技术领域technical field
本发明涉及医疗器械技术领域，特别涉及一种人工髋关节置换术后股骨假体周围骨折后的翻修锁定钢板。The invention relates to the technical field of medical devices, in particular to a revision locking plate for fractures around the femoral prosthesis after artificial hip joint replacement.
背景技术Background technique
股骨假体周围骨折除部分Vancouver A型可采用非手术治疗外，其余分型均应手术治疗。通常的手术方法有普通的钢板螺钉固定，单纯钢丝或钛缆环扎固定，异体骨移植并辅以钢板钢丝固定等。常规的钢板螺钉由于假体的存在，近端螺钉难以穿过假体，所以仅能固定一侧骨皮质，或因局部骨质量差，骨质疏松，螺钉不能与骨紧密咬合，使得骨折固定不牢固，患者也就达不到早期活动的目的。单纯钢丝或钢缆环扎固定对长斜形或螺旋形骨折是比较简洁有效的固定手段，但由于此类固定材料缺乏固定强度，其单独应用的固定效果较差，所以临床上都是二者联合使用。何健飞等报道了该单位使用钢板和钛缆联合应用于髋关节置换术后假体周围骨折的经验。钢板钛缆固定系统由钢板和通过钢板通道的钛缆组成，结合皮质骨螺钉固定股骨近端假体周围骨折。此种固定系统既不对骨水泥套造成损害，也不要求局部质量及容纳螺钉的空间，钢板覆盖假体尖端，可以避免出现应力集中区。但该系统的钛缆要通过钢板通道，这可能造成钢板的局部强度减弱。而且，钛缆只是起到捆扎作用，对抗旋转和抗弯曲能力帮助不大。Periprosthetic femoral fractures should be treated surgically except for some Vancouver type A fractures that can be treated non-operatively. The usual surgical methods include common plate and screw fixation, pure steel wire or titanium cable cerclage fixation, allograft bone transplantation supplemented by plate and steel wire fixation, etc. Due to the existence of the prosthesis, it is difficult for the proximal screw to pass through the prosthesis, so it can only fix one side of the cortical bone, or due to poor local bone quality and osteoporosis, the screw cannot be tightly occluded with the bone, making the fracture fixation difficult. If it is firm, the patient will not be able to achieve the purpose of early mobilization. Simple wire or cable cerclage fixation is a relatively simple and effective fixation method for long oblique or spiral fractures. However, due to the lack of fixation strength of this kind of fixation material, the fixation effect of its single application is poor, so clinically it is both. Combined use. He Jianfei et al. reported the unit's experience in using steel plates and titanium cables for periprosthetic fractures after hip replacement. The plate and titanium cable fixation system consists of a plate and a titanium cable through the plate channel, combined with cortical bone screws to fix proximal femoral periprosthetic fractures. This kind of fixation system does not cause damage to the bone cement sleeve, and does not require local quality and space to accommodate screws. The steel plate covers the tip of the prosthesis, which can avoid stress concentration areas. However, the titanium cables of this system have to pass through the steel plate channel, which may cause the local strength of the steel plate to weaken. Moreover, the titanium cable only plays a binding role, and the ability to resist rotation and bending is of little help.
Mennen钢板是上个世纪90年代问世的一种半环形钳夹式钢板，最开始被设计用来治疗小及中等长管状骨的骨折，收到良好的效果，在一段时间内也被用于股骨假体周围骨折。但是Mennen钢板因其固定力差，抗折弯抗旋转能力差，失败率较高。Ahuja等报道一组使用Mennen钢板治疗的病例，术后随访75％出现并发症，其中主要是骨折内翻畸形愈合。Noorda等报道36例股骨近端假体周围骨折使用Mennen环形钢板固定，术后随访27个月有28％骨折不愈合，22％钢板断裂。基于种种不良结果，该种钢板现已较少应用。Mennen plate is a semi-circular clamp-type plate that came out in the 1990s. It was originally designed to treat fractures of small and medium-length tubular bones. It received good results and was also used for femur for a period of time. Fracture around the prosthesis. However, the Mennen steel plate has a high failure rate due to its poor fixing force, poor bending resistance and rotation resistance. Ahuja et al. reported a group of cases treated with Mennen plates, and 75% of them had complications during postoperative follow-up, mainly fracture varus malunion. Noorda et al. reported that 36 cases of periprosthetic fractures of the proximal femur were fixed with Mennen ring plates. After 27 months of follow-up, 28% of the fractures were nonunion and 22% of the plates were broken. Based on various adverse results, this kind of steel plate is now less used.
