JP5930506B2 - Femoral insertion nail - Google Patents
Femoral insertion nail Download PDFInfo
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- JP5930506B2 JP5930506B2 JP2010200678A JP2010200678A JP5930506B2 JP 5930506 B2 JP5930506 B2 JP 5930506B2 JP 2010200678 A JP2010200678 A JP 2010200678A JP 2010200678 A JP2010200678 A JP 2010200678A JP 5930506 B2 JP5930506 B2 JP 5930506B2
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- nail
- insertion hole
- lag screw
- femur
- concave surface
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- 238000003780 insertion Methods 0.000 title claims description 42
- 230000037431 insertion Effects 0.000 title claims description 42
- 210000000689 upper leg Anatomy 0.000 claims description 13
- 210000000988 bone and bone Anatomy 0.000 claims description 6
- 230000002093 peripheral effect Effects 0.000 claims description 6
- 235000013372 meat Nutrition 0.000 description 7
- 206010017076 Fracture Diseases 0.000 description 6
- 208000010392 Bone Fractures Diseases 0.000 description 5
- 230000007423 decrease Effects 0.000 description 2
- 238000005553 drilling Methods 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 230000035515 penetration Effects 0.000 description 2
- 241001391944 Commicarpus scandens Species 0.000 description 1
- 208000029725 Metabolic bone disease Diseases 0.000 description 1
- 229910001182 Mo alloy Inorganic materials 0.000 description 1
- RTAQQCXQSZGOHL-UHFFFAOYSA-N Titanium Chemical compound [Ti] RTAQQCXQSZGOHL-UHFFFAOYSA-N 0.000 description 1
- 230000037396 body weight Effects 0.000 description 1
- 238000005266 casting Methods 0.000 description 1
- VNTLIPZTSJSULJ-UHFFFAOYSA-N chromium molybdenum Chemical compound [Cr].[Mo] VNTLIPZTSJSULJ-UHFFFAOYSA-N 0.000 description 1
- 230000006835 compression Effects 0.000 description 1
- 238000007906 compression Methods 0.000 description 1
- 238000005336 cracking Methods 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 238000005242 forging Methods 0.000 description 1
- 210000000527 greater trochanter Anatomy 0.000 description 1
- 238000003754 machining Methods 0.000 description 1
- 229910052751 metal Inorganic materials 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 238000005096 rolling process Methods 0.000 description 1
- 238000007790 scraping Methods 0.000 description 1
- 238000010008 shearing Methods 0.000 description 1
- 239000010936 titanium Substances 0.000 description 1
- 229910052719 titanium Inorganic materials 0.000 description 1
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- Surgical Instruments (AREA)
Description
本発明は、大腿骨の転子部が骨折した場合の治療に用いる大腿骨挿入ネイルに関するものである。 The present invention relates to a femoral insertion nail used for treatment when a trochanter part of a femur has a fracture.
骨折治療の基本は、骨折面をある程度圧迫した状態で接合して固定しておくことであり、これは大腿骨であっても同様である。大腿骨の転子部には体重による大きな荷重が集中的にかかるとともに、頚部は骨頭から大転子にかけて急に細くなっていることもあって、特に、骨密度の低い高齢者で骨折し易い。この治療を行う際の固定器具として内固定具と外固定具とがあるが、大腿骨の近位部では部位的に外固定が難しいこともあり、ほとんどの場合、内固定具が用いられている。 The basics of fracture treatment are to join and fix the fracture surface in a state of being pressed to some extent, and this is the same for the femur. The trochanter of the femur is heavily loaded with weight, and the neck is sharply narrowed from the head to the greater trochanter, making it easy to break, especially in elderly people with low bone density . There are an internal fixture and an external fixture as the fixtures for this treatment. However, it is sometimes difficult to fix externally at the proximal part of the femur, and in most cases the internal fixture is used. Yes.
この場合の内固定具とは、大腿骨挿入ネイル（以下、ネイル）と称される心棒を大腿骨の髄腔に近位端から骨軸に沿って所定深さ挿入し、ネイルの特定位置に、ネイルを回旋可能に固定した場合、左右方向に骨頭に向けて斜め上方（水平から約３０°）の挿通孔を形成し、この挿通孔にネイルの外側からラグスクリューと称されるネジ棒を骨折面を通過させて骨頭の中まで侵入させ、ラグスクリューを基端側に引き寄せて骨折面を圧迫するものである。 In this case, the internal fixation means that a mandrel called a femoral insertion nail (hereinafter referred to as a nail) is inserted into the medullary cavity of the femur to a specific depth along the bone axis from the proximal end to a specific position of the nail. When the nail is fixed so that it can be rotated, an insertion hole obliquely upward (about 30 ° from the horizontal) is formed in the left-right direction toward the head of the head, and a screw rod called a lag screw is inserted into the insertion hole from the outside of the nail. It passes through the fracture surface and penetrates into the bone head, and pulls the lag screw toward the proximal end side to compress the fracture surface.
