WO2000067652A2 - Implant for operative treatment of femoral neck fractures and the like - Google Patents

Implant for operative treatment of femoral neck fractures and the like Download PDF

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Publication number
WO2000067652A2
WO2000067652A2 PCT/EP2000/004274 EP0004274W WO0067652A2 WO 2000067652 A2 WO2000067652 A2 WO 2000067652A2 EP 0004274 W EP0004274 W EP 0004274W WO 0067652 A2 WO0067652 A2 WO 0067652A2
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WO
WIPO (PCT)
Prior art keywords
screw
sliding
implant
implant according
locking
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PCT/EP2000/004274
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German (de)
French (fr)
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WO2000067652A3 (en
WO2000067652B1 (en
Inventor
Gerhard Hehl
Original Assignee
Gerhard Hehl
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Publication date
Application filed by Gerhard Hehl filed Critical Gerhard Hehl
Priority to EP00938633A priority Critical patent/EP1124498A2/en
Publication of WO2000067652A2 publication Critical patent/WO2000067652A2/en
Publication of WO2000067652A3 publication Critical patent/WO2000067652A3/en
Publication of WO2000067652B1 publication Critical patent/WO2000067652B1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck

Definitions

  • Implant for the operative treatment of fractures of the femur and dql Implant for the operative treatment of fractures of the femur and dql.
  • the invention relates to an implant for the operative care of z.
  • Such implants for the operative treatment of fractures, in particular fractures of the femoral neck, have proven themselves.
  • the implant according to the invention is suitable for the operative care of a wide variety of fractures, for the sake of simplicity only the use of an embodiment of the implant for the operative care of a femoral neck fracture in the form of a slide screw according to the invention is described below. However, the invention is not limited to this.
  • the surgical treatment of a fracture of the femoral neck is carried out in such a way that the fracture is first reduced and a Kirschner wire is inserted between the femoral head and the femur in the planned course of the screw channel to be created. Once the Kirschner wire has been inserted in the correct position, the Kirschner wire is drilled through with a two-step drill and the two-part sliding screw is inserted into the resulting drilling channel.
  • the front part of the sliding screw has a screw thread with which it is screwed into the femoral head.
  • a sliding sleeve is used, which receives the bolt-side end of the sliding screw, and the sliding screw is supported in this sliding sleeve with axial play.
  • the invention is therefore based on the object of developing an implant of the type mentioned at the outset in such a way that it can be placed using a minimally invasive technique and that there is improved healing.
  • an essential feature of the inventive concept according to claim 1 is that the sliding pulse now at least partially has an external thread on the outer circumference with which the sliding sleeve can be screwed into the drilling channel.
  • the invention includes both a design of the sliding screw with a circumferentially provided thread on the outer circumference and another embodiment in which the screw thread is only partially present on the outer circumference.
  • the invention is also intended to protect a special locking device for implants. Protection in the form of independent independent claim 2 is sought for this locking device.
  • the basic principle of the locking device according to this feature of the invention is based on the fact that the guided sliding possibility of the implant causes the fracture to be subjected to compression when walking under weight. However, if the leg is relieved, the compression will undesirably decrease again. This is where the invention comes in, which ensures that the compression once achieved by loading remains secured in the long run. This is achieved by the locking device on the implant.
  • the principle of the arrangement of a locking device can therefore be applied to all implants that allow a so-called dynamic compression.
  • the invention also provides an area of application which also includes self-locking interfragmentary tension screws or intramedullary nails.
  • Such an intramedullary nail consists of a solid material (e.g. implant steel or titanium) with cross holes arranged at both ends. It is used to stabilize fractures of long tubular bones (e.g. thigh or lower leg) in the medullary cavity of the bone.
  • the intramedullary nail splits the fracture and allows axial compression of the bone fragments brought together and splinted through the intramedullary nail.
  • the rotation of the bone fragments must be prevented by a turnstile on the intramedullary nail.
  • bolts are provided in transverse bores of the intramedullary nail perpendicular to its longitudinal axis and act as a turnstile.
  • the transverse bores are each designed as an elongated hole oriented in the axial direction.
  • the bolts are therefore guided with play in the respective elongated hole in the transverse bore.
  • the sliding screw When the sliding screw is designed as an intramedullary nail, provision is therefore made for it to be telescopic and to have a locking device with which once compression is ensured and wound healing can thus be significantly improved.
  • Such a two-part implant consists of a sliding screw and the associated sliding sleeve. It can now be installed using a minimally invasive surgical technique because the sliding screw is anchored directly into the bone via the external thread. There is no screw-on plate. After the first pre-drilling with a Kirschner wire and after checking, the final drill channel can be drilled with a two-step drill over the lying Kirschner wire and the two-part sliding screw can be used immediately be screwed into the drilling channel via a skin incision. The screwing in is carried out in such a way that both the sliding screw itself and the sliding sleeve encompassing the sliding screw are screwed in together with a tool.
  • both the sliding screw is screwed into the femoral head in a single operation and at the same time - with the same rotation - the sliding sleeve is also screwed into the opposite femur, because the two parts are non-rotatably connected to each other by means of the tool and therefore the screwing movements in the screwing channel carry out.
  • the two-part implant is provided with a locking device between one and the other part.
