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CN209996459U - Proximal femur fracture plate - Google Patents

Proximal femur fracture plate Download PDF

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Publication number
CN209996459U
CN209996459U CN201920166770.1U CN201920166770U CN209996459U CN 209996459 U CN209996459 U CN 209996459U CN 201920166770 U CN201920166770 U CN 201920166770U CN 209996459 U CN209996459 U CN 209996459U
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plate
support plate
along
proximal
femoral bone
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刘立峰
方楠
陈涤
潘玉涛
李增春
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Shanghai Bata Medical Instrument Co ltd
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Abstract

The utility model discloses an thighbone near-end coaptation board, it includes the backup pad, the at least part of backup pad is crooked along its length direction, the protruding medial surface laminating with the thighbone near-end of side of backup pad, the coaptation board still includes the lockplate, the lockplate certainly the long limit side direction of backup pad the backup pad extends to side along the crooked protruding of its length direction, the lockplate is through the preceding laminating of configuration and thighbone near-end, the utility model provides a thighbone near-end coaptation board under the prerequisite of the fixed principle of fracture end slip pressurization, can improve the treatment of thighbone near-end fractures such as thighbone neck fracture and thighbone tuberosity fracture, increases the success rate of protecting the hip treatment.

Description

股骨近端接骨板Proximal Femoral Plate

技术领域technical field

本实用新型涉及医疗器械技术领域,具体涉及一种用于支撑股骨近端内侧的接骨板。The utility model relates to the technical field of medical devices, in particular to a bone plate for supporting the inner side of the proximal end of the femur.

背景技术Background technique

随着动力髋螺钉(DHS)、空心钉、髓内钉和髋关节假体等新材料和新技术的广泛应用,股骨近端骨折,例如股骨颈骨折、股骨粗隆间骨折等的内固定选择也越来越丰富。对于年龄大于65岁的股骨颈骨折通常采用人工髋关节置换治疗,但随着人口老龄化加速,需要二次翻修的病人也越来越多,因此,保髋治疗已成为治疗股骨颈骨折的新趋势。With the wide application of new materials and technologies such as dynamic hip screws (DHS), cannulated nails, intramedullary nails and hip prostheses, internal fixation options for proximal femoral fractures, such as femoral neck fractures, femoral intertrochanteric fractures, etc. also more and more abundant. Hip replacement is usually used for femoral neck fractures older than 65 years. However, with the accelerated aging of the population, more and more patients need a second revision. Therefore, hip preservation therapy has become a new treatment for femoral neck fractures. trend.

以股骨颈骨折为例,根据骨折线与水平方向的成角大小,分为波伟尔斯(Pauwels)I 型(≤30°)、II型(30°-50°)、III型(≥50°)(参见图1)。其中,对于波伟尔斯(Pauwels) I型、II型股骨颈骨折,股骨颈骨折的保髋治疗主要采用三枚半螺纹空心钉倒三角平行固定方式。治疗方法参见:《骨折治疗的AO原则》(第3版),作者:巴克利、莫兰;《可以用2或3 枚螺钉治疗股骨径骨折吗?》,美国骨科杂志;《一种转子处的保护螺钉可以改善垂直型股骨颈骨折吗?一种在尸体上的生物力学分析》,临床生物力学杂志;《在股骨颈骨折中皮质骨螺钉的支撑作用:基于一种新检测技术的87个骨折的放射线学分析(《AO Principles ofFracture Management-3rd edition》Richard E Buckley,Christopher G Moran,Theerachai Apivatthakakul.;Maurer SG,Wright KE,Kummer FJ,Zuckerman JD,KovalKJ.Two or three screws for fixation of femoral neck fractures?Americanjournal of orthopedics (Belle Mead,N.J.).2003;32(9):438.;Hawks MA,Kim H,Strauss JE,Oliphant BW,Golden RD,Hsieh AH,et al.Does a trochanteric lag screwimprove fixation of vertically oriented femoral neck fractures?Abiomechanical analysis in cadaveric bone.Clinical Biomechanics.2013;28(8):886-891.;Lindequist S.Cortical screw support in femoral neck fractures:Aradiographic analysis of 87 fractures with a new mensuration technique.ActaOrthopaedica.1993;64(3):289-293.),基于骨折端滑动加压固定原理,促进股骨颈骨折患者达到骨性愈合。对于Pauwels III型股骨颈骨折或伴有股骨近端内侧壁缺损、严重骨质疏松的患者,采用上述三枚半螺纹空心钉倒三角平行固定方式的治疗效果不确切,并发症多,故目前治疗上尚无统一的“金标准”。尤其对于波伟尔斯(Pauwels)III 型股骨颈骨折患者,因其高度垂直向(≥50°)的骨折线造成的剪切力S,导致空心钉固定后面临较高的并发症,如股骨头坏死、骨不连、股骨颈短缩、髋内翻畸形等,给病人和社会都带来了沉重的负担。Taking femoral neck fracture as an example, according to the angle between the fracture line and the horizontal direction, it can be divided into Pauwels type I (≤30°), type II (30°-50°), type III (≥50°). °) (see Figure 1). Among them, for Pauwels type I and II femoral neck fractures, the hip preservation treatment of femoral neck fractures mainly adopts three semi-threaded cannulated screws and inverted triangle parallel fixation. For treatment, see: AO Principles of Fracture Management (3rd Edition), by Buckley, Moran; Can 2 or 3 Screws Treat Femoral Diameter Fractures? , American Journal of Orthopedics; "Can a trochanteric protection screw improve vertical femoral neck fractures?" A Biomechanical Analysis on Cadavers", Journal of Clinical Biomechanics; "The Supporting Role of Cortical Bone Screws in Femoral Neck Fractures: Radiological Analysis of 87 Fractures Based on a New Detection Technique" ("AO Principles of Fracture Management- 3rd edition" Richard E Buckley, Christopher G Moran, Theerachai Apivatthakakul.; Maurer SG, Wright KE, Kummer FJ, Zuckerman JD, Koval KJ. Two or three screws for fixation of femoral neck fractures? American journal of orthopedics (Belle Mead, N.J.). 2003;32(9):438.; Hawks MA, Kim H, Strauss JE, Oliphant BW, Golden RD, Hsieh AH, et al. Does a trochanteric lag screwimprove fixation of vertically oriented femoral neck fractures? Abiomechanical analysis in cadaveric bone. Clinical Biomechanics. 2013; 28(8): 886-891.; Lindequist S. Cortical screw support in femoral neck fractures: Aradiographic analysis of 87 fractures with a new mensuration technique. Acta Orthopaedica. 1993; 64(3): 289-293. ), based on the principle of sliding compression fixation at the fracture end, to promote bone healing in patients with femoral neck fractures. For patients with Pauwels type III femoral neck fracture or with proximal femoral medial wall defect and severe osteoporosis, the treatment effect of the above three semi-threaded cannulated screws and inverted triangle parallel fixation is not exact, and there are many complications. Therefore, the current treatment There is no unified "gold standard". Especially for Pauwels (Pauwels) III femoral neck fracture patients, because of the shear force S caused by the highly vertical (≥50°) fracture line, they face higher complications after cannulated screw fixation, such as femoral fractures. Osteonecrosis, nonunion, shortening of the femoral neck, coxa varus deformity, etc., have brought a heavy burden to patients and society.