ところが、骨頭には体重による大きな荷重がかかるから、ラグスクリューにもそれが伝達され、ネイルとラグスクリューの挿通部に大きなモーメントが発生する。この場合、ネイルは髄腔内に強固に固定され、また、ラグスクリューはネイル内に設置してあるセットスクリューによって固定されているから、このモーメントは挿通孔の入口部では上方に、出口部では下方に共に圧縮荷重として作用し、中でも、挿通孔の入口部側が骨頭から遠いこともあって最大の圧縮荷重となる。 However, since a large load due to body weight is applied to the bone head, it is also transmitted to the lag screw, and a large moment is generated at the insertion portion between the nail and the lag screw. In this case, the nail is firmly fixed in the medullary cavity, and the lag screw is fixed by a set screw installed in the nail, so this moment is upward at the entrance portion of the insertion hole and at the exit portion. Both of them act as a compressive load in the downward direction, and in particular, the entrance portion side of the insertion hole is far from the head of the bone and becomes the maximum compressive load.
一方で、これら圧縮荷重はラグスクリューに剪断力として作用するが、ラグスクリューはある程度太くして強度を保てるが、ネイルについては、髄腔の大きさからあまり太いものにはできない。このため、ネイルの径に比べて挿通孔の径が相対的に大きくなり、挿通孔の前後に存するネイルの側肉部分は前後に薄く、しかも、左右に短いものになる。したがって、挿通孔の入口部と出口部にかかるそれぞれ上向きと下向きの圧縮荷重はこの側肉部分の圧力を相対的に高め、しかも、逆方向に増大されたネイルの軸方向の引張荷重として作用するから、この側肉部分が引っ張られて亀裂や破断を起こすことがある。 On the other hand, these compressive loads act as shearing force on the lag screw, but the lag screw can be thickened to some extent to maintain strength, but the nail cannot be made too thick due to the size of the medullary cavity. For this reason, the diameter of the insertion hole is relatively larger than the diameter of the nail, and the side wall portions of the nail existing before and after the insertion hole are thin in the front and rear, and are short in the left and right. Therefore, the upward and downward compressive loads applied to the inlet portion and the outlet portion of the insertion hole relatively increase the pressure of the side wall portion, and act as an axial tensile load of the nail increased in the opposite direction. Therefore, this side meat part may be pulled, causing cracks and breakage.
このため、種々の工夫が施されているが、下記特許文献１では、挿通孔の形状や面取りについて工夫されたものが提案されている。この先行例のものは、挿通孔の入口部及び／又は出口部の側縁部を中間に平坦部分を設けて上下端でアールにするとともに、入口部及び出口部の縁の全周をアールに面取りしたものと見受けられる。 For this reason, although various devices have been applied, the following Patent Document 1 proposes a device in which the shape and chamfering of the insertion hole are devised. In the preceding example, the side edge of the insertion hole and / or the outlet is provided with a flat portion in the middle and rounded at the upper and lower ends, and the entire circumference of the edge of the inlet and outlet is rounded. It appears to be chamfered.
こうすることで、特に、平坦部分の存在で応力集中を避けてネイルの疲労強さを高めることができるとしている（発明の効果の欄）。しかし、平坦部分を設けると、側肉部分の左右の長さ、すなわち、入口部と出口部の抉り量を上下端近くまで延長させることになるから、荷重を受ける側肉部分の容積が相対的に小さくなり、応力を高めて却って強度低下を招く。さらに、挿通孔の縁の小さなアールの面取りでは、この部分に応力を集中させてしまい、亀裂や破断の要因ともなる。 By doing this, it is said that the fatigue strength of the nail can be increased by avoiding stress concentration due to the presence of a flat portion (invention effect column). However, if a flat part is provided, the lateral length of the side meat part, that is, the amount of turning of the inlet and outlet parts will be extended to near the upper and lower ends. However, the stress is increased and the strength is decreased. Furthermore, in the case of a rounded chamfer with a small edge of the insertion hole, stress is concentrated on this portion, which causes a crack or breakage.
