CN1032621C - 鱼口状交锁髓内钉 - Google Patents
鱼口状交锁髓内钉 Download PDFInfo
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- CN1032621C CN1032621C CN 92107257 CN92107257A CN1032621C CN 1032621 C CN1032621 C CN 1032621C CN 92107257 CN92107257 CN 92107257 CN 92107257 A CN92107257 A CN 92107257A CN 1032621 C CN1032621 C CN 1032621C
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Abstract
本发明鱼口状交锁髓内钉是一种用于治疗股骨干骨折的骨外科手术器械。鱼口状交锁髓内钉整体采用不锈钢无缝管制成,外表面两侧具有纵形凹槽,下部开有槽口呈鱼口状,前端为喇叭形,上部加工有一横孔,上端具有内螺纹,顶端开有定位口。该髓内钉适用于股骨从小粗隆以下至髁以上之间稳定的或不稳定的各种类型新鲜骨折,还用于骨不连、骨畸形、骨延长和病理性骨折。胫骨和肱骨也同样可以使用。
Description
本发明鱼口状交锁髓内钉是一种用于治疗股骨干骨折的骨外科手术器械。
1940年德国Kuntscher用“V”型髓内钉治疗股骨干横型骨折后改用梅花形髓内钉,但该类钉仅适用于峡部的骨折。
1972年Klemm和Schellmann,1978年法国Kempf.Grosse和Lafforgue,1979年Huckstep采用髓腔扩孔的交锁髓内钉。由于扩大髓腔,增加了髓内钉与骨皮质的接触面积,使用更粗的髓内钉坚固程度更强,加之在骨折的近远端分别有1至2枚横行螺丝钉穿过髓内钉固定之,这样控制了骨折的支持应力、弯曲应力、剪应力和扭转应力,可以应用从小粗隆以下髁以上之间的稳定的和不稳定的股骨干骨折。交锁髓内钉分为静止型和动力型两类。动力型用于股骨干横形、短斜形和短螺旋形骨折,其中在近骨折线一端有横行螺丝钉固定。静止型用于股骨长斜形、长螺旋形和粉碎性骨折,在骨折两端分别有1至2枚横行螺丝钉固定,术后三个月骨折部有多量骨痂生长时取出远骨折线一侧的横行螺丝钉转变为动力型。这样交锁髓内钉固定后不产生骨的中性轴偏移,不存在应力遮挡作用,局部不会诱发骨质疏松,一年后取出交锁髓内钉未见像在加压钢板取出后常见的再骨折的报道。因此近十余年来在国外闭合穿交锁髓内钉已经作为股骨干骨折优先选择的治疗方法,在我国由于种种原因至今未见开展这方面工作的报道。但国外交锁髓内钉还存在着以下不足之处:(1)该髓内钉的远端有两个横行的圆形孔道,要在骨皮质外分别将两枚横行螺丝钉正好***到二圆孔内是十分困难的,虽有电视X线机和***的帮助,但所需时间较长,接触相当多的X射线,给医务人员造成损害;(2)该髓内钉近端有一斜行螺丝钉自大粗隆向小粗隆方面旋人,此处均为松质骨,因而防压应力和防旋能力均较差;(3)该髓内钉近端有一圆形或椭圆形拔出孔是为拔出髓内钉之用,因股骨本身有一向前呈7°的弧度,倘若髓内钉在髓内卡得很紧,拔出就很困难,甚至将拔出器的钩形头折断,最后只得放弃拔钉。
本发明的目的是针对上述髓内钉存在不足之处设计的一种新颖的鱼口状交锁髓内钉,可牢靠固定骨折,术后下地行走,缩短手术时间,减少医务人员X射线接触量,拔钉简便可靠,使交锁髓内钉能在国内推广,超过国外交锁髓内钉水平。
鱼口状交锁髓内钉是通过以下方案实现的。鱼口状交锁髓内钉整体采用317L不锈钢无缝管制成。交锁髓内钉外表面两侧具有纵形凹槽,有利于骨内膜生长,远端下部开有槽口,呈鱼口状,近窄远宽,前端为啦叭形,用于穿插横行螺丝钉,近侧有一横孔用于安装横行螺丝钉用,上端部具有内螺纹,可以与配套的***和打拔器相连接,髓内钉的顶端有定位口,供***定位。