  • This locking device only allows an axial displacement of the two parts in the direction in which the two parts are subjected to thrust. However, if the two parts are subjected to tension, the shift is locked.
  • the slide screw When designing the implant as a sliding screw, it is essential that the fracture surface is compressed, i. H. the slide screw should be constantly subjected to tension to allow compression of the fracture surfaces. In the opposite direction, however, axial play of the sliding screw in the sliding sleeve should be ensured. It is known that sintering occurs in the area of the fracture surfaces during the healing process, which therefore move and interlock with one another, as a result of which the sliding screw is subjected to thrust. This thrust is to be absorbed by the locking device and this ensures that no thrust forces acting on the fracture surfaces can occur.
  • the axial adjustment play of the sliding screw in the sliding sleeve should be selected so that the sliding, lateral end of the sliding sleeve does not come out of the sliding sleeve and leads to soft tissue irritation.
  • the locking device consists of a ratchet and this in turn consists of a ring that is radially inward in the Sliding sleeve is attached and which cooperates with an associated sawtooth-like catch on the outer circumference of the sliding screw.
  • a locking blade is provided instead of the locking ring, which also interacts with a sawtooth-like external toothing of the sliding screw.
  • slots are arranged on the sliding screw, into which slots the locking ring or the locking blade engage.
  • a kinematic reversal of the aforementioned embodiments provides that the sawtooth-like toothing is arranged on the inner circumference of the sliding sleeve, while the locking ring or the locking blade is connected to the sliding screw.
  • corresponding slots can be incorporated on the inner circumference of the sliding sleeve instead of the sawtooth-shaped latching.
  • spring-loaded bolts or other known machine elements can also be used, which implement such a locking mechanism.
  • Figure 1 schematically shows a femoral neck fracture with explanation of the parts
  • FIG. 1 the supplied by the two-part slide screw according to the invention
  • Figure 3 a two-part sliding screw in a first embodiment
  • Figure 4 a second embodiment of a two-part sliding screw
  • Figure 5 the front view of an embodiment of a sliding screw
  • FIG. 6 an embodiment of FIG. 4 modified from FIG.
  • FIG. 7 an embodiment of a modified compared to FIG. 5
  • FIG. 8 shows an embodiment of the FIG.
  • Figure 9 another embodiment of a locking device.
  • FIG. 1 A typical fracture of the femur is shown in FIG. 1, the femoral head 2 being broken off from the femur 1.
  • the fracture surfaces that form are labeled 3 and 4.
  • the fracture is first repositioned in order to bring the fracture surfaces 3, 4 together as shown in FIG. 2, then a Kirschner wire is first drilled from position 21 in the course of the planned course of the screw and the position is checked. The Kirschner wire is then drilled through with a two-stage drill and the two-part sliding screw 5, 7 is screwed into the bore in each case.
  • two two-part sliding screws are thus arranged next to one another. It consists of the sliding screw 7 itself and the associated sliding sleeve 5.
  • the sliding sleeve 7 consists of a screw 9 with a front threaded head 8, which is screwed into the femoral head 2.
  • the rear part of the screw bolt 9 is axially displaceably mounted in the receiving bore 10 of a sliding sleeve 5, which according to the invention is provided with an external thread 6.
  • the sliding screw 7 can move axially displaceably in the receiving bore 10 in the direction of the arrows 11, a sliding section 12 being provided which ensures that the rear end face of the screw bolt 9 does not protrude from the rear end face of the sliding sleeve 5, because otherwise this would lead to soft tissue irritation.
  • a tool is provided which engages both on the rear face of the sliding sleeve 5 and on the face of the screw bolt 9 and connects the two parts to one another in a rotationally fixed manner.
  • the two parts can be screwed simultaneously from position 21 in FIG. 2 into the screw channels aligned with one another.
  • a locking device is provided, which is shown in several exemplary embodiments in FIGS. 4 to 9.
  • the locking device In a first embodiment of the locking device, it consists of a locking ring 13 which is fixedly connected to the sliding sleeve 15, the radially inner part of the locking ring 13 being seated on barb-like locking teeth 14. In this way, it is ensured that the screw bolt 9 is under tension, because when the fracture surfaces 3, 4 are sintered, the screw bolt is displaced in the direction of arrow 11 'into the sliding sleeve 15, whereby the locking ring 13 jumps over a projection of the locking teeth 14 , and engages in the nearest locking teeth.
  • FIG. 5 shows that the locking teeth 14 need not be circumferentially arranged, it can also be provided that the locking teeth 14a are only partially provided on the circumference of the screw bolt 9.
  • FIG. 5 also shows indicated cannulas 19 which are arranged on the outer circumference of the sliding screw 7 and which are open to the outside in order to receive the Kirschner wire.
  • FIG. 6 shows as a modified exemplary embodiment that one or more latches 16 can be used instead of a latching ring 13.
  • the respective locking pawl is chamfered in its own direction and interacts with the steep flank of the locking teeth 14.
  • a sliding screw 27 can also be formed in that, instead of the locking teeth 14, slots 18 are machined in the surface of the space bolt 9, into which the locking ring 13 or the locking pawls 16 engage.
  • the bolt 9 does not have to be fully formed, it can also consist of a hollow material, so that the two-part sliding screw can be inserted over the lying Kirschner wire.
  • FIG. 9 shows the kinematic reversal of the function of the locking device compared to the locking devices according to FIGS. 4 to 8 described there. It is shown that the locking ring 13 or the locking pawls 16, which are associated with the locking teeth, can be connected to the screw bolt of the sliding screw 17 24 or slits cooperate on the inner circumference of a sliding sleeve 25.
  • a screw thread 20 is arranged on the outer circumference of the respective sliding sleeve 5, 15, 25, with which it is possible to insert and remove the two-part sliding screw by a minimally invasive intervention.

