Invention content
The purpose of the present invention is to provide a kind of ruler oar distal forearm rotate prosthese, with solve it is in the prior art underThe therapeutic scheme of ulnoradial joint dislocation cannot restore the technical issues of forearm spinfunction or unstable rotation.
Based on above-mentioned purpose, the present invention provides a kind of ruler oar distal forearm rotation prosthese, including first and second；
Described first is connected with described second, and described first can be opposite along junction with described secondRotation；
Described first is provided with the first fixed part far from the side of described second；
Described second is provided with the second fixed part far from the side of described first.
In any of the above-described technical solution, further, it is provided with protrusion on first of the present invention, described secondOn be provided with and the corresponding groove of protrusion；The protrusion is inserted in the groove, and can be turned in the grooveIt is dynamic；
Alternatively, described first upper setting is fluted, it is provided on described second and the corresponding protrusion of the groove；The protrusion is inserted in the groove, and can be rotated in the groove.
In any of the above-described technical solution, further, on first of the present invention run through and offer first positioning hole；
Run through on described second and offer the second location hole；
During described first and described second connection, the axis of the axis of the first positioning hole and second location holeLine overlaps, and forms location hole；
The axis of the rotary shaft of the ruler oar distal forearm rotation prosthese is overlapped with the axis of the location hole.
In any of the above-described technical solution, further, for protrusion of the present invention in cylinder, the groove is in cylinderBody, and the protrusion is corresponding with the groove；
Alternatively, the protrusion, in cylinder, the circumferential surface of the protrusion is provided with annular protrusion, and the axis of the annular protrusionLine is overlapped with the axis of the protrusion；The groove is in cylinder, and the circumferential surface of the groove is provided with annular groove, and the ringThe axis of connected in star is overlapped with the axis of the groove；The protrusion is corresponding with the groove, and the protrusion is inserted in describedWhen in groove, the annular protrusion and the annular groove are corresponding；
Alternatively, the protrusion, in sphere, the groove is in sphere, and the protrusion is corresponding with the groove；
Alternatively, the protrusion, in round estrade, the groove is in round estrade, and the large end face of the round estrade is far from described recessedThe slot bottom of slot, the protrusion are corresponding with the groove.
In any of the above-described technical solution, further, the first fixed part of the present invention is intramedullary nail and/or lockingPlate；
Second fixed part is intramedullary nail and/or lockplate.
In any of the above-described technical solution, further, when the first fixed part of the present invention includes lockplate, the lockFixed board and it is first described between have gap；
And/or second fixed part include lockplate when, the lockplate and it is second described between have gap.
In any of the above-described technical solution, further, first of the present invention is opened far from the side of described secondEquipped with multiple first nail hole, first nail hole is used to plug the intramedullary nail；Pass through first between multiple first nail holeIntercommunicating pore connects；
And/or described second side described first separate offers multiple second nail hole, second nail hole is usedIn plugging the intramedullary nail；It is connected between multiple second nail hole by the second intercommunicating pore.
In any of the above-described technical solution, further, intramedullary nail surface of the present invention, which is provided with, reinforces groove and micro-Pore structure；
And the intramedullary nail surface is provided with coating, the coating can induce bone cell growth.
In any of the above-described technical solution, further, the material of intramedullary nail of the present invention and/or the lockplate isMetal；
Described first is metal with the material of second.
In any of the above-described technical solution, further, first of the present invention and it is second described between connectionThe material at place is ultra-high molecular weight polyethylene or cobalt chrome molybdenum or high crosslinked polyethylene.
Using above-mentioned technical proposal, the present invention has the advantages that：
Ulna distal end microcephaly is cut off or cuts neck of the ulna close to distal end by the ulnoradial joint dislocation of patient forearmFall one end, to realize that ulna proximally and distally detaches.If by ulna distal end microcephaly cut off, by first by the first fixed part withDistal radius is fixedly connected, and second is fixedly connected by the second fixed part with proximal ulna, realizing radius can be oppositeIt is rotated in ulna；It is remote with radius by the realization of the first fixed part by first if neck of the ulna close to distal end is cut out one endEnd and ulna distal end be fixedly connected with, second is fixedly connected by the second fixed part with proximal ulna, realize radius withUlna distal end can be rotated relative to the proximal end of ulna.
