CN105078526B - Device for repairing ligament or tendon defect - Google Patents

Abstract

The invention discloses a device for repairing ligament or tendon defects, which comprises a fastening screw front section and a fastening screw rear section detachably connected with the fastening screw front section, wherein the fastening screw front section is provided with self-tapping external threads capable of being attacked into bones, the outer surface of the fastening screw rear section is provided with external threads continuously butted with the self-tapping external threads of the fastening screw front section, and the outer surface of the fastening screw rear section is made of materials capable of healing with the bones. The invention adopts sectional type, detachable design and pressurized design, so that the front section and the rear section of the fastening screw can realize different functions by different structures, shapes and materials, the complementation of the structural functions of the front section and the rear section of the fastening screw is formed, the physical fixation and the biological healing fixation are combined, the effective fixation strength is continuously kept, the tension of the reconstructed ligament or tendon can be effectively adjusted, the operation precision is improved, the ligament or tendon can freely move and move in the early stage, the operation curative effect is improved, and the difficulty of the reconstruction operation of the ligament or tendon is obviously reduced.

Description

A device for repairing a ligament or tendon defect

technical field

The present invention relates to a device for fastening tendons, ligaments and bones, in particular to a device for repairing tendon or ligament defects.

Background technique

Human tendons are located at the two ends of skeletal muscles and attached to two or more bones. It pulls the contraction of skeletal muscles to drive the movement of different bones. Human ligaments connect bone to bone, mostly located around joints, strengthen and maintain the stability of joints in motion, and limit their activities beyond the physiological range. Tendons and ligaments can realize force transmission and are the key links in various activities of the human body. With the increase of traffic trauma and sports injuries, the incidence of tendon and ligament injuries is increasing. If not treated effectively, it will seriously affect the stability of joints, affect people's daily activities, and even cause disability.

Due to the certain elasticity of ligaments and tendons, fresh simple ligament or tendon ruptures can often be repaired directly. However, for old ligament or tendon injuries, especially with defects, it becomes more difficult to repair and maintain the function of ligaments and tendons. Currently applied repair methods for ligament or tendon loss are far from ideal due to defects in various aspects.

In order to repair the defective ligament or tendon, it is necessary to replace it with an autologous or allogeneic ligament or tendon, so that the replaced ligament or tendon can heal with the bone and restore the corresponding function of the limb. Therefore, the source of the ligament or tendon graft substitute and the success rate of graft and bone healing determine the efficacy.

Ligament or tendon graft substitutes are limited by four factors: ability to heal, strength, source, and safety. Table 1 compares the graft effects of the three ligament or tendon graft substitutes used in clinical practice.

Table 1: Comparison of graft effects of three ligament or tendon graft substitutes

bone healing ability graft strength source safety autologous tendon graft better generally extremely restricted it is good tendon allograft generally poor limited Difference artificial tendon graft Difference it is good unlimited it is good

Graft substitute-bone healing is the core concept of current ligament or tendon repair and reconstruction. If it does not heal, a secondary rupture will occur sooner or later. In terms of healing ability, autologous tendon transplantation has a high ability to heal with bone, and is the first choice for clinical treatment. However, autologous tendon grafts belong to the method of "removing the east wall to make up the west wall". Using a less important tendon to replace the ligament or tendon defect that must be repaired will inevitably leave sequelae, and the source is extremely limited. The strength of the tendon is average. Can not meet the clinical needs. In this case, tendon allografts are used clinically as a last resort option. However, the allogeneic tendon needs to undergo various treatments in vitro, and its strength and healing ability are further reduced compared with the autologous tendon. In addition, the source is limited, it is easy to rupture in the late stage, and there are risks of spreading diseases and immune rejection, so it is not an ideal method. Although artificial tendons have the advantages of wide range of sources, high strength, and good safety, they are difficult to heal with the host bone, and are prone to late loosening and wear and tear, resulting in surgical failure, and cannot be effectively used to repair ligament and tendon defects.

In addition, the adjustment and maintenance of tension after ligament or tendon defect repair is also a key factor to ensure the realization of its function. Human ligaments and tendons are weakly elastic tissues that are under tension all the time, and small changes in length will greatly weaken the ability to resist traction. The repaired ligament or tendon needs to be held against tension so that the grafted ligament or tendon does not move until it has healed to sufficient strength with the bone. The fixation and repair methods of ligaments or tendons currently used all have various deficiencies in this respect. First, ligament tension cannot be adjusted after fixation. The current fixation methods for repairing ligament or tendon defects are to establish a fixed point at the starting and ending points of the ligament or tendon, and then pull the ligament or tendon from the rupture point to the fixed point by suture suture or hanging compression In fact, once fixed, it is difficult to adjust the tension of the ligament (or tendon), otherwise it is easy to cause loosening of the fixation; and this kind of traction maintains the tension and fixation of the ligament (or tendon) and it is difficult to restore the normal traction of the repaired ligament (or tendon) tension. Second, the long-term loosening rate is high. Current repair methods require the ligament (or tendon) graft substitute to finally heal with the bone for long-term stability. Loosening of fixtures against traction, incomplete or delayed healing of ligaments (or tendons) and bones will lead to weakening or disappearance of the normal tension of ligaments (or tendons), leaving the ligaments (or tendons) in a relatively loose position On healing, affecting the effectiveness of ligaments (or tendons).

In order to solve the above problems, researchers at home and abroad are exploring new methods.

US2012/0078369 US patent document discloses a method for anchoring homologous or artificial tendons. The device includes a hollow screw and an insertion screw with a hole in the tail. The surface of the hollow screw is a common thread surface, which cannot heal with the bone. The screw is screwed into the bone tunnel, the tendon passes through the hole of the plug-in screw, and then the plug-in screw is inserted into the hollow screw; its essence is still a method of using a fixator to squeeze the tendon into the bone, relying on the tendon and bone to grow together to obtain long-term way of fixing the stability. This kind of device for inserting fastening ligaments is obviously insufficient in terms of tensile tension resistance, which is prone to ligament displacement and tension failure, which affects the effectiveness of reconstructing ligaments; once fixed, it is also impossible to effectively strengthen the ligament tension through adjustment. It can be seen that this technical solution does not solve the defect of low healing ability between the graft and the bone; its structural design still has the defect that it is difficult to adjust the tension of the ligament; its long-term healing method is also the same as the current ligament (or tendon) defect repair method , does not provide long-term healing stability superior to currently applied methods.

