CN1878507B - 解剖学远端尺骨骨折固定板及其使用方法 - Google Patents
解剖学远端尺骨骨折固定板及其使用方法 Download PDFInfo
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Abstract
一种骨折固定板(102),包括一组适于单独地接受从中穿过的固定纹钉(106,108)的螺纹式纹钉孔,以及比纹钉孔直径相对较小并且优选在尺寸上设置成紧密地容纳K-钢丝的无螺纹式对准孔(150)。对准孔设在纹钉孔之间。一个对准孔构造成用于在骨切开术手术中对准板,而其它对准孔构造成用于在骨折复位后容纳K-钢丝,以便暂时地稳固骨折以及将板固定在骨上,并且确定插入穿过相邻对应纹钉孔的纹钉在钻出用于这种纹钉的较大孔之前,是否正确地定位。
Description
发明背景
1.发明领域
本发明大体上涉及手术植入物。更具体地说,本发明涉及用于远端尺骨骨折的骨折固定系统。
2.现有技术的现状
长骨干骺端部分的骨折是难于治疗的。不适当的治疗可能导致畸形和长期不适。
作为示例,科勒斯氏骨折是因作用于远端尺骨上的压力所导致的骨折,并且其会造成远端断片的后面或背侧移位以及手腕处手的径向偏移。通常,科勒斯氏骨折会导致多个骨断片,它们可移动并且相互之间未对准。如果未得到适当的治疗,这种骨折可导致永久性手腕畸形以及手腕的有限关节运动。因此重要的是,将骨折部位的骨相互对准并固定起来,以便可形成正确的愈合。
干骺端骨折(发生在长骨轴的末端)的对准和固定典型地通过以下若干种方法之一来进行:石膏固定、外部固定、骨与骨之间用钢丝固定,以及用板来固定。石膏固定是不具侵害性的,但在存在许多骨断片时不能保持骨折部位的对准。因此,作为备选,可以使用外部固定件。外部固定件采用了扎紧绷带的方法,其在关节部位提供了分开的力,并且允许根据周围绷带部位的拉力来使骨折部位对准。然而,尽管外部固定件可以保持腕骨的位置,但是,在某些骨折中,难于首先使骨正确地对准。另外,外部固定件通常不适用于造成多个骨断片的骨折。骨与骨之间用钢丝固定是有侵害性的手术程序,因此,螺钉被置入各骨断片中,然后螺钉作为支架而用钢丝固定在一起。这是比较困难而且费时的程序。另外,除非支架相当复杂,否则骨折无法被适当地稳固住。用板固定采用了一般靠在骨背侧上的稳固用金属板,以及一组从该板延伸至在骨断片中钻出的孔中的平行销钉,以便稳定地固定骨断片。然而,许多现有的板未能提供所需的对准和稳固。
尤其是,对于远端尺骨骨折而言,应当可适应远端尺骨的复杂形状,包括月状骨窝的主体手掌缘边(volar rim)、舟骨窝的较平手掌缘边,以及来自于月状骨窝的手掌边缘断片。固定板应为软骨下骨和远端尺骨关节面提供合乎需要的对准和稳固。
发明概要
因此,本发明的一个目的是提供一种用于远端尺骨骨折的改进的固定系统。
本发明的另一个目的是提供远端尺骨手掌固定系统,其比较理想地对准和稳固骨折中的多个骨断片,以允许正确的愈合。
本发明的另一个目的是提供一种远端尺骨手掌板系统,其为关节面和软骨下骨面提供了支撑。
本发明的另一个目的是提供一种远端尺骨手掌板系统,其可适应远端尺骨干骺端的解剖学结构。
本发明的另外一个目的是提供一种远端尺骨手掌板系统,其提供了支撑,同时不会与关节面边缘附近的韧带和软组织发生干涉。
根据如下所述的这些和其它目的,提供了远端尺骨手掌固定系统。该系统一般包括预期用于贴靠在尺骨的手掌侧(volar side)上的板,用于沿着尺骨的未骨折部分来固定板的多个接骨螺钉,在尺寸上设置成从板上伸出并进入尺骨干骺端的骨断片中的多个骨纹钉,以及一个或多个K-钢丝(K-wire),其用于促进板在骨上的对准和固定以及引导施加过程。提供了优选的骨纹钉和板中的纹钉孔,其有助于骨纹钉进入并且保持于纹钉孔中。
