing screw 12 as a nail fixing means in this embodiment is inserted into the through hole 3. A male screw 15 is formed on the side surface of the small nail fixing screw 12 so as to be able to be screwed with the female screw 9 of the through hole 3, and a concave portion 12 a which can be engaged with a driver or the like is formed. ing. Further, the small nail fixing screw 12 has a conical convex portion 14 that fits into the conical hole 11 of the small nail 4. The diameter of the base of the conical convex portion 14 of the nail fixing screw 12 is slightly larger than the maximum diameter of the conical hole 11, and when the nail fixing screw 12 is screwed in, the conical convex portion 14 becomes small. The conical hole 4 of 4 is pressed in the axial and radial directions.

When the nail fixing screw 12 is screwed into the female screw 9, the depth of the female screw 9 of the through hole 3 is set so that the nail fixing screw 12 does not protrude from the end face 2 of the intramedullary nail 1. The height of the nail fixing screw 12 is determined. Therefore, after inserting the peg 4 into the through hole 3 and screwing the peg fixing screw 1 2, the conical outer surface of the peg 4 is pressed against the conical portion 8 of the through hole 3, and the peg 4 becomes the intramedullary nail 1 Will be firmly fixed.

[0041] The shape of the nail 4 may be as shown in Fig. 3 in addition to the shape of an arc as shown in Figs. 1 and 2. FIG. 3 is a view showing a modified example of the shape of the nail. The nail 4a shape shown in Fig. 3 (a) is straight at the base 10a side, and three-dimensionally twisted at the tip side from almost the middle. This twisted part has a shape where no directional force appears to be a straight line. In the one shown in FIG. 3 (b), the tip portion 10b side is spirally bent. As for the shape of the nail 4b, in addition to the shape shown in FIG. 3, an optimal shape is adopted depending on the fracture site.However, the nail 3b having a three-dimensionally twisted shape as shown in FIG. Even when the humerus 30 is inserted into the cancellous bone 30b, the gripping force can be ensured.

Next, a case where the bone fragment 32a is fixed in the reduction position will be described. Figure 4 shows the bone fragment fixing screw

FIG. 7 is a schematic front view for explaining a connection relationship between 6a and an intramedullary nail la. Fig. 4 shows a state in which the bone fragment 32a is fixed to the intramedullary nail la by the bone fragment fixing screw 6a for convenience.

First, before the operation, a screw hole 16a having a female screw is formed in the body between the proximal end and the distal end of the intramedullary nail la. At least one side of the screw hole 16a is formed with a guide portion 17a that expands in a conical shape so that the bone piece fixing screw 6a can be easily guided to the screw hole 16a. To reduce the bone fragment 32a, a hole 33a is made in the bone fragment 32a using a drill (not shown). Then, with the bone fragment fixing screw 6a inserted into the hole 33a, the bone fragment fixing screw 6a is guided to the screw hole 16a of the intramedullary nail la, and the bone fragment fixing screw 6a is inserted until the bone fragment 32a is in the reduced position. Try to tighten. Then, the bone fragment 32a is firmly fixed to the intramedullary nail la via the bone fragment fixing screw 6a in the reduction position. By adjusting the tightening of the bone fragment fixing screw 6a, a compressive force that is effective in treating a fracture can be applied to the bone fragment 32a.

[0044] In this way, by adopting a structure in which the fixing screw 6a is screwed into the screw hole 16a of the intramedullary nail la, the fixing screw 6a is more securely screwed into the cancellous bone or cortical bone than the conventional one. Not only can the fixing screw 6a be fixed, but also the falling off of the fixing screw 6a can be prevented.

FIG. 5 shows a modification of FIG. 4, in which a screw hole 18b formed in the intramedullary nail lb is formed, and the screw hole 18b is screwed with the bone fragment fixing screw 6b. Only one thread force is formed. Guide portions 17b, 17b are formed on both sides of the screw hole 18b so that the bone fragment fixing screw 6b inserted into the bone fragment 32b can be screwed into the screw hole 18b from either the left or right side of the intramedullary nail lb. It has become. In this way, the fixing screw 6b can be easily inserted into the intramedullary nail lb, a sufficient fixing force can be exerted, and a plurality of bone fragments 32b can be fixed.