Specifically, when muscle pulls radius rotation, distal radius and first are fixedly connected, and first rotates therewith；In addition, first and second connection, and first and second can relatively rotate along junction, realize first relativelyIn second rotation, it is fixedly connected due to second with proximal ulna, it is thus achieved that radius is rotated relative to proximal ulna, andThe continuity of distal radius and proximal ulna is restored by prosthese, so as to restore the spinfunction of forearm, and has been radius phaseAuxiliary and supporting role are provided for ulna rotation, so as to improve the stability that radius is rotated relative to ulna.
The additional aspect and advantage of the present invention will become practice apparent or by the present invention in following description sectionRecognize.
Embodiment one
Prosthese is rotated referring to shown in Fig. 1-Figure 18, the present embodiment provides a kind of ruler oar distal forearms, including first 11 HeSecond 12；
Described first 11 is connected with described second 12, and described first 11 and it is described second 12 can along evenPlace is met to relatively rotate；
Described first 11 is provided with the first fixed part 21 far from the side of described second 12；
Described second 12 is provided with the second fixed part 22 far from the side of described first 11.
Ulna distal end microcephaly is cut off or cuts neck of the ulna close to distal end by the ulnoradial joint dislocation of patient forearmFall one end, to realize that ulna proximally and distally detaches.If by ulna distal end microcephaly cut off, by first by the first fixed part withDistal radius is fixedly connected, and second is fixedly connected by the second fixed part with proximal ulna, realizing radius can be oppositeIt is rotated in ulna；It is remote with radius by the realization of the first fixed part by first if neck of the ulna close to distal end is cut out one endEnd and ulna distal end be fixedly connected with, second is fixedly connected by the second fixed part with proximal ulna, realize radius withUlna distal end can be rotated relative to the proximal end of ulna.
Specifically, when muscle pulls radius rotation, distal radius and first are fixedly connected, and first rotates therewith；In addition, first and second connection, and first and second can relatively rotate along junction, realize first relativelyIn second rotation, it is fixedly connected due to second with proximal ulna, it is thus achieved that radius is rotated relative to proximal ulna, andThe continuity of distal radius and proximal ulna is restored by prosthese, so as to restore the spinfunction of forearm, and has been radius phaseAuxiliary and supporting role are provided for ulna rotation, so as to improve the stability that radius is rotated relative to ulna.
Optionally, ginseng is seen figure 1 and figure 2, and protrusion 3 is provided on described first, be provided on described second andConvex 3 corresponding grooves；Described raised 3 are inserted in the groove, and can be rotated in the groove；
Alternatively, described first upper setting is fluted, it is provided on described second and the corresponding protrusion of the groove3；Described raised 3 are inserted in the groove, and can be rotated in the groove.
Can realize between first and second connection limiting and first and second between it is oppositeRotation, and simple in structure, at low cost, high practicability.
Preferably, it is shown in Figure 1, run through on described first 11 and offer first positioning hole 41；
Run through on described second 12 and offer the second location hole 42；
Described first 11 and it is described second 12 connection when, the axis of the first positioning hole 41 and it is described second positioningThe axis in hole 42 overlaps, and forms location hole 4；
The axis of the rotary shaft of the ruler oar distal forearm rotation prosthese is overlapped with the axis of the location hole.
Straight trip guide pin can be accommodated in location hole 4, straight trip guide pin for example can be Kirschner wire.
Straight trip guide pin is fixed in forearm rotary shaft by the forearm rotary shaft combination assistant positioning system of patient first, is madeLocation hole is passed through straight trip guide pin by the used time, location hole to be enabled to be adjusted with guide pin is performed to the rotation overlapping of axles with forearm, so as to enableRadius, using the rotary shaft of patient forearm as practical rotary shaft, corrects for the rotation position of radius, meets relative to the rotation of ulnaHuman body forearm anatomical motion function assessment restores that while the stability between the ruler oar of distal end spinfunction can be restored.
In conclusion the characteristics of prosthese provided in this embodiment, is in forearm rotary moveable soft tissue to retainThe carpal anatomical structure of patient's ruler, while restoring continuity support of the ulna to radius, in the concentric rotation axis of forearmRotating device is designed, restores spinfunction.