鱼口状交锁髓内钉适用于股骨从小粗隆以下至髁以上之间稳定的或不稳定的各种类型的新鲜骨折,还用于骨不连、骨畸形、骨延长和病理性骨折。胫骨和肱骨也同样可以使用。
手术步骤:麻醉后病人置骨折手术床上,仰卧或侧卧位,患肢牵引手法复位后,从大粗隆内侧面***导钉达髓腔远端,用导向可屈髓腔扩孔钻顺导针扩大髓腔,选用较所用扩孔钻最大直径小1mm的鱼口状交锁髓内钉沿导针插人髓腔。当该钉在大粗隆外比鱼口长10mm时,在电视X线机下,或不用X线机而借助***旋人一枚横行螺丝钉正位于鱼口状交锁髓内钉远端鱼口的中央,插人髓内钉鱼口的一半,后再旋人一枚横行螺丝钉,也正位于鱼口的中央,全部击人髓内钉,这样鱼口状的远端正好骑跨于两枚螺丝钉上。借助***于大粗隆下向小粗隆方向经髓内钉近侧横孔穿人一枚横行螺丝钉,锁住鱼口状髓内钉,大粗隆近侧置负压引流两天。稳定性骨折在远骨折线一端不用横行螺丝钉,不稳定骨折手术后三月X线有多量骨痂生长时将远骨折线一端横行螺丝钉取出,这样就将鱼口状交锁髓内钉由静止型转为动力型。稳定性骨折手术一周后即可开始负重行走,不稳定骨折手术一周后开始不负重行走,三月后X线有多量骨痂时方可负重行走。
鱼口状交锁髓内钉有以下优点:(1)国外交锁髓内钉远端的两个圆孔要插人横行螺丝钉相当困难,本发明只要先旋人两枚横行螺丝钉,再将该髓内钉***其前端骑架于两螺丝钉上,既起到国外交锁髓内钉的相同作用,又节省手术时间,减少甚至避免按触X线。(2)鱼口状交锁髓内钉近端的横行螺丝钉固定于皮质骨内,其防压应力和防旋能力均较国外交锁髓内钉的斜行螺丝钉强。(3)鱼口状交锁髓内钉的拔出是使用该钉近端的内螺纹达到的,较之国外交锁髓内钉的拔出孔更为安全可靠。
以下将结合附图对本发明作进一步说明。
图1是鱼口状交锁髓内钉结构示意图(侧面)。
图2是鱼口状交锁髓内钉使用状态示意图(正面)。
参照附图鱼口状交锁髓内钉,外表面两侧具有纵形凹槽(4),下部(远端)开有槽口(5)呈鱼口状,上端窄下端宽,前端为啦叭形,使用时可装置横行固定螺丝钉(7)。鱼口状交锁髓内钉上部加工有一横孔(3),用于安装横行螺丝钉(6),上端部具有内螺纹(2),内螺纹与打拔器和***相配合,顶端开有定位口(1),供***定位用。
Claims (2)
1、一种鱼口状交锁髓内钉,整体采用不锈钢无缝管制成,上部加工有一横孔,顶部开有定位口,其特征是交锁髓内钉外表两侧具有纵形凹槽,上端部具有内螺纹,下部开有槽口呈鱼口状,前端为喇叭形。
2、根据权利要求1所述的鱼口状交锁髓内钉,其特征是交锁髓内钉下部开有的槽口上端窄下端宽。
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CN 92107257 CN1032621C (zh) | 1992-01-03 | 1992-01-03 | 鱼口状交锁髓内钉 |
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CN 92107257 CN1032621C (zh) | 1992-01-03 | 1992-01-03 | 鱼口状交锁髓内钉 |
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CN1062459A CN1062459A (zh) | 1992-07-08 |
CN1032621C true CN1032621C (zh) | 1996-08-28 |
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