Chinese patent No. CN201180051302 discloses a fixation device for fastening tendons or ligaments, including hollow screws, connecting screws, tendon suspension devices with holes at the tail ends, and a correction tool a for adjusting the depth of entry of hollow screws and removing the fixation device Correction tool b; this device is essentially still a fixation device that relies on the establishment of the bone tunnel of the entire bone segment, relies on the correction tool a to drag and rotate the fixation device into the bone tunnel to adjust the ligament tension, and completely relies on the thread shape of the hollow screw to adjust Obtain the stability between the fixation device and the bone; in order to allow the correction tool to be inserted, at the attachment point with the ligament (or tendon), it is necessary to establish a bone tunnel through the entire bone, which will cause greater damage to the bone and soft tissue; In addition, the end of the hollow screw is open, and there is a great risk in inserting the connecting screw through the hollow screw from the bone tunnel away from the ligament (or tendon). It is disastrous; in addition, if the bone debris in the bone tunnel falls off and enters the hollow screw, the correction tool a or the connecting screw will not be able to be placed, which will also cause the failure of the operation. It can be seen that the design of this technical solution does not improve the defect of insufficient healing ability between the graft and the bone; its structural design does not improve the weak problem of the ability of the ligament (or tendon) fixation to resist traction; its long-term healing method also does not Like the current ligament (or tendon) defect repair method, relying on the ligament (or tendon) to heal with the bone to obtain stability does not provide better long-term healing stability than the current application method; although this technical solution incorporates a design that adjusts ligament tension , but brings new defects, increases the difficulty and risk of surgery, and aggravates bone damage. The overall design is not feasible for clinical application.

Chinese Patent No. CN201380034075 and Chinese Patent No. CN201310148275 both disclose a tendon fastening screw system, but their core design is still to suspend the tendon and obtain long-term stability by healing the tendon and bone. Their tendon-fastening screws have different surface designs (such as having external threads and the way the tendon is suspended) to increase the contact area between the suspended tendon and bone to increase the possibility of tendon-bone healing. This technical solution cannot completely avoid the defect of low healing ability between the graft and the bone; its structural design still has the defect of being unable to adjust the tension of the ligament; its long-term healing method is the same as the current ligament (or tendon) defect repair method, without Provides long-term healing stability superior to currently applied methods.

All in all, the current devices and methods for reconstructing and repairing ligament (or tendon) defects are restricted by the source of ligament (or tendon) substitutes, and it is difficult to guarantee the long-term ligament (or tendon)-bone healing rate, and it is difficult to fix it during surgical fixation. The ligament (or tendon) is strengthened to the most ideal tension state. Once it is fixed, it is difficult to adjust the tension, so that the function of the repaired ligament (or tendon) varies greatly, and satisfactory curative effect cannot be achieved. Once the repair operation fails, it will be given. The patient brings further suffering.

Contents of the invention

In order to overcome the deficiencies and defects mentioned in the above background technology, provide a wide range of sources, strong tensile strength, not easy to loosen, good bone healing, adjustable reinforcement tension, easier to use new ligaments (or tendons) to replace A device used to repair ligament or tendon defects.

In order to solve the above technical problems, the technical solution proposed by the present invention is: a device for repairing ligament or tendon defects, comprising a fastening screw front section and a fastening screw rear section detachably connected to the fastening screw front section, The front section of the fastening screw has a self-tapping external thread that can be tapped into the bone, and the outer surface of the rear section of the fastening screw has an external thread that is continuously connected with the self-tapping external thread of the front section of the fastening screw. The outer surface of the rear portion of the fastening screw adopts a material that can heal with bone. The technical solution of the present invention first innovatively adopts segmented, detachable design and pressurized design, so that the front and rear sections of the fastening screw can achieve different functions through different structures, shapes and materials, and form a fastening screw. The complementary structure and function of the anterior segment and the posterior segment of the screw combine physical fixation and biological healing fixation, which is expected to achieve a better healing effect between the device used to repair the defect and the bone under the premise of a wide range of sources.

Further preferably, the shape of the front section of the fastening screw is a tapered structure with a self-tapping edge tip, and the outer wall of the front section of the fastening screw is provided with sharp, deep and wide external threads that increase in arc shape. The tapered structure with the tip of the self-tapping blade enables the device of the present invention to precisely locate the starting and ending point of the ligament (or tendon) that needs to be reconstructed, and the feature of sharp deep and wide external threads that are enlarged in an arc shape can further ensure that the fixed center point will not be damaged. Offset, so that it can be firmly fixed in the cancellous bone, and after fixation, it can obtain enough strength to resist the traction force generated by joint movement. The sharp deep and wide external thread can make it firmly fixed in the cancellous bone, and after fixation, it can obtain enough strength to resist the traction force generated by joint movement.

Further preferably, the outer wall of the rear section of the fastening screw is provided with smooth and shallow external threads, and the outer diameter of the rear section of the fastening screw is slightly smaller than the maximum outer diameter of the front section of the fastening screw. The setting of the smooth shallow and dense external thread less than the sharp deep and wide external thread can make the rear section of the fastening screw and cancellous bone realize more comprehensive contact and healing.

Further preferably, the tail of the front section of the fastening screw is provided with a front and rear section connecting shaft, and a threaded hole is opened in the front and rear section connecting shaft, the rear section of the fastening screw is a hollow structure, and the front section of the front section of the fastening screw is hollow. There are front and rear connection holes sleeved on the front and rear connection shafts on the upper part, and the rear part of the fastening screw is connected to the fastening screw through a connecting screw that passes through the front and rear connection holes and is fixed in the threaded hole. The front section of the screw forms a detachable connection. Such a detachable connection method is not only simple in structure and convenient in manufacture, but also enables modular processing, and is also convenient for disassembling and replacing components of the device in case of unexpected situations later.

Furthermore, in the device for repairing ligament or tendon defects, preferably, an internal positioning hole for a built-in rotary screwdriver is opened in the rear section of the fastening screw immediately behind the connection hole of the front and rear sections, so The inner diameter of the inner positioning hole is slightly larger than the inner diameter of the front and rear connecting holes. The inner positioning hole can be used to fix the rear section of the fastening screw. When the front and rear sections of the fastening screw are connected into one, the front section of the fastening screw and the rear section of the fastening screw can be rotated together through the internal positioning hole.