Optionally, referring to shown in Fig. 1-Figure 12, described raised 3 be in cylinder, and the groove is in cylinder, and the protrusion3 and the groove it is corresponding；
Alternatively, referring to shown in Figure 13 and Figure 14, described raised 3 be in cylinder, and raised 3 circumferential surface is provided with convex annular7 are played, and the axis of the annular protrusion 7 is overlapped with raised 3 axis；The groove is in cylinder, the week of the grooveFace is provided with annular groove, and the axis of the annular groove is overlapped with the axis of the groove；The protrusion and the grooveCorresponding, when the protrusion is inserted in the groove, the annular protrusion and the annular groove are corresponding；
Alternatively, referring to shown in Figure 15 and Figure 16, the protrusion is in sphere, and the groove is in sphere, and the protrusion and instituteIt is corresponding to state groove；
Alternatively, referring to shown in Figure 17 and Figure 18, the protrusion is in round estrade, and the groove is in round estrade, and the round platformSlot bottom of the large end face of body far from the groove, the protrusion are corresponding with the groove.
The protrusion is corresponding with the groove, that is, protrusion and groove gap cooperation, realizing can relatively rotate.
Because the rotary shaft of patient forearm has individual differences, the motion range for giving prosthese according to the forearm rotary shaft of patient is excellentSelection of land provides a variety of prostheses：
As achievable first way, the protrusion is in cylinder in cylinder, the groove, enables protrusion being capable of edgeThe axis direction movement of groove, can provide slight vertical shift of the forearm to distal end, reduce because of the long-term drawing knot of longitudinal forcePotential prosthetic loosening caused by fruit has long-term stability.
As the achievable second way, for the protrusion in cylinder, the circumferential surface of the protrusion is provided with annular protrusion,The groove is in cylinder, and the circumferential surface of the groove is provided with annular groove, and patient's such as forearm injury, interosseous membrane is unstable, precedingArm damages, and longitudinal stability power is unstable, and pain when longitudinal direction pulls, this prosthese can provide the stabilization of forearm longitudinal direction, mitigates pain.
As the third achievable mode, the protrusion is in sphere, and the groove is in sphere, for some patientss forearmThe larger patient of rotary shaft range, can be used can lateral fine motion spherical prosthese, more meet the forearm personalization whirler of patientThe anatomical reduction of rotary shaft under system.
As achievable 4th kind of mode, the protrusion is in round estrade in round estrade, the groove, this prosthese feature isLongitudinal slip and the fine motion of rotary shaft can be provided.Longitudinal direction can be rotated when rotating because of some patientss forearm along forearm rotary shaft to moveDynamic, rotary shaft moves in a certain range, non-constant, and such prosthese coaster may be selected.
Optionally, first fixed part 21 is intramedullary nail 51 and/or lockplate 52；
Second fixed part 22 is intramedullary nail 51 and/or lockplate 52.
It is achieved that proximal ulna is connected as a static entirety with second, distal radius and first are connected as oneIt is a static whole.
Optionally, the connecting hole on lockplate is unthreaded hole or threaded hole.
Specifically, shown in Figure 1, first fixed part is intramedullary nail；
Alternatively, first fixed part is lockplate；
Alternatively, referring to shown in Fig. 5 and Fig. 6, first fixed part is intramedullary nail and lockplate.
Preferably, first fixed part is intramedullary nail and lockplate.
Optionally, ginseng is seen figure 1 and figure 2, and second fixed part is intramedullary nail；
Alternatively, second fixed part is lockplate；
Alternatively, referring to shown in Fig. 3 and Fig. 4, second fixed part is intramedullary nail and lockplate.
Preferably, second fixed part is intramedullary nail and lockplate.
Optionally, lockplate is located at the ulnar side or back side of prosthese.
In conclusion fix ulna and radius down through Internal fixation technology, ulna, radius and prosthese there are continuity,The spinfunction of forearm is also restored simultaneously, distal radius can be restored and when wrist portion moves to the left and right of distal radius and wristAnd restraining force in the front-back direction, avoid the soft tissue around ulna (soft including ulnar side distal end tendon and ulnar nerve and ulnar arteryTissue complex) ulna stump is hit when forearm rotates, when forearm rotates after restoring ulna distal resection or being merged with radiusCaused ulnar side soft tissue relative quiescent is stablized, and reduces complication caused by hitting, can effectively restore patient forearm's rotationAxis reduces complication, has reached the anatomical reduction of forearm movement rotary shaft.
