CN1373646A - 骨板系统 - Google Patents

骨板系统 Download PDF

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CN1373646A
CN1373646A CN00812765A CN00812765A CN1373646A CN 1373646 A CN1373646 A CN 1373646A CN 00812765 A CN00812765 A CN 00812765A CN 00812765 A CN00812765 A CN 00812765A CN 1373646 A CN1373646 A CN 1373646A
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screw
bone
hone lamella
plate system
skeleton
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CN1172634C (zh
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保罗·C·韦弗
杰夫·W·马斯特
基斯·A·梅奥
布雷特·R·波尔霍夫纳
戴维·利特尔
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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
    • 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
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00—Surgery
    • Y10S606/902—Cortical plate specifically adapted for a particular bone

Abstract

本发明涉及一种骨板系统以及用于骨骼骨折固定的方法。该骨板系统包括一个骨板(30;50;80)、至少一个锁紧螺钉(20),以及至少一个非锁紧螺钉(10)。该骨板(30;50;80)具有带螺纹(40)的锁紧孔(36;56;86)以及非锁紧孔(38;58;88)。该锁紧螺钉(20)具有一个带螺纹的轴(26),该轴用于与骨骼相连,以及一个带螺纹(24)的头部(22),该螺纹的形状和尺寸与锁紧孔(36;56;86)的螺纹(40)相匹配。该非锁紧螺钉(10)具有与骨骼相连的螺纹以及非螺纹头部(12)。该锁紧螺钉和非锁紧螺钉(20;10)保留固定在其各自的孔(36;56;86;38;58;88)中,其时间与骨板(30;50;80)被植入的时间基本相同。当将锁紧螺钉(20)以固定的角度固定到骨板上时,非锁紧螺钉(10)将骨板(30;50;80)压向骨骼,且保持骨折减少。通过该骨板系统,可以获得混合的固定,该方法对于关节周围骨折的处理特别有用。

Description

骨板系统
本发明涉及一种用于骨折固定的骨板系统，尤其涉及这样一种包括一个骨板的系统，其中该骨板上具有为插入锁紧螺钉和非锁紧螺钉而设置的板孔。
在很多文献中，都记载有关于骨折内固定用的板和螺钉系统在临床上成功应用的例子。然而，对于某些骨折的处理(如关节周围骨折，该骨折需要在骨板和螺钉之间保持一个固定的角关系)仍然存在一些问题。用于上述骨折处理的固定角装置是可获得的，如Synthes(USA)of Paoli，PA市售的动态髁螺钉系统以及多种不同种类的叶板。所有这些装置需要较高水平的外科医术、合适的骨骼数量和质量以及与该装置相适宜的骨折类型。
当上述条件不满足时，例如对于严重粉碎性的骨骼或丧失部分骨片段的场合下，必须使用传统的骨板和螺钉系统。尽管这些传统的系统中通过将骨折端压缩在一起且使得骨骼与其它骨段和骨板处于最接近的位置，因而特别适于骨折的愈合，但是骨板和螺钉之间的角关系不是固定的，且在手术后会发生改变。这会导致校准不良的情况的发生以及临床效果较差。
