Source: https://patents.google.com/patent/JP3532622B2/en
Timestamp: 2020-01-22 20:11:56
Document Index: 456181963

Matched Legal Cases: ['art 1', 'art 2', 'art 2', 'art 1', 'art 1', 'art 1', 'art 1', 'art 20', 'art 20', 'art 21', 'art 21', 'art 21', 'art 12', 'art 2', 'art 2', 'art 3', 'art 7', 'art 13', 'art 21', 'art 22']

JP3532622B2 - Surgical instruments for percutaneous connection - Google Patents
Surgical instruments for percutaneous connection
JP3532622B2
JP3532622B2 JP23904994A JP23904994A JP3532622B2 JP 3532622 B2 JP3532622 B2 JP 3532622B2 JP 23904994 A JP23904994 A JP 23904994A JP 23904994 A JP23904994 A JP 23904994A JP 3532622 B2 JP3532622 B2 JP 3532622B2
JP23904994A
JPH08112290A (en
ゴットフリード イェチエル
1993-03-28 Priority claimed from IL10518393A external-priority patent/IL105183A/en
1994-06-08 Priority to IL109929A priority patent/IL109929A/en
1994-06-08 Priority claimed from IL109929A external-priority patent/IL109929A/en
1994-10-03 Application filed by ゴットフリード イェチエル filed Critical ゴットフリード イェチエル
1996-05-07 Publication of JPH08112290A publication Critical patent/JPH08112290A/en
2004-05-31 Publication of JP3532622B2 publication Critical patent/JP3532622B2/en
Description: BACKGROUND OF THE INVENTION The present invention relates to U.S. Pat.
No. 4,465,065, which is incorporated herein by reference.
It is about improvement. This surgical instrument can
No need to make large incisions of tissue
Rate connects the fractured neck of the femur to the femoral shaft
Help to do. 2. Description of the Prior Art
The rate has a sharp pointed lower edge and
This lower edge allows a small incision in the trochanter area to pass through
And comes into contact with the femoral shaft. During surgery,
Is temporarily attached to the horizontal part of the connecting arm,
At the same time the vertical part of the connecting arm is parallel to the connecting plate
And a hole that is coaxial with the hole in the connecting plate
I can. The concentric guide tube has a hole in the horizontal part of the connecting arm.
Through the soft tissue and push it down to the connection plate.
At the exact location where it can be observed with an X-ray machine.
It serves as a guide member to pre-drill holes. In advance
After drilling holes, the inner guide tube is removed and the outer
The tube helps insert the long screw and is later removed. Long
The screw is tightened to contact the fracture. Here, consolidation
Insert into the hole in the connecting arm that is coaxial with the hole in the plate.
Drill properly through the tubing
The short screw which helps to attach the connection plate securely,
Insert through the vertical part of the connecting arm. Here
The arm is removed from the connecting plate, closing the wound. [0003] The surgical instrument of the present invention
Is similar and serves the same purpose but refers to the type
Of the original surgical instrument found during use in
To avoid shortcomings. The main disadvantage is that bone
Most important for fast care and quick use of limbs by patients
Active tightening of the fracture part, which is the work, can be done with long screws
And that the long screw is enough for the hole in the connection plate
It is shaky without being guided to, the fractured part after connection
Often, instability and long screws
When the patient begins to walk and pressure is applied to the fracture,
Protruding into pad tissue and making holes during surgery
Securely attach the connecting plate to the difficult femur
That is not possible. [0004] A surgical instrument according to the present invention has been improved.
Eliminate these disadvantages by providing
The purpose of this component is to
Promotes and shortens the time, while the bones
Tighten the folds to keep them perfectly aligned. Furthermore,
Provide enough space for the connecting screw to slide in the axial direction.
While preventing it from protruding from the connecting plate. [0005] Details of the structure of the surgical instrument.
Before going into the detailed description, the following directions
Use for femurs, tools, connecting plates, and screws during surgery.
Please note that it is used. In any part
The expressions "top" and "upper part" in the femur
Indicates the top of the "bottom" or "bottom"
Indicates the direction toward the knee joint. "Inside" or
The term “inner part” refers to the part near or outside the bone.
Shows the part facing the direction of
Or the "outer part" is outside the person being operated on, or
The part facing away from the bone is shown. [0006] The fractured neck of the femur is connected to the femoral shaft.
And an improved surgical instrument for securing
It has components that remain in the body after surgery. this
The component comprises (1) a connecting plate,
The connecting plate allows insertion through a small incision in the skin.
Equipped with a straight lower part with a sharpened end to enable
Substantially rectangular cross section and final position along the femur
Pushed through soft tissue into place. Its connecting plate
Upper end is short and outward to fit bone contour
Bendable. The connecting plate is connected to the holding tool
Screw holes and at least one to help connect the plates
And a straight hole. Upper part of straight section
The minute part is penetrated by two screw holes
The lower part is penetrated by two or more straight countersinks
And all of them are drills to pre-drill holes in bones
Guide plate and securely attach the connecting plate to the femoral shaft
Used to insert screws to connect fractures.