Next, another embodiment of the screw hole for fixing the bone fragment fixing screw will be described. Figure 6 shows the pith FIG. 7 is a schematic diagram for explaining an example in which a nut member 19 that can rotate relatively to the inner nail lc is provided. As shown in FIG. 6, a nut member 19 rotatable relative to the intramedullary nail lc is provided, and a screw hole 16c is formed so as to penetrate the nut member 19. The outer shape of the nut member 19 is not particularly limited, such as a sphere or a column, as long as the direction of the screw hole 16c can be freely changed while the nut member 19 is held by the intramedullary nail lc.

[0047] The nut member 19 in Fig. 6 has a cylindrical shape, and is fitted into a cylindrical hole 20 of an intramedullary nail 1c formed in a direction perpendicular to the paper surface, and a screw hole 16c turns the nut member 19. By moving it, the direction can be freely changed in the direction of the arrow in FIG. Guide sections 17c are formed on both sides of the screw hole 16c so as to expand in a conical shape, so that the bone fragment fixing screw 6c inserted into the bone fragment 32c can be inserted even if the direction of the screw hole 16c changes. It has become. In this way, the fixing screw 6c can be easily inserted into the intramedullary nail lc, a sufficient fixing force can be exerted, and a plurality of bone fragments 32c can be fixed.

FIG. 7 is a schematic diagram for explaining a state in which a magnet is embedded in the nut member 19 and a magnetic force is applied to the nut member 19 from the outside to control the direction of the screw hole 16c. As shown in FIG. 7, a magnet can be embedded in the nut member 19 which can be rotated relative to the intramedullary nail lc before the operation. Then, a magnetic force is applied to the nut member 19 from the outside during the operation, and the direction of the screw hole 16c can be controlled to be a desired direction. Therefore, it becomes easy to screw the above-mentioned fixing screw 6c into the screw hole 16c.

[0049] Specifically, reference numeral 21 shown in Fig. 7 denotes two permanent magnets (external magnets) 23, 23 such that one surface on both sides of the screw hole 16c is an N pole and the other surface is an S pole. This is an external magnetic force device in which an external force is applied to the nut member 19 by arranging the magnetic force. The external magnetic force device 21 is used when a hole for a bone fragment fixing screw or an intramedullary nail fixing screw is formed in a bone. The external magnetic device 21 has a support arm 22 having two permanent magnets 23, 23 fixed to the ends, and the support arm 22 is bent so as to be able to bypass a bone 34 or a limb. I have. Two magnets 23 are arranged on the support arm 22 at a predetermined distance so that the direction of the magnetic field is on a straight line.

As shown in FIG. 7, when the external magnetic force device 21 is operated and the magnets 23 and 23 are arranged so as to face each other on both sides of the nut member 19, the magnets 23 and 23 of the external magnetic force device 21 and the nut Department Since the different poles of the permanent magnet of the material 19 attract each other, the nut member 19 is rotated, and the axial center of the screw hole 16c is positioned on the line connecting the two magnets 23, 23 of the external magnetic force device 21. Can be controlled in a desired direction.

A guide hole 26 is formed in the two magnets 23, 23 of the external magnetic force device 21 for guiding the drenole 25 of the drenole device 24, and the drill 25 is pushed in the direction of the screw hole 16 c through the guide hole 26. Thus, the hole 28 can be opened in the bone 34. Therefore, the fixing screw 6c described above can be fixed to the cortical bone through the hole 28 formed in the bone 34.

In this embodiment, the direction of the axis of the screw hole 16c of the nut member 19 is controlled by disposing two magnets 23, 23 on both sides of the nut member 19 in the external magnetic force device 21. The present invention is not limited to this. The orientation of the axis of the screw hole 16c may be controlled by disposing one magnet on either side of the nut member 19. Further, the magnet 23 used for the external magnetic force device 21 is not limited to a permanent magnet, and may be an electromagnet in which a coil is wound around a drill guide member for guiding the drill 25.

FIG. 8 is a schematic diagram illustrating a state where the magnet 27 is carried around the screw hole 16 c of the nut member 19. FIG. 8 shows the nut member 19 viewed from the axial direction of the screw hole 16c, and shows an example in which three magnets 27 are carried around the screw hole 16c.