对于粉碎性或螺旋形骨折应用形状记忆锯齿臂环抱器，可视为一种较好的固定方法。形状记忆环抱器具有如下优点：(1)弹性模量低，对骨应力遮挡小，有利于骨折愈合后期骨痂的改建；(2)可防止骨折端旋转移位，消除断端剪切力和扭转力；(3)对髓腔及骨内膜血供干扰小。对于股骨假体周围骨折，尽管环抱器避免了钢板螺钉对骨结构及假体-骨水泥-骨界面和骨水泥壳的损伤，但是需要足够大的接触面积来维持固定的牢靠，而这势必增加软组织的损伤和骨外膜血供的破坏。而且，型号的选择非常重要，过大骨折断端不稳定，过小无法正确环抱股骨近端。For comminuted or spiral fractures, the application of shape memory sawtooth arm embracing device can be regarded as a better fixation method. The shape memory embracing device has the following advantages: (1) The elastic modulus is low, and the bone stress shielding is small, which is beneficial to the reconstruction of the callus in the later stage of fracture healing; (2) It can prevent the fracture end from rotating and shifting, and eliminate the shear force and Torsional force; (3) Little disturbance to blood supply of medullary cavity and endosteum. For periprosthetic fractures of the femur, although the embracing device avoids damage to the bone structure, the prosthesis-bone cement-bone interface and the bone cement shell, it needs a large enough contact area to maintain firm fixation, which is bound to increase. Soft tissue injury and destruction of periosteal blood supply. Moreover, the selection of the model is very important. If the fracture is too large, the broken end is unstable, and if it is too small, it cannot properly encircle the proximal femur.
发明内容Contents of the invention
为解决上述技术问题，本发明的目的在于：提供一种股骨假体周围骨折翻修锁定钢板，其为一种既可以有效固定人工髋关节置换术后股骨假体周围骨折，又可以减少血运破坏，避免再次手术的翻修锁定钢板。In order to solve the above technical problems, the object of the present invention is to provide a revision locking plate for femoral periprosthetic fractures, which can effectively fix femoral periprosthetic fractures after artificial hip joint replacement and reduce blood supply damage. , to avoid revision locking plates for reoperation.
为实现上述目的，本发明所采用的技术方案是：To achieve the above object, the technical solution adopted in the present invention is:
一种股骨假体周围骨折翻修锁定钢板，具有与股骨形状相匹配的U型主体，所述主体的底端具有一收缩部，所述主体的两侧各延伸有两个侧翼，分别为第一侧翼、第二侧翼、第三侧翼和第四侧翼；所述主体和侧翼上设有若干钉孔。A revision locking plate for femoral prosthetic fractures. It has a U-shaped main body that matches the shape of the femur. The side wings, the second side wing, the third side wing and the fourth side wing; the main body and the side wings are provided with several nail holes.
所述的股骨假体周围骨折翻修锁定钢板，所述第一侧翼和第二侧翼位于主体的顶端分别用于固定大转子的前方和后方，第三侧翼固定股骨的前面，第四侧翼固定小转子。For the revision locking plate for fractures around the femoral prosthesis, the first wing and the second wing are located at the top of the main body to fix the front and rear of the greater trochanter respectively, the third wing fixes the front of the femur, and the fourth wing fixes the lesser trochanter .
所述的股骨假体周围骨折翻修锁定钢板，所述第一侧翼上具有一个钉孔，所述第二侧翼上具有两个钉孔，所述第一侧翼和第二侧翼之间的主体上设有两个钉孔。For the revision locking plate for fracture around the femoral prosthesis, there is one nail hole on the first side wing, two nail holes on the second side wing, and a main body between the first side wing and the second side wing. There are two nail holes.
所述的股骨假体周围骨折翻修锁定钢板，所述钉孔的直径为5.0mm，用与钉孔直径相匹配的锁定螺钉通过侧翼上的钉孔对股骨进行单皮质固定，无需钻透股骨假体。For the revision locking plate for fractures around the femoral prosthesis, the diameter of the nail hole is 5.0 mm, and the femur is fixed with the single cortex through the nail hole on the flank with a locking screw that matches the diameter of the nail hole, without drilling through the femoral prosthesis. body.
所述的股骨假体周围骨折翻修锁定钢板，所述锁定螺钉的材质与主体相同，所述锁定螺钉根据需要预设不同规格。For the revision locking plate for periprosthetic fractures of the femur, the material of the locking screw is the same as that of the main body, and different specifications of the locking screw are preset according to needs.
所述的股骨假体周围骨折翻修锁定钢板，所述主体的长度为20～25cm，所述主体上每一钉孔之间的距离为25.0mm。For the revision locking plate for fractures around the femoral prosthesis, the length of the main body is 20-25 cm, and the distance between each nail hole on the main body is 25.0 mm.