实用新型内容Utility model content

本实用新型的目的是为了克服现有技术中的不足,提供一种可提高股骨近端骨折的治疗效果的接骨板。The purpose of the utility model is to overcome the deficiencies in the prior art and provide a bone plate that can improve the therapeutic effect of the proximal femur fracture.

为实现以上目的,本实用新型通过以下技术方案实现:In order to achieve the above purpose, the utility model realizes through the following technical solutions:

一种股骨近端接骨板,包括支撑板,所述支撑板的至少部分沿其长度方向弯曲,所述支撑板的凸向一侧经配置与股骨近端的内侧面贴合;所述接骨板还包括锁定板,所述锁定板自所述支撑板的长边一侧向所述支撑板沿其长度方向弯曲的凸向一侧延伸,所述锁定板经配置与股骨近端的前面贴合。A proximal femur bone plate, comprising a support plate, at least a part of the support plate is bent along its length direction, the convex side of the support plate is configured to fit with the inner side of the proximal femur; the bone plate Also includes a locking plate extending from a long side of the support plate to a convex side where the support plate is bent along its length, the locking plate being configured to fit against the anterior face of the proximal femur .

优选地是,所述支撑板沿其长度方向弯曲,该弯曲的曲率半径沿其长度方向渐变,渐变的曲率半径渐变的起始点和终点落在0.3-125cm范围内。Preferably, the support plate is curved along its length direction, the curvature radius of the curvature is gradually changed along its length direction, and the starting point and the end point of the gradual curvature radius are within the range of 0.3-125 cm.

优选地是,所述支撑板包括近端部分和远端部分,所述近端部分沿所述支撑板的长度方向弯曲的曲率半径为0.3-8cm,所述远端部分沿所述支撑板的长度方向弯曲的曲率半径为 8-35cm,所述近端部分和所述远端部分沿所述支撑板的长度方向光滑连接;所述锁定板自所述远端部分的长边一侧向所述远端部分的凸向一侧延伸。Preferably, the support plate includes a proximal portion and a distal portion, the proximal portion has a curvature radius of 0.3-8 cm along the length direction of the support plate, and the distal portion is along the length of the support plate. The curvature radius of the bending in the length direction is 8-35cm, and the proximal end portion and the distal end portion are smoothly connected along the length direction of the support plate; The convex portion of the distal end portion extends to one side.

优选地是,所述支撑板的至少部分沿其宽度方向弯曲,沿宽度方向的弯曲方向与沿长度方向的弯曲方向相反;所述支撑板上沿其宽度方向弯曲的面为光滑曲面;所述支撑板沿其宽度方向的弯曲的曲率半径在0.7-4.3cm范围内。Preferably, at least part of the support plate is bent along its width direction, and the bending direction along the width direction is opposite to the bending direction along the length direction; the curved surface of the support plate along its width direction is a smooth curved surface; the The curvature radius of the bending of the support plate along its width direction is in the range of 0.7-4.3 cm.

优选地是,所述远端部分上远离所述近端部分的至少部分,沿所述支撑板的宽度方向保持平直或大体上平直。Preferably, at least a portion of the distal portion remote from the proximal portion remains flat or substantially flat along the width of the support plate.

优选地是,所述支撑板的长度为4-13cm,宽度为0.5-3cm,厚度为0.5-8mm。Preferably, the length of the support plate is 4-13 cm, the width is 0.5-3 cm, and the thickness is 0.5-8 mm.

优选地是,所述支撑板上贯穿有至少一个第一通孔,所述第一通孔沿所述支撑板的厚度方向延伸。Preferably, at least one first through hole penetrates through the support plate, and the first through hole extends along the thickness direction of the support plate.

优选地是,所述第一通孔的径向截面为圆形、椭圆形或“8”字形;所述第一通孔的径向尺寸为0.5-4.5mm,数量为1-7个。Preferably, the radial cross section of the first through hole is circular, oval or "8"-shaped; the radial dimension of the first through hole is 0.5-4.5 mm, and the number is 1-7.

优选地是,所述锁定板上贯穿有至少两个第二通孔,所述第二通孔沿所述锁定板的厚度方向延伸。Preferably, at least two second through holes penetrate through the locking plate, and the second through holes extend along the thickness direction of the locking plate.