As described above, by embedding three or more magnets 27 around the screw hole 16c, for example, the position and direction of the screw hole 16c can be accurately measured using a magnetic force sensor (not shown). be able to. Therefore, based on the measured value of the measured screw hole 16c, the hole portion 28 can be drilled from the outside using the drill device 24 or the like. In the screw holes 16a and 18 shown in FIGS. 4 and 5 described above, in order to detect the screw holes 16a and 18 with a magnetic force sensor (not shown), an intramedullary nail lathe around the screw holes 16a and 18 is required. It is good to carry a magnet in lb.

FIG. 9 is a schematic explanatory view showing a guide device 40 for passing the drill 25 through the screw hole 16c of the intramedullary nail lc. FIG. 9 shows the case where the guide device 40 is applied in addition to the case where the direction of the screw hole 16c is controlled by the external magnetic force device 21 shown in FIG. 7, but it is used together with the external magnetic force device 21. Instead, it is also possible to simply apply only the guide device 40 to the screw hole 16c of the intramedullary nail lc. The guide device 40 has a hole for a bone fragment fixing screw or an intramedullary nail fixing screw. Used when forming bone.

[0056] The guide device 40 includes a shaft rotation cap 41 attached to the base (end) of the intramedullary nail lc. The shaft rotation cap 41 has a screw hole 16c of the intramedullary nail lc at the center. A rail 43 formed in an arc shape is attached, and a guide member 45 (sleeve) is provided slidably along a guide groove 44 provided in the rail 43. The drill guide member 45 is an arc-shaped rail. 43 is provided so as to extend in a direction perpendicular to the tangent line of the arc, and the guide member 45 is provided with a hollow guide hole 46 for guiding the guide 25.

That is, the drill guide member 45 can freely move on the surface of an imaginary sphere centered on the screw hole 16c of the target intramedullary nail lc, and the guide of the drill guide member 45 can be moved at any position. Hole 46 will point toward the center of the targeted screw hole 16c.

[0058] For this reason, the cap 41 for rotating the shaft is rotated so that the rail 43 is positioned within the virtual spherical surface including the central axis of the screw hole 16c of the intramedullary nail lc, and the direction of the screw hole 16c and the drill guide member 4 If the drill guide member 45 is slid along the rail 43 so that the direction of the guide hole 46 of 5 coincides, the screw hole 16c and the guide hole 46 will be located on a straight line. In this state, the drill 25 of the drill device 24 is inserted into the guide hole 46, and the drilling device 24 is pushed toward the screw hole 16c, so that the hole 28 aligned with the screw hole 16c is formed in the bone 34. be able to. In this way, the hole 28 can be easily and accurately formed in the bone 34 in accordance with the position and orientation of the screw hole 16c of the intramedullary nail lc.

At this time, the direction of the screw hole 16c can be controlled using the external magnetic force device 21 so as to be directed to, for example, the reduction position of the bone fragment 32c. The guide hole 46 can be aligned with the hole 26.

FIG. 10 is a front view illustrating an example in which the intramedullary nail Id is used for a distal fracture of the radius 35. A small nail 4d is fixed to the proximal portion of the intramedullary nail Id, and an intramedullary nail fixing screw 5d is screwed into the intramedullary nail 1 at the distal portion. A bone fragment fixing screw 6d is screwed into the nail 4d in the same manner as that shown in FIGS. 4 to 6, and a bone fragment (not shown) is drawn and fixed to the nail 4d.

FIG. 11 is a front view illustrating an example in which the intramedullary nail le is used for a fracture of the calcaneus 36. A small nail 4e is fixed to the proximal part of the intramedullary nail le. A bone filler 37 is supplied through a slit (not shown) formed in the portion, and secures the tip of the intramedullary nail le. A bone fragment fixing screw 6e is screwed into the nail 4e in the same manner as the method shown in FIGS. 4 to 6, and a bone fragment (not shown) is drawn and fixed to the nail 4e.

Next, a further example of a nail for fixing an end of a proximal portion of an intramedullary nail will be described. FIG. 12 is a diagram illustrating a case where a small nail 53 is used to fix the proximal end portion of the intramedullary nail 51. In FIG. 12, a nail insertion portion 54 for inserting a nail 53 is provided at an end 52 of a proximal portion of the intramedullary nail 51.

