TWI337072B - Knochenplatte - Google Patents

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TWI337072B
TWI337072B TW093132078A TW93132078A TWI337072B TW I337072 B TWI337072 B TW I337072B TW 093132078 A TW093132078 A TW 093132078A TW 93132078 A TW93132078 A TW 93132078A TW I337072 B TWI337072 B TW I337072B
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hole
bone plate
plate
bone
holes
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TW200514548A (en
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Florian Beutter
Andreas Appenzeller
Franco Cicoira
Robert Frigg
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Synthes Gmbh
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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
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7291—Intramedullary pins, nails or other devices for small bones, e.g. in the foot, ankle, hand or wrist
    • 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
    • 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
    • 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
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • 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
    • A61B17/72—Intramedullary pins, nails or other devices
    • 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
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • 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
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices
    • 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
    • A61B2017/564—Methods for bone or joint treatment
    • A61B2017/565—Methods for bone or joint treatment for surgical correction of axial deviation, e.g. hallux valgus or genu valgus

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Neurology (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Description

1337072 九、發明說明： 【發明所屬之技術領域】 本發明關於申請專利範圍第1項的引文的一種骨板。 這種月板主要被設计來將足前部骨切除部 (VorfuBosteotomie)，特別是將遠體端的拇外翻（HaUux
Valgus)的骨切除部固定。這些骨固定部或其固定作用係依 以下標準達成； •旋轉穩定性， •配合橋正的相關強度， •最小侵犯性。 【先前技術】 在國際專利WO 00/06036與奥新型AT 000937U2發表 了種植入物’呈一腰帶扣環（Spange)形狀，它用於髓内 (intramedullar)。其唯一優點為在作髓内固定時；侵犯性 (InvasivitSt)最小；但在植入物本身沒有旋轉能力。在矯正 時’係依該扣環的不同之突起部（Kr0pfung)而定。因此該扣 環的侵犯性最小’但小小的緯正不能固定。 國際專利W0 01/54601 ’ FRIGG發表了一種骨板，它 具有一個組合孔，亦即二個貫穿板孔。這種組合孔的缺點 為：該二個板孔中只有一個板孔帶有一「部分内螺紋」， 因此只能在此一板孔中將一骨螺絲作角度穩定的剛性錨固 作用。 1337072 【發明内容】 對此本發明提出對策。本發明的目的在提供一種在髓 内及髓外（extramedullar)都可使用的骨板，藉之可將小的及 大的矯正作最小侵犯性的及旋轉穩定性的固定。 本發明利用一種具有申請專利範圍第1項的特點的骨 板達到此目的。這種骨板滿足上述所有要求，即： a) 旋轉穩定性
