CN103800067B - Intertrochanteric fracture wire introducer - Google Patents

Abstract

A wire guide for intertrochanteric fractures, the handle is provided with a first hole for the insertion of the main guide tube and a second hole for the insertion of the auxiliary guide tube, the proximal ends of the main guide tube and the auxiliary guide tube are respectively inserted into the handle , the distal end of the main guide tube is hook-shaped to hook the lesser trochanter fracture fragment, and the distal end of the main guide tube is connected to the distal end of the auxiliary guide tube to form a bending channel for the guide wire to bypass the inner side of the intertrochanteric fracture site; One side of the guide tube is provided with a hole for the steel wire ejection part to pass through, and the other side is provided with a gap to allow the steel wire to escape; the handle is also connected to a push mechanism, which includes a push rod inserted into the handle, and the end of the push rod The end is provided with a screw rod screwed with the handle; the main guiding tube and the pushing mechanism fix the fracture site together. The invention adopts a combined guide steel wire or titanium cable and a device for temporarily fixing fractures, which has little tissue damage, facilitates fracture healing, realizes minimally invasive operation, is convenient to use, and is easy and reliable to operate.

Description

Wire Guide for Intertrochanteric Fracture

technical field

The invention relates to a steel wire guide for intertrochanteric fracture.

Background technique

Intertrochanteric fracture refers to the fracture between the base of the femoral neck and the lesser trochanter. It is one of the most common fractures in the elderly, especially in the elderly over 70 years old and patients with severe osteoporosis. The fracture is characterized by comminuted fractures. Many fractures, osteoporosis.

Clinically, there are many surgical treatments for intertrochanteric fractures, including various internal fixation operations or artificial joint replacement operations. However, comminuted intertrochanteric fractures require additional fixation of the fracture fragments to avoid internal fixation or artificial joint surgery. Losing the support of the trochanter bone leads to failure. Technically, screws, steel wires, titanium cables and other methods can be used, but the fixation effect of steel wire or titanium cable binding is the most reliable.

The steel wire or titanium cable needs to go around the circumference of the intertrochanteric fracture before it can be bound. The existing technology is to rely on surgical forceps to guide or use guide wire hooks to achieve this purpose under blind vision. If the muscles and joint capsule tissue are attached, the muscle and joint capsule tissue need to be peeled off, and the steel wire should be circumvented by the fracture end for cerclage fixation. This requires a large incision to be exposed, the operation is difficult, and the tissue damage is large, and the minimally invasive guide wire cannot be achieved. or titanium cable and temporarily assist the function of fracture fixation,

For example, the orthopedic steel wire guide announced in Patent No. 200620080153.2 can guide the steel wire cerclage to split fracture fragments, but in actual use, the steel wire pull wire is not very convenient, and there is no clamping and fixing structure to assist the operation to ensure better effect of surgery.

Contents of the invention

In order to overcome the disadvantages of inconvenient use and poor effect of the existing steel wire guide for fracture, the present invention provides a steel wire guide for intertrochanteric fracture.

The technical scheme adopted in the present invention is:

A wire guide for femoral intertrochanteric fractures, a handle, a main guide tube and a secondary guide tube, the handle is provided with a first jack for the main guide tube to be inserted and a second jack for the secondary guide tube to be inserted into, the The proximal end of the main guiding tube is connected to the handle, the proximal end of the secondary guiding tube is inserted into the handle, the distal end of the main guiding tube is hook-shaped to hook the lesser trochanter fragment, the distal end of the main guiding tube is The end is connected with the distal end of the auxiliary guide tube to form a bending channel for the guide wire to bypass the inner side of the intertrochanteric fracture site;

The secondary guiding tube is connected to the second jack through the cannula connected thereto, and the length and angle of the connecting handle of the cannula are adapted to the connection between the distal end of the main guiding tube and the distal end of the secondary guiding tube;

One side of the main guide tube is provided with a hole for the steel wire ejector to pass through, and the other side is provided with a gap allowing the steel wire to escape;

The handle is also connected to a push mechanism, the push mechanism includes a push rod inserted into the handle, the tail end of the push rod is provided with a screw threaded with the handle, and the head end of the push rod is provided with a push rod on the rear outer side of the large rotor. A pushing pad on the bone surface; the distal end of the main guiding tube cooperates with the pushing pad to fix the fracture site.

After the steel wire escapes from the secondary guide tube and moves out of the secondary guide tube, the push rod of the pushing mechanism is inserted into the second insertion hole.