As shown in FIG. 12, in the present embodiment, the small nail fitting portion 54 has a substantially cylindrical shape, the entrance side for inserting the small nail 53 is slightly above, and the hook 58 of the small nail 53 is The axis ct I of the nail 51 in the longitudinal direction of the intramedullary nail 51 so that the exit side protruding is located slightly below

2

The axis is inclined at a predetermined angle Θ (approximately 10 ° to 80 °) in a direction perpendicular to the axis; 3.

twenty two

The The intramedullary nail 51 and the small nail 53 are formed of, for example, stainless steel, a cobalt chrome alloy, titanium, or a titanium alloy material.

FIG. 13 is a cross-sectional view of the nail insert section 54 in FIG. FIG. 13 shows a state where the small nail 53 has been inserted into the small nail insertion portion 54. The nail insertion portion 54 has a through hole 55 having a circular cross section. A partition wall 56 having a substantially triangular cross section is fixed to the exit side of the through hole 55 at a position where the through hole 55 is bisected. A female screw portion 57 is formed on the inlet side of the through hole 55, and a small nail fixing screw 59 is screwed into the female screw portion 57 of the through hole 55.

[0065] The nail 53 has a circular cross-section at its base, and a bifurcated hook 58 that expands from the base of the circle and extends. Each hook 58 has a plate shape with a rectangular cross section, is expanded on the short side of the rectangle, and formed in an arc shape toward one direction on the long side.

As shown in FIG. 13, when the small nail 53 is inserted into the through hole 55 and the small nail fixing screw 59 is screwed into the female screw portion 57 of the through hole 55, the forked portion of the hook 58 of the small nail 53 is The nail 53 is firmly fixed to the intramedullary nail 51 by being pressed against the partition wall 56. At this time, the hook 58 of the peg 53 is expanded by the partition wall 56 so that the hook 58 is expanded in the cancellous bone. [0067] Since the bone is a locomotor and is premised on movement, the intramedullary nail placed in the bone receives a fluctuating force. For this reason, in the case of the conventional method of fixing with a pin, lag screw or screw, the pin, lag screw or screw may come off (a phenomenon called backout). The nails 53 are not loosened even if the nails 53 are subjected to the fluctuating stress because they are integrally fixed to the partition wall 56 by being pushed by the nail fixing screws 59.

Further, the shape of the hook 58 may be a forked shape shown in FIG. 12 and FIG. Since the hook 58 has a plate-like cross section, the contact area with the bone is large.

FIG. 14 is a view showing a modification of the peg 53 in FIG. Fig. 14 shows a case where a small nail 53a having a three-pronged hook 58a is used. Fig. 14 (a) is a perspective view of the entire intramedullary nail 51a, and Fig. 14 (b) is a small nail. FIG. 9 is a cross-sectional BB view of the small nail insertion portion 54a of the intramedullary nail 51a showing a state before the nail 53a is inserted. As shown in FIG. 14 (b), the partition wall 56 has a triangular pyramid shape corresponding to the forked hook 58a. When the small nail 53a is inserted into the small nail fitting portion 54a, as shown in FIG. 14 (a), the pushed-in three-pronged hook 58a is expanded at 120 ° intervals.

FIG. 15 is an explanatory diagram showing a modified example of a nail that fixes the end of the proximal portion of the intramedullary nail 51b. In FIG. 15, a screw is used for the peg 60. A female screw portion 61 for screwing a small nail 60 (screw) is formed inside the small nail fitting portion 54b of the intramedullary nail 51b, and a screw head is provided at the entrance side of the female screw portion 61. An accommodation hole 62 for accommodating the portion 60b is provided.

[0071] Fig. 12 shows the ends of the intramedullary nails 51, 51a, and 51b shown in Fig. 15, and the nails 53, 53a, and 60 are inserted into the nails 53, 53a, and 60. Since there is no problem that one end of the root of 60 protrudes from the side of the nail 51, 51a, 51b, the range of motion of the joint including the bone into which the nail 51, 51a, 51b is inserted, or It does not contribute to remaining human damage. Further, the problem that a new skin incision has to be made to insert the pegs 53, 53a, 60 is eliminated.