利用在疏骨（l)(Metatarsel)的幹軸中的二個孔以及其頭區 域中的二個孔，使骨板兩側充分穩定。利用在幹轴區域中 骨板内的二個圓枉形螺技’以及利用二枚螺絲將此板鎖Θ 住，使該板也可受保護防止在標記空腔内轉動及移動B b) 固定作用配合該矯正的對應強度 這點係利用瞄準扣環（Zielbiigel)達成，該MT (疏骨）小 頭各依需要而定向側面以對應的強度移動。然後沿該小頭 將板放入或打入，然後螺合。 c) 最小侵犯性 鋸切（SSgeschnitt)係利用一道切開口而進行，該切開口正 好夠大’使鋸片可通過去，但此切開口足夠使骨板放入。 然後’可穿過皮膚錢出孔，以將骨板在骨幹區域螺合。 d) 即使是小的矯正也有可能 小小的修正（它們不超出標記空間的皮質邊緣出去）可利 用這種骨板作髓外固定。在此該板略依矯正而作彎曲，並 在皮膚下移動°孔的第二部分（它們係設計來將骨幹鎖問 住者）設有一錐形螺紋，且係設計來作髓外之角度穩定的 1337072 固定者。如果該板移動到皮膚下，則可查覺到這些孔。如 此在°玄—孔之間作一個切口（Einschnitt)就足以達到這二 個孔了。 #J用本發明骨板的「組合孔」--該組合孔宜有二個 部段設在骨板的下方近體端的部分——可使該骨板用髓内 及趙外的方式都能使用。 人’’且合孔」（Kombiloch)由一圓柱形孔及一錐形孔構 成’邊一孔各有一個設有螺紋（至少佔其一部分）的部分。 圓柱形部分用於在髓内固定，且利用一骨螺絲的一幹軸螺 紋鎖閃住。該錐形部分在該骨板作髓外的應用時，同樣用 於將骨板鎖閂住，其中在此情形係使用一「螺紋頭螺絲」 (Gewnidekopf-Schraube)，因此造成所謂之「内部固定」 (fuateur interne)。由於疏骨的小頭部（Kdpfchen)係為移動的 部分，因此在此處固定方式的選擇（髓内/髓外）並不重 要。因此，在骨板上方遠體端部分的二個板孔對應於一般 之角度穩定的板孔（具有内螺紋的圓柱形孔或錐形孔）。 要將本發明的骨板作髓内固定，需要一瞄準裝置 (ZielgerM)，它可使骨板準確地鎖閂在骨中。但這種瞄準裝 置同時也要能使骨板正確地放置以及當作「打入工具」。 在作髓外固定時不需瞄準裝置，因為骨板的孔可在皮 膚下方檢測到，該二個組合孔（它們宜設在骨板的近體端） 互相很靠近，因此該二孔可藉著作單一個切口並將皮膚移 開而到達。 而係也可為等效的能 「内螺紋」不僅指螺旋形構造， 1337072 達成與螺紋相同功能的肋條形構造β 如申請專利範圍第！項定義的骨板有一優點，即··在 製造時材料損失較少。第二優點在於：可使骨板長度減少， 其結果能使侵犯性較小。 在一特別實施例中，這種由二個重疊孔構成的板孔設 在骨板的第一端附近。 在一較佳實施例中，該骨板的第一端變細窄。如此， 它可較容易地放入骨腔中，且一—作髓外應用時較容 易到皮膚下方。 在另—實施例中，該第一孔的内螺紋設計成為多股螺 線者（多頭螺紋）（mehrgSiigig，英：muUiple sUr卜比代以）， 且宜為雙股螺線（雙頭螺紋）（zweigangig，英：d〇ubu thread) 者。如此在一螺紋頭螺絲旋入時，可較快地夾緊。又，第 二孔的内螺紋也可設計成多股螺線者，且宜為雙股螺線中。 在又一實施例中，該二個重疊的孔的轴（圓柱轴與錐 形軸）大致互相平行延伸。該圓柱軸與錐形軸的互相距離A 宜為 A > 〇· 1 mm。 在-特別實施例中，該骨板至少有二個板孔，它們由 二個不同種的互相部分地重疊的孔組合構成。最好至少有 另-板孔接到其後，此另一板孔並非由二個部分重叠的孔 構成。該接到組合孔的板孔可設計成圓柱形或錐形，可具 有或不具有内螺紋。 在再一實施例中，該骨板有—「壓縮孔」。 在另-個實施例中，該骨板的第二端設計成¥形。所 1337072 要固定的骨碎片可能太短，無法用二個前後相隨的孔固 定。在此情形中，骨板的γ形端有一優點，可在γ字形的 各一腿中各有一個孔。 在此，該Y形末端的二個分枝之一或之二宜有一壓縮 孔。也可使用一種組合孔，換言之，由一壓縮孔與一鎖閂 孔組合。但也可只使用該二種類型的孔的一種（壓縮孔或 鎖閂孔）。 將一壓縮孔與Y字形另一臂上的一鎖閂孔組合有一優 點，即：可經由第二孔作角度穩定的固定之前，可經由該 骨板作壓縮。 在又一個實施例中，骨板的上側與下側設計成彎曲 狀。該彎曲的上側與下側以典型方式大致對應於二個圓枉 形的表面K上及κ T «1。該上側（2)與下側（3)宜呈不同程度 的彎曲。如果該板用於髓内及髓外，則可利用上下側的不 同曲度’一方面最佳地配合標記室的髓内表面，另方面最 佳地配合骨的髄外表面，在一特別實施例中，圓柱形的上 側K上《的半徑尺上例宜為圓柱形下側Ktw的半徑侧的至 多50%，且宜為至多40%。 【實施方式】 第1圖與第2圖所示的骨板（】）有一上側（2)、一朝向骨 側的下側(3)、-第-端(11)、及—第二端⑽、及多數設在 該二端⑴）（12)之間的板孔⑷’將上側⑺與下側⑺連接， 以容納骨螺絲。 1337072 該二個鄰接第一端（11)的骨板（4)由二個不同種之部分 重疊的孔（5)(6)組合形成。在此第一孔（5)設計成圓柱形，具 有—圓柱軸（9)及一内螺紋（7)。第二孔（6)從上側（2)向下側 呈截錐形變窄，且具有一錐體軸（1 〇)及一内螺紋（8)。該圓柱 軸（9)與錐形軸（10)互相平行延伸，且互隔一距離A=2mm。 該二個由二重叠孔（5)(6)構成的孔（5)(6)構成的板孔（4) 的末端的孔設在骨板（1)的第一端（11)附近，呈變細窄縮小 狀。 該接到該組合礼的板孔（4)設計成錐形，且用_内螺紋 (8)造成角度穩定的固定。 【圖式簡單說明】 第1圖係本發明的骨板的上側圖，具有二個組人孔. 第2圖係經第1圖的骨板在一組合孔區域的縱剖面圖。 【主要元件符號說明】 0) 骨板 (2) 上側 (3) 下側 (4) 骨板 (5) 第一孔 (6) 第二孔 (7)(8) 内螺紋 (9) 圓柱軸 1337072 (10) 錐體軸 (Π) 第- -端 (12) 第」 二端
11