As achievable mode, ginseng is seen figure 1 and figure 2, and the first fixed part is intramedullary nail, and the second fixed part is in marrowNail；
Referring to shown in Fig. 3 and Fig. 4, the first fixed part is intramedullary nail, and the second fixed part is intramedullary nail and fixed plate；
Referring to shown in Fig. 5 and Fig. 6, the second fixed part is intramedullary nail, and the first fixed part is intramedullary nail and fixed plate；
Referring to shown in Fig. 7 and Fig. 8, the second fixed part is intramedullary nail and fixed plate, and the first fixed part is intramedullary nail and fixationPlate.
Preferably, it is shown in Figure 8, when first fixed part includes lockplate, the lockplate and first describedBetween have gap；
And/or it is shown in Figure 7, second fixed part include lockplate when, the lockplate and it is described second itBetween have gap.
Specifically, first fixed part include lockplate when, the lockplate and it is first described between have gap；
Alternatively, second fixed part include lockplate when, the lockplate and it is second described between have gap；
Alternatively, first fixed part include lockplate when, the lockplate and it is first described between have gap；And instituteState the second fixed part include lockplate when, the lockplate and it is second described between have gap.
Preferably, first fixed part include lockplate when, the lockplate and it is first described between have gap；AndSecond fixed part include lockplate when, the lockplate and it is second described between have gap.
The lockplate and it is first described between have gap, state lockplate and it is second described between have gap, it is feasibleCortex of bone passes through.Realization induction of bone growth simultaneously merges well with first, increase stability, fixing-stable power in raising；WithAnd realize and induction of bone growth and merged well with second, increase stability, fixing-stable power in raising.
Preferably, ginseng is seen figure 1 and figure 2, and described first offers multiple first far from the side of described secondNail hole, first nail hole are used to plug the intramedullary nail；Between multiple first nail hole 61 are connected by the first intercommunicating pore；
And/or described second side described first separate offers multiple second nail hole, second nail hole is usedIn plugging the intramedullary nail；Between multiple second nail hole 62 are connected by the second intercommunicating pore.
Specifically, described first offers multiple first nail hole, first nail far from the side of described secondHole is used to plug the intramedullary nail；It is connected between multiple first nail hole by the first intercommunicating pore；
Alternatively, described second offers multiple second nail hole far from the side of described first, second nail hole is usedIn plugging the intramedullary nail；It is connected between multiple second nail hole by the second intercommunicating pore；
Alternatively, described first offers multiple first nail hole far from the side of described second, first nail hole is usedIn plugging the intramedullary nail；It is connected between multiple first nail hole by the first intercommunicating pore；And described second separate describedThe side of first offers multiple second nail hole, and second nail hole is used to plug the intramedullary nail；Multiple second nailsIt is connected between hole by the second intercommunicating pore.
Preferably, described first offers multiple first nail hole, first nail hole far from the side of described secondFor plugging the intramedullary nail；It is connected between multiple first nail hole by the first intercommunicating pore；And described second separate instituteIt states the side of first and offers multiple second nail hole, second nail hole is used to plug the intramedullary nail；Multiple described secondIt is connected between nail hole by the second intercommunicating pore.The compatibility of marrow and sclerotin can be used and combine Intramedullary nailing technology, inductionBone uptake simultaneously merges well, is less prone to first and/or second rotation and longitudinal direction loosens and unstable and avoid feelingDye.
Preferably, the intramedullary nail surface, which is provided with, reinforces groove and microcellular structure；
And the intramedullary nail surface is provided with coating, the coating can induce bone cell growth.
It can further realize with induction of bone growth and merge well, increase stability.
Intramedullary nail face coat preferably 1, tantalum micro porous coating.2nd, hydroxyapatite can be realized further and induction boneIt grows and merges well, increase stability 3, possess the porous ceramics coating that induction bone cell growth realizes biological fixation.
Preferably, the material of the intramedullary nail and/or the lockplate is metal；
Described first is metal with the material of second.
Specifically, the material of the intramedullary nail is metal；Alternatively, the material of the lockplate is metal；It is alternatively, describedThe material of intramedullary nail and lockplate is metal.