[0072] In addition, since the bases of the intramedullary nails 51, 51a, and 51b can be seen with the naked eye, the nails 53, 53a, and 60 can be easily operated without using a target device as in the related art. Type It comes out.

Next, a flexible intramedullary nail will be described. Conventionally, if an intramedullary nail with low flexibility is used, the cortical bone around the pin, lag screw or screw for fixing the intramedullary nail will be broken, and the pin, lag screw or screw will be loosened. However, there is a problem that the lag screw or the screw is damaged. Figures 16, 17, and 18 show structures with flexibility near the longitudinal center of the nail.

FIG. 16 (a) is a front view of a flexible intramedullary nail 51c, and FIG. 16 (b) is a side view of the intramedullary nail 51c. At the proximal part (upper part) of the intramedullary nail 51c, a small nail 53c inserted into the small nail insertion part 54c and a fixing screw (not shown) inserted into a screw hole 63c arranged at the distal part (lower part) Is fixed to the bone. Near the central portion in the long axis direction of the intramedullary nail 51c, a small-diameter portion 64c having a smaller cross-sectional shape than the proximal portion and the distal portion is formed. The small diameter portion 64c is determined in diameter and length so as to exhibit flexibility against bending acting on the intramedullary nail 5lc.

FIG. 17 (a) is a front view of a flexible intramedullary nail 51d, and FIG. 17 (b) is a side view of the intramedullary nail 51d. The intramedullary nail 51d has a substantially circular cross section at the proximal part (upper part) and the distal part (lower part), and is inserted into the small nail insertion part 54d at the proximal part (upper part) of the intramedullary nail 51d. It is fixed to the bone by a small nail 53d to be inserted and a fixing screw (not shown) inserted into a screw hole 63d arranged at the distal part (lower part). In the vicinity of the central portion in the longitudinal direction of the intramedullary nail 51d, a plate-like portion 65d having a rectangular cross section and a smaller cross-sectional area than both sides is formed. The plate-like portion 65d has a wide mounting direction for the peg 53d and a narrow mounting direction for a fixing screw (not shown) inserted through the screw hole 63d, and a fixing screw inserted through the screw hole 63d. It is possible to give flexibility to the mounting direction (not shown).

FIG. 18 (a) is a front view of a flexible intramedullary nail 51e, and FIG. 18 (b) is a side view of the intramedullary nail 51e. The intramedullary nail 51e has a hollow circular cross section, and is located at the proximal part (upper part) of the intramedullary nail 51e, at the small part 53e inserted into the small nail fitting part 54e, and at the distal part (lower part). It is fixed to the bone by a fixing screw (not shown) inserted through the screw hole 63e. Near the center in the longitudinal direction of the intramedullary nail 51e, a pair of slit holes 66e as slit forming portions in the present embodiment are formed on both sides. Therefore, the intramedullary nail 51e can have flexibility in a mounting direction of a fixing screw (not shown) inserted through the screw hole 63e. As described above, by giving flexibility to the intramedullary nails 51c, 51d, and 51e, the intramedullary nails 51c, 51d, and 51e are formed at the proximal and distal portions of the intramedullary nails 51c, 51d, and 51e. Of the small nails 53c, 53d, 53e or the fixing screw (not shown) can be prevented.

[0078] The intramedullary nails 51c, 51d, and 51e provided with flexibility as shown in Figs. 16, 17, and 18 may be affected by the shape of the bone when inserted into the bone. . If the intramedullary nails 51c, 51d, and 51e bend, a fixing screw (not shown) cannot be accurately inserted into the screw holes 63c, 63d, and 63e at the distal portion when the guide device described later is used. It is desirable that the bending of the intramedullary nails 51c, 51d, and 51e be prevented when the inner nails 51c, 51d, and 51e are inserted into the bone.

FIG. 19 is a view showing a reinforcing member 95 for preventing the flexible intramedullary nail 51f from bending when inserted into the bone. As shown in FIG. 19, in the intramedullary nail 51f provided with flexibility by the small diameter portion 64f, the reinforcing member 95 for reinforcing the intramedullary nail 51f can be detachably attached using the hollow portion of the intramedullary nail. It is like that. At the upper and lower ends of the small-diameter portion 64f of the intramedullary nail 51f, a large-diameter portion 75f at the upper and lower ends is formed with a fitting recess 96 into which the reinforcing member 95 is inserted. It can be attached to and detached from.

