JP6426482B2 - Surgical instruments - Google Patents

Description

  The present invention relates to a surgical instrument, in particular, a surgical instrument for treating a fracture near a bony head of a bone provided with a femoral head such as a femur and a humerus.

  The bones of old people are often found to be fragile due to the progress of osteoporosis. In such a state, when an external force different from usual is applied to a bone provided with a bone head such as a femur and a humerus due to a fall or the like, the vicinity of the bone head of the bone may fracture.

  In recent years, as a method for treating such fractures in the vicinity of the bony head, an intramedullary nail (nail) inserted inside the bone along an axial direction of the bone, and a bone joint (lag) inserted through the intramedullary nail It has been proposed to use a surgical instrument (an instrument for fixation) provided with a screw) (see, for example, Patent Document 1).

  Here, the intramedullary nail is provided with a transverse hole (insertion hole) for inserting the bone fastener, which extends in a direction inclined in the axial direction, and this transverse hole is opened on both sides of the intramedullary nail ing. Then, the intramedullary nail is inserted into the inner side (lumen) along the axial direction of the bone from the end on the bone head side, and the osteosynthesis device is inserted into the intramedullary bone with its tip screwed into the bone head. The fracture site in the vicinity of the bony head is firmly fixed by inserting it through the transverse hole of the nail.

  However, as described above, since bone is weakened due to osteoporosis, an intramedullary nail is inserted into the bone from the end on the bone head side in the case of a fracture near the bone head or along the axial direction of the bone At this end, cracks may occur in the back wall or side wall along the axial direction of the bone. Therefore, due to this fissure, a part of the side wall or the back wall is exfoliated at the end on the bone head side, and as a result, there has been a problem that bone healing can not be smoothly performed in the exfoliated area.

JP 2012-55463 A

  The object of the present invention is to allow the fusion of bones in the area where the posterior wall or the side wall is exfoliated smoothly at the end of the bony side of the bone, and also to firmly fix the fracture site in the vicinity of the bony head It is in providing a surgical instrument.

Such an object is achieved by the present invention described in the following (1) to ( 4 ).
(1) A surgical instrument used to treat a fracture in the vicinity of a bone head of a bone provided with the bone head,
Intramedullary having an axial hole which is long and is used by being inserted into the medullary cavity of the bone and which is open at at least one end in the axial direction, and has an internal thread formed on the inner wall of one end of the axial hole With nails,
It is connected to one end of the main body, which is in contact with the bone, by being arranged in the form of a flat plate made of a long plate and arranged along the axial direction of the intramedullary nail A contact plate provided with a connecting portion provided with a through hole corresponding to the axial hole;
The insertion portion has a cylindrical shape and an external thread formed on the outer peripheral surface, and the axis of the insertion portion coincides with the axis of the intramedullary nail through the through hole of the contact plate. It said female screw of the intramedullary nail, by screwing the male screw of the insertion portion, possess a fastener for securing said contact plate in the intramedullary nail,
Prior to fixing the abutment plate to the intramedullary nail by the fastener, the abutment plate is configured to be pivotable about an axis of the intramedullary nail Appliance.

  According to the surgical instrument having such a configuration, it is possible to facilitate bone healing in the area in which a part of the back wall or the side wall is exfoliated at the end on the bone head side of the bone. In addition, the fracture site in the vicinity of the bone head can be firmly fixed.

( 2 ) The intramedullary nail is provided with a transverse hole that opens at both of its outer peripheral surfaces,
The surgical instrument according to the above (1) , further comprising a bone joint tool having a long shape and inserted through the cross hole.
Thereby, the fracture site near the bone head can be fixed.

( 3 ) The surgical instrument according to the above (1) or (2) , wherein the main body portion is used by being bent substantially along the shape of the bone with which the main body portion abuts.

  In this manner, the main body portion can be made to abut against the bone by being bent substantially along the shape of the bone abutted against the main body portion, so that the position before the abutted bone is exfoliated is better It can be arranged with high accuracy.

( 4 ) The surgical instrument according to any one of (1) to ( 3 ), wherein the bone is a femur and the surgical instrument is used for femoral neck fracture.