Further preferably, the device also includes a tendon fixation pressure screw connected to the rear section of the fastening screw, and the tendon fixation pressure screw is provided with an outer end rotatably connected to the artificial tendon and can be affixed to the The inner end of the rear section of the fastening screw; the tail of the rear section of the fastening screw is provided with a tendon fixation pressure screw hole for fastening the inner end of the tendon fixation pressure screw.

Further preferably, the tendon fixation pressure screw includes a rotating connection part that cooperates with each other and a driving part that drives the rotating connection part to rotate; the mutual cooperation between the rotating connecting part and the driving part can realize the adjustment of the tension of the artificial tendon adjustment. More preferably, the specific structure of the rotating connection part and the driving part is: the rotating connecting part is a hollow tendon fixation compression screw nut, and its outer surface is provided with a screw cap for fastening to the tendon fixation and compression screw. The external thread of the tendon screw in the screw hole, the tail end of the nut of the tendon fixing pressure screw is provided with nut ratchet teeth; The riveted and pressurized ratchet disk includes a riveted rod and a ratchet head connected to both ends of the riveted rod and stoppers. The side of the ratcheted head facing the riveted rod is provided with ratchet teeth. The pressure screw nut is sleeved on the periphery of the riveting rod and is clamped between the ratchet head and the stopper, and the ratchet teeth of the ratchet are matched with the ratchet teeth of the nut.

Further preferably, the tail end of the tendon fixation compression screw nut is provided with a cross-shaped nut rotation groove for rotating the tendon fixation compression screw nut, and the riveted compression ratchet disc is provided with a groove for rotation The ratchet disc rotation groove in the shape of a cross of the riveted pressurized ratchet disc.

Further, the artificial tendon is an artificial tendon with a hemispherical head, and the artificial tendon with a hemispherical head includes a hemispherical head, a tendon body and a tendon constriction, and the tendon constriction is connected between the hemispherical head and the tendon body, so The tendon fixation compression screw is a hollow structure, the outer diameter of the tendon constriction part is smaller than the inner diameter of the tendon fixation compression screw, the bottom surface diameter of the hemispherical head is larger than the inner diameter of the tendon fixation compression screw, the The tendon fixation compression screw is sleeved on the periphery of the constricting part of the tendon and stuck between the hemispherical head and the tendon body. The hemispherical head artificial tendon and the tendon fixation compression screw can produce radial movement and rotation to achieve "central fixation of the tendon", avoiding the current situation of squeezing the screw to the side of the bone tunnel in the current ligament (or tendon) repair surgery. Shortcomings, at the same time realize the micro-movement between tendon and bone, avoid the current shortcoming of "rigid combination of tendon and bone". More preferably, the hemispherical head artificial tendon is made of polyester fiber or elastic metal wire.

Further, the device also includes an anti-tendon friction protection clasp arranged between the rear section of the fastening screw and the artificial tendon to prevent friction between the two. The anti-tendon friction protection clasp is provided to avoid direct contact between the artificial tendon and the back section of the fastening screw, avoid friction, and reduce the angled friction effect after the current ligament (or tendon) reconstruction operation. prolong prosthetic life. More preferably, the anti-tendon friction protection clasp is a C-shaped structure sleeved on the outside of the tendon with elasticity, and an operation hole is provided at both ends of the C-shaped structure, and the clamping operation hole is closed by locking the operation hole. The anti-tendon friction protection clasp is provided with a clasp groove for placing the anti-tendon friction protection clasp at the tail end of the rear section of the fastening screw.

Compared with the current surgical methods for repairing ligament or tendon defects, there are insufficient sources, secondary injury caused by autologous tendon, immune rejection and disease transmission caused by allogeneic tendon application, difficulty in adjusting the tension of repaired ligament or tendon, and transplant substitutes Insufficient bone long-term healing ability and other defects, the technical solution of the present invention has the following significant advantages:

(1) The front part of the fastening screw designed as a tapered sharp deep and wide external thread can directly penetrate into the bone, the sharp deep and wide external thread can achieve sufficient early fixation strength, and the rear part of the fastening screw with a metal trabecular structure can Convert tendon-bone healing with long healing time, many restrictions, and low success rate to bone-metal trabecular healing with high healing rate and lifelong maintenance, avoiding the successful healing of ligament (or tendon) defect repair surgery Due to the disadvantage of low rate, the combination of physical fixation and biological fixation can greatly improve the curative effect of ligament (or tendon) defect repair surgery.

(2) By fixing the compression screw through the tendon, the tension of the repaired ligament (or tendon) can be adjusted, and multiple adjustments can be made to make the tension of the repaired ligament (or tendon) to the most satisfactory state, avoiding the usual ligament (or tendon) tension The shortcoming of "once fixed, the tension cannot be adjusted" in defect repair surgery improves the surgical accuracy; the combination of tendon fixation pressure screw and hemispherical head artificial tendon, combined with the tapered design of the front section of the fastening screw, realizes true "central positioning and central fixation of the tendon" ", to avoid the shortcomings of extruding the screw to the side of the bone tunnel in the current ligament (or tendon) repair surgery, improve surgical accuracy, conform to biomechanical characteristics, avoid stress concentration, and prolong the survival time of ligament (or tendon) substitutes.

(3) The existence of the anti-tendon friction protection clasp greatly reduces the angular friction effect between the ligament (or tendon) and the bone after the current ligament (or tendon) reconstruction operation, and avoids the wear and tear of the ligament (or tendon).

(4) The present invention takes into account the advantages of extensive sources of artificial tendons, high strength, and safety, avoids the shortcoming of its low tendon-bone healing ability, expands the source of ligament substitute materials, and avoids the damage to patients caused by autologous tendon transplantation. Avoid the disadvantages of immunological rejection and disease transmission in the application of allogeneic tendon.

The device of the present invention is used to repair the defect or loss of the ligament, and the segmental design of the fastening screw combines the two fixation concepts of "mechanical fixation" and "biological healing fixation", continuously maintains effective fixation strength, and can move freely and freely in the early stage. Exercise can avoid the long recovery period and cumbersome rehabilitation methods after the current ligament (or tendon) defect repair surgery, and can also significantly reduce the difficulty of ligament (or tendon) revision surgery.