板为大致T形的,其限定了细长的主体以及相对于该主体向上成角倾斜的大致横向头部,并且包括预期用于接触骨的第一侧,以及与第一侧相对的第二侧。该主体包括用于接骨螺钉从中延伸通过的多个螺钉孔,并且选择性地包括一个或多个小得多的对准孔。头部的径向侧和尺骨侧部分的下表面相对于头部其余部分(在Z方向上)向上形成轮廓,以便适应月状骨和舟骨处理。延伸部沿着头部的远端尺骨侧而设在头部部分,以便支持尺骨月状骨窝的手掌唇边(边缘断片),从而提供支撑,以便将腕关节保持在关节窝内。另外,形成轮廓的形状提供了防止该板在骨上摇动的稳固形状。上表面和下表面是倒角的,以便具有会限制与月状骨窝边缘附近的韧带和软组织发生干涉的经复位后外形。头部包括多个有螺纹的纹钉孔,其用于接受从中通过的纹钉。纹钉孔设置成位于头部近端部分的第一组,以及优选位于头部渐缩形部分中的第二比较远端的组。
第一组纹钉孔基本上呈直线布置成大致横向穿过头部。纹钉的排列直线优选相对于穿过板主体的纵轴线而稍微地倾斜。穿过第一组孔的轴线优选彼此相对地倾斜,并且优选在二维平面内彼此相对地成角度,使得从中通过的所插入的纹钉类似地彼此相对地成斜角。第一组纹钉孔中的纹钉为软骨下骨断片的背面提供支撑。
第二组纹钉孔设置在第一组的较远端。第二组的孔,如果提供了一个以上的话,则会稍微地不对准,但会大致线性地排列。第二组纹钉孔中的纹钉为软骨下骨的位于关节骨面后面并且与其大致平行的手掌面提供支撑。
远端对准孔一般设置在第二组纹钉孔的两个纹钉孔之间。在板的上表面,远端对准孔是大致圆柱形的,而在下表面,孔是横向长圆形的。尺寸比纹钉孔小得多的一个或多个近端对准孔基本上沿着由插入第一组纹钉孔中的纹钉轴的切线所限定的远端边缘来提供,并且有助于用K-钢丝将板临时固定在骨上。另外,还沿着主体提供了两个纵向地移位的对准孔。所有对准孔在尺寸上设置成可紧密地容纳单独的K-钢丝。
该板可以至少两种不同方式来使用。根据第一种使用,外科医生复位了骨折,并且将板对准于其上。外科医生然后穿过近端对准孔来钻孔,以便暂时地将板头部的定向固定在远端断片上。一旦这样来固定了对准,就在荧光检查法下检测骨折,以便确定K-钢丝是否相对于关节面正确地对准。在近端对准孔的轴线符合相邻纹钉孔的轴线时,用荧光检查的K-钢丝可显示纹钉是否正确地定向。如果定位正确,则K-钢丝就保持住该板在骨折部位上的位置。在肯定其位置和定向正确的情况下,然后可钻出纹钉孔。如果定位不是最佳的,就可取出K-钢丝,并且外科医生有机会重新定位和/或重新定向和重新钻孔。由于各K-钢丝具有相对较小的直径,因此骨不会受到钻孔加工的显著损害,并且外科医生不会受到初始钻孔位置和/或定向的限制。
根据第二种使用,板可用于校正干骺端畸形(例如畸形的骨折或先天性畸形)。出于这种目的,K-钢丝以在荧光检查下在横向视图中平行于关节面的方式而被钻入骨中,直到K-钢丝的一端处于或穿过骨,而另一端是自由的。K-钢丝的自由端被引导通过板头部的远端长圆形对准孔,并且板在K-钢丝上向下滑到靠在骨上的位置中。长圆形对准孔允许板在K-钢丝上横向地倾斜,以便平坦地贴靠在骨上,但不允许板在前-后平面中在K-钢丝上移动。一旦板承靠在骨上,外科医生就在骨中钻出与纹钉孔对准的孔,然后用纹钉将板相对于骨来固定。骨然后被切开,板的主体朝着骨的轴而抬起,以便为骨重新定向。板的主体然后固定在骨的轴上,以便校正解剖学缺陷。
本领域的技术人员在参考了详细描述连同附图之后,可以清楚本发明的其它目的和优点。
附图简介
图1是根据本发明的右手手掌板的径向侧视图,显示为带有连接于其上的纹钉;
图2是根据本发明的右手手掌板的尺骨侧视图,显示为带有连接于其上的纹钉;
图3是根据本发明的右手手掌板的顶视图,显示为带有纹钉和螺钉;
图4是根据本发明的右手手掌板的底视图,显示为带有连接于其上的纹钉;
图5是根据本发明的右手手掌板的透视图,显示为带有连接于其上的纹钉,以及延伸穿过主体和近端头部对准孔的K-钢丝;
图6是根据本发明的右手手掌板的前端视图,显示为带有连接于其上的纹钉和延伸穿过对准孔的K-钢丝;