用于角度关系改变的主要机械与能量存储有关。如上所述，将骨螺钉拧入骨骼中使得骨骼压缩骨板。该压缩导致在骨骼中产生很高的压力，相应地会产生能量存储。在因生理条件而产生的动态荷载作用下，会导致骨板和螺钉变得松弛以及发生能量存储损失的现象。
将螺钉固定到骨板上使得骨板和螺钉之间保持一个固定的角度关系，且减少了上述松弛现象的发生。将螺钉固定到骨板上的一种方法是采用所谓的“锁紧螺钉”。锁紧螺钉的头部外表面上具有与板孔的表面上的螺纹相匹配的螺纹以便将螺钉锁紧到骨板上。在现有技术中，已经公开了具有用于容纳锁紧螺钉的螺纹孔的骨板。例如德国专利申请No.4343117公开了一种具有为螺钉的插入而设的带螺纹孔的骨板。因为锁紧螺钉和骨板之间的关系是固定的，所以，锁紧螺钉的设置提供了对剪切力或扭转力的较高的抵抗力。然而，锁紧螺钉只具有有限的能力来压缩骨片段。
总之，传统的骨螺钉，即不固定到骨板上的螺钉以便在骨板和螺钉之间保持一个固定的角度关系(此后称为“非紧固螺钉”)，能够有效地压缩骨片段，但是对剪切力具有较低的抵抗力，而该剪切力导致螺钉发生松弛现象。锁紧螺钉具有对剪切力具有较高的抵抗力，在该抵抗力的作用下，使得在骨螺钉/骨板孔界面上保证稳定性，但是其只具有有限的能力来压缩该骨片段。这样，在某些临床应用中，使用非锁紧螺钉与锁紧螺钉相结合的骨板系统将会是理想的选择。
US专利No.5 601 553公开了一种锁紧板和骨螺钉。该骨板具有多个用于接收锁紧螺钉的带螺纹的板孔。该骨板也具有用于接收临时螺钉的非螺纹板孔，当插入锁紧螺钉时，该临时螺钉用于保持骨板的位置。当锁紧螺钉被插入之后，临时螺钉被移去。这样，不能获得将非锁紧螺钉和锁紧螺钉相结合使用的长期好处。美国专利US 5 709 686公开了一种带有局部螺纹板孔的骨板。该局部螺纹板孔使得非锁紧螺钉或锁紧螺钉得以使用。因为板孔为局部带螺纹的，所以，在生理荷载的作用下，该使用的锁紧螺钉可能不能够在螺钉和板之间保持固定的角度关系。特别地，位于骨板内的锁紧螺钉只为局部地被接合，这样，仅局部地被螺纹包围。在高压的作用下，锁紧板孔发生变形，造成锁紧螺钉和骨板之间的固定角度关系发生改变。这会导致固定损失的发生以及已确定的外科手术进行时发生板向损失。另外，由于板孔的几何形状，骨板与非锁紧螺钉之间的平动仅限于一个方向。这对于碎片的减少和处理带来不利的影响。
这样，需要对骨板系统进行改进以克服现有技术中的缺点。
本发明的用于固定骨骼的骨板系统包括：具有上表面和骨接触表面的骨板；至少一个贯通该上表面和骨接触表面且带螺纹的第一孔；以及至少一个贯通该上表面和骨接触表面的第二孔。该骨板系统还包括：一个具有轴的第一螺钉，该轴具有用于与骨骼相连的螺纹以及形状和尺寸与第一孔的螺纹相匹配的螺纹头部；一个具有轴的第二螺钉，该轴具有用于与骨骼相连的螺纹和头部。该第一、第二螺钉保留固定在其各自相应的孔中的时间基本上与骨板被植入的时间一样长。最佳地，骨板包括多个第一、第二孔，以及相应的多个第一、第二螺钉。
为便于插入，该第一、第二螺钉可以为自攻螺钉。当然，这些螺钉也可以为自钻螺钉。另外，该第一、第二螺钉内可设有通道以便于容纳导线以引导螺钉定位。该第一板孔的形状基本上为锥形且具有双线螺纹。
在一个实施例中，位于第一和第二板孔之间区域的骨板的横截面为不规则四边形，以便于减小骨骼和骨接触表面之间的接触面积。另外，至少一个第二板孔呈纵向狭长形，且具有一个以与上表面成一定的角度朝向骨接触表面倾斜的边缘，该边缘用于当其与被第二骨螺钉相连时使得骨板发生位移。
在一个解释性的实施例中，骨板包括一个头部，该头部的形状和尺寸与骨骼的干骺端相一致，以及一个轴部分，该轴部分的形状和尺寸与骨骼的骨干相一致。头部仅具有第一板孔，轴部具有第一、第二板孔。在一个实施例中，头部具有曲面，包括一个前叉，该前叉基本上与轴部的前侧相平行，还包括一个后叉，该后叉从轴部的后侧延伸出去。在另一实施例中，头部从轴部向外张开，且呈曲面形状、逐渐变细以及扭曲。头部还设有用于骨板的缝合固定的缝合孔。