Description of drawings

In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the following will briefly introduce the drawings that need to be used in the description of the embodiments or the prior art. Obviously, the accompanying drawings in the following description are For some embodiments of the present invention, those skilled in the art can also obtain other drawings based on these drawings without creative work.

Fig. 1 is the front view of fastening screw front section in the embodiment of the present invention;

Fig. 2 is a cross-sectional view of the front section of the fastening screw in the embodiment of the present invention;

Fig. 3 is the bottom view of the front section of the fastening screw in the embodiment of the present invention;

Fig. 4 is a schematic perspective view of the structure of the front section of the fastening screw in the embodiment of the present invention;

Fig. 5 is the front view of the rear section of the fastening screw in the embodiment of the present invention;

Figure 6 is a cross-sectional view of the rear section of the fastening screw in the embodiment of the present invention;

Fig. 7 is a bottom view of the rear section of the fastening screw in the embodiment of the present invention;

Fig. 8 is a front view of the connecting screw in the embodiment of the present invention;

Fig. 9 is a top view of the connecting screw in the embodiment of the present invention;

Fig. 10 is an assembly front view of the front section of the fastening screw and the rear section of the fastening screw in the embodiment of the present invention;

Fig. 11 is an assembly cross-sectional view of the front section of the fastening screw and the rear section of the fastening screw in the embodiment of the present invention;

Fig. 12 is a schematic diagram of the structure of the hemispherical head artificial tendon in the embodiment of the present invention;

Fig. 13 is a schematic perspective view of the structure of the tendon fixation compression screw nut in the embodiment of the present invention;

Fig. 14 is a schematic perspective view of the structure of the riveted pressurized ratchet disc in the embodiment of the present invention;

Fig. 15 is a schematic perspective view of the structure of the tendon fixation compression screw in the embodiment of the present invention;

Figure 16 is a schematic diagram of the assembly structure of the hemispherical head artificial tendon and the tendon fixation pressure screw in the embodiment of the present invention;

Fig. 17 is a schematic diagram of the structure of the anti-tendon friction protection snap ring in the embodiment of the present invention;

Fig. 18 is an exploded view of the overall assembly structure of the device in the embodiment of the present invention;

Figure 19 is a schematic structural view of the device after assembly in the embodiment of the present invention;

Figure 20 is a schematic structural view of another preferred embodiment of the device in the embodiment of the present invention;

Fig. 21 is the sectional view of device repairing quadriceps tendon defect in the embodiment of the present invention;

Fig. 22 is a cross-sectional view of the device repairing the injury of the anterior tibiofibular ligament in the embodiment of the present invention.

1. Sharp deep and wide external thread; 2. Front and rear connecting shaft; 3. Threaded hole; 4. Maximum diameter of sharp deep and wide external thread; 5. Front section of fastening screw; 6. Smooth and shallow dense external thread; 7. Smooth and shallow Maximum diameter of dense external thread; 8. Front and rear connection holes; 9. Inner positioning hole; 10. Tendon fixation pressure screw hole; 11. Snap ring groove; 12. Tendon outlet; 13. Connecting screw nut; 14. Connection Screw screw; 15, cross groove of connecting screw nut; 16, rear section of fastening screw; 17, connecting screw; 18, hemispherical head; 19, constricting part of tendon; 20, tendon body; 21, external thread of tendon screw 22. Nut ratchet teeth; 23. Nut rotation groove; 24. Riveting rod; 25. Ratchet disc ratchet teeth; 26. Ratchet disc rotation groove; 27. Riveting and pressurizing ratchet disc; Screw nut; 29, artificial tendon; 30, tendon fixation pressure screw; 31, operation hole; 32, C-shaped snap ring; 33, anti-tendon friction protection snap ring; 34, tibia; 35, fibula; 36, talus; 37. Quadriceps tendon stump; 38. Patella; 39. Femur; 40. Suture.

detailed description

In order to facilitate the understanding of the present invention, the present invention will be described more fully and in detail below in conjunction with the accompanying drawings and preferred embodiments, but the protection scope of the present invention is not limited to the following specific embodiments.

It should be noted that when an element is described as "fixed, affixed, connected or communicated with" another element, it may be directly fixed, affixed, connected or communicated with another element , can also be indirectly fixed, affixed, connected or communicated with another element through other intermediate connectors.

Unless otherwise defined, all technical terms used hereinafter have the same meanings as commonly understood by those skilled in the art. The terminology used herein is only for the purpose of describing specific embodiments, and is not intended to limit the protection scope of the present invention.

Unless otherwise specified, various raw materials, reagents, instruments and equipment used in the present invention can be purchased from the market or prepared by existing methods.

Example:

As shown in Figure 18, the present invention provides a device for repairing ligament or tendon defects, including fastening screw front section 5, fastening screw rear section 16, connecting screw 17, tendon fixation compression screw 30, tendon friction protection As for the clasp 33 and the artificial tendon 29, FIG. 19 is a schematic diagram of the assembly of the components of the device. The structure in which the front section 5 of the fastening screw and the rear section 16 of the fastening screw are connected as one is called the fastening screw.

As shown in Fig. 1 to Fig. 4 and Fig. 10, Fig. 11, Fig. 18, and Fig. 19, in order to obtain early and firm fixation, the front section 5 of the fastening screw used in this embodiment is made of metal (it can also be made of absorbable material or ceramic material), the front section 5 of the fastening screw can be deeply implanted in the metaphyseal cancellous bone, which is a tapered structure with a self-tapping edge tip, and the outer wall of the front section 5 of the fastening screw is provided with a structure that gradually increases along the spiral direction. The sharp deep and wide external thread 1. The tapered tip with a self-tapping edge can accurately locate the starting and ending points of the tendon after the ligament needs to be reconstructed. The sharp deep and wide external thread 1 gradually increases along the spiral direction to ensure that the fixed center point will not be shifted. The sharp deep and wide external thread 1 The front section 5 of the fastening screw can be firmly fixed in the cancellous bone, and after fixing, it can obtain sufficient strength to withstand the tension generated by joint movement. Fastening screw front section 5 and fastening screw rear section 16 are detachably connected by connecting screw 17, and the tail portion of fastening screw front section 5 is provided with front and rear section connecting shaft 2 for connecting fastening screw rear section 16, front and rear section connecting shaft 2 Threaded holes 3 for fixing connecting screws 17 are opened inside.