优选地是,所述第二通孔包括至少一个径向尺寸为2.5-5mm的通孔,所述径向尺寸为 2.5-5mm的通孔的数量为2-5个;所述第二通孔还包括至少一个径向尺寸为0.5-3mm的通孔,所述径向尺寸为0.5-3mm的通孔的数量为1-6个。Preferably, the second through hole includes at least one through hole with a radial dimension of 2.5-5 mm, and the number of the through holes with a radial dimension of 2.5-5 mm is 2-5; the second through hole It also includes at least one through hole with a radial size of 0.5-3 mm, and the number of the through holes with a radial size of 0.5-3 mm is 1-6.

优选地是,所述锁定板与所述支撑板的夹角为70-140°;所述锁定板的长度为1-6cm,宽度为0.5-5cm,厚度为0.5-8mm。Preferably, the included angle between the locking plate and the supporting plate is 70-140°; the length of the locking plate is 1-6 cm, the width is 0.5-5 cm, and the thickness is 0.5-8 mm.

优选地是,所述锁定板的尺寸满足将所述锁定板贴合在所述股骨近端的前面时,所述锁定板的覆盖区域不包括用于固定骨折端的钉子所在的区域。Preferably, the size of the locking plate is such that when the locking plate is fitted in front of the proximal end of the femur, the coverage area of the locking plate does not include the area where the nails used to fix the fracture end are located.

本实用新型提供的股骨近端接骨板,在不违背骨折端滑动加压固定原理的前提下,解决了股骨近端内侧有效支撑和股骨近端内侧置入螺钉固定困难等问题,可协助骨折部位解剖复位,抵抗骨折端剪切力,将剪切力转化为压应力,提高股骨颈骨折和股骨粗隆间骨折等股骨近端骨折的治疗效果,增加保髋治疗的成功率。The femoral proximal end bone plate provided by the utility model solves the problems of effective support on the inner side of the proximal femur and difficulty in placing screws on the inner side of the proximal femur, and can assist the fracture site on the premise of not violating the principle of sliding compression and fixation of the fracture end. Anatomical reduction can resist the shear force of the fracture end, convert the shear force into compressive stress, improve the treatment effect of proximal femoral fractures such as femoral neck fractures and intertrochanteric fractures, and increase the success rate of hip preservation treatment.

附图说明Description of drawings

图1为股骨颈骨折示意图;Figure 1 is a schematic diagram of a femoral neck fracture;

图2为本实用新型中的股骨近端接骨板的结构主视图;Fig. 2 is the structural front view of the proximal femoral bone plate in the utility model;

图3为图2所示结构的另一角度示意图;Fig. 3 is another perspective schematic diagram of the structure shown in Fig. 2;

图4为图2所示结构的另一角度示意图;Fig. 4 is another perspective schematic diagram of the structure shown in Fig. 2;

图5为本实用新型中的股骨近端接骨板安装在股骨颈骨折上的示意图;5 is a schematic view of the proximal femoral bone plate in the utility model being installed on the femoral neck fracture;

图6为本实用新型中的股骨近端接骨板安装在股骨粗隆间骨折上的示意图Figure 6 is a schematic view of the proximal femoral bone plate in the utility model installed on the intertrochanteric fracture of the femur

图7为将空心钉置入股骨的示意图;Fig. 7 is the schematic diagram of inserting the cannulated screw into the femur;

图8为仅将支撑板安装在股骨上的示意图。Figure 8 is a schematic view of the mounting of the support plate on the femur only.

具体实施方式Detailed ways

下面结合附图对本实用新型进行详细的描述:Below in conjunction with accompanying drawing, the utility model is described in detail:

如图2-4所示,股骨近端接骨板10包括支撑板12和锁定板14。其中,支撑板12的至少部分沿其长度方向L弯曲,锁定板14自支撑板12的长边121一侧向支撑板12沿其长度方向L弯曲的凸向一侧E延伸。As shown in FIGS. 2-4 , the proximal femoral plate 10 includes a support plate 12 and a locking plate 14 . Wherein, at least part of the support plate 12 is bent along its length direction L, and the locking plate 14 extends from the long side 121 side of the support plate 12 to the convex side E of the support plate 12 along its length direction L.

具体的,支撑板12的长度为4-13cm,宽度为0.5-3cm,厚度为0.5-8mm。支撑板沿其长度方向弯曲,该弯曲的曲率半径沿其长度方向渐变,渐变的曲率半径渐变的起始点和终点落在0.3-125cm范围内。Specifically, the length of the support plate 12 is 4-13 cm, the width is 0.5-3 cm, and the thickness is 0.5-8 mm. The support plate is curved along its length direction, the curvature radius of the curvature is gradually changed along its length direction, and the starting point and the end point of the gradual curvature radius gradient fall within the range of 0.3-125 cm.

支撑板12可以包括近端部分123和远端部分125,近端部分123沿支撑板12的长度方向L弯曲的曲率半径为0.3-8cm,远端部分125沿支撑板12的长度方向L弯曲的曲率半径为8-35cm,近端部分123和远端部分125沿支撑板12的长度方向L光滑连接。The support plate 12 may include a proximal end portion 123 and a distal end portion 125, the proximal end portion 123 is curved along the length direction L of the support plate 12 with a radius of curvature of 0.3-8 cm, and the distal portion 125 is curved along the length direction L of the support plate 12. The radius of curvature is 8-35 cm, and the proximal portion 123 and the distal portion 125 are smoothly connected along the length direction L of the support plate 12 .