图7至12显示了根据本发明的进行远端尺骨的骨切开术的方法;
图13是根据本发明的部分有螺纹的纹钉的侧视图;和
图14是根据本发明一个实施例的接合在纹钉孔内的纹钉的示意图。
优选实施例的详细描述
现在来看图1至图6,显示了根据本发明骨折固定系统100。系统100尤其适用于对准和稳固在背侧移位的远端尺骨骨折(或科勒斯氏骨折)中的多个骨断片。系统100一般包括常常称为手掌板的大致刚性的T形板102、接骨螺钉104(图3)、纹钉106,108,以及K-钢丝110(图5和6)。纹钉106具有螺纹式头部和无螺纹式轴,而纹钉108具有螺纹式头部和螺纹轴。纹钉106或108或其组合可在外科医生的判断下使用。示例性纹钉在美国专利No.6364882中更详细地介绍,该专利通过引用而完全地结合于本文中。
另外,优选的部分螺纹轴式纹钉108如图6和图13最佳地所示。纹钉108包括带有第一螺距的优选单条螺旋车削螺纹202的头部部分200,以及具有更大第二螺距的一条或多条螺纹206的轴204部分(无螺纹轴式纹钉106的头部部分也优选包括单条螺旋螺纹)。螺纹206也优选沿着轴204的远端部分208延伸,最优选在这里,该远端部分包括大约一半长度的轴。作为备选,或作为附加,一个或多个纹钉可在螺纹沿着轴的大致全部或全部或其长度而延伸之处使用。
如图所示的手掌板102是右手板,其预期用于靠在右臂的骨折尺骨的手掌侧上。可以理解,左手手掌板是所示和现在所述的板的大致镜像。T形板102限定了细长的主体116,以及相对于头部(在Z-方向上)向上成角倾斜的头部118。头部118和主体116之间的角度α优选为大约25°。头部118包括远端支持件120(即头部的位于第一组纹钉孔134远端的那部分,如下所述)。板102具有优选大约0.1英寸的厚度,并且优选由钛合金制成,例如Ti-6Al-4V。
参见图4,主体116包括四个优选的埋头螺钉孔124,125,126,127,以便接骨螺钉104从中延伸通过(图2)。其中一个螺钉孔127优选为大致卵形的形状,从而允许在螺钉未紧紧地夹紧在板上时板102相对于接骨螺钉的轴的纵向运动。
参见图3和4,根据板102的一个优选方面,头部部分118包括第一组有螺纹的优选圆柱形的纹钉孔134(用于将纹钉106108置于其中),以及第二组有螺纹的优选圆柱形的纹钉孔138(用于将纹钉106和/或108置于其中)。参见图14,纹钉孔134,138选择性地具有双导程内螺纹210,212,进入这些螺纹的部位定位成分开180°。各螺纹210,212适于与纹钉头部200上的螺纹202紧密配合,然而,在任何时候,螺纹202可仅仅与其中一个螺纹210,212相配合。各双导程内螺纹210,212的深度优选比纹钉头部200上的螺纹202的深度小得多,最优选为这种深度的大约一半。双导程螺纹210,212促进纹钉头部螺纹202对准和进入纹钉孔的螺纹中,因为在螺纹啮合之前,纹钉将要求在单个旋转方向上的最大180°旋转。另外,与锥形头部和孔不同的是,圆柱形的双导程螺纹孔不会有损于由纹钉头部200的螺纹202全部行进穿过圆柱形的纹钉孔134而达到例如900°所得到的牢固互锁。另外,无论是使用单导程螺纹或双导程螺纹纹钉,双导程螺纹都将横向旋拧减少了50%。
回头参见图3和图4,第一组的纹钉孔134设置成大致平行于直线L1,直线L1优选相对于主体部分116的轴线的垂直线P而稍微倾斜(例如倾斜5°至10°的角度)。通过第一组纹钉孔的轴线(由从中延伸通过的纹钉106所示)优选彼此相对地倾斜,并且优选在二维平面内彼此相对地成角度,如同在共同所有的美国专利No.6364882中所述,其通过引用而完全地结合于本文中。纹钉的这种定向有助于将板102的头部稳固并固定在骨上,即使在这种纹钉106不具有带螺纹的轴时也是如此。