It is. The component further comprises (2) two long screws
This long screw connects the fracture part to the connecting plate
And a relatively short sleeve in the longitudinal and
Has an outer end that is reliably movably guided in the rotating direction
You. Extends through the superior hole through the neck of the femur and
Threaded to the sleeve, and the outer end of the sleeve is
The two upper holes of the seat are securely held and
While maintaining the position in the
enable. The outer ends of the screws are recessed, each with a screw
Coaxial recess of hexagonal or other polygonal section following hole
Parts. The inner edge of the sleeve is slightly bent
The screw comes in contact with the screw
To prevent them from falling out of the box. The components are (3) linked
Attach the lower part of the plate to the femoral shaft and pan the head
It further comprises two or more short screws to hide in the holes. Improved
Surgical instruments are (B) inserted and fixed with permanent components.
It is further equipped with an auxiliary device for
(1) Shortening for connecting to the upper end of the connecting plate
Extends parallel to the direction of the horizontal part and the connecting plate
And an angular connecting arm including an elongated vertical portion. Hanging
The straight part is made up of two oblique holes and a more straight hole.
A coaxial and larger diameter guide tube
Allow passage and fixing of the Square connection arm is preferred
Or setting screw for placing the guide tube and below
Means for attaching the sighting device at one end.
I can. The short horizontal part penetrates in the longitudinal direction and the long screw
And screw holes and straight holes at the upper end of the connection plate
At least one protruding pin to Supplement
Auxiliary equipment is connected according to (2) the oblique hole of the connection plate
Two long enough to extend through the hole in the arm
Further comprising a composite guide tube. These broke
Depending on the diameter of the screw to be inserted into the neck and screwed
Outer tube with corresponding inner diameter and two inner movable tubes
And thus the diameter of the guide wire to be pushed into the bone
First tube concentrically drilled in the tube and two long screws
Drill diameter suitable for drilling holes for receiving
Includes a second tube concentrically perforated. Auxiliary equipment
(3) Securely attach the connecting plate to the femoral shaft
Pre-drill the bone before finally inserting the screws for
Connecting holes until the corresponding holes in the connecting plate
Two or more shorter guide channels for insertion into straight holes in the
And a tube. Auxiliary equipment is (4) connected play
Insert long screws and sleeves into
Equipped with a special screwdriver suitable for fixing. [0007] In the auxiliary device, the connecting plate is secured to the femoral shaft.
It is actually connected, the fracture part is connected and the long screw properly
After being tightened, it is removed from the body, and then the wound is
Close with a bandage. Surgery is described in US Pat. No. 4,465,065.
As described above in conjunction with the disclosed surgical instrument
In the surgical instrument according to the present invention, a long screw
Has a screw end that is securely connected to the hole in the connection plate.
Active movement and axial movement in each sleeve
And passive movement are both possible. With this feature
Surgeons can actively tighten fractures
The screw head gradually protrudes into the soft tissue,
To prevent irritation or damage. In addition,
Improved assistive devices according to the literature only make surgery easier
And take less time for patients and surgeons
There are great benefits for both. Method and procedure for surgery on a fractured neck of a femur
Figure showing the components of the various permanent and auxiliary instruments
Describe in detail with reference to. [0010] The second auxiliary surgical instrument is inserted percutaneously.
And hold the connecting plate in place while simultaneously
It becomes a holding tool that presses the connecting plate against the surface
The first foot, which helps to grasp the far side of the bone
One end of the hook is a long straight line
It has the shape of a screw bar, and then extends outside the limb.
On the other hand, the back of the hook is thin and sharp
Edge, and then slide along the straight bar
It is a movable tube and the outside of the grip shape
Bone with one end of the hook-shaped member terminating at the end
Helps to grip the connection plate located on the near side
The second hook-shaped member and the outer end of the screw bar are releasably attached.
Straight handle that can be attached and wing nut that can be moved with a screw bar
And further comprising: In the first embodiment, the hook-shaped member is adapted to the bone.
With a facing toothed surface, while in other embodiments
These surfaces will safely surround the connecting plate.
It is shaped like. [0012] In another embodiment, the second member is a tube.
With teeth that can be pivotally attached to a protrusion that extends sideways
Includes hook, so toothed hook is angled to bone
Can be engaged with a connection plate that is arranged
It becomes possible. In a third embodiment, the inside of the hook is a tooth
And the shape of the connecting plate to be fastened
You. Surgical instruments are small incisions in the skin or tissue
Through the limb, pushed by the limb, and
The hook is on the far side and the hook of the second member is on the near side
Until the two hooks are placed on one side of the bone
While cutting soft tissues and muscles,
Lined up. Here, the first member is gradually rotated at a right angle, and
Make sharp, sharp edges until the hook grips the posterior side of the bone.
Push through meat and tissue. Then, similarly, the teeth of the second member
The second member is rotated until it faces the connection plate. Linking
Press the plate against the bone and the connecting plate
Rotate the wing nut until the second member
To the connecting plate. Hole in the connecting plate
Through the bone material and through the connecting plate and the bone
After tightening the screws, remove the surgical instrument in the reverse order.
It can close the wound and wrap a bandage. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A connecting plate I shown in FIGS.
The main part 1 below the straight line and the main part to fit the outline of the bone
1 and a head portion 2 bent outwardly. H
The door part 2 is connected to the connecting part as described in more detail below.