As shown in FIGS. 5 to 7 and FIG. 10 , FIG. 11 , and FIG. 18 , the rear section 16 of the fastening screw is used to connect the front section 5 of the fastening screw in front of it and the tendon fixation compression screw 30 behind it. The rear section 16 of the fastening screw in this embodiment is a hollow structure, preferably a hollow cylindrical structure. The outer surface of the rear section 16 of the fastening screw has a smooth surface that is continuously docked with the sharp deep and wide external thread 1 of the front section 5 of the fastening screw. Shallow and dense external thread 6, the outer diameter of the rear section 16 of the fastening screw is slightly smaller than the maximum outer diameter of the front section 5 of the fastening screw. The smooth shallow and dense external thread 6 is shallower and smoother than the sharp deep and wide external thread 1, and the maximum diameter 7 of the smooth shallow and dense external thread is slightly smaller than the maximum diameter 4 of the sharp deep and wide external thread, so that the rear section 16 of the fastening screw can be fully connected with the bone s contact. The back section 16 of the fastening screw is provided with front and rear connection holes 8, inner positioning holes 9, threaded tendon fixation pressure screw holes 10, snap ring grooves 11 and tendon outlets 12 in sequence. The front and rear connecting shafts 2 can be inserted into the front and rear connecting holes 8, and the connecting screws 17 pass through the front and rear connecting holes 8 and are affixed on the front and rear connecting shafts 2. During the operation, when the rear section 16 of the fastening screw is fixedly connected with the front section 5 of the fastening screw by the connecting screw 17, the docking point of the sharp deep and wide external thread 1 and the smooth shallow and dense external thread 6 are adjusted so that the two are continuously docked. The inner diameter of the inner positioning hole 9 is slightly larger than the inner diameter of the front and rear connecting holes 8, which is convenient for connecting a screwdriver for rotating the rear section 16 of the fastening screw; after the front section 5 of the fastening screw is connected with the rear section 16 of the fastening screw, the The inner positioning hole 9 can rotate the front section 5 of the fastening screw and the rear section 16 of the fastening screw simultaneously.

As shown in Fig. 8, Fig. 9, Fig. 11 and Fig. 18, the connecting screw 17 of this embodiment is used to fix the fastening screw front section 5 and the fastening screw rear section 16, which includes a connecting screw nut 13 and a connecting screw screw rod 14. There is a cross groove 15 for the connecting screw and nut at the bottom of the connecting screw and nut 13 .

The outer surface of the rear section 16 of the fastening screw in this embodiment uses a material that can heal with bone (such as a metal trabecular material) to achieve biological healing with the bone, so as to obtain long-term stable strength. In addition, the metal trabecular material on the outer surface of the rear section 16 of the fastening screw may contain commonly used bone growth-promoting factors, such as bone morphogenetic protein (BMP), or other similar factors.

In this embodiment, the snap ring groove 11 in the rear section 16 of the fastening screw is cylindrical, and its diameter is larger than the tendon fixation pressure screw hole 10 and the tendon exit 12, and is used to accommodate the anti-tendon friction protection snap ring 33 . The tendon outlet 12 is cylindrical, and its diameter is larger than the tendon fixing pressure screw hole 10 and smaller than the snap ring groove 11 , and the tendon body 20 protrudes from the tendon outlet 12 .

As shown in Figure 13, Figure 14, Figure 15, Figure 16, and Figure 18, in order to fix the repaired ligament (or tendon) centrally, and to adjust the tension of the ligament (or tendon) after fixation, to achieve the optimal Ligament function, the present invention has designed the tendon fixation pressure screw 30 of hollow type band ratchet pressure plate. The tendon fixation compression screw 30 of the present invention is in the shape of a hollow cylinder, and includes a rotating connecting portion that cooperates with each other and a driving portion that drives the rotating connecting portion to rotate. The rotating joint is a hollow tendon fixation compression screw nut 28, the outer surface of which is provided with tendon screw external thread 21, the tail end is provided with nut ratchet teeth 22 and a cross-shaped nut rotation groove 23 (see Figure 13). The driving part is a riveted and pressurized ratchet disc 27 with a hollow structure, including a riveted rod 24, a ratchet disc head and a stopper connected to both ends of the riveted rod 24 (see FIG. 14 ), and the riveted and pressurized ratchet disc 27 has a cross-shaped The ratchet disc rotation groove 26. The tendon screw external thread 21 matches the tendon fixation pressure screw hole 10 of the above-mentioned fastening screw rear section 16 (the tendon fixation pressure screw hole 10 is cylindrical, and it matches the tendon fixation pressure screw nut 28 shown in Figure 15 Screw external thread 21 matches), the thread axial length of tendon fixation compression screw hole 10 is greater than the length of tendon fixation compression screw nut 28, so that tendon fixation compression screw nut 28 has a certain distance adjustment therein space. The riveting rod 24 is a hollow cylinder, and the tendon fixation pressure screw nut 28 is sleeved on the periphery of the riveting rod 24 and stuck between the ratchet pan head and the stopper (see FIG. 15 ), and the ratchet pan head faces toward the riveting rod 24. One side is provided with the ratchet plate ratchet teeth 25, and the nut ratchet teeth 22 and the ratchet plate ratchet teeth 25 match each other.