第二组纹钉孔138设置在第一组纹钉孔134的比较远端,并且最优选主要位于支持件(buttress)120中。各纹钉孔138优选限定了轴线,其相对于纹钉孔136和138中的另一个倾斜。因此,每一纹钉106就在处于相应纹钉孔134,138中时限定了相对于其它纹钉而区分开的轴线。另外,纹钉孔138的轴线优选相对于纹钉孔134的轴线定向成使得纹钉孔内的纹钉106,108以交错的方式,而在纹钉孔134内的纹钉(或其轴线)之间延伸(或者限定了其延伸轴线)。
具体参见图1、2、5和6,根据板102的另一优选方面,为了在解剖学上近似,以便提供理想的骨折支撑和保持低型面的外形,支持件120的各上表面和下表面140,142被倒角,其中下表面142的倒角形成轮廓,以用于其将叠置于其上的解剖学结构。尤其是,下表面142在头部部分的尺骨侧部分144处在远端方向上主要是抬升的,以便适应月状骨窝的主体手掌缘边,并且下表面142在头部118的径向侧部分146相对于头部其余部分横向地抬升,以便适应在骨径向面处的隆凸,如图1和图2的侧视图和图6的头部视图中的这些下表面所示。该形成轮廓的形状(一般带有三个限定的平面)提供了稳固形状,其防止板在骨上摇动。另外,上表面和下表面140,142被倒角而具有复位的外形,从而限制在关节面的边缘附近与韧带和软组织(例如腱)的可能干涉。远端延伸部148也设在尺骨侧部分146处,以便进一步支持尺骨关节窝的手掌唇边(月状骨窝的手掌边缘断片),从而提供支撑以便将腕关节保持在关节窝内。
具体参见图3和图4,根据本发明的另一优选方面,板102设有主体对准孔150,近端头部对准孔152a,152b,152c(统称为152),以及远端头部对准孔154,它们各自在尺寸上设置成紧密地接受直径例如为0.7-1.3mm的标准基尔希纳氏钢丝(K-钢丝)。所有对准孔150,152,154的上部开口在直径上比螺钉104的轴(大约3.15mm的直径)和纹钉106,108的轴(大约2.25mm的直径)小得多(例如,小了30至50%)。主体对准孔沿着主体部分116纵向地移位,并且设置成相对于主体部分116的下表面形成斜角(优选大约70°,如图5所示)。近端头部对准孔152与纹钉孔134交替地设置。头部对准孔152的最远侧点的切线H优选基本上重合于或紧密地平行于相邻于板102的头部部分118的插入穿过孔134的纹钉106的轴圆周上的点的切线。对于近端头部对准孔而言,可以理解,纹钉的轴106一般在直径上要小于纹钉头部106b(图6)。因此,纹钉孔134(各自在尺寸上设置成用于接受纹钉106的头部106b)的切线将紧密地定位相对于、但平行于相应对准孔152的最远侧点的切线。然而,出于权利要求的目的,即,(i)切线,其优选与纹钉的轴圆周上的点的切线基本上重合,以及(ii)一组纹钉孔的切线,这两条切线都应被视为与对准孔152的最远侧点的切线″基本上重合″。通过对准孔152的轴线优选一般接近于相邻纹钉孔134的轴线达一定的角度(例如为3°)。另外,穿过各近端对准孔152的轴线优选定向成在对准孔的任一侧上在通过纹钉孔134的轴线之间基本上等距。同样,插入近端对准孔152中(并且与从中穿过的轴线同轴地延伸)的K-钢丝110限定了一虚表面(virtualsurface),其与由插入穿过纹钉孔134的纹钉106所限定的虚表面基本上相同。该共同虚表面顺应于软骨下骨的背面。因此,如下详述,将K-钢丝110通过近端对准孔152的插入就为外科医生针对板102的对准和随后插入纹钉106,108而提供了视觉指引线索。远端头部对准孔154设在中心纹钉孔和径向侧纹钉孔138之间,并且具有圆形的上部开口和横向长圆形的下部开口,如图6最佳地所示。