本発明は、ラグスクリューの挿通孔に大きな力がかかる入口部の凹面範囲を近位側にまで延長させることで、圧縮荷重を分散させ、結果的に側肉部分の引張応力を低減させて亀裂や破断を防止せんとしたものである。 The present invention extends the concave surface area of the inlet portion where a large force is applied to the insertion hole of the lag screw to the proximal side, thereby dispersing the compressive load and consequently reducing the tensile stress of the side wall portion and cracking. And prevents breakage.
以上の課題の下、本発明は、請求項１に記載した、大腿骨に近位側から挿入され、骨頭に向く傾斜でラグスクリューの挿通孔を形成した大腿骨挿入ネイルにおいて、挿通孔の入口部をその周縁を含んで凹曲面で抉るとともに、この凹曲面範囲を近位側にのみ延長したことを特徴とする大腿骨挿入ネイルを提供したものである。
Under the above object, the present invention is described in claim 1, is inserted from the proximal side to the femur, the femur insertion nail forming the insertion hole of the lag screw in an inclined facing the bone head, the input of the insertion hole The present invention provides a femoral insertion nail characterized in that the mouth is swollen with a concave curved surface including its peripheral edge and the concave curved surface range is extended only to the proximal side.
請求項１の発明によると、大きな力がかかるラグスクリューの挿通孔の入口部をその周縁を含んで凹曲面で抉ることによって力を全方位に分散できる。また、その凹曲面範囲(以下、凹面範囲)を近位側にのみ延長することで、最も大きな力(圧縮力)がかかる方向の力のみを効果的に分放させることができ、不必要な方向に凹曲面範囲を広げて強度を落とすこともない。
According to invention of Claim 1, force can be disperse | distributed to all directions by rolling the entrance part of the penetration hole of a lag screw to which a big force is applied on the concave curved surface including the periphery. In addition, by extending the concave curved surface range (hereinafter referred to as concave surface range) only to the proximal side, only the force in the direction where the greatest force (compression force) is applied can be effectively divided, which is unnecessary. It does not decrease the strength by expanding the concave curved surface range in the direction.
以下、本発明の実施の形態を図面を参照して説明するが、以下の説明で前後、上下、左右とあるのは、ネイルを挿入した大腿骨を正面から見たものを基準にしている。図１は右大腿骨におけるネイルとラグスクリューとの関係を示す前面図（通常、回旋を防ぐためにキー溝が施されているが、ここでは理解の容易のためにこのキー溝を省略している）、図２はネイルの外側面図、図３、図４はネイルの挿通孔部分の下方断面図、図５はネイルにラグスクリューを通した状態の前面図である。 Hereinafter, embodiments of the present invention will be described with reference to the drawings. In the following description, front and rear, top and bottom, and left and right are based on a frontal view of a femur into which a nail is inserted. FIG. 1 is a front view showing the relationship between a nail and a lag screw in the right femur (usually a keyway is provided to prevent rotation, but this keyway is omitted here for ease of understanding. 2 is an outer side view of the nail, FIGS. 3 and 4 are lower cross-sectional views of an insertion hole portion of the nail, and FIG. 5 is a front view of a state where a lag screw is passed through the nail.
図５に示すように、ネイル１は、大腿骨Ａの近位端側から髄腔内に挿入されるものであり、その頭部付近に右側方向に斜め上方に形成された挿入孔２からラグスクリュー３が大腿骨Ａの頚部Ｂを通って骨頭Ｃ内に挿入されるものである。この場合、生体に合わせて挿通孔２は先端側が約５°程度前方に向いている。なお、挿通孔２は精度を要することから、最終的にはリーマやホーニングによる機械加工で仕上げられるが、下孔は鋳造や鍛造又はドリルによる孔あけ加工で成形される。また、ネイル１及びラグスクリュー３ともにチタン、クロムモリブデン合金等の生体適合金属で製作される。さらに、ラグスクリュー３には回転防止のためのキー４が上面及び／又は下面に埋設されるが、これに伴って、挿通孔２にも当然にキー溝５が形成されている。 As shown in FIG. 5, the nail 1 is inserted into the medullary cavity from the proximal end side of the femur A, and the lug is inserted from the insertion hole 2 formed obliquely upward in the right direction near the head. The screw 3 is inserted into the head C through the neck B of the femur A. In this case, the distal end of the insertion hole 2 faces about 5 ° forward according to the living body. Since the insertion hole 2 requires accuracy, it is finally finished by machining by reamer or honing, but the lower hole is formed by casting, forging or drilling by drilling. Further, both the nail 1 and the lag screw 3 are made of a biocompatible metal such as titanium or chromium molybdenum alloy. Further, a key 4 for preventing rotation is embedded in the upper surface and / or the lower surface of the lag screw 3, and accordingly, a key groove 5 is naturally formed in the insertion hole 2.