支撑板12的至少部分沿其宽度方向M弯曲,沿宽度方向M的弯曲方向与沿长度方向L的弯曲方向相反。支撑板12上沿其宽度方向弯曲的面为光滑曲面,支撑板12沿其宽度方向M 的弯曲的曲率半径在0.7-4.3cm范围内,该曲率半径呈渐变势态。远端部分125上远离近端部分123的至少部分,沿支撑板12的宽度方向M保持平直或大体上平直。At least a portion of the support plate 12 is bent in the width direction M thereof, and the bending direction in the width direction M is opposite to the bending direction in the length direction L. As shown in FIG. The curved surface of the support plate 12 along its width direction is a smooth curved surface, the curvature radius of the support plate 12 along its width direction M is in the range of 0.7-4.3 cm, and the curvature radius is in a gradual state. At least a portion of the distal portion 125 away from the proximal portion 123 remains straight or substantially straight along the width direction M of the support plate 12 .

具体的,本实施例的优选方案,近端部分123自其端部1231沿支撑板12的长度方向L 延伸不低于三分之二的近端部分123的部分,沿支撑板12的宽度方向M弯曲,该部分沿支撑板12的宽度方向M弯曲的曲率半径为0.7-4.3cm。远端部分125自其端部1251沿支撑板12的长度方向L延伸不低于三分之一的远端部分的部分,沿支撑板12的宽度方向M保持平直或大体上平直。Specifically, in the preferred solution of this embodiment, the proximal portion 123 extends from its end portion 1231 along the length direction L of the support plate 12 not less than two-thirds of the portion of the proximal portion 123 along the width direction of the support plate 12 . M is curved, and the curvature radius of this part along the width direction M of the support plate 12 is 0.7-4.3 cm. The distal portion 125 extends from its end 1251 along the length direction L of the support plate 12 by not less than one third of the portion of the distal portion, remaining straight or substantially straight along the width direction M of the support plate 12 .

支撑板12上贯穿有至少一个第一通孔127,第一通孔127沿支撑板12的厚度方向N延伸。第一通孔127的径向截面为圆形、椭圆形或“8”字形,径向截面的径向尺寸,即圆形的直径、椭圆的长轴和短轴、或“8”字形的圆形直径,为0.5-4.5mm,第一通孔127的数量为 1-7个。第一通孔127为用于供克氏针或临时螺钉贯穿后将支撑板12固定在股骨近端上的孔,或是用于分散应力的孔。其中,临时螺钉同克氏针的用途相同,均用于在手术中临时将股骨近端接骨板10稳固在股骨上,待接骨板10被螺钉(普通的螺钉或特殊的螺钉,其中特殊的螺钉可以为本领域常用的锁定螺钉)固定后,再将其取出。At least one first through hole 127 penetrates through the support plate 12 , and the first through hole 127 extends along the thickness direction N of the support plate 12 . The radial cross-section of the first through hole 127 is a circle, an ellipse or an "8" shape, and the radial dimension of the radial cross-section is the diameter of the circle, the major and minor axes of the ellipse, or the "8"-shaped circle. The diameter of the shape is 0.5-4.5mm, and the number of the first through holes 127 is 1-7. The first through hole 127 is a hole for fixing the support plate 12 on the proximal end of the femur after the Kirschner wire or temporary screw is passed through, or a hole for dispersing stress. Among them, the purpose of the temporary screw is the same as that of the Kirschner wire, and both are used to temporarily stabilize the proximal femoral plate 10 on the femur during the operation. It can be fixed with a locking screw commonly used in the field, and then taken out.

锁定板14为平直或大体上平直的板,长度为1-5cm,宽度为0.5-5cm,厚度为0.5-8mm。锁定板14自远端部分125的长边1253一侧向远端部分125沿支撑板12的长度方向L弯曲的凸向一侧E延伸。锁定板14与远端部分125之间的夹角α可根据股骨的内侧面25向前面26的过渡区域的角度设定,以股骨颈骨折为例,锁定板14与远端部分125之间的夹角α可设定为70-140°,以确保锁定板14贴合股骨近端的前面26。The locking plate 14 is a flat or substantially flat plate with a length of 1-5 cm, a width of 0.5-5 cm, and a thickness of 0.5-8 mm. The locking plate 14 extends from the long side 1253 side of the distal end portion 125 to the convex side E of the distal end portion 125 bent along the length direction L of the support plate 12 . The included angle α between the locking plate 14 and the distal portion 125 can be set according to the angle of the transition area from the medial side 25 to the anterior 26 of the femur. Taking femoral neck fracture as an example, the angle between the locking plate 14 and the distal portion 125 is The included angle α can be set at 70-140° to ensure that the locking plate 14 fits the anterior surface 26 of the proximal femur.

锁定板14上贯穿有第二通孔,第二通孔沿锁定板14的厚度方向H延伸。第二通孔至少包括一种尺寸,即径向尺寸,例如圆形切面的直径为2.5-5mm的通孔143,以供螺钉贯穿后将锁定板14固定在股骨上,数量为2-5个。第二通孔还可包括另一种尺寸,例如圆形切面的直径为0.5-3mm的通孔141,以供克氏针贯穿并刺入股骨内,数量为0-6个。A second through hole extends through the locking plate 14 along the thickness direction H of the locking plate 14 . The second through hole includes at least one dimension, that is, a radial dimension, for example, a through hole 143 with a diameter of 2.5-5mm in a circular section, for fixing the locking plate 14 on the femur after the screw penetrates through, and the number is 2-5 . The second through hole may also include another size, such as a through hole 141 with a circular cut surface and a diameter of 0.5-3 mm, for the Kirschner wire to penetrate and penetrate into the femur, and the number is 0-6.

上述支撑板的曲率半径、长度、宽度等取值,可根据接受手术的病人的股骨的实际的尺寸进行调整,符合人体工程学原理。The values of the curvature radius, length, width, etc. of the above-mentioned support plate can be adjusted according to the actual size of the femur of the patient undergoing surgery, which conforms to the ergonomic principle.

