CN101077315A - 用于跟骨骨折的关节固定术恢复的固定钉*** - Google Patents
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Abstract
一种用于跟骨骨折的关节固定术恢复的固定钉***,包括钉(1)、多个跟骨-距骨螺钉(2)、导向装置(3)、引导管、钻头、深度计、导管***型螺丝刀、叉形撞击器、具有限动件的钻头以及定位导销,该***的主要目的是人类跟骨严重粉碎性骨折的恢复以及在恢复其主要形式后该骨头对距骨的固定,以便实现与距骨的固定术或融合。
Description
技术领域
本发明涉及用于跟骨骨折的关节固定术恢复的固定钉***,主要目的是用于人类跟骨严重粉碎性骨折的恢复,以及用于在恢复该骨头的主要形式后该骨头到距骨的固定,以便实现与距骨的固定术或融合。
背景技术
在跟骨的距骨粉碎性骨折后,慢性后遗症疼痛是最普遍的后遗症。这一问题可有多种原因:骨筋膜室综合症,反射交感神经性营养不良,足底筋膜综合症,跗骨(tarsal)和腓骨小管综合症,以及距骨下关节炎。已经发现后一原因是当前对这些骨折的治疗的不良长期结果的主要原因。
8-10%的跗管综合症(tarsal tunnel syndrome),特别是侧面的足底筋膜综合症,以及78%的腓骨神经卡压综合症(peroneal nerve entrapment)(外踝下疼痛),是由于距骨骨折造成的。在70%这些严重骨折中,存在由后面的距骨下关节引起的慢性疼痛,其通常在伤后逐渐愈合。
虽然,最近的出版物支持切开复位术和跟骨骨折的内部固定的结果,但是,整形外科的处理依然有很多拥护者。在其他的情况下,选择采用最初的保守方法,如果出现后遗症则对其进行处理。同伯纳德(Barnard)和奥德伽德(Odegard)一样,我们认为距骨下关节的完全修复是不可能的。
已经公开了多种关节固定术技术,用于外伤后距骨下关节炎的治疗,包括关节置换术。在其他情况下,在距骨下独立融合的基础上提倡三关节固定术,以便提高脚的生物力,并防止相邻关节的退化。根据对各医院的不同处理的回顾,即使在术后多年后,距骨下关节独立的固定术也不会造成相邻关节的退化。
该经验引起大家相信,对于目前还未解决的骨折,斯图兹(Stulz)和诺贝尔(Noble)的旧的假设可能对尚未解决的骨折提供了解决办法。由于在很多严重的骨折情况中,距骨下关节不能以外科手术方式重建,并且通常会退化,解决办法将是短期内立即采取关节固定术,以便防止在之后的发展中出现残废的后遗症。
但是除融合损坏的关节外,应当尽可能地尝试重建后足(hindfoot)的形式,以便避免其他相关的并发症,例如骨筋膜室综合症,反射交感神经性营养不良,足底筋膜综合症,跗骨和腓骨小管综合症,从骨折复位方面考虑,这样是明显有利的。
公开号为ES 2164543的西班牙专利公开了一种钉(nail),其通过两个螺钉来固定。因为该钉成直角的楔入几何形状,在该钉***骨头时存在一些问题,并且存在阻力问题,这是由于其在末梢位置具有很小的截面,这也同样限制螺钉底部的固定。
发明内容
为缓解上述问题,在此公开用于跟骨骨折的关节固定术恢复的新的固定钉***,该***是本发明的目的。
该***包括这样的结构:一个圆柱形钉,带有两个稳定翼片,一个锥形尖点和两个螺纹孔,钉***跟骨的较大结节区域。而且,该***包括两个导管***型螺钉,螺钉旋入钉孔,螺钉***在距骨内,直到螺钉在钉内被锁定,由此使整个装置稳定,增加其刚度并抵抗其将承受的负荷。
该用于距骨下关节骨折的导管***型螺钉的使用是已知的且是对这类骨折提供了最好的治疗结果的植入技术。作为本发明的目的的用于跟骨骨折的关节固定术恢复的固定钉***,对惯用的技术提供显著的改进,这是由于钉的***,既支撑又固定了所述螺钉,由此使该***更加稳定而且可靠,并且防止由螺钉移动引起的失败。这样,脚恢复其自然解剖结构,修补了跟骨和距骨之间的关系,并由此恢复了其生物功能。
附图说明
为补充该说明,并出于有助于更好地理解本发明的特征的目的,该说明附有一系列同样构成本发明的一体部分的附图。这些附图是说明性的而并非是限定性的,附图中:
图1是固定钉的视图。
图2是导管***型螺钉(cannulated screw)的视图。
图3是***导向装置的视图,该导向装置包括施加钉的导向装置。
图4是带有已***的螺钉的钉的视图。
图5是带有已***的固定钉***的脚的视图。
具体实施方式
如各附图所示,用于跟骨骨折的关节固定术恢复的固定钉***包括以下部件:钉(nail)1、螺钉(screw)2、跟骨-距骨导向装置(calcaneus-talar guide)3、引导管、钻头(bit)、深度计、导管***型螺丝刀(cannulated screwdriver)、叉形撞击器(diapason impactor)、具有限动件的钻头以及相应的定位导销(reference guide-pin)。
钉1是一个呈圆柱形几何外形的部件,具有锥形尖点以便方便***。其钝的一端具有螺纹孔12和凹槽13,以便与***导向器33相结合。而且,其具有两个侧翼片14,以便使稳定***并防止其旋转。钉1具有两个通孔15和16,通孔的局部具有螺纹并且相对于水平轴以10°角设置,以便通过使用螺钉2来固定距骨下关节。
跟骨-距骨螺钉2是导管***型(22)的,以便螺钉与引导管一起***。螺钉在末梢具有螺纹21,以便在距骨的海绵状骨头内进行固定。其尖端是自攻孔和自攻螺纹类型的,以通过最优扭矩的方式帮助其***。其头部具有金属螺纹,用于使其在钉1内固定,并且其具有六叶形连接件,其确保更有效的转动动作。螺钉2的优选长度不小于60mm且不大于90mm。
导向装置3为这样一种器具,其用于使不同部件在***内就位,并且其包括:主要支撑件31,主要支撑件31在顶部具有导向孔32,该导向孔32具有钉1的外部几何形状,以便通过施加导向器33将钉引入,施加导向器33在一端部具有突出部34,该突出部与钉1的凹槽13相配合,以确保固定,防止转动运动。此外,施加导向器33具有纵向键35,该纵向键使钉1通过导向孔32,以很好的角度布置在跟骨内。
导向装置3的下部具有一个填塞部,该填塞部带有两个孔36,这两个孔相对于水平轴以10°角布置,以便穿过整个导管***和器具,使螺钉2布置在跟骨-距骨内。
导向装置3具有手柄38,该手柄的作用,除用于握紧外,还连接于夹紧装置37,夹紧装置37附着于一个销子,该销子已预先位于距骨内并且作为基准轴,并且还作为一个支撑,以通过把手39来调节钉1的位置,把手39布置在手柄38的一端。
除套管针尖之外,必须嵌入两个引导管,以便使用于准备底座(prepare the bed)并布置螺钉2的不同器具具有适当的引导和方向。用于准备底座的器具为:引导销,具有与螺钉2的核心相应的直径的导管***型钻头(cannulated bit),以及螺钉2本身。由此,需要有不同直径的三个引导管,以及套管针尖。用于该***的其它要素是,用于确定螺钉2的长度的深度计,用于***螺钉2的导管***型螺丝刀,用于击打钉1的叉形撞击器,用于使钉1进入底座的具有限动件的钻头,以及用于导向装置3的支撑的定位销。
作为本发明的目的的用于跟骨骨折的关节固定术恢复的固定钉***的植入过程具体如下:
首先,在适当的手术过程后,引导销布置在距骨头中心内。该引导销相对于钉器具1是空间参照物。它从脚的内表面布置,通过射线装置定位在距骨头的中心。在前平面上,该引导销应布置为平行于踝关节中间线(ankle joint interline),而在轴向平面上,该引导销应布置为垂直于足轴(foot shaft)。只有确定了引导销位于正确位置时,方可继续进行外科手术。
导向装置3开始时通过布置在距骨头内的引导销支撑,然后,导向装置3采用位于手柄38一端的把手39,相对于较大结节区域作初始调整。
在该位置进行射线控制,通过在孔36内***螺钉,采用引导销来模拟螺钉2的方向,在导向装置3的臂内的孔36就是用于这个目的。这些销导向装置将指示螺钉2的确切位置。如果螺钉不是位于距骨头内的适当位置,必须将导向装置3重新定位。