  The surgical instrument of the present invention is particularly preferably applied to the fixation of a fracture site of a femoral neck fracture in which the vicinity of the femoral head of the femur is fractured.

  According to the present invention, at the bone head end of the bone, the abutment plate provided on the surgical instrument is brought into contact with the area where the back wall or part of the side wall is detached, and the bone located in this area is It can be repositioned at the position before peeling. As a result, bone healing in this area is facilitated. Furthermore, the fracture site in the vicinity of the bony head can be firmly fixed by using the intramedullary nail and the bone joint provided in the surgical instrument.

It is a figure showing a 1st embodiment of a surgical instrument of the present invention. It is a figure which shows the state which fixed the fracture site | part of the femoral head vicinity of a femur with the surgical instrument shown in FIG. It is a longitudinal cross-sectional view which shows the state which fixed the fracture site | part of the femoral head vicinity of a femur with the surgical instrument shown in FIG. It is a figure which shows the contact | abutting board with which the surgical instrument shown in FIG. 1 is provided. It is a figure which shows the state which fixed the fracture site | part of the femoral head vicinity of the femur with 2nd Embodiment of the surgical instrument of this invention. It is a figure which shows the contact | abutting board with which the surgical instrument shown in FIG. 5 is provided. It is a figure which shows the state which fixed the fracture site | part of the femoral head vicinity of the femur with 3rd Embodiment of the surgical instrument of this invention.

Hereinafter, the surgical instrument of the present invention will be described in detail based on a preferred embodiment shown in the attached drawings.
In addition, below, the case where the surgical instrument of this invention is applied to treatment of the fracture (femoral neck fracture) in the bone head vicinity of a femur is demonstrated to an example.

First Embodiment
FIG. 1 shows a first embodiment of the surgical instrument according to the present invention (a perspective view, FIG. 2 b an exploded perspective view), and FIG. 2 shows the surgical instrument shown in FIG. The figure which shows the state which fixed the fracture site (a perspective view, (b) back view, (c) side view), FIG. 3 is a surgical instrument shown in FIG. The longitudinal cross-sectional view which shows the fixed state, FIG. 4 is a figure ((a) front view, (b) top view, (c) side view) which shows the contact plate with which the surgical instrument shown in FIG. 1 is equipped.

  In the following description, unless otherwise specified, the direction is specified on the basis of the state in which the fracture site of the patient's femur is fixed by the surgical instrument 100. That is, the ventral side of the patient is referred to as "front", the dorsal side as "rear", the head side of the patient as "upper", and the leg side of the patient as "lower". Further, in FIG. 3, the hatching on the femur is omitted for the convenience of description.

  In the present embodiment, as shown in FIG. 1 and FIG. 3, the surgical instrument 100 includes an intramedullary nail (nail) 101, a bone fastener (lag screw) 201, an abutment plate (plate) 301, and a fixture. (Fixing screw or end cap) 401 and engaging tool (set screw) 451 are included.

  The intramedullary nail 101 has an elongated overall shape, and is used by being inserted into the intramedullary cavity (lumen) of the femur 500.

  The intramedullary nail 101 comprises an axially proximal proximal portion 102 and a distal portion 103 extending distally continuously to the proximal portion 102.

  The intramedullary nail 101 is in communication with the proximal portion 102 and the distal portion 103 and has an axial hole 121 extending in its axial direction and opening at both ends. In the vicinity of the opening on the proximal portion 102 side of the axial hole 121, a female screw 122 is formed on the inner wall (inner surface). The axial hole 121 may be provided only on the proximal portion 102 side of the intramedullary nail 101 and may not communicate with the distal portion 103. That is, the distal portion 103 may be solid.

  Furthermore, the intramedullary nail 101 has a transverse hole 131 which penetrates the proximal portion 102 and which is open at both ends of the outer peripheral surface (side surface) of the proximal portion 102.

  The transverse hole 131 obliquely penetrates the intramedullary nail 101 so as to have an axis inclined with respect to the axial direction of the intramedullary nail 101. In this embodiment, the inclination angle of the cross hole 131 is such that when the intramedullary nail 101 is inserted into the intramedullary cavity of the femur 500, the bone fastener 201 can fix a fracture site near the femoral head of the femur. The inclination angle is set so as to substantially coincide with the angle between the axial direction of the femur 500 and the direction in which the bone head 502 projects from the femur 500. Thus, the inclination angle of the cross hole 131 is appropriately set according to the application site of the surgical instrument 100.