One larger screw to connect to the horizontal part of the arm
It includes a hole 3 and two smaller holes 4. Head part 2
Next, the two screw holes 5 facing in the oblique direction are about 130 °.
Through the main part 1 at an angle of
Is thickened by two protrusions 6 and thus the screw
The length of the hole 5 is longer. Below the two screw holes
And three countersinks 7 at right angles to the main part 1
Opened through one. The lower end of the main part 1 is leather
When inserting the main part 1 through a small incision in the skin
Penetrate soft tissues and muscles near the diaphysis
At the same time (reference number 8). FIGS. 3 to 7 show one of the two long screws II.
And its sleeve III. This long screw
II is provided on a relatively long shaft 10 and a wood screw
An inner end with a thread 11 similar to that of
Concave as 12 and follows a smaller diameter screw hole 13
And an outer end. The outer end of long screw II is slidable
And firmly inserted into the inner hole of the sleeve 14, this
Reeve 14 has an outer end with outer threads 15;
12 and FIG. 13 and FIG.
Two or four slots 16 to engage with different drivers
Is provided. Assembled long screw II and sleeve III
Is shown in FIG. 7 in a side partial sectional view. Sleeve I
The inner end of II is bent inward (reference number 1).
8) and therefore contact with the step 17 of the screw shaft 10
And the screw slides out of the sleeve III
Prevent it from getting lost. Connecting plate I with three countersinks 7
Three screws to connect the to the femoral shaft
Because it is a normal type and size used in
Not. FIGS. 8, 9, 10 and 11 show long cables.
Insert the II and tighten it.
Figure 2 shows an aid for pressing the minute. Main vessel
The tool is an L-shaped connecting arm IV, and this connecting arm IV
Horizontal part 20 and vertical firmly connected to each other at right angles
And a portion 21. The horizontal section 20 has two pins at its inner end.
(Not shown), and these pins are connected to the connecting plate I
Of the connecting plate I with the vertical portion 21
And make them exactly parallel. Connection screw 22 in horizontal part 20
Extending through the central hole and connecting plate by grip 23
I connect the connecting arm IV to the connecting plate
Connect to I. At the same time, the two pins enter hole 4 and connect
The relative rotational movement of the plate I and the connecting arm IV is prevented. Contact
Since the connecting screw 22 is hollow, it is forcibly inserted into the bone and
Both connecting plate I and connecting arm IV for femur
Long end with grip 25 for accurate positioning
A sharp bar 24 can be passed through. The vertical part 21 is large
It includes two holes 26 that are oriented diagonally
The hole 26 is coaxially aligned with the screw hole 5 of the connecting plate I.
And have a larger diameter. Above the two holes 26
On the other hand, three smaller holes 27
Through the vertical part 21 at the corner and the countersink of the connecting plate I
7 and open coaxially. Setting screw 28
Penetrates the sides of the holes 26 and 27 and
Helps to hold the pad in place. Connecting arm IV
An additional feature is a lateral extension through the lower end of the vertical part 21
Hole 29, which is formed by a set screw 28 '.
Suitable for holding a rod-shaped aiming device
are doing. FIG. 15 shows the aiming device in place and the connection
X-ray devices placed above and below the fracture to be performed
ing. FIG. 8 shows the hand made by the aiming device.
The first stage of the operation is shown. From small incision to thigh
Insert connecting plate I, and X-ray device and sight
After sliding to the appropriate position as seen by the tool, guide
Once the wire 30 finds the correct position for the neck
The guide wire 30 has an inner tubular shape.
Femoral shaft bone material through guide 32
And into the cervical bone, the inner tubular guide
Reference numeral 32 denotes a connection plate I through the hole 26 of the connection arm IV.
Is arranged in the outer tube 31 extending to the screw hole 5 of
You. The inner tubular guide 32 is screwed into the hole 5 of the connecting plate I.
When retracted, guide wire 30 is centered
Can be detached from the connecting plate I
prevent. If not correctly positioned, guide wire 30
And the connecting plate I is moved by the connecting arm IV.
The guide wire 30 is inserted into the bone again.
Is entered. Do you know that the position is accurate by X-ray scanning?
The sharp bar 24 is forced into the bone.
And finally fix the position of the bone and the connecting plate I,
At this time, the guide wire 30 and the inner tubular guide 32 are removed.
Removed. These are the second insides with wider internal holes
Replaced with a tubular guide, insert the drill there, mechanical
To make a hole in the femoral shaft and neck, followed by a long screw
Insert one of the IIs into the hole. FIG. 12, FIG. 13 and FIG.
Special driver V has three concentrically arranged
Shafts, these shafts
It is possible to move independently in both directions of rotation. These
The shaft has (1) a screw hole 13 at the rear end of the long screw II.
Engaged and rotated by the grip on the driver's outer end.
Innermost shell with a threaded end 41 suitable for turning
Shaft 2 and the hexagonal recess 12 of the long screw II.
Inner tubular shaft with hexagonal ends 44 for mating
43 and the inner tubular shaft 43
A disk 46 that can be securely attached to the shaft 43
Pre-drilled holes with cylindrical grip 45
Turned to screw long screw II into the bone material
(3) Engage with the slot 16 of the screw sleeve III.