板可用于至少两种不同的应用:骨折固定和校正干骺端畸形。无论是哪一种应用,首先在远端尺骨上进行切开,并且将旋前方肌从其径向插入方向上翻过来,从而暴露出在远端桡尺骨关节尺侧的整个远端尺骨。为了进行骨折固定,外科医生复位骨折并且将板102对准在其上。外科医生然后钻出优选两条K-钢丝110可穿过相应主体的对准孔150,并且优选多条K-钢丝通过选择性的近端头部对准孔152而定位在外科医生基于解剖学和/或荧光指引而认为可定位纹钉106,108的位置。K-钢丝暂时地将板在远端断片上的定向固定住。尽管这种固定是暂时的,但在主体对准孔150、近端头部对准孔152和从中通过的K-钢丝110相对于板的下表面而倾斜成不同的角定向方面,它是比较安全的。一旦相对于关节面正确地对准,就例如在荧光检查下检查骨折部位,以便确定K-钢丝110是否相对于关节面正确地对准。在近端头部对准孔152的轴线与相邻纹钉孔134的轴线重合时,荧光目视检查K-钢丝就能够显示纹钉106,108是否正确地定向。如果定位是正确的,那么K-钢丝110就保持板102在骨折上的位置,同时通过螺钉孔124,125,126,127而在骨中钻出用于螺钉104的孔以及用于纹钉106,108的纹钉孔134,138,同时能够肯定插入其中的螺钉和纹钉的位置和定向在解剖学上是合适的。另外,在使用纹钉108之处,由于头部螺纹202和轴螺纹206之间的螺距不同,因此就对远端或背侧移位的头部200朝着近端断片或断骨稍微地施压(例如1.5mm的行程),即使头部200将相对于板100的头部118锁定时也是如此。一旦螺钉104和纹钉106已经将板固定在骨上,就优选将K-钢丝取出。
如果荧光检测显示K-钢丝110的定位不是最佳的,那么就可取出K-钢丝,外科医生就有机会重新定位和/或重新定向K-钢丝和再次钻孔。由于各K-钢丝具有相对较小的直径,因此骨不会受到钻孔处理的显著损害,并且外科医生不会受到初始钻孔位置和/或定向的约束。
纹钉孔内的纹钉106限定了凸起,其在骨面的关节面后面的手掌面处提供了支撑。横向地穿过纹钉孔134,138的多组纹钉106,108重叠,使得纹钉优选横向地交错,以便提供软骨下骨的紧密间隔开的切向支承。软骨下骨支撑的优选程度设有四个穿过板头部118的近端部分的纹钉孔134(和相关的纹钉),以及三个穿过头部118远端部分的纹钉孔138(和相关的纹钉)。骨折固定系统从而限定了构架,其基本上沿切线方向地将骨断片支撑在其正确的定向中。根据一个备选的不太优选的实施例,也可在其中纹钉106和108相互平行之处,或者在另一相对定向中,或者利用更少的纹钉孔和/或纹钉,来提供合适的支撑。
该方法尤其有助于稳固干骺端骨折,其可包括与更大近端断片间隔开的更小远端骨断片。插入一个或多个有螺纹的纹钉108(优选连同若干个无螺纹式纹钉106一起),其中轴206上的螺纹所具有的螺距大于头部200上的螺纹202的螺距,这就导致将更小的远端骨断片朝着更大的近端骨断片并因此朝着板而有限量地压紧。
根据第二种使用,板可用于校正干骺端畸形200(例如畸形的骨折或先天性畸形),如图7所示。出于这种目的,K-钢丝110以在荧光检查下平行于关节面S的方式被钻入骨中(图8)。直到K-钢丝的一端处于或穿过骨,而另一端是自由的。K-钢丝110的自由端被引导通过长圆形远端头部对准孔154,并且板102向下滑到靠在骨上的位置中(图9)。长圆形对准孔154允许板102在K-钢丝110上横向地倾斜,以便平面地贴靠在骨上,但不允许板在前-后平面中相对于K-钢丝移动。一旦板102承靠在骨上,外科医生就在骨中钻出与纹钉孔134,138对准的孔(图3),然后用纹钉106,108将板相对于骨来固定(图10)。将K-钢丝110取出。骨然后在靠近板102的头部118的位置在202处被切开(图11),将板的主体116朝着近端骨干骨204抬起,从而在畸形部位处形成开口楔形206(图12)。当板102的主体116与骨的骨干接触和纵向对准时,切口远端的骨就相对于骨的轴重新定位在解剖学上正确的定向中。板102的主体116然后用螺钉104固定在骨上。在操作之后,骨中的开口楔形地愈合,导致形成解剖学上正确的远端尺骨。