  The axial hole 121 is opened to the cross hole 131 in the middle of opening at both ends of the intramedullary nail 101, and the axial hole 121 and the cross hole 131 communicate with each other at this position. Furthermore, in this position, a female screw 123 is formed on the inner wall (inner surface) in the vicinity of the communication port on the proximal portion 102 side of the shaft hole 121.

  Furthermore, the intramedullary nail 101 has a transverse hole 141 which penetrates the distal portion 103 and which is open at both ends of the outer peripheral surface of the distal portion 103. The cross hole 141 is formed in a direction substantially orthogonal to the axial direction of the distal portion 103.

  The proximal part 102 and the distal part 103 may be integrally formed, or those separately provided are the base of the tip of the proximal part 102 and the base of the distal part 103. At the end, they may be joined by fitting, screwing or the like.

  Further, in the present invention, although it is not excluded that the intramedullary nail is provided with the artificial bone head, in the present embodiment, the femoral head 502 remains in the femur 500, and the intramedullary nail 101 is the artificial bone head. I do not prepare. There is also a type of surgical instrument provided with an artificial bone head, but this type of surgical instrument tends to enlarge the area near the artificial bone head in order to secure the strength near the artificial bone head which is subjected to a large load. Therefore, the rotation of the abutment plate (joint plate) to be described later around the axis of the surgical instrument (intramedullary nail) is limited by the vicinity of the enlarged artificial bone head. However, according to the intramedullary nail 101 of the present embodiment, the contact plate (joint plate) 301 described later rotates the axis of the intramedullary nail 101 in a wide range without being limited in the vicinity of the artificial bone head. be able to. Therefore, the position adjustment of the contact plate (bonding plate) 301 can be easily performed in a wide range.

  The bone joint tool (lug screw) 201 is a threaded engaging portion, which is a tip end thereof, when inserted into the cross hole 131 provided in the intramedullary nail 101 inserted into the intramedullary cavity of the femur 500. By screwing 211 into the bone head 502, a fracture site in the vicinity of the bone head is fixed.

  The bone joint tool 201 has an engaging portion 211 formed on the distal end side and formed with a screw groove screwed into the bone head 502, and extends from the engaging portion 211 to the proximal end side and is inserted into the cross hole 131. And an axial part 221. Further, on the outer peripheral surface of the shaft portion 221, a plurality of groove portions 222 extending in the axial direction are formed at equal intervals around the axis, and in this groove portion 222, the tip of the engagement tool 451 is engaged. Then, the bone connector 201 is fixed to the intramedullary nail 101 while its rotation is prevented.

  The engaging tool (set screw) 451 is for screwing into the axial hole 121 of the intramedullary nail 101 to fix the bone joining tool 201 inserted in the cross hole 131 to the intramedullary nail 101. is there.

  The engaging member 451 has a screw shape including a head portion and a threaded portion on which an external thread is formed. The female member is formed on the inner wall of the axial hole 121 in the axial hole 121 of the intramedullary nail 101. By screwing the screw portion with the screw 123, the screw hole is fixed to the axial hole 121 of the intramedullary nail 101. Under the present circumstances, in the state where the tip of engaging tool 451 (screw part) engaged with slot 222 of bone joining tool 201 in the opening where axial hole 121 opens in crossing hole 131, axial hole of engaging tool 451 It is screwed into 121. Therefore, the bone fastener 201 inserted into the cross hole 131 is fixed to the intramedullary nail 101.

  The fixture (end cap) 401 is screwed at the proximal end of the axial hole 121 in the intramedullary nail 101 via the through-hole 312 of the contact plate 301 described later, so that the contact plate 301 is intramedullary. While fixing to the nail 101, it is for sealing the axial hole 121 at a proximal end.

  The fixture 401 has a head 411 located on the base end side, a screw portion 431 located on the tip end side, and a cylindrical portion 421 located between the head 411 and the screw portion (insertion portion) 431. Each of these parts has a cylindrical shape as a whole, and the outer diameter is reduced in the order of the head portion 411, the cylindrical portion 421 and the screw portion 431.