股骨近端接骨板10可采用可吸收的生物合成材料或者不可吸收的不锈钢、医用纯钛、钛合金等制作。The proximal femoral bone plate 10 can be made of absorbable biosynthetic materials or non-absorbable stainless steel, medical pure titanium, titanium alloy, and the like.

如图5所示,股骨近端20具有股骨头21、股骨颈22、大粗隆23和小粗隆24。其中,股骨近端20弯曲的凹向一侧的表面为内侧面25,内侧面25位于人体的大腿内侧;股骨近端 20的前面26位于人体的大腿前侧。将股骨近端接骨板10安装配置在股骨近端20上时,以股骨颈骨折为例(如图5所示),支撑板12的凸向一侧E与股骨近端20的内侧面25贴合,以从内侧面25一侧托住股骨颈22处的骨折线201处,锁定板14与股骨近端20的前面26贴合,锁定板14的靠近股骨颈22一侧的边缘145紧贴股骨粗隆间线27的靠近小粗隆24的一端;以股骨粗隆间骨折为例(如图6所示),支撑板12的凸向一侧E与股骨近端20的内侧面 25贴合,以从内侧面25一侧托住股骨粗隆间线202处,锁定板14与股骨近端20的前面26 贴合,锁定板14的靠近股骨颈22一侧的边缘145紧贴股骨粗隆间线27的靠近小粗隆24的一端。As shown in FIG. 5 , the proximal femur 20 has a femoral head 21 , a femoral neck 22 , a greater trochanter 23 and a lesser trochanter 24 . Wherein, the curved concave side surface of the proximal femur 20 is the inner side 25, and the inner side 25 is located on the inner side of the thigh of the human body; the front 26 of the proximal femur 20 is located on the front side of the thigh of the human body. When the proximal femoral plate 10 is installed on the proximal femur 20, taking the femoral neck fracture as an example (as shown in FIG. 5), the convex side E of the support plate 12 is attached to the medial side 25 of the proximal femur 20. to support the fracture line 201 at the femoral neck 22 from the medial side 25 side, the locking plate 14 is in close contact with the front face 26 of the proximal femur 20, and the edge 145 of the locking plate 14 on the side close to the femoral neck 22 is in close contact The end of the femoral intertrochanteric line 27 close to the lesser trochanter 24; taking the intertrochanteric fracture as an example (as shown in Figure 6), the convex side E of the support plate 12 is attached to the medial side 25 of the proximal femur 20 to hold the femoral intertrochanteric line 202 from the medial side 25 side, the locking plate 14 fits with the anterior surface 26 of the proximal femur 20, and the edge 145 of the locking plate 14 on the side close to the femoral neck 22 is close to the femoral thickness The end of the intercarina 27 close to the minor trochanter 24 .

如图7所示,传统的仅通过三枚平行空心钉31的方式固定股骨颈骨折的股骨近端,虽然满足骨折端可滑动加压的原理,即股骨头21沿空心钉31轴向施压以帮助愈合,但对于股骨颈骨折患者,尤其是波伟尔斯(Pauwels)III型股骨颈骨折患者,很难克服其高度垂直向 (≥50°)的骨折线造成的剪切力S,会使空心钉31沿剪切力S的方向移位,导致错位,从而引发如股骨头坏死、骨不连、股骨颈短缩、髋内翻畸形、空心钉31穿出等并发症。As shown in FIG. 7 , the traditional method of fixing the proximal femur of the femoral neck fracture is only through three parallel cannulated screws 31 , although the principle of sliding pressure on the fracture end is satisfied, that is, the femoral head 21 is pressed axially along the hollow screws 31 . To aid healing, but for patients with femoral neck fractures, especially Pauwels type III femoral neck fractures, it is difficult to overcome the shear force S caused by their highly vertical (≥50°) fracture line, which will The cannulated nail 31 is displaced in the direction of the shearing force S, resulting in dislocation, thereby causing complications such as necrosis of the femoral head, nonunion, shortening of the femoral neck, coxa varus deformity, and penetration of the cannulated nail 31 .

相比之下,采用股骨近端接骨板10来辅助治疗股骨近端骨折,在置入三枚平行空心钉 31的基础上,即在不违背骨折端滑动加压原理的前提下,通过股骨近端接骨板10的支撑板 12在骨折线处对骨折处进行支撑,以对抗沿骨折线方向的剪切力S,减小或消除由剪切力S 存在所带来的沿骨折线方向的位移,并通过将锁定板14固定在股骨近端20上的位于骨折线远离股骨头21的一侧,以将股骨近端接骨板10固定在股骨近端20上,从而避免错位引发的并发症,提高术后愈合效果。In contrast, the proximal femoral plate 10 is used to assist in the treatment of proximal femoral fractures. On the basis of placing three parallel cannulated screws 31, that is, on the premise of not violating the principle of sliding compression of the fracture end, the proximal femur is passed through the proximal femur. The support plate 12 of the terminated bone plate 10 supports the fracture at the fracture line to resist the shear force S along the fracture line, reducing or eliminating the displacement along the fracture line caused by the presence of the shear force S , and fix the proximal femoral plate 10 on the proximal femur 20 by fixing the locking plate 14 on the side of the proximal femur 20, which is located on the side of the fracture line away from the femoral head 21, so as to avoid complications caused by dislocation, Improve postoperative healing effect.

