CN1157159C - 髓内钉 - Google Patents
髓内钉 Download PDFInfo
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- CN1157159C CN1157159C CNB998170135A CN99817013A CN1157159C CN 1157159 C CN1157159 C CN 1157159C CN B998170135 A CNB998170135 A CN B998170135A CN 99817013 A CN99817013 A CN 99817013A CN 1157159 C CN1157159 C CN 1157159C
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- 210000000988 bone and bone Anatomy 0.000 claims description 8
- 210000000689 upper leg Anatomy 0.000 claims description 6
- 208000037873 arthrodesis Diseases 0.000 claims description 5
- 210000001185 bone marrow Anatomy 0.000 claims description 5
- 210000001624 hip Anatomy 0.000 abstract description 23
- 210000001694 thigh bone Anatomy 0.000 abstract 1
- 238000005516 engineering process Methods 0.000 description 2
- 238000005452 bending Methods 0.000 description 1
- 238000000354 decomposition reaction Methods 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 230000002349 favourable effect Effects 0.000 description 1
- 239000012634 fragment Substances 0.000 description 1
- 210000004394 hip joint Anatomy 0.000 description 1
- 238000003754 machining Methods 0.000 description 1
- 238000003801 milling Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 238000002360 preparation method Methods 0.000 description 1
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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
Abstract
髓内钉(1)用来处理股骨骨折。它具有一个确定用来插入到骨髓腔管内的远中端(2)、一个近中端(3)以及一个纵轴(4)。一个靠近近中端(3)的、与纵轴(4)横向相交的第一孔(5)用来容纳一个股骨头螺钉(10),其中第一孔(5)的中心线(6)与纵轴相交成一个110°到150°的角度。一个位于第一孔(5)和近中端(3)之间的、与纵轴(4)横向相交的第二孔(7)用来容纳一个髋销钉(20)。第二孔(7)至少局部做成长孔,它具有一个宽度B和一个长度L>B,其中长孔的长度沿纵轴(4)方向分布。
Description
技术领域
本发明涉及一种髓内钉。
背景技术
由EP-A 0 551 588已知一种这一类型的髓内钉。这种结构的缺点是,装在股骨头内的两个髋螺钉(股骨头螺钉和髋销钉)角度稳定地插入到髓内钉的圆柱形孔内。由于其由尺寸决定的抗弯强度的不同,在临床上可能出现两个螺钉相互的相对移动。由于较小的髋销钉轴向滑动性能很差或者甚至卡死,它可能穿透髋关节。
发明内容
本发明在此将提出一些改进办法。本发明的目的是创造一种髓内钉,它没有上述缺点。
根据本发明,提出一种用来处理股骨骨折的固定装置,具有一个髓内钉、一个股骨头螺钉和一个髋销钉,其特征为:A)所述髓内钉具有一个确定用来插入到骨髓腔管中的远中端、一个近中端、一个纵轴以及一个靠近近中端的、与纵轴横向相交的、用来容纳一个股骨头螺钉的第一孔,其中,所述第一孔的中心线与纵轴相交成一个30°至70°的角α,B)所述髓内钉具有一个位于第一孔和近中端之间的、与纵轴横向相交的用来容纳一个髋销钉的第二孔,其中,所述第二孔至少局部做成长孔,长孔具有一个宽度B和一个长度L>B,其中所述长孔的长度L沿纵轴方向分布。