The first insertion hole and the second insertion hole of the handle are both along the length direction of the handle, and the main guiding tube and the secondary guiding tube are parallel to each other.

The intubation tube on the auxiliary guide tube is U-shaped, one end of the intubation tube is connected to the second through hole, the other end is communicated with the auxiliary guide tube and a steel wire outlet is provided at the bend.

The screw rod is equipped with a manual knob, the front end of the screw rod of the knob is provided with a protruding post, and the end of the push rod is provided with a slot forming a mortise and tenon structure with the protruding post; the front end of the protruding post is provided with a The annular slot of the protruding column, the push rod is provided with a stopper that can be inserted into the annular slot.

Both sides of the handle are provided with non-slip surfaces.

In order to preserve the intertrochanteric bone mass and maintain the supporting role of the trochanteric bone, it is necessary to bind the comminuted fragments of the intertrochanteric fracture with additional steel wire or titanium cable to increase the fixation strength of the fracture. Through the minimally invasive small incision technique on the outside of the hip joint, the two major fracture fragments of the femoral intertrochanteric fracture—the lesser trochanter fragment and the greater trochanter fracture fragment can be temporarily repaired by using the guide tube and the step-by-step operation of the push rod. Resetting, fixing and guiding metal cable binding, the operation is simple and reliable.

The wire guide for femoral intertrochanteric fractures includes a main guide tube, and the handle has two through holes along its entire length, one of which has a smaller diameter is the first hole connected to the inner channel of the main guide tube, and the first hole The holes are circular in cross-section and are used to guide steel wires or titanium cables through them. Another second jack with a larger diameter is on the opposite side. The second jack has a circular cross-section at the end of the handle and an oval shape at the head of the handle. It is used for inserting the auxiliary guide tube and the push rod. The distal end of the main guiding tube is in the form of a small semicircle, and its diameter is adapted to the width of the bone between the femoral trochanters. Insert it into the second socket at the end of the handle where the main guiding tube is located, and push it to the end just to connect with the tip of the main guiding tube. The guide wire hole on the caudal side of the main guiding tube handle guides the steel wire or titanium cable. There is a gap in the ventral side of the main guiding tube, and a small hole is opened at the caudal end of the main guiding tube. After the steel wire or titanium cable passes through the main guiding tube and After the combined guidance of the auxiliary guide tube is successful, the steel wire or titanium cable is pushed through the small hole with a steel needle and separated from the main guide tube. Remove the secondary guide tube, insert a push rod into the second socket, and add a push pad to the head of the push rod to adapt to the arc of the posterolateral bone surface of the greater trochanter. The push pad is asymmetrically designed and biased towards the greater trochanter Posterior direction. There is a circular knob on the tail side of the push rod. By turning the knob, the push rod advances (there is a rotation-advance conversion structure in the middle of the push rod), and cooperates with the main guide tube to temporarily clamp and reset in the medial and lateral directions, and fix the fracture. Tighten the steel wire or titanium cable to complete the binding of the intertrochanteric fracture.

The beneficial effect of the present invention is reflected in: the present invention adopts combined guide steel wire or titanium cable and the device for temporarily fixing the fracture, and only needs to use a minimally invasive small incision on the outside of the hip joint, and through the cooperation of the guide tube and the push rod, Realize the reduction, temporary fixation and guide metal cable binding of the two major fracture fragments of the intertrochanteric fracture—the lesser trochanter fragment and the posterolateral fragment of the greater trochanter, which can maximize the protection of the integrity of the periosteum and soft tissue around the fracture , less tissue damage, beneficial to fracture healing, and minimally invasive operation; simple structure, convenient use, simple and reliable operation.

Description of drawings

Fig. 1 is a schematic diagram of a main guiding tube and a secondary guiding tube connected to guide metal cables.

Fig. 2 is a cross-sectional view of the main guiding tube and the secondary guiding tube connecting and guiding metal cables.

Fig. 3 is a schematic view of the structure of the auxiliary guide tube when it is removed from the handle.

Figure 4 is a schematic diagram of the connection between the main guiding tube and the push rod.

Fig. 5 is a schematic cross-sectional view of the connection between the main guide tube and the push rod.

Fig. 6 is a schematic diagram of the push rod rotation-propulsion structure (details of the structure circled in Fig. 5).

Fig. 7 is a schematic diagram of the connection between the main wire hook and the push rod.