As shown in Fig. 12, Fig. 16 and Fig. 18, the artificial tendon 29 of the present invention is a hemispherical head artificial tendon, comprising a hemispherical head 18, a tendon constriction portion 19 and a tendon body portion 20, and the tendon constriction portion 19 is connected to the hemispherical head 18 and tendon body 20 between. The outer diameter of the tendon constricting part 19 is smaller than the inner diameter of the tendon constricting screw 30, the bottom surface diameter of the hemispherical head 18 is larger than the inner diameter of the tendon constricting screw 30, and the tendon constricting screw 30 is sleeved on the periphery of the tendon constricting part 19 and Stuck between the hemispherical head 18 and the tendon body 20 . The inner surface of the tendon fixation compression screw 30 is smooth and can hold the hemispherical head 18 of the artificial tendon, and can freely rotate on the tendon constricting part 19 . Radial movement and rotation can be generated between the artificial tendon 29 and the tendon fixation pressure screw 30 . The artificial tendon 29 in this embodiment can be braided from polyester fibers, or other similar biomechanical materials, such as braided elastic metal wires. The tendon fixation compression screw 30 cooperates with the tapered design of the front section 5 of the fastening screw, which can realize the true "central positioning and central fixation of the tendon", avoiding the defect that the screw pushes the tendon to the side of the bone tunnel in the current ligament (or tendon) repair surgery , can improve surgical accuracy, conform to biomechanical characteristics, avoid stress concentration, and prolong the survival time of ligament (or tendon) substitutes.

As shown in Figure 17 and Figure 18, the anti-tendon friction protection clasp 33 of this embodiment is arranged between the rear section 16 of the fastening screw and the artificial tendon 29, and the anti-tendon friction protection clasp 33 is sleeved on the outside of the artificial tendon 29 And there is an elastic C-shaped snap ring 32, and an operation hole 31 is respectively arranged at the two ends of its C-shaped structure, and the C-shaped snap ring 32 can be closed by clamping the operation hole 31. The C-shaped clasp 32 can be inserted into the clasp groove 11 through the tendon exit 12 of the rear section 16 of the fastening screw, and the C-shaped clasp 32 can return to its original shape after the operation hole 31 is loosened. The anti-tendon friction protection clasp 33 can avoid the direct contact between the fastening screw rear section 16 and the artificial tendon 29, reduce friction, and reduce the angular friction effect between the ligament (or tendon) and the bone after the current ligament (or tendon) defect repair, avoid Ligament (or tendon) wear and tear.

The device of this embodiment is suitable for the repair and reconstruction of partial or complete loss of ligaments or tendons.

Taking the repair of old quadriceps tendon rupture as an example, as shown in Figure 21, when an old quadriceps tendon rupture occurs, the operation process of repairing the quadriceps tendon with the device of this embodiment is as follows:

1. Loosen the quadriceps tendon stump 37 on the femur 39 and measure the distance from it to the upper pole of the patella 38 .

2. According to the size of the patella 38, select the front section 5 of the fastening screw, the rear section 16 of the fastening screw and the connecting screw 17 of appropriate size, and select the combination of the tendon fixation compression screw 30 and the artificial tendon 29 of appropriate length according to the distance in step 1 .

3. Drill the cortical bone at the inner edge and outer edge of the original quadriceps tendon insertion on the upper pole of the patella 38, and use the connecting screw 17 to securely connect the front section 5 of the fastening screw and the rear section 16 of the fastening screw to obtain the fastening screw, and ensure that The threads between the front and rear sections are continuous; then respectively align the tips of the front sections 5 of the two fastening screws and slowly screw in the fastening screws along the drilling direction until the ends of the rear sections 16 of the fastening screws are flush with the bone surface. If it is an elderly patient with osteoporosis, bone cement can be filled around the rear segment 16 of the fastening screw first, and then the fastening screw can be implanted, so as to obtain more stable fixation.

4. Expand the free ends of the two artificial tendons 29, that is, one end that is not connected to the tendon fixing pressure screw 30, pull the quadriceps tendon stump 37 to a suitable tension, and wrap the free ends of the artificial tendons 29 around the quadriceps muscle The tendon stump 37 is sutured together with suture 40 for reinforcement.

5. The bilateral knee flexion experiment was compared in vitro, and the tension of the repaired quadriceps tendon was adjusted according to the experimental comparison until it was completely consistent with the healthy side. The blocking and twisting of the repair ligament (or tendon) in clinical operation are the difficulties affecting the operation. After the repaired ligament (or tendon) is fixed on the bone, its tension has been determined. If the tension needs to be adjusted, it is necessary to remove the fixation and re-screw the fixation, otherwise it will be blocked by the repaired ligament (or tendon). And torsion occurs, and repeated operations tend to reduce the fixing strength. The fastening screw of the device of the present invention adopts the mode of the ratchet teeth and the ratchet disc to solve this problem well. Taking this embodiment as an example, when in use, use a hollow "one" screwdriver to apply radial pressure to the ratchet disc rotation groove 26 of the riveted pressurized ratchet disc 27 and rotate it 90° clockwise, and the ratchet disc ratchet teeth 25 drive the nut The ratchet teeth 22 make the tendon fixation pressure screw nut 28 rotate clockwise, the tendon fixation pressure screw 30 is screwed into the rear section 16 of the fastening screw, and the radial pressure exerted by the screwdriver on the ratchet disc rotation groove 26 is relaxed. Rotate the riveted pressurized ratchet disc 27 counterclockwise by 90°, the transmission effect between the ratchet disc ratchet teeth 25 and the nut ratchet teeth 22 will disappear, and the tendon fixation pressurized screw 30 will not rotate counterclockwise. The word screwdriver applies radial pressure to the ratchet disc rotation groove 26 and rotates 90° clockwise, so that the tendon fixation compression screw 30 can be screwed into the rear section 16 of the fastening screw. Repeat the above steps, each time the rotation angle is about 90°, the torsion of the artificial tendon 29 and the blocking of the screwdriver can be avoided (the principle is to change the continuous 360° circular motion into a reciprocating 90° motion), and increase the artificial tendon 29 tension. When it is necessary to loosen the tension of the artificial tendon 29, a hollow "one" screwdriver can be used to simultaneously insert the ratchet disc rotation groove 26 of the riveted pressure ratchet disc 27 and the nut rotation groove 23 of the tendon fixing pressure screw nut 28 , and rotate the riveted pressurized ratchet disc 27 and the tendon fixation pressurized screw nut 28 counterclockwise at the same time, and the tendon fixation pressurized screw nut 28 rotates in the direction of unscrewing. In clinical use, the riveted pressure ratchet disc 27 can also effectively block the reverse rotation of the tendon fixation pressure screw 30, the artificial tendon 29 does not directly contact the tendon fixation pressure screw nut 28, and the pulling tension of the artificial tendon 29 It directly acts on the stop part of the riveted pressurized ratchet disc 27, and the riveted pressurized ratchet disc 27 can rotate freely relative to the tendon fixing pressurized screw nut 28, which avoids the tension conversion of the artificial tendon 29 In order to make the tendon fixation compression screw 30 generate reverse rotation force, the tension of the artificial tendon 29 is avoided from becoming loose.