これにおいて、挿通孔２はネイル１を貫通するため、その入口部２ａと出口部２ｂとは、前面方向からみると凹面（円弧）に形成されており、その最深点は挿通孔２の中心になる。本発明は、入口部２ａの凹面を周縁を含んで近位側６まで延長したものである。この場合、挿通孔２の特定のレベルでの下方断面を見てみると、入口部２ａの肉端は直線の場合（図３）と円弧状の場合とがある（図４）。 In this case, since the insertion hole 2 penetrates the nail 1, the inlet portion 2 a and the outlet portion 2 b are formed in a concave surface (arc) when viewed from the front direction, and the deepest point is at the center of the insertion hole 2. Become. In the present invention, the concave surface of the inlet portion 2a is extended to the proximal side 6 including the peripheral edge. In this case, looking at the lower cross section of the insertion hole 2 at a specific level, the meat end of the inlet portion 2a may be a straight line (FIG. 3) or an arc shape (FIG. 4).
ネイル１に挿通孔２を貫通させると前者の状態になるが、本発明では、その入口部２ａの凹面範囲をその周縁を含んで近位側６に延長するのである。延長部分は凹面の最深点より漸浅状にし、最深点は挿通孔２の入口部２ａの間、中でも、入口部２ａの上端付近が好ましい。その加工は、円筒形をしたカッター７で入口部２ａを浚えればよいが、その軌道を調整することで、凹面範囲を近位側６に延長できる。なお、周縁を含んでとあるのは、入口部２ａの全縁を含んでと言う意味であり、挿通孔２の中心から下方（遠位側）は面取りされることになる。 When the insertion hole 2 is passed through the nail 1, the former state is obtained, but in the present invention, the concave surface area of the inlet portion 2a is extended to the proximal side 6 including its peripheral edge. The extended portion is formed to be gradually shallower than the deepest point of the concave surface, and the deepest point is preferably between the inlet portions 2a of the insertion holes 2 and, particularly, near the upper end of the inlet portion 2a. The processing may be performed by holding the inlet portion 2a with a cylindrical cutter 7, but the concave surface range can be extended to the proximal side 6 by adjusting the trajectory. Including the peripheral edge means that the entire edge of the inlet portion 2a is included, and the lower side (distal side) of the insertion hole 2 is chamfered.
図１に示すように、ラグスクリュー３の骨頭Ｃ挿入個所には荷重Ｆがかかり、この荷重によって挿通孔２の入口部２ａには上向きの圧縮荷重がかかり、その上方にかけて漸小する圧縮応力が生ずる（出口部２ｃではこれと反対）。しかし、凹面範囲が近位側６に延長されることで、入口部２ａの上方域が曲面長となり、応力を減ずる。この意味から凹面範囲は長いほどよいことになるが、あまり長いと肉を削って却って強度を弱めることから、最大でも、挿通孔２の径程度が好ましいであろう。 As shown in FIG. 1, a load F is applied to the place where the head C of the lag screw 3 is inserted. Due to this load, an upward compressive load is applied to the inlet portion 2 a of the insertion hole 2, and a compressive stress gradually decreases upward. It occurs (the opposite is true at the outlet 2c). However, since the concave surface range is extended to the proximal side 6, the upper area of the inlet portion 2a becomes a curved surface length, and stress is reduced. In this sense, the longer the concave surface range, the better. However, if the length is too long, the strength is reduced by scraping the meat, so that the diameter of the insertion hole 2 is preferably at most.