所述的股骨假体周围骨折翻修锁定钢板，所述主体和锁定螺钉的材质为钛合金或钴铬钼合金。In the revision locking plate for fractures around the femoral prosthesis, the main body and locking screws are made of titanium alloy or cobalt-chromium-molybdenum alloy.
与现有技术相比，采用上述技术方案的本发明的优点在于：1、本发明可以多个角度固定骨折近端，无需增加钢板宽度，螺钉把持力、钢板抗弯曲力、抗旋转能力均强于以往任何固定材料。2、锁定设计可以避免由于钢板过于贴近骨面和过度剥离骨膜及软组织造成的血运破坏。3、本发明的力臂较长，分散固定可以避免应力集中引起的钢板折断和应力遮挡引起的骨不连。4、结合MIPPO(微创经皮钢板内固定)技术，可以进一步减少软组织损伤。Compared with the prior art, the advantages of the present invention adopting the above technical solution are: 1. The present invention can fix the proximal end of the fracture at multiple angles without increasing the width of the steel plate, and the screw holding force, bending resistance and rotation resistance of the steel plate are all strong than any previous fixed material. 2. The locking design can avoid blood supply damage caused by the steel plate being too close to the bone surface and excessive stripping of the periosteum and soft tissue. 3. The moment arm of the present invention is relatively long, and dispersed fixation can avoid the fracture of the steel plate caused by stress concentration and the nonunion caused by stress shielding. 4. Combined with MIPPO (Minimally Invasive Percutaneous Plate Internal Fixation) technology, it can further reduce soft tissue damage.
附图说明Description of drawings
图1为本发明的主视结构示意图；Fig. 1 is the front view structure schematic diagram of the present invention;
图2为本发明的俯视结构示意图；Fig. 2 is the top view structure schematic diagram of the present invention;
图3为本发明的右视结构示意图；Fig. 3 is a right view structure schematic diagram of the present invention;
图4为本发明的立体结构示意图；Fig. 4 is the three-dimensional structure schematic diagram of the present invention;
图5为本发明应用在股骨上的结构示意图。Fig. 5 is a schematic diagram of the structure of the present invention applied to the femur.
附图标记说明：1-主体；2-收缩部；3-第一侧翼；4-第二侧翼；5-第三侧翼；6-第四侧翼；7-钉孔；8-股骨；81-大转子。Explanation of reference numerals: 1-main body; 2-constriction; 3-first flank; 4-second flank; 5-third flank; 6-fourth flank; 7-nail hole; 8-femur; 81-big rotor.
具体实施方式Detailed ways
下面结合具体实施例和附图来进一步描述本发明，本发明的优点和特点将会随着描述而更为清楚。The present invention will be further described below in combination with specific embodiments and accompanying drawings, and the advantages and characteristics of the present invention will become clearer along with the description.
如图1至图4所示，为本发明的一种股骨假体周围骨折翻修锁定钢板的结构示意图，具有与股骨8(以身高170cm的成人左侧股骨为例)形状相匹配的主体1，所述主体1的材质为钛合金或钴铬钼合金，所述主体1呈U型(如图3所示)并固定在股骨8的外侧，所述主体的长度为20～25cm，所述主体1具有两端，其底端为一收缩部2，目的在于减轻主体1的重量。本发明的主体1弹性模量低，对骨应力遮挡小，有利于骨折愈合后期骨痂的改建。As shown in Fig. 1 to Fig. 4, it is a schematic structural view of a femoral prosthetic fracture revision locking plate around the present invention, which has a main body 1 that matches the shape of the femur 8 (taking the left femur of an adult with a height of 170cm as an example), The material of the main body 1 is titanium alloy or cobalt-chromium-molybdenum alloy. The main body 1 is U-shaped (as shown in FIG. 3 ) and fixed on the outside of the femur 8. The length of the main body is 20-25 cm. 1 has two ends, the bottom end of which is a constricted part 2, the purpose of which is to reduce the weight of the main body 1. The main body 1 of the present invention has a low elastic modulus, less shielding of bone stress, and is beneficial to the reconstruction of callus in the later stage of fracture healing.
而本发明的创新点在于，在所述主体1的顶端的两侧向U型结构开口方向各延伸有两个侧翼，即共有四个侧翼，所述的侧翼可防止骨折端旋转移位，消除断端剪切力和扭转力。The innovation of the present invention is that two wings are respectively extended to the opening direction of the U-shaped structure on both sides of the top of the main body 1, that is, there are four wings in total, and the wings can prevent the fracture end from rotating and shifting, eliminating End shear and torsional forces.