6. According to the size of the rear section 16 of the fastening screw, select an anti-tendon friction protection clasp 33 of an appropriate size, close the C-shaped clasp 32 by clamping the operation hole 31, and put it into the clasp groove 11 through the tendon outlet 12, After the operation hole 31 is loosened, the C-shaped snap ring 32 can be restored to its original shape, and is stuck between the artificial tendon 29 and the rear section 16 of the fastening screw. Rotate the anti-tendon friction protection snap ring 33 to ensure that there is no contact between the artificial tendon 29 and the rear section 16 of the fastening screw.

In order to treat the situation where the ligament is completely missing or the residual end of the ligament is insufficient, another preferred embodiment of the device of the present invention is that each of the two ends of the artificial tendon 29 is connected with a fastening screw, that is, the artificial tendon 29 includes two hemispherical heads 18 and is connected to two The tendon body 20 between the two hemispherical heads 18, the two hemispherical heads 18 and the tendon body 20 are all connected by the tendon converging portion 19, the fastening screw front section 5 of the two fastening screws and the fastening screw rear section 16 is fixedly connected by the connecting screw 17, and then the two tendon fixing pressure screws 30 sleeved at the two ends of the artificial tendon 29 are respectively rotated and connected into the fastening screw rear section 16 of the two fastening screws, and finally the two anti-tendon The friction protection snap ring 33 is respectively inserted into the snap ring groove 11 of the fastening screw rear section 16 of the two fastening screws, and the device of the present invention after assembly is shown in FIG. 20 .

When the ligament is completely lost, the device shown in Figure 20 can be used to repair the ligament.

Taking the repair of the rupture of the anterior tibiofibular ligament as an example, as shown in Figure 22, when the defect of the anterior tibiofibular ligament breaks, the surgical procedure for repairing the anterior tibiofibular ligament with the device of this embodiment is as follows:

1. Measure the distance between the starting and ending points of the upper border and the lower border of the anterior tibiofibular ligament.

2. According to the size of the bone to be connected, select two fastening screws of the appropriate size, the front section of the two fastening screws 5, the rear section of the two fastening screws 16, and the two connecting screws 17. A compression screw 30 and an artificial tendon 29 are connected to form a set of ligands.

3. Drill the bone cortex at the starting and ending points of the upper edge and the lower edge of the anterior tibiofibular ligament on the tibia 34 and fibula 35 respectively, and fix the front section 5 of the fastening screw and the rear section 16 of the fastening screw with the connecting screw 17 to obtain fastening and ensure that the threads between the front and rear sections are continuous; then align the tip of the front section 5 of the fastening screw with the center point of the starting and ending point of the ligament, and slowly screw in the fastening screw along the drilling direction until the end of the back section 16 of the fastening screw is flush with the bone noodle.

4. Screw the combination of the tendon fixation pressure screw 30 and the artificial tendon 29 into the fastening screws at the tibia 34 and fibula 35 on the upper and lower borders of the anterior tibiofibular ligament, until the artificial tendon 29 is taut and produces a certain degree of tension. tension. Relatively move the tibia 34, fibula 35, and talus 36, and decide to increase or decrease the tension of the reconstructed ligament according to the experimental comparison until it is completely consistent with the healthy side. The tension adjustment here is basically the same as the above-mentioned adjustment method when the tendon is repaired. When both ends are fixed, continue to tighten the tendon fixation pressure screw 30 to increase the tension of the artificial tendon 29, and loosen the tendon fixation pressure screw 30 to increase the tension. Reduce the tension of the artificial tendon 29 and avoid the shortcoming of "no adjustment of tension once fixed" in the usual repair ligament surgery.

5. According to the size of the rear section 16 of the fastening screw, select an anti-tendon friction protection clasp 33 of an appropriate size, close the C-shaped clasp 32 by clamping the operation hole 31, and put it into the clasp groove 11 through the tendon outlet 12, After the operation hole 31 is loosened, the C-shaped snap ring 32 can be restored to its original shape, and is stuck between the artificial tendon 29 and the rear section 16 of the fastening screw. Rotate the anti-tendon friction protection snap ring 33 to ensure that there is no contact between the artificial tendon 29 and the rear section 16 of the fastening screw.

After applying the device of the present invention to repair the defective tendon, the front section 5 of the fastening screw is deeply fixed in the cancellous bone, which can obtain sufficient early stability (generally about 1 year), and the rear section 16 of the fastening screw passes through the connecting screw. 17 is connected with fastening screw front section 5, can not produce any displacement. After 3 to 6 months, the surface of the rear section 16 of the fastening screw contains porous metal trabecular material, and is attached with bone growth-promoting factors, so that it can heal well with cancellous bone, and the healing rate is close to 100%. achieve a good stabilization effect. When the device of the present invention is used to repair a defective ligament, the starting and ending points of the repaired ligament are basically consistent with the position of the bioanatomical attachment point of the patient's ligament, and the tension of the repaired ligament is also adjusted to be consistent with the healthy side. Therefore, the function of the repaired ligament is the most similar to that of the normal ligament, and it can restore proprioception to the greatest extent.

It can be seen from the above that the outer layer of the rear section of the fastening screw in the present invention is made of metal trabecular material, and its healing rate in cancellous bone is close to 100%. In addition, the segmental design of the fastening screw makes "mechanical fixation Combining the two fixation concepts of "biological healing and fixation", the effective fixation strength can be maintained continuously, which has changed the difficult situation of tendon and bone healing in ligament or tendon repair surgery, and is the key point to obtain long-term survival of repaired ligament or tendon. The tendon fixation compression screw in the present invention can allow the tension of the ligament or tendon to be adjusted after the repair is completed, and how to adjust the tension can be determined through the test and comparison of the ligament or tendon function of the bilateral limbs. This is the existing ligament or tendon defect repair. What the device cannot accomplish is also an important improvement to ensure the excellent function of the reconstructed ligament or tendon. The present invention takes into account the advantages of extensive sources of artificial tendons, high strength and safety, avoids the disadvantage of low tendon-bone healing ability, expands the source of ligament substitute materials, avoids the damage to patients caused by autologous tendon transplantation, and avoids the use of the same artificial tendon. The shortcoming of allogeneic tendon immune rejection and disease transmission is simple, the operation trauma is reduced, and the curative effect is improved. At the same time, the unique segmented design can significantly reduce the difficulty of revision surgery after ligament or tendon repair surgery.