如图8所示,若股骨近端接骨板10仅具有支撑板12部分,则需要通过从支撑板12处置入螺钉32以将股骨近端接骨板10固定在股骨近端20上。由于支撑板12与股骨近端20的内侧面25贴合,螺钉32的置入方向是人体的大腿内侧,术中患者的腿需要摆成4字型,而且该处有很多肌肉、神经、血管和韧带,因此,通过在支撑板12处置入螺钉32以固定股骨近端接骨板10需要克服很多困难,置入难度较大,对手术的要求较高。另一方面,从支撑板 12处置入的螺钉32必然限制了股骨头21沿空心钉31轴向的移动,不再符合骨折端滑动加压原理,使骨折端无法愈合,最后引起内固定物失效。As shown in FIG. 8 , if the proximal femoral plate 10 has only a portion of the support plate 12 , it is necessary to fix the proximal femoral plate 10 to the proximal femur 20 by inserting screws 32 from the support plate 12 . Since the support plate 12 is in contact with the inner surface 25 of the proximal femur 20, the screw 32 is placed in the inner thigh of the human body. During the operation, the patient's leg needs to be placed in a figure-4 shape, and there are many muscles, nerves, and blood vessels there. Therefore, many difficulties need to be overcome to fix the proximal femoral bone plate 10 by inserting screws 32 into the support plate 12, the insertion difficulty is relatively high, and the operation requirements are relatively high. On the other hand, the screw 32 disposed from the support plate 12 must limit the axial movement of the femoral head 21 along the cannulated screw 31, which no longer conforms to the principle of sliding and compression of the fracture end, so that the fracture end cannot be healed, and finally the internal fixator fails. .

相比之下,采用股骨近端接骨板10来辅助治疗股骨近端骨折,用于将接骨板10固定在股骨近端20上的螺钉是从锁定板14处置入股骨近端20,置入方向是从患者的大腿前面,术中人体保持正常的仰卧位即可,且该处位于股骨近端20的前侧,无肌肉、神经、血管和韧带的阻挡,置入方式简化,手术难度降低。将螺钉大体上垂直于用于固定骨折端(如股骨头21) 的钉子(如图5所示,用于固定股骨颈骨折的骨折端时,钉子包括三枚平行空心钉31;如图 6所示,用于固定股骨粗隆间骨折的骨折端时,钉子包括螺旋刀片33和髓内钉34;采用上述钉子固定骨折端为本领域常规手段,在此不做赘述)所在面的方向置入股骨近端20,在空心钉31或螺旋刀片33的轴向不会产生位移限制,股骨头21仍可沿空心钉31或螺旋刀片33的轴向移动产生有利于骨折处愈合的压力,即满足骨折端滑动加压原理。进一步的,可通过设定锁定板14的尺寸,使其满足将锁定板14贴合在股骨近端20的前面26时,锁定板14的覆盖区域不包括空心钉31或螺旋刀片33、及髓内钉34所在的区域,有效避免螺钉与用于固定骨折端的钉子之间发生碰撞。In contrast, the proximal femoral plate 10 is used to assist in the treatment of proximal femoral fractures. The screws used to secure the plate 10 to the proximal femur 20 are placed from the locking plate 14 into the proximal femur 20. The direction of placement It is from the front of the patient's thigh, and the human body can maintain a normal supine position during the operation, and this place is located on the anterior side of the proximal femur 20, without the obstruction of muscles, nerves, blood vessels and ligaments, the insertion method is simplified, and the difficulty of the operation is reduced. Place the screw substantially perpendicular to the nail used to fix the fracture end (such as the femoral head 21) (as shown in Figure 5, when used to fix the fracture end of the femoral neck fracture, the nail includes three parallel cannulated nails 31; as shown in Figure 6). shown, when used for fixing the fracture end of the intertrochanteric fracture of the femur, the nail includes a helical blade 33 and an intramedullary nail 34; using the above-mentioned nail to fix the fracture end is a conventional means in this area, and will not be repeated here) The direction of the face is placed The proximal femoral end 20 does not have any displacement restriction in the axial direction of the cannulated screw 31 or the helical blade 33, and the femoral head 21 can still move along the axial direction of the cannulated screw 31 or the helical blade 33 to generate a pressure that is conducive to the healing of the fracture, that is to say: The principle of sliding compression at the fracture end. Further, the size of the locking plate 14 can be set so that when the locking plate 14 is attached to the anterior surface 26 of the proximal femur 20, the coverage area of the locking plate 14 does not include the cannulated nail 31 or the helical blade 33, and the marrow. The area where the inner nail 34 is located can effectively avoid the collision between the screw and the nail for fixing the fracture end.

采用本实施例提供的股骨近端接骨板10辅助治疗股骨颈骨折,可以使得失效所需能量增加183%,内固定后的股骨的整体强度增加35%,空心钉31辅助股骨近端接骨板10的生物力学强度最强。其中失效主要是指内固定物固定失败,内固定物包括股骨近端接骨板10和空心钉31等,比如内固定物断裂、退出等。失效的原因主要是在骨折愈合之前,内固定物发生疲劳断裂,或者内固定物固定骨折以后导致应力集中在内固定物的某一点或某些地方,引起内固定物断裂、退出等,理想情况是应力分散在股骨近端接骨板10上。Using the proximal femoral plate 10 provided in this embodiment to assist in the treatment of femoral neck fractures, the energy required for failure can be increased by 183%, and the overall strength of the femur after internal fixation can be increased by 35%. The cannulated screw 31 assists the proximal femoral plate 10 the strongest biomechanical strength. The failure mainly refers to the failure of fixation of the internal fixator, and the internal fixator includes the proximal femoral bone plate 10 and the hollow screw 31, etc., for example, the internal fixator is broken or withdrawn. The main reason for the failure is that the internal fixator is fatigued and fractured before the fracture heals, or after the internal fixator fixes the fracture, the stress is concentrated on a certain point or some place of the internal fixator, causing the internal fixator to break and withdraw, etc. Ideally It is the stress distribution on the proximal femoral plate 10.