本发明的骨骼的骨折固定的方法包括如下步骤：减少骨折以将骨骼碎片收拢处于接近的状态；利用至少一个第一紧固件将骨板压向骨骼以保持骨折减少；将至少一个第二紧固件以固定的角度关系固定到骨板上。第一紧固件先于第二紧固件插入。该第一、第二紧固件保留在骨骼中基本上与骨板植入的时间一样长。
附图说明
图1为本发明的非锁紧螺钉实施例的侧视图；
图2为本发明的锁紧螺钉实施例的侧视图；
图3为本发明的部分骨板的透视图；
图4为沿图3中线4-4进行剖切的一个第一板孔的横截面图；
图5为沿图3中线5-5进行剖切的一个第二板孔的横截面图；
图6为沿图3中线6-6进行剖切的第二板孔的另一横截面图；
图7为被设计用于末梢股骨上的本发明的骨板实施例的俯视图；
图8为图7中的骨板的侧视图；
图9为插入在末梢股骨中的图7中的骨板的透视图；
图10为具有标示不同横截面的图7中的骨板的俯视图；
图11为沿图10中线A-A进行剖切的骨板的横截面图；
图12为沿图10中线B-B进行剖切的骨板的横截面图；
图13为沿图10中线C-C进行剖切的骨板的横截面图；
图14为沿图10中线D-D进行剖切的骨板的横截面图；
图15为沿图10中线E-E进行剖切的骨板的横截面图；
图16为沿图10中线F-F进行剖切的骨板的横截面图；
图17为沿图10中线G-G进行剖切的骨板的横截面图；
图18为沿图10中线H-H进行剖切的骨板的横截面图；
图19为沿图10中线I-I进行剖切的骨板的横截面图；
图20为被设计用于近端胫骨上的本发明的骨板实施例的侧视图；
图21为图20中的骨板的俯视图；
图22为插入在近中心胫骨中的图20中的骨板的透视图；
图23为具有标示不同横截面的图20中的骨板的端视图；
图24为沿图21中线A-A进行剖切的骨板的横截面图；
图25为沿图21中线I-I进行剖切的骨板的横截面图；
图26为沿图21中线D-D进行剖切的骨板的横截面图。
具体实施方式
本发明的骨板系统包括一个骨板、非锁紧螺钉以及锁紧螺钉。图1中表示出与本发明同时使用的非锁紧螺钉10。在通常情况下以及如下详述，可以使用具有非螺纹(不带螺纹)的头部12的任何外科用螺钉，该头部12的尺寸和几何形状的设计与骨板上的板孔相适应。非锁紧螺钉10具有一个轴14，该轴14至少局部带有螺纹以便于与骨骼连接。根据不同的应用场合，可选择该轴14的相应长度以及轴螺纹的设置。如现有的公知技术，螺纹和末端16可制成自攻型和/或自钻型以利于插入。轴14内可装设有一个通道，该通道用于将导线保持在合适的位置处。
图2表示出与本发明同时使用的锁紧螺钉20的实施例。在通常情况下以及如下详述，可以使用具有螺纹24的头部22的任何外科用螺钉，只要该头部22的尺寸和几何形状的设计与骨板上的板孔相适应且该螺纹24与板孔的螺纹相匹配。锁紧螺钉20具有一个轴26，该轴26至少局部带有螺纹以便于与骨骼连接。根据不同的应用场合，可选择该轴26的相应长度以及轴螺纹的设置。如现有的公知技术，螺纹和末端28可制成自攻型和/或自钻型以利于插入。轴26内可设有一个用于接收导线的通道。
图3表示出本发明的部分骨板30。骨板30可制成各种不同尺寸和形状以便广泛地应用于临床上。该骨板30包括一个上表面32和一个骨接触面34。该骨板30具有多个第一板孔36和多个第二板孔38。每个第一、二板孔36、38贯通上表面32和骨接触面34。每个第一板孔36具有与锁紧螺钉20的头部22上的螺纹24相匹配的螺纹40以便将该锁紧螺钉20以临时固定的角向固定到骨板30上。第二板孔38内不设有螺纹，且用于接收具有非螺纹头部12的非锁紧螺钉10。将非锁紧螺钉10插入第二板孔38中朝向骨接触面34拉骨骼以压紧该骨骼。这样，非锁紧螺钉10固定在该第二板孔38内，使得骨骼压紧该骨接触面34，锁紧螺钉20固定在该第一板孔36内，使得头部22固定到该骨板30上以在锁紧螺钉20和骨板30之间保持固定的角关系。同时使用带有非锁紧螺钉10、锁紧螺钉20的骨板30能够增加螺钉和骨板之间、骨板和骨骼之间的稳定性。因为该非锁紧螺钉10通常用于固定松质骨，所以，轴14上的螺纹要大于该锁紧螺钉20的轴26上的螺纹。