[0080] When the intramedullary nail 51f to which the reinforcing member 95 is attached is inserted into the bone, the reinforcing member 95 is attached to the intramedullary nail 5If to suppress the flexibility of the intramedullary nail 5If. Intramedullary nail 5 Prevents bending of If. In this state, the fixing screw 63f is inserted into the intramedullary nail 51f. After the fixing screw 63f is inserted, the reinforcing member 95 is removed, and the intramedullary nail 5Π is made flexible. Note that, in this example, the case where the above-described nail insertion portion is not provided in the intramedullary nail 5Π is described. It goes without saying that it can be applied.

FIG. 20 is a diagram showing a reinforcing member 97 for preventing the flexible intramedullary nail 51g from bending when inserted into the bone. As shown in FIG. 20, in the intramedullary nail 51g provided with the flexibility by the slit hole 66g as the slit forming portion in the present embodiment, the reinforcing member 97 for reinforcing the intramedullary nail 51g is replaced with the hollow of the intramedullary nail. It is designed so that it can be attached and detached using parts. The reinforcing member 97 has a shape capable of being fitted into the slit hole 66g, and is fitted or removed from the hollow portion of the intramedullary nail 51g into the slit hole 66g using a not-shown holding tool. Next, the drill guide device will be described. The drill guide device can be used, for example, when an operator cannot see the screw hole, such as when a fixing screw is driven into the distal portion of an intramedullary nail inserted into a bone. And a device that guides a drill and a fixing screw when a fixing screw is screwed into a screw hole.

FIG. 21 is a diagram showing a conventional general drill guide device 67h. A drill guide device 67h is attached to the base of the intramedullary nail 51h. The Dorinore guide device 67h includes a mounting device 68h to be attached to the base of the intramedullary nail 51h, and a substantially L-shaped and highly rigid arm 69h is fixed to the mounting device 68h. The arm 69h is bent at a predetermined distance from the intramedullary nail 51h and then extends parallel to the longitudinal direction of the intramedullary nail 51h. In this arm 69h, a sleeve 70h as a drill guide member in the present embodiment is provided so as to face the screw hole 71h of the intramedullary nail 51h toward the center of rotation.

By the way, as shown in FIG. 21, when the intramedullary nail 51h is inserted into the bone 84h, a slight bending may occur as shown by a broken line in FIG. In that case, the position of the screw hole 71h also changes. Even if the arm 69h is rotated to move the sleeve 7 Oh near the position of the screw hole 71h, since the axis of the screw hole 71h does not match the axis of the sleeve 70h, the drill 72h of the drill unit 86h must be There was a problem that it could not be driven into the screw hole 71h.

FIG. 22 is a diagram illustrating a drill guide device 67i of the present invention. The arm 69i of the drill guide device 67i constituting the osteosynthesis device of the present embodiment is provided with a hinge 73i in parallel with the long axis of the sleeve 70i as the drill guide member of the present embodiment. The arm 69i can rotate around the mounting device 68i as a central axis, and the rotation can be fixed if necessary. In addition, a telescoping device 74i that can extend and contract the length of the arm 69i in parallel with the rotation center axis is provided. The hinge 73i is the same as a known hinge, and the extension device 74i is the same as a known slide-type extension device. By operating a set screw 75i that is engaged with the engagement groove 85i, the sleeve 70i is removed. It can be fixed at an appropriate position.

[0086] When the intramedullary nail 51i is inserted into the bone 84i, there is a force that may bend as shown by the broken line in Fig. 22. In this case, the bending is bending in the bending direction. Yeah Since there is no bending in the torsion direction, the position of the screw hole 71i changes. There is no change in the long axis direction of the screw hole 71i. Therefore, the position of the sleeve 70i can be matched with the position of the screw hole 71i by combining the rotation with the hinge 73i as a fulcrum and the length adjustment by the expansion and contraction device 74i. The number of hinges is not limited to one, and a plurality of hinges may be provided as necessary. Further, the hinge 73i can be fixed if necessary.