尽管已经公开了与板一起使用的固定的单角度式纹钉(即,这些纹钉可固定在其各自的螺纹式纹钉孔134,136中,仅与各自纹钉孔所限定的轴线同轴),但是可以理解,也可使用其它的铰接纹钉系统,例如在共有的美国专利No.6440135或共有的和共同未决的美国专利申请No.10/159612中所公开的,这些专利及申请均通过引用而整体地结合于本文中。在这种铰接纹钉系统中,纹钉孔和纹钉在结构上适于使得单独的纹钉可固定在一定角度范围内的任何角度下。另外,但不太优选的是,一组或两组纹钉可被优选的钝齿来取代,所述钝齿集成在板上,使得板和所述齿构造成一体。类似地,其它细长的凸起可连接在板上,以便形成所需的支撑。
已经在本文中介绍和显示了固定板的实施例,尤其是用于远端尺骨骨折固定的板,以及对准和稳固远端尺骨骨折和执行骨切开术的方法。尽管已经介绍了本发明的特定实施例,但是,本发明并不限于此,而是,本发明的范围如本技术领域所允许的那么广,并且本说明书也应以如此广泛的范围来阅读。因此,尽管已经公开了用于该系统特定部件的特定材料、尺寸和相对角度,但是可以理解,其它材料、尺寸和相对角度也是可以使用的。另外,尽管已经介绍了手掌板中的螺钉孔和接骨螺钉的特定数量,但是可以理解,其它数量的螺钉孔和螺钉也是可以使用的。另外,可以采用比螺钉孔数量更少的螺钉来将板固定在骨上。同样,可以采用更多或更少的纹钉孔和骨纹钉,优选使得至少两个纹钉在二维平面内彼此相对地成角度。另外,尽管已经公开了特别优选的头部和主体之间的角度,但是,也可以使用其它角度。另外,尽管已经公开了圆柱形的双导程螺纹孔和相对于骨折板的单个螺纹头部接口以用于远端尺骨骨折,但是可以理解,这种系统具有比其它矫形稳固装置如断片板(其可具有矩形形状或不同形状)和专门设计的用于其它骨骨折的板更有利的优点。类似地,在头部上以及沿着轴设置的具有不同螺距的螺纹式纹钉(即锁定螺钉)也可用于其它应用中。另外,尽管双导程螺纹孔优选与在其头部具有单条螺纹的纹钉一起使用,但是可以理解,例如,三导程的螺纹孔可用于其中进入导程的偏开角度为120°的情形下。这将减少三分之二的横向旋拧,但也会进一步降低孔的旋拧深度。同样,尽管针对骨板介绍了双导程螺纹系统,但是可以理解,它也可应用于其它具有固定用孔的矫形植入体如杆、钉子假肢上。另外,尽管双导程螺纹孔显示为连同在其头部部分上具有单导程螺纹的纹钉在一起,但是可以理解,双导程螺纹孔完全可适用于在其头部部分上具有双导程螺纹的纹钉。因此,本领域的技术人员可以理解,在不脱离本发明的精神和范围的前提下,可以进行其它的修改。
Claims (25)
1.一种固定板,包括:
大致刚性的板,其限定了第一组适于单独地接受从中穿过的固定纹钉的螺纹式纹钉孔和至少一个无螺纹式第一对准孔,各所述纹钉孔具有第一直径,并且所述至少一个第一对准孔具有第二相对较小的直径,其在尺寸上设置成紧密地容纳K-钢丝,各所述至少一个第一对准孔设在纹钉孔之间,
其中,所述至少一个无螺纹式第一对准孔限定了切线,其与所述第一组螺纹式纹钉孔的切线基本上重合,以及其中,穿过所述第一组螺纹式纹钉孔的轴线彼此相对地倾斜。
2.根据权利要求1所述的固定板,其特征在于:
所述板具有主体和头部,其中所述头部相对于所述主体向上成角倾斜,并且所述第一组纹钉孔设在所述头部中。
3.根据权利要求2所述的固定板,其特征在于:
所述头部包括第二组螺纹式纹钉孔,其相对于所述第一组设置在远端。
4.根据权利要求3所述的固定板,其特征在于:
所述头部包括远端无螺纹式对准孔,其处于所述第二组纹钉孔的两个纹钉之间。
5.根据权利要求4所述的固定板,其特征在于:
所述远端对准孔具有圆形的上部开口和横向长圆形的下部开口。
6.根据权利要求2所述的固定板,其特征在于:
所述头部和主体一起大体上形成T形板构造,所述头部包括下表面、侧面、内侧和中心部分,所述侧面和内侧处的所述下表面相对于所述中心部分处的所述下表面而朝向上。
7.根据权利要求6所述的固定板,其特征在于:
所述下表面的所述侧面和内侧的所述方向通过所述下表面的倒角来形成。
8.根据权利要求6所述的固定板,其特征在于:
所述头部包括上表面,和所述上表面和下表面是倒角的。
9.一种固定板,包括:
具有主体和头部的大致刚性的板,其中所述头部相对于所述主体向上成角倾斜,所述头部限定了第一组纵向地移位的螺纹式纹钉孔,以及第一无螺纹式对准孔,其在直径上比所述纹钉孔小得多并且在所述第一组纹钉孔的两个纹钉孔之间横向地移位,
其中,所述第一无螺纹式对准孔限定了切线,其与所述第一组纹钉孔的切线基本上重合,以及其中,穿过所述第一组纹钉孔的轴线彼此相对地倾斜。
10.根据权利要求9所述的固定板,其特征在于:
所述头部限定了相对于所述第一组纵向地移位的第二组纵向地移位的螺纹式纹钉孔,以及第二无螺纹式对准孔,其在直径上比所述第二组纹钉孔小得多并且在所述第二组纹钉孔的两个纹钉孔之间横向地移位。
11.根据权利要求9所述的固定板,其特征在于:
所述第一组螺纹式纹钉孔和所述第一对准孔均定向成在至少一个维度上彼此相对地倾斜。
12.根据权利要求9所述的固定板,其特征在于:
所述第一组螺纹式纹钉孔和所述第一对准孔均定向成在二维上彼此相对地倾斜。
13.根据权利要求9所述的固定板,其特征在于:
所述对准孔具有圆形上部开口和横向长圆形的下部开口。
14.一种固定板,包括:
大致刚性的板,其限定了第一组和第二组纵向地移位的螺纹式纹钉孔,其中所述第一组的所述纹钉孔与所述第二组的所述纹钉孔横向地交替设置,
其中,所述板还包括近端无螺纹式对准孔,所述近端无螺纹式对准孔限定了切线,其与所述第一组纹钉孔的切线基本上重合,以及其中,穿过所述第一组纹钉孔的轴线彼此相对地倾斜。
15.根据权利要求14所述的固定板,其特征在于:
所述板具有主体和头部,其中所述头部相对于所述主体向上成角倾斜,并且所述第一组和第二组纹钉孔设在所述头部中。
16.根据权利要求15所述的固定板,其特征在于:
所述近端无螺纹式对准孔横向地定位在所述第一组螺纹式纹钉孔的两个纹钉孔之间,所述近端对准孔具有比所述纹钉孔小得多的直径。
17.根据权利要求16所述的固定板,其特征在于:
所述板包括横向地定位在所述第二组螺纹式纹钉孔的两个纹钉孔之间的远端无螺纹式对准孔,所述远端对准孔具有比所述第二组所述纹钉孔的直径小得多的直径。
18.根据权利要求17所述的固定板,其特征在于:
所述远端对准孔具有圆形的上部开口和横向长圆形的下部开口。
19.根据权利要求16所述的固定板,其特征在于:
所述近端对准孔相对于所述纹钉孔成斜角。
20.一种用于稳固远端尺骨骨折的大致刚性的固定板,包括:
a)细长的主体部分;
b)相对于所述主体部分成角度的横向头部部分,其中,所述头部和主体部分在尺寸上设置成用在所述远端尺骨骨折部位上,所述头部部分包括螺纹式纹钉孔,其单独地接受从中穿过的固定纹钉,以及其中,穿过所述螺纹式纹钉孔的轴线彼此相对地倾斜;和
c)稳固器具,其用于防止在将所述头部部分机械式连接在所述骨上之前所述头部部分在所述远端尺骨上摇动。
21.根据权利要求20所述的固定板,其特征在于:
所述头部部分具有下表面,而所述稳固器具包括所述下表面的限定了三个接触面的轮廓。
22.根据权利要求21所述的固定板,其特征在于:
所述头部部分包括上表面,所述上表面和下表面是倒角的。
23.根据权利要求21所述的固定板,其特征在于:
所述中间部分包括相对于所述侧面部分向远端延伸的延伸部。
24.一种用于所述远端尺骨骨折固定的系统,包括:
a)板,其具有第一部分和相对于所述第一部分成角度的第二部分,所述第一部分限定了至少一个螺钉孔,所述头部限定了多个螺纹式纹钉孔和至少一个位于两个相邻纹钉孔之间的小得多的无螺纹式对准孔,其中,所述对准孔限定了切线,其与所述纹钉孔的切线基本上重合,以及其中,穿过所述纹钉孔的轴线彼此相对地倾斜;
b)至少一个螺钉,其在尺寸上设置成用于插入所述至少一个螺钉孔中;