该第一板孔36最好呈圆锥形。如图4所示，位于该第一板孔36上的该螺纹40也最好为双线螺纹。该双线圆锥螺纹使得多个螺纹接合而保持较小的断面。另外，与圆柱形螺纹等其它螺纹相比，该双线圆锥形螺纹不易受到错扣的影响。
最好参见图5、6，该第二板孔38最好为动力压缩单元(DCU)螺孔。该螺孔与再次授予Allgower等人的美国专利NO.RE.31628中公开的螺孔相类似，其中的内容在这里谈及主要用作参考。该DCU螺孔通过将断裂端压在一起而有利于骨骼的康复。简要地，该第二板孔38具有一个包括一个倾斜部分或斜坡44的边缘42，该斜坡的坡度如此设计以保证当该斜坡44与非锁紧螺钉10的头部12的下侧相连时，该骨板30发生位移而将该斜坡44移向远离该非锁紧螺钉10的方向，从而使得该骨板30施加一定压力而将断裂端紧密地相连。
该骨板30上的该骨接触面34的形状如此设计以保证减小与骨骼的接触面积。对骨板和骨骼之间的接触面积进行限制具有许多生物上和机械上的优点，上述的优点包括减少对血液供给的损害以及易于骨板的去除。其中一种减小接触面积的措施可采取将骨板30的位于第一、二板孔34和36之间的区域的横截面设计成不规则四边形(梯形)(图11)。在US5 151 103，5 053 036、5 002 544、4 838 252等专利中公开了其它的措施。上述专利中的内容可结合在此处作为参考。
通过在同一骨板上结合使用锁紧螺钉和非锁紧螺钉，本发明提供了一种新颖的混合固定方式。利用非锁紧螺钉，借助骨板和骨骼之间的摩擦力作用使得骨折复位。该摩擦力是通过将非锁紧螺钉拧紧在骨骼中而产生的。然而，非锁紧螺钉和骨骼之间的微运动会导致骨骼再吸收现象的发生以及复位的丧失。另外，非锁紧螺钉的插入需要骨骼承受拧紧螺钉的应力。这导致在非锁紧螺钉周围的骨骼承受巨大的应力。通常，上述的高压能够导致非锁紧螺钉的螺纹发生剥落(骨骼中的螺纹的剪切力不足)和/或在骨骼中发生蠕变(因为骨骼属于粘弹性材料)。上述现象中的任何一种均可导致骨骼复位的丧失。
在本发明中，通过增加至少一个锁紧螺钉，能够减小或消除骨骼复位的丧失。特别地，通过将锁紧螺钉固定到骨板上而不是固定到骨骼上，骨骼的粘弹性的性状效果得以减弱，螺纹不会发生剥落，防止了微运动的发生。锁紧螺钉和骨板之间的连接为高强度的连接，其中该锁紧螺钉必须从侧面插入到骨骼中。
因为对某些关节周围骨折的处理主要包括以各种角度(相对于骨板而言)插入螺钉，所以，最为理想的就是保持各个螺钉和骨板之间的初始角度关系，本发明的骨板系统尤其适用于这些临床应用中。图7-19表示出本发明的专用于末梢股骨上的骨板50。该骨板50主要用于(但是不限于)粉碎性骨折(包括Hoffa型骨折)上。
该骨板50具有上表面52和骨接触表面54，该骨板50具有多个用于接收锁紧螺钉20的带螺纹的板孔56a、56b、56c(共同地称为带螺纹板孔56)，以及多个用于接收非锁紧螺钉10的非螺纹(不带螺纹)板孔58。每个螺纹板孔56、非螺纹板孔58贯通在上表面52和骨接触表面54之间。对于骨板30而言，位于螺纹板孔56上的螺纹与锁紧螺钉20上的带螺纹头部22相匹配以便以暂时固定的角度方向将锁紧螺钉20固定到骨板50上，将非锁紧螺钉10插入到非螺纹板孔58中使得骨接触表面54与骨骼更加靠近且压紧骨骼。
骨板50包括一个头部60，该头部60的形状和尺寸与末梢股骨的干骺端相一致；一个轴部62，该轴部62的形状和尺寸与骨骼的骨干相一致。如图8所示，头部60的骨接触表面54呈曲面以适合于末梢股骨的外形。该头部60包括一个基本上与轴部62的前侧66相平行的前叉64以及一个从轴部62的后侧70横向延伸出的后叉68。
该非螺纹板孔58最好为与该第二板孔38相类似的动力压缩单元(DCU)螺孔。该轴部62具有螺纹板孔56a和非螺纹板孔58以便锁紧螺钉和非锁紧螺钉可适用于该轴部62上。当骨干部分的远皮层丢失或被严重地损坏时，能够在轴部62上使用锁紧螺钉是非常有利的，由于远皮层的状况，此时利用非锁紧螺钉进行固定是存在问题的。如图11所示，螺纹板孔56a和非螺纹板孔58之间的区域具有不规则四边形横截面，该横截面如此设计使得轴部62的骨接触表面54和股骨之间的接触面积得以限制。该轴部62具有收敛尾部72(图19)。