Preferably, intramedullary nail, fixed plate and first, the material of second are vitallium or titanium alloy.
Preferably, described first and it is second described between junction material be ultra-high molecular weight polyethylene orCobalt chrome molybdenum or high crosslinked polyethylene.
Spin friction coefficient is low, prolongs the service life.
When neck of the ulna close to distal end is cut out one end, the advantageous effect of rotation prosthese provided in this embodiment is usedFor：Retain ulna distal end, while the continuity for restoring ulna stump to radius supports on the Pivot axle of forearm is coaxialRotating device is designed, restores spinfunction.
Ulna distance end is fixed in prosthese both ends by Internal fixation technology, and far and near end and prosthese exist continuous after ulnar osteotomiesProperty, while also restore spinfunction, distal radius can be restored and when wrist portion moves to the left and right of distal radius and wrist and precedingThe restraining force of rear direction avoids the soft tissue (soft tissue including ulnar side distal end tendon and ulnar nerve and ulnar artery around ulnaComplex) ulna stump is hit when forearm rotates, cause when forearm rotates after restoring ulna distal resection or being merged with radiusUlnar side soft tissue relative quiescent stablize, reduce hit caused by complication, effectively restored patient forearm's rotary shaft rotation,Reduce complication.
Referring to shown in Fig. 9-Figure 12, this right gives the intramedullary nail at far and near end preferably combining locking because of individual differenceIt is fixed in plate, lockplate is distally placed in ulnar side, proximal end lockplate is preferably put in back side.Because being such as put in ulnar side, patientFeeling of pain may be depressed into because of pad when hand is positioned on table, if patient's ulna is shorter, steel plate placement in proximal end need to be completely exfoliatedShow finger extensor muscle of fingers, can be selected to be positioned over the circulator of the steel plate class of ulnar side.
Specific operation method：First patient forearm's rotary shaft combination assistant positioning system is existed one piece of Kirschner wire fixation in artIn rotary shaft (need to be from notch a certain distance), Kirschner wire can pass through the location hole of rotation coaster.
Operation takes back side notch, successively cuts to ulna distal end, patient forearm's supinator position gives head of ulna proximally row oneSection property osteotomy (retaining a part of backbone, about 1.5-2cm under head of ulna), the length of osteotomy varies with each individual.
Give the ulna stump at the Using prosthesis distance end of the present embodiment, the ruler being implanted into after osteotomy section is modified under lower ruler oarThe gap (when necessary here implantation self-bone grafting growth-gen) of radius, screw is screwed into from ulnar side, together fixes head of ulna, Hui ZhiOsteocomma and distal radius form distal radius and wrist portion and the protrusion of head of ulna, distal end Medullary fixation stick and rotation coasterThe distal end of rotation, the intramedullary nail of proximal end are fixed through back side thenad skidding screw, the recess portion and intramedullary nail and ruler of proximal end rotation coasterProximal bone to olecranon forms a static rotation proximal end.It is needed the rotation axial adjustment of prosthese and forearm rotary shaft side in art in timeUpward Kirschner wire can pass through location hole, adjust forearm rotary shaft and the rotation overlapping of axles of prosthese.Intramedullary nail is according to state of an illness necessityWhen can combine bone cement use.
Finally it should be noted that：The above embodiments are only used to illustrate the technical solution of the present invention., rather than its limitations；To the greatest extentPipe is described in detail the present invention with reference to foregoing embodiments, it will be understood by those of ordinary skill in the art that：Its according toCan so modify to the technical solution recorded in foregoing embodiments either to which part or all technical features intoRow equivalent replacement；And these modifications or replacement, various embodiments of the present invention technology that it does not separate the essence of the corresponding technical solutionThe range of scheme.
In addition, it will be appreciated by those of skill in the art that although some embodiments described herein include other embodimentsIn included certain features rather than other feature, but the combination of the feature of different embodiments means in of the inventionWithin the scope of and form different embodiments.For example, in claims above, embodiment claimed is appointedOne of meaning mode can use in any combination.The information for being disclosed in the background technology part is merely intended to deepen to thisThe understanding of the general background technology of utility model, and be not construed as recognizing or imply that information composition has been in any formThe prior art known in those skilled in the art.