由于长孔而放弃髋销钉在钉纵轴方向的角度稳定性意味着与现有技术相比没有缺点,因为始终借助于髋销钉阻止股骨头环绕股骨头螺钉的转动,这是髋销钉本身的任务并保持不变。
通过采用用来容纳髋销钉的长孔,可以达到这样的优点,即两个髋螺钉的机械应力可以得到分摊。此外较大的股骨头螺钉还承担在股骨头内的螺钉固定相对于髓内钉的角度稳定性的功能,并通过在相应的髓内钉孔内的轴向滑动允许股骨头碎片“熔结”。而较小的髋销钉仅仅承担防止股骨头相对于较大的股骨头螺钉旋转的功能。
在本发明一种优选的实施形式中,第一孔做成圆柱形。第二孔的侧面入口最好做成圆柱形,而第二孔的在中间出口最好做成长孔。在另一种实施形式中,第二孔的侧面入口和中间出口都做成长孔。第二孔的宽度B最好小于第一孔的直径D。
第一孔的中心线最好与纵轴相交成一个40°至55°的角α。第二孔的中心线最好与纵轴相交成一个30°至70°的角β,或者一个110°至150-180°的角β。这种位置最好用于一个非滑动的固定螺钉。但是角β也可以具有70°至90°的数值,如果角α处于同样的角度范围的话。这种位置最好用于滑动髋螺钉。长孔的长度L最好为8至12mm,通常是9至11mm。长孔的宽度B最好为5至10mm,通常为6至7mm,L∶B的比值最好在1.05至2.00范围内,通常在1.10至1.60的范围内。
在一种优选的实施形式中,附加设有至少一个靠近远中端的、与纵轴横向相交的第三孔,用以容纳一个远中的闩式关节固定螺钉。
在另一种实施形式中,第二孔的侧面入口做成长孔,而第二孔的中间出口做成圆柱形。
在一个固定装置之内与髓内钉一起使用的髋销钉应该最好比所使用的股骨头螺钉短5至20mm,特别是短10至15mm。其中髋销钉的直径应该相当于做成长孔的第二孔的宽度B。
附图说明
下面借助于一个实施例的局部示意图对本发明和本发明的改进结构作更详细的说明。
附图表示:
图1是本发明髓内钉连同适合于它的髋螺钉和闩式关节固定螺钉的分解纵剖视图;
图2是图1髓内钉的近中部分旋转90°的视图;
图3是图1髓内钉的近中部分的变型;
图4是植入和固定到股骨内的图1的髓内钉的透视图;
图5是带有一个完全倒圆的长孔的髓内钉的近中部分的侧视图;
图6是带有一个矩形长孔的髓内钉的近中部分的侧视图;
图7是带有一个略微倒圆的长孔的髓内钉的近中部分的侧视图;
图8是带有一个向中侧面扩展的、向近中方向倾斜的长孔的图3的近中部分的剖面图;
图9是带有一个向中侧面扩展的长孔的髓内钉的近中部分的剖面图;
图10是带有一个向中侧面缩小的长孔的髓内钉的近中部分的剖面图。
具体实施方式
在图1和图4中所示的用来处理股骨骨折的髓内钉1具有一个确定用来插入到骨髓腔管中的远中端2、一个近中端3和一个纵轴4。此外所述髓内钉1还具有一个靠近近中端3的、与纵轴4横向相交的具有纵轴6的第一孔5,它确定用来容纳股骨头螺钉10。该第一圆柱形孔5的中心线6与纵轴4相交成一个30°至70°的角α,或者一个110°至150°的角180°-α。其次所述髓内钉1还设有一个位于第一孔5和近中端3之间的、与纵轴4横向相交的具有纵轴8的第二孔7,用以容纳一个髋销钉20。该第二孔的中心线与纵轴交成一个45°的角β。
如图2所示,第二孔7的侧面入口13和中间出口14都做成长孔,在本实施形式中,插入到所述孔7内的髋销钉20在中侧平面内(它相当于图1中的图形平面)相对于轴线8可向两个方向,也就是向上和向下偏转一定角度。
如图3(以及图8和9)中所示,第二孔7也可以设计成这样,将它的侧面入口13做成圆柱形,而将中间出口14做成长孔。在这种实施形式中,插入到所述孔7内的髋销钉20在侧面入口13处完全被包住,因此它在中侧平面(它相当于图1中的图形平面)内只能相对于轴线8作有限的运动。
如图2、3、5和7中所示,长孔可以是倒圆的(这种形状在加工孔时可以借助于一个圆柱形钻头或铣刀垂直于钻头轴线运动得到),或者如图6中所示,做成有角的矩形形状。与多角的或倒圆的长孔形状无关,它具有一个宽度B和一个长度L>B,其中长孔的长度L沿纵轴4方向分布。第二孔7的宽度B最好小于第一孔5的直径D。长孔的长度L为10mm,其宽度为6.5mm。L和B之间的比例因此为1.538。
如图1和4中所示,髓内钉1具有一个附加的、靠近远中端2的、与纵轴4横向相交的第三孔9,用以容纳一个远中的闩式关节固定螺钉30。
如图4中所示,如果由杆部22和带螺纹的前部21组成的髋销钉20比由杆部12和带螺纹的前部11组成的股骨头螺钉10短5到20mm,尤其是短10至15mm,是有利的。
下面简要说明按本发明的髓内钉的操作技术:
a)对股骨的骨髓腔管的准备工作;
b)将髓内钉敲入骨髓腔管内;