Figure 8 is an enlarged view of the rear side of the push rod.

Fig. 9 is a schematic diagram of the implementation of the guide wire hook for intertrochanteric fractures (wherein a is the head end of the main guide tube to hook the lesser trochanter fracture fragment, introduce the steel wire or titanium cable through the first through hole port at the tail of the handle, and pass through the secondary guide tube The steel wire exits through; b is the tail end of the second through hole handle is inserted into the push rod, and a push pad is added to the head end of the push rod, and the push rod is rotated and advanced to make the push rod advance, and cooperate with the main guide tube to temporarily reset in the medial and lateral direction and clamp and fix the bone ; c is tightening the steel wire or titanium cable to complete the binding of intertrochanteric fracture; d is the structural entity diagram of removing the main guide tube and push rod to complete the operation).

Detailed ways

With reference to the accompanying drawings, a wire guide for femoral intertrochanteric fractures, a handle 1, a main guide tube 3 and a secondary guide tube 4, the handle 1 is provided with a first socket 11 for the main guide tube 3 to be inserted and a secondary guide tube The second socket 12 where the tube 4 is inserted, the proximal end of the main guiding tube 3 is connected to the handle, the proximal end of the secondary guiding tube 4 is inserted into the handle 1, and the distal end of the main guiding tube 3 is a hook The distal end of the main guide tube 3 is connected to the distal end of the secondary guide tube 4 to form a bending channel for the guide wire 2 to bypass the inner side of the intertrochanteric fracture site;

The secondary guide tube 4 is connected to the second socket 12 through the cannula 41 connected thereto, and the length and angle of the cannula 41 connected to the handle 1 are adapted to the distal end of the main guide tube 3 and the secondary guide tube 4 the remote connection;

One side of the main guide tube 3 is provided with a hole 32 for the steel wire ejector to pass through, and the other side is provided with a gap 31 allowing the steel wire 2 to escape;

The handle 1 is also connected with a push mechanism, the push mechanism includes a push rod 5 inserted into the handle, the tail end of the push rod 5 is provided with a screw 6 screwed with the handle 1, and the head end of the push rod 5 is provided with Pushing the pushing pad 52 on the posterolateral bone surface of the greater trochanter; the distal end of the main guiding tube 3 cooperates with the pushing pad 52 to fix the fracture site.

After the steel wire 2 escapes from the secondary guide tube 4 and moves out of the secondary guide tube 4 , the push rod 5 of the pushing mechanism is inserted into the second insertion hole 12 .

The first insertion hole 11 and the second insertion hole 12 of the handle 1 are along the length direction of the handle 1, and the main guide tube 3 and the secondary guide tube 4 are parallel to each other.

The intubation tube 41 on the auxiliary guide tube 4 is U-shaped, one end of the intubation tube 41 is connected to the second through hole 12 , the other end is in communication with the auxiliary guide tube 4 and a steel wire outlet 411 is provided at the bend.

The screw rod 6 is provided with a manual knob 62, the front end of the screw rod 6 of the knob 62 is provided with a boss 61, and the end of the push rod 5 is provided with a slot 51 forming a mortise and tenon structure with the boss 61; The front end of the boss 61 is provided with an annular slot 611 surrounding the boss 61 , and the push rod 5 is provided with a stop pin 511 that can be inserted into the annular slot 611 to limit the stroke of the knob 62 .

Both sides of the handle 1 are provided with anti-skid surfaces 13 .

The direction expression of the present invention adopts the direction expression of the human body in medicine. Take the midline of the human body as the standard, the "inside" is close to the midline, and the "outside" is far away from the midline. The direction of the ventral side of the body is "front side", and the direction of the back side of the body is "posterior side". The guide tube is close to the midline of the human body as the "cranial side", and it is far away from the midline of the human body as the "caudal side". The side of the guide tube close to the bone surface is called "ventral side", and the side away from the bone surface is called "dorsal side".