c)各自具有螺纹式头部和轴的多个纹钉,所述纹钉在尺寸上设置成可插入所述纹钉孔;和
d)至少一条K-钢丝,其中所述对准孔在尺寸上设置成紧密地容纳所述K-钢丝。
25.根据权利要求24所述的系统,其特征在于:
所述板的所述头部包括稳固器具,其用于防止在将所述头部部分机械式连接在所述骨上之前所述头部部分在所述远端尺骨上摇动。
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2003
- 2003-09-17 US US10/664,371 patent/US7857838B2/en active Active
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2004
- 2004-03-22 AT AT04817171T patent/ATE546102T1/de active
- 2004-03-22 CN CN2004800333324A patent/CN1878507B/zh not_active Expired - Lifetime
- 2004-03-22 EP EP10173545.4A patent/EP2258288B1/en not_active Expired - Lifetime
-
2006
- 2006-03-16 ZA ZA200602225A patent/ZA200602225B/en unknown
-
2010
- 2010-06-01 US US12/791,405 patent/US8556945B2/en active Active
- 2010-12-20 US US12/972,803 patent/US8579946B2/en not_active Expired - Lifetime
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2013
- 2013-08-14 US US13/966,391 patent/US9072558B2/en not_active Expired - Lifetime
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WO2002096309A1 (de) * | 2001-05-28 | 2002-12-05 | Synthes Ag Chur | Knochenplatte zur fixation von proximalen humerusfrakturen |
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US20110166571A1 (en) | 2011-07-07 |
US9072558B2 (en) | 2015-07-07 |
EP2258288A1 (en) | 2010-12-08 |
US7857838B2 (en) | 2010-12-28 |
US8579946B2 (en) | 2013-11-12 |
ZA200602225B (en) | 2007-06-27 |
US8556945B2 (en) | 2013-10-15 |
US20040193164A1 (en) | 2004-09-30 |
ATE546102T1 (de) | 2012-03-15 |
EP2258288B1 (en) | 2014-09-03 |
US20140058456A1 (en) | 2014-02-27 |
US20100241173A1 (en) | 2010-09-23 |
CN1878507A (zh) | 2006-12-13 |
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