  In addition, the outer peripheral surface of the screw portion 431 has a screw groove (male screw). The screw portion 431 is screwed to the female screw 122 formed on the inner wall of the axial hole 121 so that the axis of the intramedullary nail 101 and the axis of the screw portion 431 coincide with each other at the proximal end of the axial hole 121 Then, the fixture 401 is fixed to the axial hole 121 of the intramedullary nail 101. Under the present circumstances, in order to fix the fixing tool 401 to the axial hole 121 of the intramedullary nail 101 in the state through the through-hole 312 of the contact plate 301, accompanying fixing of the fixing tool 401 to the intramedullary nail 101, The abutment plate 301 is also fixed to the intramedullary nail 101.

  Furthermore, a groove is formed in the middle of the outer peripheral surface of the cylindrical portion 421 in the direction orthogonal to the axial direction, and a C ring 422 is attached to the groove. When the fixing tool 401 is inserted into the through hole 312 of the contact plate 301 by making the cylindrical portion 421 have such a configuration, the connection portion 311 of the contact plate 301 is closer than the C ring 422 of the cylindrical portion 421. It will be arrange | positioned in the position by the side of the head 411. FIG. Thereby, it is possible to properly prevent the contact plate 301 attached to the fixture 401 from falling off the fixture 401 through the through hole 312 during the operation. In addition, when the C ring 422 has a C shape and a notch is provided in part of the C ring 422, the connecting portion 311 is disposed at a position closer to the head 411 than the C ring 422 of the cylindrical portion 421. In addition, since the C-ring 422 easily reduces its diameter, such arrangement can be carried out smoothly.

  The abutment plate 301 is fixed to the intramedullary nail 101 so that the end portion of the femur 500 on the bone head 502 side is abutted against a region where a part of the back wall or side wall is exfoliated, whereby this region It is for making the exfoliated bone located in (4) re-place in the position before exfoliating.

  As shown in FIGS. 1, 2 and 4, the contact plate 301 has a main body 321 to be in contact with the separated bone and a through hole 312 connected to one end (proximal end) of the main body. And a connection portion 311.

  The connecting portion 311 has an annular shape as a whole and has a through hole 312 having a hole diameter corresponding to the axial hole 121 provided in the intramedullary nail 101. By fixing the fixing tool 401 to the axial hole 121 of the intramedullary nail 101 in the state through the through hole 312, the connection portion 311 (the abutment plate 301) is fixed to the intramedullary nail 101. As a result, the main body portion 321 connected to the connection portion 311 is in contact with the peeled bone.

  The main body portion 321 has a flat shape as a whole, and in the present embodiment, is constituted by a single plate. The connection portion 311 is bent and connected at one end of the main body portion 321, and the connection portion 311 is fixed to the intramedullary nail 101 by the fixing tool 401 so as to be in contact with the peeled bone.

  Here, as described above, in elderly people, the femur 500 is often weakened due to osteoporosis, and the intramedullary nail in the marrow cavity along the axial direction of the femur 500 is the end on the side of the bone head 502 During insertion from 501, at this end 501, a crack may occur along the axial direction of the femur 500 in the back wall or side wall. Therefore, due to this fissure, a part of the side wall or the back wall exfoliates at the end portion 501, and as a result, there may occur a problem that bone healing is not smoothly performed in the exfoliated area.

  On the other hand, in the surgical instrument 100, the main body portion 321 abuts on the peeled bone, and the abutted bone can be repositioned at the position before peeling. As a result, bone healing in the exfoliated area is facilitated. In FIG. 2, the side wall is cracked along the axial direction of the femur 500, and due to this, a part of the rear wall on the end 501 side is exfoliated, and in this exfoliated region, The case where the main-body part 321 arrange | positioned at the wall side is contact | abutting is shown.

  Further, in the present embodiment, the main body portion 321 is formed of a single plate, but a plurality of (two in the present embodiment) groove portions 322 are formed along the short direction in the middle of the longitudinal direction (See Figure 4). By providing such a groove portion 322, the main body portion 321 can be made to abut on the bone by being bent substantially along the shape of the bone to which the main body portion 321 abuts. Therefore, this abutted bone can be placed with better accuracy in the position before peeling.