一方、入口部２ａの側肉部分１ａの下方断面視をその周縁を含んで円弧（全体で言えば球面）状にすることも可能である。この場合は上記したカッターター７を球面形にすればよい。入口部２ａの下方断面視を円弧状にすると、その曲面長は二次元的に拡がり、応力の減少が大きい。なお、出口部２ｂについては、その凹面範囲を荷重方向である遠位側に延長することも考えられるが、一方では、側肉部分１ａの抉り量を大きくすることにもなって強度を低下させることにもなるから、通常は行わないことが多い。 On the other hand, the lower cross-sectional view of the side flesh portion 1a of the inlet portion 2a can be formed into an arc (spherical as a whole) including its peripheral edge. In this case, the above cutter cutter 7 may be formed into a spherical shape. When the lower sectional view of the inlet portion 2a is formed in an arc shape, the length of the curved surface is expanded two-dimensionally, and the reduction of stress is large. In addition, about the exit part 2b, although extending the concave surface range to the distal side which is a load direction is also considered, on the other hand, it also increases the amount of twisting of the side meat | floc part 1a, and reduces intensity | strength. In many cases, it is not usually done.
この他、挿通孔２の入口部２ａと出口部２ｂ及び入口部２ａの凹面加工が終了した後に曲面の交差部分等に稜線ができるようであれば、この稜線の部分を丸面取り等しておくのはいうまでもない。さらに、挿通孔２にキー溝５が必要なものについては、最後にスロッターのようなもので加工すればよい。 In addition, if the ridgeline is formed at the intersection of the curved surface after the concave surface processing of the inlet portion 2a and the outlet portion 2b and the inlet portion 2a of the insertion hole 2 is finished, the ridgeline portion is rounded or the like. Needless to say. Furthermore, what needs the keyway 5 in the insertion hole 2 may be finally processed with a slotter or the like.
以上により、側肉部分１ａの亀裂や破断の危険性が減ったのであるが、本発明者等は、本発明による効果をＦＥＭで解析してみた。それによると、挿通孔の入口部の凹面範囲を近位側まで延長したものによると、入口部を単純に面取りしたものや入口部の側縁の中央を前面視で平坦化にしたものに比べてや側肉部分の引張強度が約１２％向上したことを確認している。 Although the risk of cracks and fractures in the side meat portion 1a has been reduced as described above, the present inventors have analyzed the effect of the present invention with FEM. According to it, according to what extended the concave surface area of the entrance part of the insertion hole to the proximal side, compared with the one where the entrance part is simply chamfered or the center of the side edge of the entrance part is flattened in front view It has been confirmed that the tensile strength of the side meat part has improved by about 12%.
１ ネイル
１ａ ネイルの側肉部分
２ ラグスクリューの挿入孔
２ａ 〃 の入口部
２ｂ 〃 の出口部
３ ラグスクリュー
４ キー
５ キー溝
６ 近位側
７ カッター
DESCRIPTION OF SYMBOLS 1 Nail 1a Side wall part of nail 2 Insertion hole 2a ラ グ Inlet part 2b 入口 Outlet part 3 Lag screw 4 Key 5 Keyway 6 Proximal side 7 Cutter
Claims (1)
Is inserted from the proximal side to the femur, the femur insertion nail forming the insertion hole of the lag screw in an inclined facing the bone head, the inlet mouth of the insertion hole with gouging by the concave surface including the peripheral edge, the concave surface A femoral insertion nail characterized by extending the region only proximally.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2010200678A JP5930506B2 (en) | 2010-09-08 | 2010-09-08 | Femoral insertion nail |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2010200678A JP5930506B2 (en) | 2010-09-08 | 2010-09-08 | Femoral insertion nail |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JP2012055463A JP2012055463A (en) | 2012-03-22 |
| JP5930506B2 true JP5930506B2 (en) | 2016-06-08 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2010200678A Active JP5930506B2 (en) | 2010-09-08 | 2010-09-08 | Femoral insertion nail |
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| Country | Link |
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| JP (1) | JP5930506B2 (en) |
Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US9427266B2 (en) * | 2012-04-16 | 2016-08-30 | DePuy Synthes Products, Inc. | Bump cut on hole edge |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE20301902U1 (en) * | 2003-02-07 | 2003-05-15 | stryker Trauma GmbH, 24232 Schönkirchen | Locking nail, especially for proximal femur fractures |
| CN102176873A (en) * | 2008-10-15 | 2011-09-07 | 捷迈有限公司 | Intramedullary nail |
| US20110196372A1 (en) * | 2008-10-31 | 2011-08-11 | Robert Reid, Inc. | Bone Fixing Material and Thighbone Fixing System |
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2010
- 2010-09-08 JP JP2010200678A patent/JP5930506B2/en active Active
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| Publication number | Publication date |
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| JP2012055463A (en) | 2012-03-22 |
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