Outermost with inner edge of cross-shaped edge 48 for
Tubular shaft 47, and this tubular shaft 47 is cylindrical
Sleeve II to connecting plate I by grip 49
(4) Movable inner tubular chassis that is rotated to twist
The outer three movable in the rotation direction and the longitudinal direction by the shaft 43
And an outer sleeve 56 which is an inner tubular chassis.
A pin 5 which serves to limit the longitudinal movement of the shaft 43
9 with a peripheral recess 58 engaging the second peripheral recess.
Provided at the other end of the sleeve 56 to engage with the stopping member 57
I do. The components can be moved axially with respect to each other.
And a normal position by the helical spring 50.
And simultaneously move the tubular shaft 43 further in the axial direction.
Can be removed by pulling out the stop member 57
It becomes. The final stage of surgery for these special uses
This will be further described in connection with. Connect the broken femoral head to the femoral shaft
The final stage of the surgical procedure is shown in FIG.
After being pierced through the inner tubular guide 32 is removed
Is done. Here, the two screw-sleeve assemblies are screwed
-Insert one at a time and tighten as follows. Long
Screw II is pulled back into sleeve III to the outer end,
The hexagonal end 44 of the driver V has a corresponding shape of the screw end
It is pushed by the concave part 12 of a shape. Rotate the grip 42 and vine
Pressing the grip 42 against the urging force of the winding spring 51
And the innermost shaft 40 of the driver V
The screw end 41 is screwed into the screw hole 13 of the long screw II,
At the same time, the projecting edge 48 of the outermost tubular shaft 47 is
The end of the sleeve III is slotted by the
Pressed to the target 16. Screw end 41 into screw hole 13
Further tightening will cause the screw-sleeve assembly to
Connects to Iver V and is securely attached. here
The screw-sleeve assembly is screwed by the driver V to the outer tube.
The sleeve III
The sleeve III is rotated as long as the
The hole 5 of the connecting plate I is
Screwed into. By pulling out the stopping member 57,
Connected to the inner tubular shaft 43 by a collar 46
The grip 45 is moved inward, and
To push the inner tubular shaft 43 inward. Grip 45
By rotating inward and pushing the long screw II
Broken femoral head moved along sleeve III
Pre-drilled hole in bone material, pressed towards the part
To the depth required for viewing by X-ray equipment
Immediately or the step 17 of the long screw II is
Stop rotation whenever it reaches the bent end 18 of 3
Stop. The pin 60 engaging with the peripheral groove 61 is
2 is moved outwardly and at the same time by the helical spring 51
Limit the distance pushed into it. In addition, they are broken
During the operation, the pressing pin 60 is connected to the grip 4 via the grip 42.
5 to the innermost shaft 40. Big
Pull the fractured femoral head towards the femoral shaft to remove the fracture
The retraction device VI is inserted into the corresponding hole 53 to press it.
To the grip 45 and the grip 49 by the pin 52
It is attached. By rotating the handle 54
The screw 55 is connected to the grip 49, the grip 45 and the
Pull the grip 42 away from the
Screw the attached long screw II to the connection plate I
To sleeve III which is screwed and attached
pull. After inserting the 1st long screw and fixing it,
The bar 24 has been removed and the second long screw has been removed
Is inserted into After inserting both long screws, the connecting plate
I put two or three short screws on the femoral shaft
And attach it. For this purpose, connect a short tubular guide
And into the tissue through one of the holes 27 in the
Attach by 28. Then drill holes using conventional methods
Screw 33, and insert the screw 33 head into the countersink hole 7.
So that the head does not protrude from the connection plate I.
To do. Fix all screws, remove screws 22
Remove the connecting arm IV from the connecting plate I to the outside of the body
After that, close the incision in the skin and bandage the wound. FIG. 16, FIG. 17, FIG. 18 and FIG.
A simplified version of the connecting plate shown in FIGS.
An example is shown. The difference from the first embodiment is that
Shaved head part 2, two small holes 4, two
The protrusion 6 is eliminated, and other components
Are the same in both embodiments, and are given the same reference numbers.
is there. The connecting plate here has a thicker upper part
While the lower part is almost the same as shown in FIG.
Thickness. Thick top instead of bent head
The lower side is cut into a slope 102 corresponding to the shape of the femur.
Has been removed. The protrusion 6 seen in FIG.
It is necessary to secure enough length, but here the connection
Due to the larger thickness of the plate, the material
Is enough for. The two holes 4 in FIG.
Connected to connecting arm IV by two engaging pins
It is necessary for The connection here is the curved end 1 of the arm
20 is engaged with the rounded top surface of the connecting plate.
(See Figure 18), so the two are firmly
Retained and aligned straight. A second embodiment of the driver V is shown in FIG.
Hand to release grip 49 and grip 45
The step is a cup-shaped spacer 62. Spacer 62
An inner thread cooperating with an outer thread of the lip 49 is provided. Space
Rotate the spacer 62 to move the spacer 62
The grip 42 via the pin 60.
Move the screw II backward so that the long screw II
To the sleeve by screw end 41 engaging with screw hole 13
Pull backwards, thus tightening the fracture. FIG. 15 is an additional feature of the present invention.