所述侧翼分别为第一侧翼3、第二侧翼4、第三侧翼5和第四侧翼6；其中，如图5所示，所述第一侧翼3和第二侧翼4位于主体1的顶端，所述第一侧翼3用于固定大转子81的前方，所述第二侧翼4用于固定大转子81的后方，第三侧翼5固定在股骨8的前面，第四侧翼位于小转子处用于固定小转子(图中未显示)。所述第一侧翼3的宽度大于第二侧翼4的宽度。The wings are respectively a first wing 3, a second wing 4, a third wing 5 and a fourth wing 6; wherein, as shown in FIG. 5, the first wing 3 and the second wing 4 are located at the top of the main body 1, The first wing 3 is used to fix the front of the greater trochanter 81, the second wing 4 is used to fix the rear of the greater trochanter 81, the third wing 5 is fixed to the front of the femur 8, and the fourth wing is located at the lesser trochanter for Fix the lesser trochanter (not shown). The width of the first wing 3 is greater than the width of the second wing 4 .
再如图1至图5所示，所述主体1和所述各侧翼上设有若干钉孔7，且每一钉孔7的直径为5.0mm，其中，所述第一侧翼3上具有一个钉孔8，所述第二侧翼4上具有两个钉孔7，所述第一侧翼3和第二侧翼4之间的主体上设有两个钉孔7。所述主体1上每一钉孔7之间的距离为25.0mm。用与钉孔7直径相匹配的锁定螺钉通过侧翼上的钉孔7对股骨8进行单皮质固定，因此无需钻透股骨假体。所述锁定螺钉(图中未显示)和主体1的材质相同，为钛合金或钴铬钼合金，所述锁定螺钉根据需要预设不同的长度规格。As shown in Figures 1 to 5 again, the main body 1 and the side wings are provided with a number of nail holes 7, and the diameter of each nail hole 7 is 5.0 mm, wherein the first side wing 3 has a Nail holes 8 , two nail holes 7 are provided on the second side wing 4 , and two nail holes 7 are provided on the main body between the first side wing 3 and the second side wing 4 . The distance between each nail hole 7 on the main body 1 is 25.0 mm. Unicortical fixation of the femur 8 is performed through the pin holes 7 on the flanks with locking screws matching the diameter of the pin holes 7, thus eliminating the need to drill through the femoral prosthesis. The material of the locking screw (not shown in the figure) is the same as that of the main body 1, which is titanium alloy or cobalt-chromium-molybdenum alloy, and the locking screw is preset with different length specifications as required.
因此，综上所述，本发明具有的优点为：Therefore, in summary, the present invention has the advantages of:
1、本发明可以多个角度固定骨折近端，无需增加钢板宽度，螺钉把持力、钢板抗弯曲力、抗旋转能力均强于以往任何固定材料。2、锁定设计可以避免由于钢板过于贴近骨面和过度剥离骨膜及软组织造成的血运破坏。3、本发明的力臂较长，分散固定可以避免应力集中引起的钢板折断和应力遮挡引起的骨不连。4、结合MIPPO(微创经皮钢板内固定)技术，可以进一步减少软组织损伤。1. The present invention can fix the proximal fracture at multiple angles without increasing the width of the steel plate, and the screw holding force, bending resistance and rotation resistance of the steel plate are stronger than any previous fixing materials. 2. The locking design can avoid blood supply damage caused by the steel plate being too close to the bone surface and excessive stripping of the periosteum and soft tissue. 3. The moment arm of the present invention is relatively long, and dispersed fixation can avoid the fracture of the steel plate caused by stress concentration and the nonunion caused by stress shielding. 4. Combined with MIPPO (Minimally Invasive Percutaneous Plate Internal Fixation) technology, it can further reduce soft tissue damage.
以上的说明和实施例仅是范例性的，并不对本发明的范围构成任何限制。本领域技术人员应该理解的是，在不偏离本发明的精神和范围下可以对本发明技术方案的细节和形式进行修改或替换，但这些修改和替换均落入本发明的保护范围内。The above descriptions and examples are only exemplary and do not constitute any limitation to the scope of the present invention. Those skilled in the art should understand that the details and forms of the technical solutions of the present invention can be modified or replaced without departing from the spirit and scope of the present invention, but these modifications and replacements all fall within the protection scope of the present invention.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201610076433.4ACN105640635B (en) | 2016-02-03 | 2016-02-03 | A kind of Periprosthetic Fracture After Total Hip Arthroplasty overhauls locking steel plate |
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201610076433.4ACN105640635B (en) | 2016-02-03 | 2016-02-03 | A kind of Periprosthetic Fracture After Total Hip Arthroplasty overhauls locking steel plate |
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| CN105640635A CN105640635A (en) | 2016-06-08 |
| CN105640635Btrue CN105640635B (en) | 2018-08-31 |
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| CN201610076433.4AExpired - Fee RelatedCN105640635B (en) | 2016-02-03 | 2016-02-03 | A kind of Periprosthetic Fracture After Total Hip Arthroplasty overhauls locking steel plate |
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