本实施例提供的股骨近端接骨板10,①其骨折解剖复位:患者在无需牵引床的情况下,采用改良直接前方入路(Smith-Peterson入路,又称Direct Anterior Approach,DAA)暴露股骨颈,以股骨近端接骨板10为复位模板,利用克氏针(ScanZ针)协助达到骨折端解剖复位;②其生物学固定:股骨近端接骨板10只需在股骨近端20前面26,即锁定板14处置入2枚用于固定接骨板10的螺钉进行4层皮质坚强固定,避免内侧面25置入螺钉需改变体位,如下肢保持4字体位,及对空心钉31或髓内钉的影响,同时通过支撑板12的内侧支撑减少或消除在骨折线处由骨折端的剪切力S带来的位移,整个设计不违背空心钉滑动加压原理或股骨近端髓内钉亚洲型(PFNA)髓内固定技术原理,使骨折达到生物学固定;③其保护血供:股骨近端接骨板10置入需切开关节囊,可对股骨头21进行减压;由于旋股内侧动脉是供应股骨头的最重要血供来源,旋股内、外侧动脉之间并无交通支,采用直接前面26入路方法放置股骨近端接骨板10虽然切断旋股外侧动脉,但对股骨头21血供并无影响;股骨近端接骨板10协助骨折达到解剖复位,避免牵引床下反复牵拉,软组织激惹少;④其手术操作优势:患者全程只需在仰卧位下完成手术,减少手术步骤、缩短手术时间,减少感染机会;接骨板的使用无需特殊器械,操作简单,可重复性高,基层医院即可开展;改良直接前方入路(Smith-Peterson入路)技术成熟,利用阔筋膜张肌和缝匠肌的肌间隙进入,损伤小,恢复快。In the proximal femoral bone plate 10 provided in this example, ① its fracture anatomical reduction: the patient uses a modified direct anterior approach (Smith-Peterson approach, also known as Direct Anterior Approach, DAA) to expose the femur without a traction bed For the neck, the proximal femur plate 10 is used as the reduction template, and Kirschner wire (ScanZ needle) is used to assist the anatomical reduction of the fracture end; ② its biological fixation: the proximal femur plate 10 only needs to be placed in front of the proximal femur 20 26 , That is, the locking plate 14 is placed with 2 screws for fixing the bone plate 10 for 4-layer cortical firm fixation, avoiding the need to change the body position when placing screws on the medial side 25. At the same time, the internal support of the support plate 12 reduces or eliminates the displacement caused by the shear force S of the fracture end at the fracture line. PFNA) The principle of intramedullary fixation technology can achieve biological fixation of fractures; 3. It protects blood supply: the proximal femoral bone plate 10 needs to be cut into the joint capsule, which can decompress the femoral head 21; because the medial circumflex femoral artery is a The most important source of blood supply to the femoral head, there is no communicating branch between the medial and lateral femoral circumflex arteries, and the proximal femoral plate is placed by the direct anterior 26 approach. The proximal femoral bone plate 10 assists the fracture to achieve anatomical reduction, avoids repeated traction under the traction bed, and reduces soft tissue irritation; ④The advantages of its surgical operation: the patient only needs to complete the operation in the supine position during the whole process, reducing the number of surgical steps, Shorten the operation time and reduce the chance of infection; the use of bone plate does not require special equipment, the operation is simple, the repeatability is high, and it can be carried out in primary hospitals; the improved direct anterior approach (Smith-Peterson approach) is mature in technology, using fascia lata to stretch The muscle space between the muscle and the sartorius enters the muscle, the damage is small, and the recovery is fast.

本实用新型中的实施例仅用于对本实用新型进行说明,并不构成对权利要求范围的限制,本领域内技术人员可以想到的其他实质上等同的替代,均在本实用新型保护范围内。The embodiments in the present utility model are only used to illustrate the present utility model, and do not constitute a limitation on the scope of the claims. Other substantially equivalent substitutions that can be thought of by those skilled in the art are all within the protection scope of the present utility model.

Claims (13)