在这个阶段,采用把手39和手柄38,导向装置允许跟骨轴被转移,并且,通过移动导向装置3,以位于距骨头内的引导销为轴,导向装置同样允许对跟骨轴施加挠曲扩展动作。然后,钻出一个孔,以便在较大结节区域中容纳钉1。如果导向装置3位于正确位置,在较大结节区域钻孔不存在问题。应持续钻孔直到钻头限动件处。唯一需要警惕的是要适当地保护阿希里氏跟腱(Achiles tendon)。
在一些情况下,严重的粉碎性骨折意味着要在骨折的骨头上进行钻孔。这种情况不会对***植入物造成任何不利,因为后者不需要完整的骨头以正确地发挥其功能。当移走钻头时,它需要连续旋转以便取出在钻削时剥离的骨头。钻孔方向不能倒转。在多数情况下,在距骨下固定术中的骨头将充分接合。
钉1通过导向装置3保持,并且布置在预设的标记槽内。钉1通过锤打***。导向装置3将把钉引导朝向较大结节区域低处,该位置将被***足底绷带。钉1必须完全***直到施加限动件处,由此使螺钉2的孔以及施加该螺钉的导向装置3实现正确的排列。
使用就位于导向装置3上的引导管,外科医生制作出一个到达骨头的小切口。***引导销。螺钉2的长度通过深度计测量。在引导销后,***4.5mm的导管***型钻头。然后,布置螺钉2。当该***定位时,钉1钻孔时掘出的骨头被加以应用。
已经充分公开了本发明的本质,同时公开了本发明的实用实施方案,唯一要附加说明的是,所述发明可进行某些关于形式和材料的改变,条件是这些改变未从本质上改变所附权利要求的特征。
Claims (5)
1.用于跟骨骨折的关节固定术恢复的固定钉***,该***包括钉(1)、多个跟骨-距骨螺钉(2)、导向装置(3)、引导管、钻头、深度计、导管***型螺丝刀、叉形撞击器、具有限动件的钻头以及定位导销,其特征在于:
钉(1)是一个圆柱形几何外形部件,具有锥形尖点;它的钝的一端具有螺纹孔(12)和凹槽(13),以便与***物或者施加导向器(33)相结合;它具有两个侧翼片(14)以及两个通孔(15和16),通孔的局部具有螺纹并且相对于水平轴以10°角设置;
跟骨-距骨螺钉(2)是导管***型(22)的,以便通过引导管被引导;螺钉在末梢具有螺纹(21),以便在距骨的海绵状骨头内进行固定;其尖端是自攻孔和自攻螺纹类型的;其头部具有金属螺纹,用于在钉(1)内使其固定,并且其具有六叶形连接件;
导向装置(3)包括主要支撑件(31),主要支撑件(31)在顶部具有导向孔(32),该导向孔(32)具有钉(1)的外部几何形状,以便通过施加导向器(33)引导钉,并且导向装置(3)的底部具有一个填塞部,该填塞部带有两个孔(36);另外,导向装置(3)具有手柄(38),该手柄连接于夹紧装置(37),夹紧装置(37)附着于一个销子,该销子预先已位于距骨内并且作为基准轴,并作为一个支撑,用于通过把手(39)调节钉(1)的位置,该把手(39)布置在手柄(38)的一端;
除套管针尖之外,必须嵌入两个引导管,以便使得用于准备底座并布置跟骨-距骨螺钉(2)的不同器具具有适当的引导和方向;
该***采用的其它元件是,用于确定螺钉(2)长度的上述深度计,用于***螺钉(2)的上述导管***型螺丝刀,用于击打钉(1)的上述叉形撞击器,用于制作出钉底座(1)的具有限动件的上述钻头,以及用于引导支撑(3)的上述定位导销。
2.根据权利要求1所述的用于跟骨骨折的关节固定术恢复的固定钉***,其特征在于:侧翼片(14)使***稳定并防止其旋转。
3.根据权利要求1所述的用于跟骨骨折的关节固定术恢复的固定钉***,其特征在于:通孔(15和16)使距骨下关节通过跟骨-距骨螺钉(2)方式固定。
4.根据权利要求1所述的用于跟骨骨折的关节固定术恢复的固定钉***,其特征在于:跟骨-距骨螺钉(2)的优选长度不小于60mm且不大于90mm。
5.根据权利要求1所述的用于跟骨骨折的关节固定术恢复的固定钉***,其特征在于:施加导向器(33)在一端部具有突出部(34),该突出部与钉(1)的凹槽(13)相配合,以确保其固定,防止转动运动;此外,施加导向器(33)具有纵向键(35),该纵向键使钉(1)通过导向孔(32),以很好的角度布置在跟骨内。