  Furthermore, the main body portion 321 is provided with a locking portion 323 and a locking portion 324 on the surface contacting the femur 500 at one end (proximal end) and the other end (distal end). Since the abutted bones are locked by the locking portions 323 and the locking portions 324, it is possible to properly suppress or prevent the occurrence of a gap between the main body portion 321 and the bones abutted. Can.

  It is preferable that each part (the intramedullary nail 101, the bone connector 201, the abutment plate 301, etc.) of such a surgical instrument 100 is mainly made of a metal material or a polymer material. The metallic material and the polymeric material have excellent strength and elasticity, so that the fracture site can be firmly fixed by the surgical instrument 100.

  As the metal material, various materials can be mentioned, but in particular, titanium or a titanium alloy is preferable. Titanium or a titanium alloy is preferably used as a constituent material of each part because it has high biocompatibility and excellent strength. The titanium alloy is not particularly limited. For example, Ti-6Al-4V or Ti such as Ti-29Nb-13Ta-4.6Zr is a main component, and Al, Sn, Cr, Zr, Mo, Ni And those to which Pd, Ta, Nb, V, Pt and the like are added.

  In addition, as the polymer material, various materials can be mentioned, and in particular, polyether ether ketone is preferable. Besides these, polyethylene, polyethylene terephthalate, polymethyl methacrylate and the like which are used in clinical practice can be mentioned.

  Further, among the respective parts of the surgical instrument 100, those exposed from the femur 500 (particularly, the abutment plate 301 and the fixture 401) have rounded corners throughout the whole as in the present embodiment. It is preferable that it has a shape (R-shaped). With this configuration, when fixing the surgical instrument 100 to the fracture site of the femur 500, damage to surrounding tissue can be prevented.

<< Surgery method using surgical instruments >>
In the present embodiment, the surgical instrument 100 described above is applied to the treatment of a fracture (femoral neck fracture) in the vicinity of the femoral head, and, for example, surgery is performed as follows.

  [1] First, after an entry hole is formed using an owl etc. at the end 501 of the femur 500 on the bone head 502 side, the entry hole is expanded using a drilling tool such as a drill and a reamer, and the cortical bone is formed. By forming an opening at the end portion 501, the end portion 501 is perforated so as to communicate with the marrow cavity of the femur 500.

  [2] Next, as shown in FIG. 3, by introducing the tip of the intramedullary nail 101 from the opening formed at the end 501, the intramedullary nail 101 is made into the intrathecal space and the axis of the femur 500 is obtained. Insert along.

  [3] Next, connect the intramedullary nail attachment (not shown) to the proximal end of the intramedullary nail 101 exposed from the femur 500, and follow the guidance of the intramedullary nail attachment from outside the crossing hole 131 Along the axis, a guide pin (not shown) is inserted across the fracture line 505 until its tip reaches the cortical bone of the bony head 502.

  [4] Next, while the drilling tool such as a drill and a reamer is guided by the guide pin, a bone hole 503 is created in the femur 500 along the axis of the cross hole 131 using the drilling tool.

  [5] Next, while the bone connector 201 is inserted into the cross hole 131 while guiding the bone connector (lag screw) 201 by the guide pin, the bone hole 503 formed in the femur 500. Screw into. At this time, the bone welding tool 201 is twisted into the bone hole 503 until the engaging portion 211 formed with the screw groove, which is the tip of the bone welding tool 201, passes over the fracture line 505 and reaches the cortical bone of the bone head 502. Incorporate.

  Thereby, the bone joint device 201 is fixed to the bone head 502, and the bone joint device 201 is further pulled toward the intramedullary nail 101. At this time, the fracture line 505 of the femur 500 is aligned and fractured. The fracture sites on both sides abutting at line 505 are reduced so as to be in close contact with each other.

  [6] Next, in this state, the engagement tool 451 is screwed from the proximal end of the intramedullary nail 101 in the axial hole 121, and the tip of the engagement tool 451 is brought into contact with the bone connector 201. . Thereby, the bone fastener 201 is fixed to the intramedullary nail 101.