[0087] With this configuration, the sleeve 70i of the drill guide device 67i has a structure capable of coping with the bending due to the bending in the longitudinal direction of the intramedullary nail 51i, and the screw hole 7 provided in the distal portion of the intramedullary nail 51i. It is possible to hit the drill 72i while maintaining the same direction as the axial direction of li. In order to confirm the position of the screw hole 71i of the intramedullary nail 51i placed in the bone 84i, as described above, the magnet 27 is carried around the screw hole 71i, and a magnetic force sensor is used. The position of the screw hole 71i may be confirmed by using a screw hole guide device 87 described later.

Next, the screw hole guide device 87 will be described. The screw hole guide device 87 according to the embodiment of the present invention irradiates light from the outside of the bone 94 so that the screw hole 71 of the intramedullary nail 51 k mounted inside the bone 94 can be clearly indicated to the operator. It was done.

FIG. 23 is an explanatory diagram showing an overall image of the screw hole guide device 87. A light emitting device 77 for emitting light and a light emitting device 77 inserted into the bone 94 are provided around a front side (tip side) of a hollow drill guide 76 (sleeve) for guiding a drill 88 constituting the osteosynthesis device in this embodiment. A plurality of photodetectors 78 for detecting light reflected by the intramedullary nail 51k are provided alternately. The light emitted from the plurality of light emitters 77 is set to have different wavelengths, so that it is possible to specify from which light emitter 77 the light is emitted. The light emitted from the plurality of light emitters 77 is set to have the same wavelength, the light is emitted as a pulse, and the light emission timing is shifted, whereby it is possible to identify which light emitter 77 is emitted. Method

The light emitters 77 shown in FIG. 23 are each connected to a light source 80 via an optical fiber 79. Further, the light detector 78 detects the light reflected from the intramedullary nail 51k, and transmits the signal to the arithmetic unit 82 via the cable 81. The calculator 82 calculates the position of the screw hole 71 and displays it on the display 83. As the photodetector 78, for example, the surface resistance of a photodiode You can use a spot light position sensor, CCD camera, or photodetector array that uses a resistance. The display 83 is provided in the drill guide 76 so that the user of the drill device 88 can easily view the display 83.

[0091] Note that some intramedullary nails are not hollow, and in that case, it is difficult to install a light emitter in the intramedullary nail. Further, even with a hollow intramedullary nail, it may be difficult to insert the luminous body at a predetermined position depending on the shape of the intramedullary nail.

[0092] Even if the luminous body could be arranged in the intramedullary nail as used in the prior art, after the screw hole was confirmed, the luminous body in the intramedullary nail was moved to the intramedullary nail. If you do not take it out of the nail, you will not be able to hit the fixing screw. If the position of the screw hole is lost while taking out the light emitter, it is necessary to set the light emitter in the intramedullary nail again.

However, according to the screw hole guide device 87 shown in FIG. 23, even if the intramedullary nail 51k is solid and the light emitter cannot be arranged inside, the position of the screw hole 71 is confirmed by the external light emitter 77. You can do it. In addition, since the operator can determine the direction in which the drill 88 is to be hit while looking at the display 83 and proceed with the operation, all the conventional problems can be solved.

[0094] According to the screw hole guide device 87 shown in Fig. 23, by providing the drill guide 76 with the light emitter 77 and the light detector 78, the position of the screw hole 71 can be visually recognized until the drilling operation is completed. . Furthermore, by using light having different wavelengths for the light emitter 77 or by shifting the emission timing of the nose light, the position of the screw hole 71 can be accurately specified even if the light passing through the bone 94 is scattered. Power S can.

[0095] Fig. 24 shows the use of a small nail 53m for the small nail insertion part 54m at the proximal part of the intramedullary nail 51m, a fixing screw 63m for the distal part, and a fracture of the proximal humerus. It is a schematic diagram which shows the case applied to F

[0096] Fig. 25 is a schematic diagram showing a case where a screw 60η is inserted into a through hole of a small nail fitting portion 54η of an intramedullary nail 51η and is applied to a fracture portion G of a metaphyseal radius.

[0097] Although the embodiments of the present invention have been described with reference to the drawings, the specific configuration is not limited to these embodiments, and even if there are changes and additions without departing from the gist of the present invention. include.

Claims

The scope of the claims

[1] At the proximal end of the intramedullary nail, a nail insertion portion for inserting a nail for fixing the intramedullary nail is provided in a direction intersecting the longitudinal direction of the intramedullary nail. Characterized osteosynthesis device.