In order to preserve the intertrochanteric bone mass and maintain the supporting role of the trochanteric bone, it is necessary to bind the comminuted fragments of the intertrochanteric fracture with additional steel wire or titanium cable to increase the fixation strength of the fracture. During the operation, through a minimally invasive small incision on the outside of the hip joint, a stripper is used to dissect the soft tissue on the front side close to the intertrochanteric bone to form a channel that allows the main guide tube 3 to work, and insert the main guide tube 3 until the head end crosses the inner edge of the femur , turn over the head end of the main guide tube 3 by 90° to hook the lesser trochanter fracture fragment 81. At this time, it can be confirmed under fluoroscopy whether the hooking of the lesser trochanter fracture fragment 81 is successful. After success, insert the secondary guide tube 4 into the second channel of the handle. Hole 12, and pushed to the end to communicate with the main guide tube 3. Lead the steel wire 2 or titanium cable through the first through hole 11 port at the tail of the handle 1, and remove the secondary guide tube 4 after passing through the steel wire outlet 411 of the secondary guide tube 4. One side of the main guide pipe 3 is provided with a hole 32 for the steel wire ejection part to pass through, and the other side has a gap 31 that allows the steel wire 2 to escape, and the steel wire 2 or titanium cable is pushed through the small hole 32 with a steel needle. Out of the main guide tube 3, the steel wire 2 or titanium cable is separated from the main guide tube 3 from the gap 31 for standby. Put the push rod 5 through the second through hole 12, the head end of the push rod 5 is provided with a push pad 52 that pushes the posterolateral bone surface of the greater trochanter 82, and the push pad 52 is in contact with the greater trochanter 82. 82 is an arc surface adapted to the posterolateral bone surface 82 , and the push pad 52 is an asymmetric structure that is biased to the outside, that is, to the posterior direction of the greater trochanter 82 of the femur. Manually rotate the knob 62 to advance the push rod 5, cooperate with the main guide tube 3 from the medial and lateral direction to temporarily reset and clamp and fix the fracture. Finally, the steel wire 2 or titanium cable is tightened to complete the binding of the intertrochanteric fracture, and the main guide tube 3 and push rod 5 are removed to complete the operation.

The content described in the embodiments of this specification is only an enumeration of the implementation forms of the utility model concept. The protection scope of the present invention should not be regarded as limited to the specific forms stated in the embodiments. The protection scope of the present invention also extends to the field Equivalent technical means that the skilled person can think of based on the concept of the present invention.

Claims (6)

1. A wire guide for intertrochanteric fractures, comprising a handle and a main guide tube, the distal end of the main guide tube is a hook-shaped hook to hook the lesser trochanter fracture fragment, it is characterized in that: it also includes a secondary guide tube, the The handle is provided with a first socket for the main guide tube to be inserted and a second socket for the secondary guide tube to be inserted, the proximal end of the main guide tube is connected to the handle, and the proximal end of the secondary guide tube is plugged into the handle , the distal end of the main guide tube is connected to the distal end of the secondary guide tube to form a bending channel for the guide wire to bypass the inner side of the intertrochanteric fracture site; The secondary guiding tube is connected to the second jack through the cannula connected thereto, and the length and angle of the connecting handle of the cannula are adapted to the connection between the distal end of the main guiding tube and the distal end of the secondary guiding tube; One side of the main guide tube is provided with a hole for the steel wire ejector to pass through, and the other side is provided with a gap allowing the steel wire to escape; The handle is also connected to a push mechanism, the push mechanism includes a push rod inserted into the handle, the tail end of the push rod is provided with a screw threaded with the handle, and the head end of the push rod is provided with a push rod on the rear outer side of the large rotor. A pushing pad on the bone surface; the distal end of the main guiding tube cooperates with the pushing pad to fix the fracture site. 2. The wire guide as claimed in claim 1, characterized in that: after the wire escapes from the secondary guiding tube and moves out of the secondary guiding tube, the push rod of the pushing mechanism is inserted into the second insertion hole. 3. The wire guide according to claim 1 or 2, characterized in that: the first jack and the second jack of the handle are all along the length direction of the handle, and the main guide tube and the secondary guide tube are parallel to each other. 4. The wire guide as claimed in claim 3, characterized in that: the insertion tube on the auxiliary guide tube is U-shaped, one end of the insertion tube is connected to the second through hole, and the other end is connected to the auxiliary guide tube Unicom and a steel wire outlet is provided at the bend. 5. The wire guide as claimed in claim 4, characterized in that: said screw rod is provided with a manual knob, the front end of the screw rod of said knob is provided with a boss, and the end of said push rod is provided with a A slot with a mortise and tenon structure; the front end of the protruding post is provided with an annular slot surrounding the protruding post, and the push rod is provided with a stopper that can be inserted into the annular slot. 6 . The wire guide for intertrochanteric fractures according to claim 5 , wherein anti-slip surfaces are provided on both sides of the handle. 7 .