Figure 2 shows the shape and use of the device. This aiming device
Place the screw inserted into the fractured bone in the optimal final position
Used in the early stages of surgery. This is a connection
To the fracture 21 from the outside of the thigh
Adjusted to Femoral neck by X-ray devices 73 and 74
By looking at the position of the aiming device relative to the
Rate I and the position of assistive devices are adjusted and the most appropriate position
To be placed. The aiming instrument has an aiming rod 70
And the aiming rod 70 is made at right angles by the fastening means 72.
It is connected to the end of the connection bar 71. Connection bar 71 is connected
The arm 21 is held at a predetermined position in a horizontally elongated hole 29 at the bottom end.
And set it in the oblong hole 29 with the setting screw 28 '.
Attached. After adjusting the connecting plate I, the aiming device
Is removed. As is known, all further steps of the surgery
The floor is similarly controlled by X-ray observation. The fastening device shown in FIGS. 23 and 24
Are a first hook-shaped member A, a second hook-shaped member B, and a butterfly.
It includes a nut C and a straight handle D. First hook-shaped part
Material A is a rounded hook 1 having a toothed inner surface 111
10 and one end of the hook 110 is connected
And has the shape of a straight screw bar 113.
The screw bar 113 can be moved out of the limb towards the surgeon during surgery.
Extend to the side. The back or outer surface 114 of the hook 110
Narrowed, forming sharp chisels or knife blades,
Carve out its own path through muscles and tissues. The second hook-shaped member B moves on the screw bar 113.
The screw bar 1 comprises a sliding tube 124 and
13 and is slidable along
Open toward the hook 110 of one hook-shaped member A
Hook 121 and opposite tooth 12 of the first hook
2 having sides. The other end of the tube 124 is
A lip 123 is formed, which allows the connection
The placement and adjustment of rate I instruments is possible. 3rd configuration required
The raw wing nut C is a female screw that cooperates with the screw of the screw bar 113.
Central hub pierced by the dice 131 and two opposing
Wing 132. Handle D is secure
Provided with appropriate grooves (141) to provide
It is a straight bar 140 whose center is penetrated by a screw hole 142.
And the screw hole 142 cooperates with the screw bar 113
I do. The device shown in FIG.
Pivotable by a pin 126 on a projection 125 at the distal end of the
Except for the hook of the second hook-shaped member attached to Noh
23, and is substantially the same as that shown in FIG. Remaining
All parts are identical to the device of FIG. The device of FIG. 26 is that of FIGS. 23 and 24.
Substantially the same as the above, but with teeth on the inside of the hook
And has a connection plate shape that is fastened to the bone.
You. As explained above, the device is
Pass through a small incision in the skin until it is parallel
Carving out its own path through tissues and muscles,
Pushed to limbs. Here, the first hook-shaped member is the one shown in FIG.
And as can be seen from FIG. 28, it is the posterior side of the bone
Rotated almost at right angle by handle D until gripping
I have. Here, the other hook faces the connecting plate E
Until the connecting plate E is a bone
Connected play with wing nut C until firmly fastened
Toward E, secure drilling and screw insertion
Will be possible. Some of the steps described above for percutaneous surgery
Floors disclosed in Applicant's U.S. Pat. No. 4,465,065
Similar to what has been done, but most of the devices of the present invention
Repeated that the components of have been changed and changed
And mention it. Disclosed in the applicant's first patent application
Improvements to surgical instruments protrude from bone and soft tissue
Do not allow sliding movement in the axial direction.
Then, fix the long screw of the sleeve and use a special tool
Insert the long screw quickly, and after inserting the long screw,
By actively tightening the fracture using a river
there were. Furthermore, by changing the connection plate,
The stability of the connection between the
Temporary connecting plate on femur with pointed bar 24
Very precise pre-drilling of the bone by mechanical fixation
It will be sure that Only one screw is inserted into the fractured bone
In the case, one of the oblique holes 5 of the connecting plate and the connecting arm
Only one of the holes 26 is used or
Only one oblique hole is provided in both the arm and the connecting arm
Can be In the latter case, a somewhat larger diameter
Bolts are correspondingly large sleeves of instrument components
Used with and large holes. The different components, both permanent and auxiliary,
Appearance and shape may seem necessary with conventional instruments
By excluding changing tools and equipment to the surgeon
To perform the manual work in the shortest and most convenient time for
It is made in. However, these are
Fractures to the extent that helps to perform the stage, that is, for the patient
Connect and tighten while maintaining percutaneous surgical techniques
Can be changed and changed to the extent that it helps
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a partial side sectional view of a connecting plate. FIG. 2 is a plan view of the connection plate shown in FIG. 1; FIG. 3 is a side view of a long screw. FIG. 4 is a cross-sectional view passing through an outer end of the long screw shown in FIG. 3; FIG. 5 is an end view of the long screw shown in FIG. 3; FIG. 6 is a longitudinal sectional view of a sleeve covering an outer end portion of a long screw. 7A is a side cross-sectional view of a long screw arranged on a sleeve of FIG. 6, and FIG. 7B is a side view of a long screw II and a sleeve II.