[2] A through-hole is provided from the proximal end face of the intramedullary nail in a direction having a certain angle with respect to the center line of the intramedullary nail, and the through-hole has a conical portion that decreases in diameter from the entrance side to the exit side. A nail having a conical portion that fits with the conical portion of the through hole is inserted into the through hole, and the nail is pressed and fixed from the entrance side of the through hole by the nail fixing means. The osteosynthesis device according to claim 1, wherein:

[3] The osteosynthesis device according to claim 1 or 2, wherein the nail has a twisted arc shape or a spiral shape.

[4] A through-hole is provided inside the nail insertion part, and the through-hole is divided into two at the exit side of the through-hole.

In addition to providing a partition so as to divide into three, a female screw portion into which a small nail fixing screw for fixing a small nail is screwed is provided at the entrance side of the through hole, and the small nail is inserted from the original portion first. The osteosynthesis device according to any one of claims 1 to 3, further comprising a hook that is expanded and extended in a bifurcated or trifurcated shape.

[5] A receiving hole for receiving the head of the screw for fixing the intramedullary nail is provided on the entrance side inside the nail insertion portion, and a female screw portion for screwing the screw is provided following the receiving hole. 2. The osteosynthesis device according to claim 1, wherein a screw is used as the nail.

[6] An osteosynthesis device characterized in that a soft portion comprising a small-diameter portion, a plate-shaped portion or a slit-formed portion is formed near a central portion in the longitudinal direction of the intramedullary nail.

[7] The osteosynthesis according to claim 6, wherein a reinforcing member for temporarily reinforcing the flexible portion of the intramedullary nail can be detachably attached via a hollow portion formed in the intramedullary nail. Utensil

[8] A guide for forming at least one screw hole having at least one thread between the proximal end and the distal end of the intramedullary nail, and expanding the conical diameter on at least one side of the screw hole. An osteosynthesis device formed with a portion, comprising a shaft rotation cap attached to the base of the intramedullary nail, wherein the shaft rotation cap is formed in an arc shape centered on a screw hole of the intramedullary nail. A rail is mounted, and a drill guide member is slidably provided along a guide groove provided in the rail. An osteosynthesis device, wherein the member extends in a direction perpendicular to a tangent to the arc of the arc-shaped rail, and the drill guide member has a guide hole for guiding a drill.

[9] At least one nut member having a screw hole is pivotally mounted between the proximal end and the distal end of the intramedullary nail, and at least one side of the nut member has a conical shape. An osteosynthesis device having an intramedullary nail formed with a guide portion for expanding the diameter, comprising a shaft rotation cap attached to the base of the intramedullary nail, wherein the shaft rotation cap is provided with a screw hole of a nut member as a center. And a drill guide member is provided slidably along a guide groove provided in the rail, and the drill guide member is perpendicular to a tangent to the arc of the arc rail. An osteosynthesis device, which is provided so as to extend in a direction, and a drill guide member is provided with a guide hole for guiding a drill.

[10] The external magnets are opposed to each other so that the polarity is opposite to the magnets mounted on both sides of the screw hole of the nut member, and the direction of the screw hole of the nut member is adjusted by using the attractive force of the facing magnet. The osteosynthesis device according to claim 9, wherein the osteosynthesis device can be controlled.

[11] At the base of the intramedullary nail, there is provided a drill guide device provided with an arm spaced a certain distance from the intramedullary nail and extending in parallel with the longitudinal direction of the intramedullary nail and a sleeve facing the screw hole. An osteosynthesis device, wherein a hinge is provided on the arm in parallel with the longitudinal direction of the sleeve, and a telescopic device is provided which is extendable and contractible in the longitudinal direction of the intramedullary nail.

[12] A hollow drill guide for guiding a drill is provided with a plurality of light-emitting devices for emitting light and a plurality of light detectors for detecting reflected light so that the wavelengths of light emitted from the plurality of light-emitting devices are different. An osteosynthesis device characterized by being set.

13. The bone joint according to claim 12, wherein the light emitted from the plurality of light emitters is emitted in the form of pulses, and the emission timing of each emitted light is set to be shifted. Appliances.