1.一种股骨近端接骨板,其特征在于,包括支撑板,所述支撑板的至少部分沿其长度方向弯曲,所述支撑板的凸向一侧经配置与股骨近端的内侧面贴合;所述接骨板还包括锁定板,所述锁定板自所述支撑板的长边一侧向所述支撑板沿其长度方向弯曲的凸向一侧延伸,所述锁定板经配置与股骨近端的前面贴合。1. A proximal femoral bone plate, characterized in that it comprises a support plate, at least a part of the support plate is bent along its length direction, and a convex side of the support plate is configured to be attached to the medial side of the proximal femur. The bone plate further includes a locking plate extending from the long side of the support plate to the convex side where the support plate is bent along its length direction, the locking plate is configured with the femur Proximal front fit. 2.根据权利要求1所述的股骨近端接骨板,其特征在于,所述支撑板沿其长度方向弯曲,该弯曲的曲率半径沿其长度方向渐变,渐变的曲率半径渐变的起始点和终点落在0.3-125cm范围内。2 . The proximal femoral bone plate according to claim 1 , wherein the support plate is curved along its length direction, and the curvature radius of the curve is gradually changed along its length direction, and the starting point and the end point of the gradual curvature radius are gradually changed. 3 . falls within the range of 0.3-125cm. 3.根据权利要求2所述的股骨近端接骨板,其特征在于,所述支撑板包括近端部分和远端部分,所述近端部分沿所述支撑板的长度方向弯曲的曲率半径为0.3-8cm,所述远端部分沿所述支撑板的长度方向弯曲的曲率半径为8-35cm,所述近端部分和所述远端部分沿所述支撑板的长度方向光滑连接;所述锁定板自所述远端部分的长边一侧向所述远端部分的凸向一侧延伸。3. The proximal femoral bone plate according to claim 2, wherein the support plate comprises a proximal end portion and a distal end portion, and the proximal end portion is bent along the length direction of the support plate with a radius of curvature of 0.3-8cm, the radius of curvature of the distal part along the length direction of the support plate is 8-35cm, the proximal part and the distal part are smoothly connected along the length direction of the support plate; the The locking plate extends from the long side of the distal portion to the convex side of the distal portion. 4.根据权利要求2所述的股骨近端接骨板,其特征在于,所述支撑板的至少部分沿其宽度方向弯曲,沿宽度方向的弯曲方向与沿长度方向的弯曲方向相反;所述支撑板上沿其宽度方向弯曲的面为光滑曲面;所述支撑板沿其宽度方向的弯曲的曲率半径在0.7-4.3cm范围内。4. The proximal femoral bone plate according to claim 2, wherein at least part of the support plate is bent along its width direction, and the bending direction along the width direction is opposite to the bending direction along the length direction; the support plate The curved surface of the plate along its width direction is a smooth curved surface; the curvature radius of the support plate along its width direction is in the range of 0.7-4.3 cm. 5.根据权利要求3所述的股骨近端接骨板,其特征在于,所述支撑板的至少部分沿其宽度方向弯曲,沿宽度方向的弯曲方向与沿长度方向的弯曲方向相反;所述支撑板上沿其宽度方向弯曲的面为光滑曲面;所述支撑板沿其宽度方向的弯曲的曲率半径在0.7-4.3cm范围内。5. The proximal femoral bone plate according to claim 3, wherein at least part of the support plate is bent along its width direction, and the bending direction along the width direction is opposite to the bending direction along the length direction; the support plate The curved surface of the plate along its width direction is a smooth curved surface; the curvature radius of the support plate along its width direction is in the range of 0.7-4.3 cm. 6.根据权利要求5所述的股骨近端接骨板,其特征在于,所述远端部分上远离所述近端部分的至少部分,沿所述支撑板的宽度方向保持平直或大体上平直。6. The proximal femoral plate of claim 5, wherein at least a portion of the distal portion remote from the proximal portion remains flat or substantially flat along the width of the support plate straight. 7.根据权利要求1所述的股骨近端接骨板,其特征在于,所述支撑板的长度为4-13cm,宽度为0.5-3cm,厚度为0.5-8mm。7 . The proximal femoral bone plate according to claim 1 , wherein the support plate has a length of 4-13 cm, a width of 0.5-3 cm, and a thickness of 0.5-8 mm. 8 . 8.根据权利要求1所述的股骨近端接骨板,其特征在于,所述支撑板上贯穿有至少一个第一通孔,所述第一通孔沿所述支撑板的厚度方向延伸。8 . The proximal femoral bone plate according to claim 1 , wherein at least one first through hole penetrates through the support plate, and the first through hole extends along the thickness direction of the support plate. 9 . 9.根据权利要求8所述的股骨近端接骨板,其特征在于,所述第一通孔的径向截面为圆形、椭圆形或“8”字形;所述第一通孔的径向尺寸为0.5-4.5mm,数量为1-7个。9 . The proximal femoral bone plate according to claim 8 , wherein the radial cross-section of the first through hole is a circle, an ellipse, or an “8” shape; The size is 0.5-4.5mm, and the quantity is 1-7. 10.根据权利要求1所述的股骨近端接骨板,其特征在于,所述锁定板上贯穿有至少两个第二通孔,所述第二通孔沿所述锁定板的厚度方向延伸。10 . The proximal femoral bone plate according to claim 1 , wherein at least two second through holes penetrate through the locking plate, and the second through holes extend along the thickness direction of the locking plate. 11 . 11.根据权利要求10所述的股骨近端接骨板,其特征在于,所述第二通孔包括至少一个径向尺寸为2.5-5mm的通孔,所述径向尺寸为2.5-5mm的通孔的数量为2-5个;所述第二通孔还包括至少一个径向尺寸为0.5-3mm的通孔,所述径向尺寸为0.5-3mm的通孔的数量为1-6个。11. The proximal femoral bone plate according to claim 10, wherein the second through hole comprises at least one through hole with a radial size of 2.5-5 mm, and the through hole with a radial size of 2.5-5 mm The number of holes is 2-5; the second through hole further includes at least one through hole with a radial dimension of 0.5-3 mm, and the number of the through holes with a radial dimension of 0.5-3 mm is 1-6. 12.根据权利要求1所述的股骨近端接骨板,其特征在于,所述锁定板与所述支撑板的夹角为70-140°;所述锁定板的长度为1-6cm,宽度为0.5-5cm,厚度为0.5-8mm。12 . The proximal femoral bone plate according to claim 1 , wherein the included angle between the locking plate and the supporting plate is 70-140°; the length of the locking plate is 1-6 cm, and the width is 12. 12 . 0.5-5cm, thickness is 0.5-8mm. 13.根据权利要求1所述的股骨近端接骨板,其特征在于,所述锁定板的尺寸满足将所述锁定板贴合在所述股骨近端的前面时,所述锁定板的覆盖区域不包括用于固定骨折端的钉子所在的区域。13. The proximal femoral bone plate according to claim 1, wherein the size of the locking plate satisfies the coverage area of the locking plate when the locking plate is fitted in front of the proximal femur Does not include the area where the nails used to fix the fracture end are located.
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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109620381A (en) * 2019-01-30 2019-04-16 刘立峰 Near end of thighbone bone plate

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109620381A (en) * 2019-01-30 2019-04-16 刘立峰 Near end of thighbone bone plate
CN109620381B (en) * 2019-01-30 2024-11-08 上海伯塔医疗器械有限公司 Proximal Femoral Plate

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