It is a partial expanded sectional view of I. FIG. 8 is a cross-sectional view of a connection plate, a connection arm, and an auxiliary device at an early stage of a surgery. FIG. 9 is an end view of the connecting arm taken along line 9-9 in FIG. 8; FIG. 10 is a cross-sectional view of the connection plate, the connection arm, and the driver with one long screw and sleeve in a predetermined position and a second long screw in the middle of the final position in a state further advanced in the operation; It is. FIG. 11 is a longitudinal sectional view of a second movable tube and a drill inserted into a main sleeve. FIG. 12 is a longitudinal sectional view of a driver used to insert a long screw and a sleeve. FIG. 13 is an enlarged sectional view of a left-hand end of the driver of FIG. 11; FIG. 14 is an end view of the driver of FIG. 11; FIG. 15 is a diagram showing a stage of an operation using a rod-shaped aiming device. FIG. 16 is a partial side sectional view of a second embodiment of the connecting plate. FIG. 17 is a plan view of the connection plate of FIG. 13; FIG. 18 is a sectional view taken along lines 15a-15a of FIG. 17; 19 is a sectional view taken along line 16-16 of FIG. 8, showing the connection of the connecting plate of FIG. 16 to the connecting arm. FIG. 20 is a longitudinal sectional view of another embodiment of the driver shown in FIG. 12; FIG. 21 is an enlarged sectional view of a left end portion of the driver in FIG. 20; FIG. 22 is an end view of the driver of FIG. 20; FIG. 23 shows a preferred embodiment of the connection fastening tool in a fully assembled state. FIG. 24 shows different components of the coupling fastening tool of FIG. 23 in an exploded state. 25 shows the coupling and fastening tool of FIG. 23 with the addition of a hook of a second hook member pivotally attached to this member. FIG. 26 shows a slightly modified embodiment of the device of FIG. 1; FIG. 27 shows an instrument for fastening a connection plate to the neck of a broken femur. FIG. 28 shows an instrument for fastening a connecting plate to two parts of a broken bone. [Description of Signs] I ... Connecting plate II ... Long screw III ... Sleeve IV ... Connecting arm V ... Driver A ... First hook-shaped member B ... Second hook-shaped member C ... Wing nut D ... Handle E ... Connecting plate 1 ... Main part 2 Head part 3 Screw hole 4 Hole 5 Screw hole 6 Projection part 7 Countersink hole 10 Shaft 11 Screw 12 Hexagonal part 13 Screw hole 14 Sleeve 15 Outer thread 16 ... Slot 17 ... Step 18 ... Bent end 20 ... Horizontal part 21 ... Vertical part 22 ... Connection screw 23,25 ... Grip 24 ... Bar 26,27 ... Hole 28,28 '... Setting screw 29 ... Long hole 30 ... guide wire 31 ... outer tube 32 ... inner tubular guide 33, 55 ... screw 40 ... innermost shaft 41 ... screw ends 42, 45, 49 ... grip 43 ... inner tubular shaft 44 ... hexagonal end 46 ... empty 47 outermost tubular shaft 48 edge 50, 51 helical spring 53 hole 54 handle 56 outer sleeve 57 stopping member 58 peripheral recess 59, 60 pin 61 peripheral groove 62 spacer 71 Connection bar 70 Aiming rod 72 Fastening means 73, 74 X-ray device 102 Incline 110 Hook 111 Inner surface 113 Screw bar 114 Outer surface 120 Curved end 121 Hook 122 Teeth 123 Grips 124 Tube 125 Projection 126 Pin 131 Female screw 132 Wing 140 Bar 141 Groove 142 Screw hole
──────────────────────────────────────────────────続 き Continued on the front page (58) Field surveyed (Int.Cl. 7 , DB name) A61B 17/56-17/60
Claims: 1. A surgical instrument comprising a component that remains in the body for percutaneously connecting an upper fracture of a patient's femur to a femoral shaft, the surgical instrument comprising: The component comprises a rod-shaped connecting plate (I) which passes through the axis, the medial surface to be placed in the femur, the lateral surface, the head portion and a small incision in the patient's skin. A bottom portion with a sharp end (8) for inserting the connecting plate, and at least two countersink holes (7) in a lower portion thereof, and an upper portion of about 130 °. The head part (2) is provided with a screw hole (3) perpendicular to the axis of the connecting plate (I), comprising two adjacent oblique screw holes (5) directed upward at an angle; The above component has two long screws (II), each long screw is straight A shaft (10), a wood-screwed inner end (11) inserted into the upper fracture of the femur, and an outer end with a coaxial polygonal recess (12); The recess (12) is followed by a screw hole (13) concentric with the axis of the linear shaft (10), and the component comprises a sleeve (III) shorter than the length of the long screw;
The outer end of each long screw is movably disposed in the sleeve in both the axial direction and the rotational direction of the sleeve, and the sleeve has a screw thread (5) corresponding to the screw thread of the oblique screw hole (5) of the connecting plate. 15) and at least two recesses (16) for engaging with a driver, said component extending through said countersink (7) and into the bone of the femoral shaft to form a connecting plate (I). Surgical instrument comprising at least two short screws (33) for attaching the to the femoral shaft. 2. The connecting plate according to claim 1, wherein the outer portion of the connecting plate surrounding the oblique screw hole is thickened in the form of two oblique projections projecting from the surface of the connecting plate. Surgical instruments. 3. The head part (2) of the connecting plate (I) is bent outwardly to conform to the contour of the femur and is defined by the screw hole (3) and at least one sliding hole (4). 2. The through-hole according to claim 1, wherein both holes are perpendicular to the axis of the connecting plate.