c)将导针插入到第一近中孔6和第二近中孔7;
d)在骨头内钻出用于髋销钉20的孔;
e)将髋销钉20通过第二近中孔7插入到骨头内准备好的孔中;
在髋销钉20成功插入后,在随后插入股骨头螺钉10时,股骨
头便不能转动;
f)在骨头内钻出用于股骨头螺钉10的孔;
g)将股骨头螺钉10通过第一近中孔5插入到骨头内准备好的孔中并取出导针;
h)钻出用于远中固定髓内钉的孔;将闩式关节固定螺钉30插入位于远中端的第三孔9中。
Claims (15)
1.一种用来处理股骨骨折的固定装置,具有一个髓内钉(1)、一个股骨头螺钉(10)和一个髋销钉(20),
其特征为:
A)所述髓内钉(1)具有一个确定用来插入到骨髓腔管中的远中端(2)、一个近中端(3)、一个纵轴(4)以及一个靠近近中端(3)的、与纵轴(4)横向相交的、用来容纳一个股骨头螺钉(10)的第一孔(5),其中,所述第一孔(5)的中心线(6)与纵轴(4)相交成一个30°至70°的角α,
B)所述髓内钉(1)具有一个位于第一孔(5)和近中端(3)之间的、与纵轴(4)横向相交的用来容纳一个髋销钉(20)的第二孔(7),其中,所述第二孔(7)至少局部做成长孔,长孔具有一个宽度B和一个长度L>B,其中所述长孔的长度L沿纵轴(4)方向分布。
2.按权利要求1的固定装置,其特征为:第一孔(5)是圆柱形的。
3.按权利要求1或2的固定装置,其特征为:第二孔(7)的侧面入口(13)做成圆柱形,而第二孔(7)的中间出口(14)做成长孔。
4.按权利要求1或2的固定装置,其特征为:第二孔(7)的侧面入口(13)和中间出口(14)都做成长孔。
5.按权利要求1或2的固定装置,其特征为:第二孔(7)的宽度B小于第一孔(5)的直径D。
6.按权利要求1或2的固定装置,其特征为:第二孔(7)的中心线(8)与纵轴(4)相交成一个30°至70°的角β。
7.按权利要求1或2的髓内钉,其特征为:第二孔(7)的中心线(8)与纵轴(4)相交成一个70°至90°的角β。
8.按权利要求1或2的固定装置,其特征为:长孔的长度L为8至12mm。
9.按权利要求1或2的固定装置,其特征为:长孔的宽度B为5至10mm。
10.按权利要求1或2的固定装置,其特征为:附加设有至少一个靠近远中端(2)的、与纵轴(4)横向相交的、用来容纳一个远中的闩式关节固定螺钉(30)的第三孔(9)。
11.按权利要求1或2的固定装置,其特征为:第一孔(5)的中心线(6)与纵轴(4)相交成一个40°至55°的角α。
12.按权利要求1或2的固定装置,其特征为:L与B之比在1.05至2.00范围内。
13.按权利要求1或2的固定装置,其特征为:第二孔(7)的侧面入口(13)做成长孔,而第二孔(7)的中间出口(14)做成圆柱形。
14.按权利要求1或2的固定装置,其特征为:所述髋销钉(20)比股骨头螺钉(10)短5至20mm。
15.按权利要求14的固定装置,其特征为:所述髋销钉(20)的直径相当于做成长孔的第二孔(7)的宽度B。
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/CH1999/000581 WO2001039679A1 (de) | 1999-12-03 | 1999-12-03 | Intramedullärer marknagel |
Publications (2)
Publication Number | Publication Date |
---|---|
CN1378438A CN1378438A (zh) | 2002-11-06 |
CN1157159C true CN1157159C (zh) | 2004-07-14 |
Family
ID=4551742
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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CNB998170135A Expired - Fee Related CN1157159C (zh) | 1999-12-03 | 1999-12-03 | 髓内钉 |
Country Status (15)
Country | Link |
---|---|
US (1) | US6855146B2 (zh) |
EP (1) | EP1233712B1 (zh) |
JP (1) | JP4242588B2 (zh) |
KR (1) | KR100582744B1 (zh) |
CN (1) | CN1157159C (zh) |
AT (1) | ATE260074T1 (zh) |
AU (1) | AU771408B2 (zh) |
CA (1) | CA2396385C (zh) |