The technical solution of the present invention has been disclosed by the preferred embodiments as above. Those skilled in the art should realize that changes and modifications made without departing from the scope and spirit of the present invention disclosed by the appended claims of the present invention are within the protection scope of the claims of the present invention.

Claims (9)

1. a kind of device for repairing ligament or Tendon Defection, it is characterised in that：Including trip bolt leading portion（5）And with it is described Trip bolt leading portion（5）The trip bolt back segment of detachable connection（16）, the trip bolt leading portion（5）With bone can be shot In self-taped type external screw thread, the trip bolt back segment（16）Outer surface has and the trip bolt leading portion（5）Self-taped type The external screw thread that external screw thread is continuously docked, the trip bolt back segment（16）Outer surface uses can be with the material of knitting；

The device also includes being connected to the trip bolt back segment（16）Tendon fix forcing screw（30）, the tendon fixes Forcing screw（30）It is provided with and is turnably connected to artificial tendon（29）Outer end and detachable be fixed in the trip bolt Back segment（16）The inner；The trip bolt back segment（16）Afterbody be provided with and fix forcing screw for fastening the tendon（30） Inner tendon fixes forcing screw hole（10）.

2. the device for repairing ligament or Tendon Defection according to claim 1, it is characterised in that：The trip bolt Leading portion（5）Profile be the pyramidal structure with self tapping blade tip end, the trip bolt leading portion（5）Outer wall be provided with curved increasing Big sharp keen deep width external screw thread（1）.

3. the device for repairing ligament or Tendon Defection according to claim 1, it is characterised in that：The trip bolt Back segment（16）Outer wall be provided with smooth shallow close external screw thread（6）, the trip bolt back segment（16）External diameter be slightly less than the fastening Screw leading portion（5）Maximum outside diameter.

4. the device for repairing ligament or Tendon Defection according to claim 1, it is characterised in that：The trip bolt Leading portion（5）Afterbody be provided with front and rear section connecting shaft（2）, the front and rear section connecting shaft（2）Inside offer screwed hole（3）, it is described tight Gu screw back segment（16）It is hollow structure, the trip bolt back segment（16）Front portion offers and is socketed on the front and rear section connecting shaft （2）On front and rear section connecting hole（8）, the trip bolt back segment（16）Its front and rear section connecting hole is worn by one（8）And it is affixed In screwed hole（3）Interior attachment screw（17）With the trip bolt leading portion（5）Form detachable connection.

5. the device for repairing ligament or Tendon Defection according to claim 4, it is characterised in that：The trip bolt Back segment（16）It is internal close to the front and rear section connecting hole（8）Rear offer for it is built-in rotation screwdriver interior location hole（9）, The interior location hole（9）Internal diameter slightly larger than section connecting hole before and after described（8）Internal diameter.

6. the device for repairing ligament or Tendon Defection according to claim 1, it is characterised in that：The tendon is fixed Forcing screw（30）Drive division including the rotary connector for cooperating and the driving rotary connector rotation；

The rotary connector is that the tendon of a hollow form fixes forcing screw nut（28）, its outer surface is offered for fastening Forcing screw hole is fixed to the tendon（10）Tendon screw external screw thread（21）, the tendon fixation forcing screw nut（28） Tail end is provided with nut hook tooth（22）；The drive division is a riveting pressurization ratchet cover plate（27）, the riveting pressurization ratchet cover plate （27）It is hollow structure, the riveting pressurization ratchet cover plate（27）Including riveting bar（24）Be connected to the riveting bar（24）Two ends Ratchet coiled hair and stopper section, the ratchet coiled hair is towards the riveting bar（24）One side be provided with ratchet cover plate hook tooth（25）, The tendon fixes forcing screw nut（28）It is socketed in the riveting bar（24）Periphery and be stuck in the ratchet coiled hair and institute State between stopper section, the ratchet cover plate hook tooth（25）With the nut hook tooth（22）It is engaged.

7. the device for repairing ligament or Tendon Defection according to claim 6, it is characterised in that：The tendon is fixed Forcing screw nut（28）Tail end is provided with fixes forcing screw nut for rotating the tendon（28）The nut in crosswise Rotated trench（23）, the riveting pressurization ratchet cover plate（27）It is provided with for rotating the riveting pressurization ratchet cover plate（27）In cross The ratchet cover plate rotated trench of shape（26）.

8. the device for repairing ligament or Tendon Defection according to claim 1, it is characterised in that：The artificial tendon （29）It is hemispherical head artificial tendon, the hemispherical head artificial tendon includes hemispherical head（18）, tendon body portion（20）Collected with tendon Portion（19）, the tendon shrinkage part（19）It is connected to the hemispherical head（18）With tendon body portion（20）Between, the tendon is fixed Forcing screw（30）It is hollow structure, the tendon shrinkage part（19）External diameter less than the tendon fix forcing screw（30）'s Internal diameter, the hemispherical head（18）Basal diameter more than the tendon fix forcing screw（30）Internal diameter, the tendon fixes Forcing screw（30）It is socketed in the tendon shrinkage part（19）Periphery is simultaneously stuck in the hemispherical head（18）With tendon body portion（20）It Between.

9. the device for repairing ligament or Tendon Defection according to any one of claim 1 to 8, it is characterised in that：Should Device also includes being arranged on the trip bolt back segment（16）With the artificial tendon（29）Between prevent from producing between the two and rub The anti-tendon friction protection snap ring wiped（33）；

The anti-tendon friction protection snap ring（33）To be socketed in the artificial tendon（29）Outside and elastic C-shaped knot Structure, a handle hole is provided with two ends of its C-shaped configuration（31）, by blocking the handle hole（31）Close up the anti-tendon Friction protection snap ring（33）, in the trip bolt back segment（16）Tail end be provided with the placement anti-tendon friction protection snap ring （33）Snap ring groove（11）.