A surgical instrument according to claim 1. 4. The surgical instrument according to claim 1, wherein the inner surface of the head portion of the connecting plate is inclined outwardly (102) according to the femoral contour. 5. The surgical instrument according to claim 1, wherein an outer surface of a head portion of the connection plate is convex. 6. Each of the long screws (II) has a peripheral step (17), and the inner end (18) of each sleeve is bent inward, the bent inner end and the peripheral step. The surgical instrument according to claim 1, wherein the long screw (II) is prevented from sliding due to the contact with the surgical instrument. 7. An auxiliary tool for inserting and connecting the surgical instrument according to claim 1 to an upper fracture portion of a femur, comprising: a short horizontal portion (20) connected to a head portion of a connecting plate. ) And a rectangular connecting arm (IV) having a longer vertical part (21) extending parallel to the lower part of the connecting plate, said horizontal part being provided with screw holes (3) in the head part of the connecting plate. ) And the screw (2
2) having an axial penetration for the passage, the shape of which is adapted to the shape of the head part to ensure an absolute parallel state of the connecting plate and the vertical part; Two adjacent obliquely oriented oblique holes (26) whose parts are coaxially aligned with the two oblique screw holes (5) of the connecting plate, and at least two through countersunk holes (7) of the connecting plate. And at least two straight holes (27) coaxially aligned, the outer diameter of which is an outer diameter cooperating with the oblique hole of the connecting arm and the inner diameter of which is outside the sleeve (III) covering the long screw. A first tubular guide (31) having an inner diameter corresponding to the diameter and having a length adapted to a distance between the corresponding oblique hole of the connecting plate and the oblique hole of the connecting arm; Inserted into the guide (31),
A first movable tube (32) having an inner diameter corresponding to the outer diameter of the guide wire (30) to be pushed into the upper fracture portion of the femur, and inserted into the first tubular guide (31), A second movable tube having a bore with an inner diameter corresponding to the diameter of the drill for pre-drilling, a guide wire (30) to be pushed through a hole in the first movable tube (32), and a second movable tube A drill to be inserted into the bone through a hole in the connecting arm and into the straight hole (27) of the connecting arm, the length of which is adapted to the distance to the connecting plate (I) and the inner diameter of which is a short screw (33) It further comprises a second tubular guide having an inner diameter suitable for the passage, and a screwdriver (V) for inserting and fixing a long screw, the screwdriver being a screw at the outer end of each long screw. The inner screw end (41) which engages the hole (13) Inner shaft with the (4
0), a tubular intermediate shaft (43) with a polygonal inner end (44) for engaging the polygonal recess (12) of each long screw, and a sleeve recess (16) covering the long screw. )
And a tubular outer shaft (47) having an inner end with protruding teeth (48) for engaging with the grips (4) attached to its outer end.
2, 45, 49), which are independently movable in the axial and rotational directions, and helical springs (50, 51) for adjusting the axial alignment of their respective shafts.
Auxiliary equipment provided with. 8. The surgical instrument according to claim 7, wherein the vertical portion of the connecting arm comprises a setting screw (28) that serves to hold the tubular guide. 9. Surgical instrument according to claim 7, wherein the inner end (120) of the horizontal part of the connecting arm is curved corresponding to the convex surface of the head part of the connecting plate. 10. Surgical procedure according to claim 7, wherein the lower end of the vertical part of the connecting arm comprises means (28 ', 29) for holding a rod-shaped aiming device (70, 71, 72). Appliances. 11. The aiming device comprises an aiming rod (70) connected at right angles to a connecting bar (71), said connecting bar being provided by means capable of adjusting the angular orientation of the aiming rod. The surgical instrument according to claim 10, adapted to be attached to a lower end of a vertical portion of a connecting arm. 12. The surgical instrument of claim 7, wherein the driver includes means to help pull the threaded end of the inner shaft toward the outer shaft and pull the long screw outwardly with respect to the sleeve. . 13. An outer sleeve (56), wherein said driver is held in place by a removable pin (57), said outer sleeve being movable along a peripheral recess (58) outside said outer sleeve. The surgical instrument according to claim 7, wherein the outer shaft is engaged with the outer shaft by a pin (59). 14. A screw (22) extending through the horizontal part of the connecting arm has a grip (23) at its outer end, and a pointed bar (24) for accurately fixing the connecting arm. The surgical instrument of claim 7, wherein the surgical instrument is centrally pierced so as to be pushed into the bone. 15. A surgical instrument comprising components remaining in the body for percutaneously connecting an upper fracture portion of a femur to a femoral shaft, said components comprising a rod-shaped connecting plate (I). A bottom having an inner surface, an outer surface, a head portion, and a pointed end (8) for inserting the connecting plate through a small incision in the skin, comprising: And at least two through countersinks (7) in its lower part and a larger diameter oblique threaded hole (5) in its upper part oriented upward at an angle of about 130 °. On the other hand, the head portion is provided with a screw hole (3) perpendicular to the axis of the connecting plate, and the component further comprises a long screw (II), wherein the long screw is a straight shaft (10); Wood screw-like inside inserted into upper fracture Includes a section (11) and an outer end with a recess (12) of the polygon on the coaxial line, the recess (1
Subsequent to 2), a screw hole (13) is provided concentrically with the axis of the linear shaft (10), and the outer end of the long screw (II) is inserted into the sleeve (III) shorter than the length of the long screw. A thread (15) movably arranged in both the direction and the rotational direction, the outer end of the sleeve corresponding to the thread of the oblique thread of the connecting plate, and at least two recesses (16) for engaging the driver. Wherein said component further attaches the connecting plate (I) to the femoral shaft,
A surgical instrument comprising at least two short screws (33) extending through said countersink (7) to the femoral shaft bone. 16. An additional surgical instrument for holding a connecting plate according to claim 15 in place on a femoral shaft while pressing against a surface of a bone, said connecting plate (I).