DE (1) | DE59908678D1 (zh) |
DK (1) | DK1233712T3 (zh) |
ES (1) | ES2214071T3 (zh) |
NZ (1) | NZ518261A (zh) |
PT (1) | PT1233712E (zh) |
TW (1) | TW520280B (zh) |
WO (1) | WO2001039679A1 (zh) |
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-
1999
- 1999-12-03 JP JP2001541415A patent/JP4242588B2/ja not_active Expired - Fee Related
- 1999-12-03 KR KR1020027007100A patent/KR100582744B1/ko not_active IP Right Cessation
- 1999-12-03 CA CA002396385A patent/CA2396385C/en not_active Expired - Fee Related
- 1999-12-03 AT AT99974233T patent/ATE260074T1/de active
- 1999-12-03 DK DK99974233T patent/DK1233712T3/da active
- 1999-12-03 NZ NZ518261A patent/NZ518261A/en not_active IP Right Cessation
- 1999-12-03 PT PT99974233T patent/PT1233712E/pt unknown
- 1999-12-03 DE DE59908678T patent/DE59908678D1/de not_active Expired - Lifetime
- 1999-12-03 ES ES99974233T patent/ES2214071T3/es not_active Expired - Lifetime
- 1999-12-03 CN CNB998170135A patent/CN1157159C/zh not_active Expired - Fee Related
- 1999-12-03 EP EP99974233A patent/EP1233712B1/de not_active Expired - Lifetime
- 1999-12-03 AU AU13709/00A patent/AU771408B2/en not_active Ceased
- 1999-12-03 WO PCT/CH1999/000581 patent/WO2001039679A1/de active IP Right Grant
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2000
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CN1378438A (zh) | 2002-11-06 |
DE59908678D1 (de) | 2004-04-01 |
JP4242588B2 (ja) | 2009-03-25 |
KR20020065546A (ko) | 2002-08-13 |
EP1233712A1 (de) | 2002-08-28 |
NZ518261A (en) | 2004-01-30 |
WO2001039679A1 (de) | 2001-06-07 |
CA2396385C (en) | 2007-10-30 |
EP1233712B1 (de) | 2004-02-25 |
CA2396385A1 (en) | 2001-06-07 |
DK1233712T3 (da) | 2004-06-01 |
US20030004514A1 (en) | 2003-01-02 |
US6855146B2 (en) | 2005-02-15 |
ATE260074T1 (de) | 2004-03-15 |
AU1370900A (en) | 2001-06-12 |
JP2003515382A (ja) | 2003-05-07 |
ES2214071T3 (es) | 2004-09-01 |
PT1233712E (pt) | 2004-07-30 |
AU771408B2 (en) | 2004-03-18 |
TW520280B (en) | 2003-02-11 |
KR100582744B1 (ko) | 2006-05-23 |
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