[7] Next, the abutment plate 301 is attached to the fixture 401.
In this mounting, the through hole 312 of the contact plate 301 is inserted into the cylindrical portion 421 of the fixture 401, and at this time, the connecting portion 311 is disposed at a position closer to the head 411 than the C ring 422 of the cylindrical portion 421. It is done by. Further, by disposing the connection portion 311 at a position closer to the head 411 than the C ring 422 of the cylindrical portion 421, the C ring 422 is locked to the lower surface of the connection portion 311. As a result, the contact plate The reference numeral 301 is properly held without falling off the fixture 401.

  [8] Next, at the proximal end of the shaft hole 121, the screw portion 431 of the fixture 401 is screwed into the female screw 122 formed on the inner wall of the shaft hole 121, whereby the fixture 401 is attached to the intramedullary nail 101. Fix it.

  Under the present circumstances, since the contact plate 301 is mounted | worn with the fixing tool 401 by inserting the through-hole 312 of the contact plate 301 in the cylindrical part 421 of the fixing tool 401, With the fixation to the nail 101, the abutment plate 301 is also fixed to the intramedullary nail 101. Then, by fixing the contact plate 301 to the intramedullary nail 101, the main body portion 321 of the contact plate 301 is brought into contact with the peeled bone.

  In addition, before the screw portion 431 is screwed into the female screw 122 and the fixing tool 401 is fixed to the intramedullary nail 101, that is, before the screw portion 431 is completely screwed into the female screw 122, the contact plate 301 The (connection portion 311) is rotatable around the axis of the intramedullary nail 101. Therefore, at the end on the bone head 502 side, the position at which the bone is exfoliated is a crack formed when inserting the intramedullary nail 101 into the marrow cavity from the end 501 on the bone head 502 side, such as the back wall or side wall. Depending on the position of the body, the main body portion 321 can be disposed at a desired position depending on the position at which the bone is exfoliated. That is, the abutment plate 301 can be fixed to the intramedullary nail 101 at a position suitable for the patient to which the surgical instrument 100 is applied.

  [9] Next, the intramedullary nail 101 is fixed to the femur 500 by screwing a screw (distal screw) 601 into the cross hole 141 of the intramedullary nail 101.

  As described above, the fracture site in the vicinity of the bone head 502 of the femur 500 is fixed using the surgical instrument 100.

Second Embodiment
Next, a second embodiment of the surgical instrument of the present invention will be described.

  FIG. 5 is a second embodiment of the surgical instrument according to the present invention, showing a state in which a fracture site in the vicinity of the femoral head of a femur is fixed ((a) perspective view, (b) posterior view, (c) side view) FIG. 6 is a view ((a) front view, (b) plan view, (c) side view) showing an abutment plate provided in the surgical instrument shown in FIG.

  Hereinafter, the surgical instrument 100 of the second embodiment will be described focusing on differences from the surgical instrument 100 of the first embodiment, and the description of the same matters will be omitted.

  The surgical instrument 100 shown in FIGS. 5 and 6 is the same as the surgical instrument 100 shown in FIG. 1 except that it comprises an abutment plate 301A different in configuration from the abutment plate 301.

  That is, in the surgical instrument 100 according to the second embodiment, the contact plate 301A includes a main body 321A, and the main body 321A has a shape in which two flat plates are connected at one end (base end) side. There is no. That is, the region of the main body 321A that is in contact with the peeled bone has a bifurcated shape such as a U-shape (tuning fork).

  By forming the main body portion 321A in such a shape, in a bifurcated position of the main body portion 321A, each of them is independently bent along the shape of the bone with which the main body portion 321A abuts with better accuracy. be able to. In addition, the contact area of the bone with which the main body portion 321 abuts can be increased. Therefore, the area in which the bone is exfoliated can be more reliably abutted by the main body portion 321A.

  Also by the surgical instrument 100 of the second embodiment, the same effect as that of the first embodiment can be obtained.

Third Embodiment
Next, a third embodiment of the surgical instrument of the present invention will be described.

  FIG. 7 is a third embodiment of the surgical instrument according to the present invention, showing a state in which a fracture site in the vicinity of the femoral head of a femur is fixed ((a) perspective view, (b) posterior view, (c) side view) It is.