与轴部62相比，该头部60仅包括螺纹板孔56。特别地，该螺纹板孔56b包围着一个设置在中心的螺纹板孔56c。该螺纹板孔56c的直径大于螺纹板孔56b的直径以便于容纳具有较大直径的锁紧螺钉。例如，该螺纹板孔56b的直径为5.0mm，该螺纹板孔56c的直径为7.3mm。图12-18表示出各个螺纹板孔56b、56c的不同角度方向。通常，螺纹板孔56b、56c如此设置以保证被插入的锁紧螺钉彼此呈收敛状态。值得注意的是，如果确定了外科医生后，非锁紧螺钉可被用于任何一个螺纹板孔56中。最后，值得注意的是，该骨板50与髁支柱板具有多个结构上的差别，该托韧板可从Paoli，Pennsylvania Synthes(U.S.A.)处买到。例如，托韧板的头部轮廓呈纵向和横向延伸，而骨板50的头部60仅沿着纵向延伸以便于更加适于解剖学特性。另外，该尾部72具有上升端以使得其位于组织的下面。
图20-26表示出本发明的专用于近端胫骨上的骨板80。该骨板80主要用于(但是不限于)横向近中心胫骨坪的骨折。该骨板80具有上表面82和骨接触表面84。该骨板80具有多个用于接收锁紧螺钉20的带螺纹板孔86a、86b、86c(共同地称为带螺纹板孔86)，以及多个用于接收非锁紧螺钉10的非螺纹板孔88。每个带螺纹板孔86、非螺纹板孔88贯通在上表面82和骨接触表面84之间，对于骨板30而言，位于带螺纹板孔86上的螺纹与锁紧螺钉20上的带螺纹头部22相匹配以便以暂时固定的角度方向将锁紧螺钉20固定到骨板80上。将非锁紧螺钉10插入到非螺纹板孔88中使得骨接触表面84与骨骼更加靠近且压紧骨骼。
骨板80包括一个头部90，该头部90的形状和尺寸与横向近端胫骨的干骺端相一致；一个轴部92，该轴部92的形状和尺寸与横向近中心胫骨的骨干相一致。如图20-26所示，头部90的骨接触表面84呈弯曲形状、逐渐变细以及扭曲以适合于横向近中心胫骨坪的外形。该头部90上还设有用于缝合固定以及骨板80的临时固定用的缝合孔。
该非螺纹板孔88最好为与该第二板孔38相类似的动力压缩单元(DCU)螺孔。该轴部92具有带螺纹板孔86a和非螺纹板孔88以便锁紧螺钉和非锁紧螺钉可适用于该轴部92上。当骨干部分的远皮层丢失或被严重地损坏时，能够在轴部92上使用锁紧螺钉是非常有利的，由于远皮层的状况，此时利用非锁紧螺钉进行固定是存在问题的。如图24所示，带螺纹板孔86a和非螺纹板孔88之间的区域具有矩形横截面，该矩形横截面的设计使得轴部92的骨骼接触表面84和胫骨之间的接触面积得以限制。该轴部92具有收敛尾部102(图25)。
与轴部92相比，该头部90包括带螺纹板孔86和非螺纹板孔88。头部90上设有带螺纹板孔86b和86c。该带螺纹板孔86b和86c的直径为5.0mm，方向如图23-26所示。通常，带螺纹板孔86b、86c如此设置以保证被插入的锁紧螺钉彼此呈收敛状态。如图23所示，确定带螺纹板孔86b的方向以便使得上述孔在距离骨接触表面84一定距离处收敛，以便优化锁紧螺钉20在胫骨坪内的位置。如图26所示，确定该带螺纹板孔86c的方向以使得其与带螺纹板孔86b在一定的距离处相互收敛，以便对锁紧的固定角度的结构提供辅助的稳定性。值得注意的是，如果确定了外科医生，非锁紧螺钉可被用在任何一种带螺纹板孔86中。
显然，本文中公开的本发明解释性的实施例能够实现上述的发明目的，但是值得注意的是，对于本领域的技术人员来讲，对本发明可以作多种改进和变形。例如，对于一些骨折而言，尽管至少每种板孔的数量为两个是有利的，但是仅需要一个第一板孔和一个第二板孔亦可。另外，为方便外科医生在使用中更加灵活，板上可设有没有螺钉的附加板孔。因此，附后的权利要求力图覆盖在本发明范围之内的所有变型和实施例。

Claims (18)

1.一种用于骨骼固定的骨板系统，包括：
一个骨板(30；50；80)具有：
一个上表面(32；52；82)；
一个骨接触表面(34；54；84)；