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EP06010709A EP1859750B9 (en) | 2006-05-24 | 2006-05-24 | Locking nail system for arthrodesis reconstruction in calcaneus fractures |
EP06010709.1 | 2006-05-24 |
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CN104116551A (zh) * | 2014-08-08 | 2014-10-29 | 王加利 | 一种用于跟骨骨折闭合或微创复位内固定的跟骨辅助复位固定装置 |
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Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN101574279B (zh) * | 2008-05-09 | 2012-07-04 | Ebi有限责任公司 | 具有锁紧装置和压紧装置的髓内植入物 |
CN104622554A (zh) * | 2013-11-12 | 2015-05-20 | 玉林市骨科医院 | 一种微创治疗股骨粗隆间骨折的锁定支架 |
CN104116551A (zh) * | 2014-08-08 | 2014-10-29 | 王加利 | 一种用于跟骨骨折闭合或微创复位内固定的跟骨辅助复位固定装置 |
CN104116551B (zh) * | 2014-08-08 | 2016-03-02 | 王加利 | 一种用于跟骨骨折闭合或微创复位内固定的跟骨辅助复位固定装置 |
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DE602006008439D1 (de) | 2009-09-24 |
PL1859750T3 (pl) | 2010-01-29 |
EP1859750B1 (en) | 2009-08-12 |
ATE439094T1 (de) | 2009-08-15 |
NO20072510L (no) | 2007-11-26 |
ZA200703960B (en) | 2008-08-27 |
CN101077315B (zh) | 2010-06-23 |
JP2007313318A (ja) | 2007-12-06 |
HRP20090604T1 (hr) | 2010-03-31 |
BRPI0701660A (pt) | 2008-01-15 |
EP1859750A1 (en) | 2007-11-28 |
CR9138A (es) | 2008-11-12 |
AU2007202335B2 (en) | 2009-07-16 |
RU2007119200A (ru) | 2008-11-27 |
MX2007006218A (es) | 2008-12-11 |
AU2007202335A1 (en) | 2007-12-13 |
NO340145B1 (no) | 2017-03-13 |
RU2355340C2 (ru) | 2009-05-20 |
US20080015587A1 (en) | 2008-01-17 |
JP4572909B2 (ja) | 2010-11-04 |
CA2588425A1 (en) | 2007-11-24 |
EP1859750B9 (en) | 2010-02-17 |
CO5920048A1 (es) | 2008-05-30 |
IL182924A (en) | 2011-07-31 |
DK1859750T3 (da) | 2009-12-14 |
IL182924A0 (en) | 2007-09-20 |
PT1859750E (pt) | 2009-11-13 |
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