  Hereinafter, the surgical instrument 100 according to the third embodiment will be described focusing on differences from the surgical instrument 100 according to the first embodiment, and the description of the same matters will be omitted.

  The surgical instrument 100 shown in FIG. 7 is the same as the surgical instrument 100 shown in FIG. 1 except that an abutment plate 301B different in configuration from the abutment plate 301 is provided.

  That is, in the surgical instrument 100 according to the third embodiment, the contact plate 301B includes a main body 321B, and the main body 321B is configured by connecting a plurality of top parts 331 in a band shape.

  Also when the main body portion 321B has such a shape, it can be bent along the shape of the bone with which the main body portion 321B abuts with excellent accuracy. Therefore, the area in which the bone is exfoliated can be reliably abutted by the main body portion 321B.

  In addition, a through hole penetrating in the short direction is formed in one of the top parts 331, and the wire 332 is tightened to the femur 500 in a state of being inserted into the through hole, the main body 321 Is fixed to the femur 500. Thereby, the bone to which the main body portion 321B is abutted can be reliably disposed at the position before peeling.

  Also by the surgical instrument 100 of the third embodiment, the same effect as that of the first embodiment can be obtained.

  As mentioned above, although the surgical instrument of this invention was demonstrated based on embodiment of illustration, this invention is not limited to this.

  For example, in the surgical instrument of the present invention, each configuration can be replaced with any that can perform the same function, or any configuration can be added.

  For example, in the present invention, any two or more configurations shown in the first to third embodiments may be combined.

  Moreover, although the case where the surgical instrument 100 is applied to the treatment of a fracture (femoral neck fracture) in the vicinity of the femoral head in the above embodiment has been described, the surgical instrument 100 of the present invention is in the vicinity of the bony head of the bone provided with the bony head. For example, it can be applied to fractures near the humeral head of the humerus.

DESCRIPTION OF SYMBOLS 100 Surgical instrument 101 Intramedullary nail 102 Proximal part 103 Distal part 121 Axial hole 122 Female screw 123 Female screw 131 Crossing hole 141 Crossing hole 201 Bone joint tool 211 Engagement part 221 Shaft part 222 Groove part 301 Contact plate 301A contact Plate 301B Abutment plate 311 Connection portion 312 Through hole 321 Body portion 321A Body portion 321B Body portion 322 Groove portion 323 Locking portion 324 Locking portion 331 Top part 332 Wire 401 Fixing tool 411 Head 421 Column portion 422 C ring 431 Screw portion 451 engaging tool 500 femur 501 end 502 bone head 503 bone hole 505 fracture line 601 screw

Claims (4)

A surgical instrument used to treat a fracture in the vicinity of a bone head of a bone provided with the bone head, comprising:
Intramedullary having an axial hole which is long and is used by being inserted into the medullary cavity of the bone and which is open at at least one end in the axial direction, and has an internal thread formed on the inner wall of one end of the axial hole With nails,
It is connected to one end of the main body, which is in contact with the bone, by being arranged in the form of a flat plate made of a long plate and arranged along the axial direction of the intramedullary nail A contact plate provided with a connecting portion provided with a through hole corresponding to the axial hole;
The insertion portion has a cylindrical shape and an external thread formed on the outer peripheral surface, and the axis of the insertion portion coincides with the axis of the intramedullary nail through the through hole of the contact plate. It said female screw of the intramedullary nail, by screwing the male screw of the insertion portion, possess a fastener for securing said contact plate in the intramedullary nail,
Prior to fixing the abutment plate to the intramedullary nail by the fastener, the abutment plate is configured to be pivotable about an axis of the intramedullary nail Appliance. The intramedullary nail is provided with a transverse hole opening at both of its outer peripheral surfaces,
The surgical instrument further, without an elongate surgical instrument according to claim 1 having an osteosynthesis instrument is inserted through the transverse bore. The surgical instrument according to claim 1 or 2 , wherein the body portion is used by being bent substantially along the shape of the bone on which the body portion abuts. The surgical instrument according to any one of claims 1 to 3 , wherein the bone is a femur and the surgical instrument is used for a femoral neck fracture.

Images