至少一个第一孔(36；56；86)，该孔贯通在上表面和骨接触表面(32；52；82；34；54；84)之间且具有螺纹(40)；以及
至少一个第二孔(38；58；88)，该孔贯通在上表面和骨接触表面(32；52；82；34；54；84)之间；
一个具有轴(26)的第一螺钉，该轴具有用于与骨骼相连的螺纹，以及一个具有螺纹(24)的头部(22)，该螺纹的形状和尺寸与第一孔(36；56；86)的螺纹相匹配；以及
一个具有轴(14)的第二螺钉，该轴具有用于与骨骼相连的螺纹，以及一个头部(12)；
其中该第一、第二螺钉保留固定在其各自的孔(36；56；86；38；58；88)中，其保留时间与骨板(30；50；80)被植入的时间基本相同。
2.根据权利要求1所述的骨板系统，其中该骨板(30；50；80)包括多个第一、第二孔(36；56；86；38；58；88)，以及相应的多个第一、第二螺钉。
3.根据权利要求1所述的骨板系统，其中该第一螺钉为自攻螺钉。
4.根据权利要求3所述的骨板系统，其中该第一螺钉为自钻螺钉。
5.根据权利要求1所述的骨板系统，其中该第一螺钉上设有通道以便于导线的插入来引导螺钉的定位。
6.根据权利要求1所述的骨板系统，其中该第二螺钉为自攻螺钉。
7.根据权利要求1所述的骨板系统，其中该第一板孔(36；56；86)呈锥形。
8.根据权利要求7所述的骨板系统，其中该第一板孔(36；56；86)具有双线螺纹。
9.根据权利要求1所述的骨板系统，其中该骨板(30；50；80)位于第一、第二板孔(36；56；86；38；58；88)之间的区域的横截面呈不规则四边形，以便于减小骨骼和骨接触表面(34；54；84)之间的接触面积。
10.根据权利要求2所述的骨板系统，其中至少一个第二板孔(38；58；88)呈纵向狭长形且具有一个与上表面(32；52；82)成一定的角度朝向骨接触表面倾斜的边缘(41)，该边缘用于当其与第二骨螺钉头部相连时使得骨板(30；50；80)发生位移。
11.根据权利要求2所述的骨板系统，其中骨板(30；50；80)包括一个头部(60；90)，该头部的形状和尺寸与骨骼的干骺端相一致，以及一个轴部分(62；92)，该轴部分的形状和尺寸与骨骼的骨干相一致。
12.根据权利要求11所述的骨板系统，其中头部(60；90)上仅具有第一板孔(36；56；86)。
13.根据权利要求11所述的骨板系统，其中轴部(62；92)上具有第一、第二板孔(36；56；86；38；58；88)。
14.根据权利要求11所述的骨板系统，其中头部(60；90)呈曲面形状，包括一个前叉，该前叉基本上与轴部(62；92)的前侧相平行，还包括一个后叉，该后叉从轴部(62；92)的后侧延伸出去。
15.根据权利要求11所述的骨板系统，其中该轴位于第一、第二螺孔(36；56；86；38；58；88)之间的区域的横截面呈不规则四边形，以便于减小骨骼与骨接触表面(34；54；84)之间的接触面积。
16.根据权利要求11所述的骨板系统，其中该头部(60；90)从轴部向外张开。
17.根据权利要求15所述的骨板系统，其中该头部(60；90)上设有缝合孔。
18.一种骨骼的骨折固定方法，包括如下步骤：
减少骨折以将骨骼碎片收拢处于接近的状态；
利用至少一个第一紧固件将骨板(30；50；80)压向骨骼以保持骨折减少；
将至少一个第二紧固件以固定的角度关系固定到骨板(30；50；80)上，
其中至少一个第一紧固件先于至少一个第二紧固件插入，至少一个第一紧固件和至少一个第二紧固件保留在骨骼中基本上与骨板(30；50；80)植入的时间一样长。
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US8641744B2 (en) 2014-02-04
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US7128744B2 (en) 2006-10-31

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