Claims (1)

  1. 丄 丄 ::α L. _ 、申請專利範固Ί' 一 1板⑴’具有-上側(2)、-朝向骨側的下側 知⑴)、一第二端(12)、及數個板孔⑷；該板孔 二端⑴）（12)之間，將上側⑺將與下糊接通， :::月螺絲’其中至少有一板孔(4)由二個互相移動且部 ::的孔（5)(6)的組合而形成；且該二孔的第—孔⑺設計 且至少部分地帶有-内螺紋⑺，且有-圓柱軸 (9) ’其特徵在： A) 4 一孔的第—孔（6)有—錐體軸⑽且呈截錐形從上側 向下側（3)變細窄； B) §玄二孔的第二孔（6)至少部分地帶有-内螺紋（8);且 C) 該圓柱軸（9)距錐形軸的距離A不為〇。 2.如申請專利範圍第1項之Ί*板，其中： 。亥由一個重疊之孔（5)(6)構成的板孔（4)設在骨板（！）的 第—端（11)附近。 3. 如申請專利範圍第1或第2項之骨板，其中： 該骨板（1)第一端（11)變細窄。 4. 如申請專利範圍第1或第2項之骨板，其中： 該第一孔（5)的内螺紋（7)設計成多股螺線式，且宜為雙 賤螺線式。 ，又 5. 如申請專利範圍第1或第2項之骨板，其中： 該第二孔（6)的内螺紋（8)設計成多股螺線式，且宜為雙 賊螺線式。 6. 如申請專利範圍第1或第2項之骨板，其中： 12 1337072 遠圓柱軸（9)與錐形軸（1 〇)大致互相平行延伸。 7,如申請專利範圍第1或第2項之骨板，其令： 該圓柱軸（9)與錐形軸（10)互相間隔的距離a> 〇 lmm。 8·如申請專利範圍第丨或第2項之骨板，其中： 至少有二個板孔（4)由二個不同類互相部分重最 (5)(6)構成。 且 9.如申請專利範圍第8項之骨板，其中：
    該骨板另外至少有另一板孔⑷’不是由二個部分地互 相部分重疊的孔構成者。 10·如申請專利範圍第！或第2項之骨板，其中： 該第二端（12)設計成γ形。 H·如申請專利範圍第10項之骨板，其中： 該骨板有一壓縮孔。 12·如申請專利範圍第U項之骨板’豆中. 該y形端⑽的二分枝之一分枝有一壓縮孔。
    :3.如申請專利範圍第i或第2項之骨板其中： μ上側（2)與下側（3)係彎曲者。 Μ.如申請專利範圍第13項之骨板，直中. =的上側(2)與下側(3)大致對應於: 側的表面Κ上《及κ下w。 … V工 15·如申請專利範圍第14 該上側⑺與下側⑽不_;中· 1 6如由4主* J征汉的·考曲。 專利範圍第15項 該圓柱上側尺^的半^ -. 上例為下側κ下的半徑R 1 13 1337072 的至多50%，且宜為40%。 十一、圖式： 如次頁
    14
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US20070016205A1 (en) 2007-01-18
CN100400008C (zh) 2008-07-09
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DE50311436D1 (de) 2009-05-28
BR0318585B1 (pt) 2012-05-02
US8246661B2 (en) 2012-08-21
AU2003271507B2 (en) 2009-04-09
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BR0318585A (pt) 2006-10-10
AR047228A1 (es) 2006-01-11
JP4398429B2 (ja) 2010-01-13
ATE428362T1 (de) 2009-05-15
NZ546739A (en) 2009-02-28
EP1677693A1 (de) 2006-07-12
CA2545019C (en) 2012-02-28
ES2322575T3 (es) 2009-06-23
CA2545019A1 (en) 2005-05-12
AU2003271507A1 (en) 2005-05-19
KR20060089743A (ko) 2006-08-09
KR101136203B1 (ko) 2012-04-17
TW200514548A (en) 2005-05-01

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