Chisel shaped to grip the side of the bone opposite to the one end, and one end of which is integrally provided on a straight bar extending to the outside of the limb and whose back is narrowed to cut through tissue and muscle Alternatively, a first member having a hook forming a knife blade, and a gripping connection plate (I), one end of which extends to the outside of the limb and is aligned and slid on a straight bar of the first member. A second member having a hook integrally provided with the tube, and a second member provided at the outer end of the straight bar of the first member and moving the hook of the first member through tissue and muscle to a predetermined position around the bone. And handle means provided at the outer end of the tube of the second member and adapted to move and rotate the hook of the second member to a predetermined position on the connecting plate (I). , First Connection plate toward and bone move the tubes of the second member along a linear bar Material (I)
Means for advancing the hook of the second member to hold the connecting plate (I) in the correct position of the fracture. 17. The additional surgical instrument according to claim 16, wherein the hooks of both the first member and the second member have teeth on a surface facing each of the bone and the connection plate. 18. The additional surgical instrument according to claim 16, wherein the hook of the first member has a toothed surface for gripping bone, and the hook of the second member has a shape adapted to the shape of the connecting plate. . 19. The additional surgical instrument according to claim 16, wherein the hooks of both the first member and the second member have a smooth surface for grasping each of the bone and the connecting plate. 20. The additional surgical instrument of claim 16, wherein the second member has a hook pivotally mounted on a protrusion extending laterally from an inner end of the tube of the second member. 21. A wing nut, wherein the straight bar of the first member is threaded, the wing nut being rotated on the straight bar to advance the hook of the second member to the connecting plate. 17. The additional surgical instrument of claim 16, wherein a wing nut is mounted proximate the outer end of the tube of the second member. 22. A handle, wherein the means for moving and rotating the hook of the first member into position about the bone comprises a central female threaded hole for attaching the handle to an outer end of a thread of the straight bar. 3. The shape of claim 2.
2. The additional surgical instrument according to 1. 23. The means for moving and rotating the hook of the first member into position around the bone is in the form of a handle attached to the square end of the straight bar by a square hole. Item 17. The additional surgical instrument according to Item 16. 24. The surgical instrument according to claim 16, wherein the means for moving and rotating the second member is in the form of a handle securely attached to the outer end of the tube of the second member. .
JP23904994A 1993-03-28 1994-10-03 Surgical instruments for percutaneous connection Expired - Lifetime JP3532622B2 (en)
IL109929A IL109929A (en) 1994-06-08 1994-06-08 Surgical instrument for use during connection of a fractured bone
DE1994616020 DE69416020D1 (en) 1993-03-28 1994-03-24 A surgical device for the connection of bone fractures
EP19940302143 EP0617927B1 (en) 1993-03-28 1994-03-24 Surgical device for connection of fractured bones
US08/371,300 US5690640A (en) 1994-06-08 1995-01-11 Surgical instrument for use during connection of fractured bones
ES95630054T ES2160684T3 (en) 1994-06-08 1995-06-01 surgical instrument for use during the connection of fractured bones.
DE69521842T DE69521842T2 (en) 1994-06-08 1995-06-01 A surgical instrument for use in joining a broken bone
DE69521842A DE69521842D1 (en) 1994-06-08 1995-06-01 A surgical instrument for use in joining a broken bone
EP95630054A EP0686375B1 (en) 1994-06-08 1995-06-01 Surgical instrument for use during connection of a fractured bone
JPH08112290A JPH08112290A (en) 1996-05-07
JP3532622B2 true JP3532622B2 (en) 2004-05-31
ID=27271597
JP23904994A Expired - Lifetime JP3532622B2 (en) 1993-03-28 1994-10-03 Surgical instruments for percutaneous connection
JP (1) JP3532622B2 (en)
CA2413982C (en) * 2000-05-31 2009-09-29 Vese, Silvana Device for fixing a bone plate
JP5129816B2 (en) * 2006-07-31 2013-01-30 ティー．エー．ジー． メディカル デヴァイシス−アグリカルチャー コーポラティヴ リミテッド Arthroscopic bone grafting and medical devices useful for it
1994-10-03 JP JP23904994A patent/JP3532622B2/en not_active Expired - Lifetime
JPH08112290A (en) 1996-05-07
EP1058520B1 (en) 2003-12-03 Bone fixation device introducer
JP3573461B2 (en) 2004-10-06 Modular intramedullary nail inserted into cannula
2006-03-06 S111 Request for change of ownership or part of ownership
2006-03-06 S631 Written request for registration of reclamation of domicile
2006-03-14 R350 Written notification of registration of transfer