Abstract

A two-part implant which is used to provide operative treatment of femoral neck fractures, comprising a sliding screw that has a threaded head on the front end thereof and a bolt which extends beyond the surface of the fracture, whereby a sliding bushing having an inserted thread on the outer periphery thereof is screwed into the other part of the bone. The two-part sliding screw is positioned in a minimally invasive manner. A stop device is arranged in between both parts to ensure that only one part can be displaced axially towards the other in a single direction.

Description

Implantat zur operativen Versorgung von Schenkelhalsbrüchen und dql. Implant for the operative treatment of fractures of the femur and dql.
Die Erfindung betrifft ein Implantat zur operativen Versorgung von z. B. Schenkelhalsbrüchen nach dem Oberbegriff des Patentanspruchs 1. Derartige Implantate zur operativen Versorgung von Brüchen, insbesondere von Schenkelhalsbrüchen, haben sich bewährt.The invention relates to an implant for the operative care of z. B. Fractures of the femoral neck according to the preamble of claim 1. Such implants for the operative treatment of fractures, in particular fractures of the femoral neck, have proven themselves.
Obwohl das erfindungsgemäße Implantat für die operative Versorgung unterschiedlichster Brüche geeignet ist, wird im folgenden der Einfachheit halber lediglich die Anwendung einer Ausführungsform des Implantates für die operative Versorgung eines Schenkelhalsbruches in Form einer erfindungsgemäßen Gleitschraube beschrieben. Die Erfindung ist hierauf jedoch nicht beschränkt.Although the implant according to the invention is suitable for the operative care of a wide variety of fractures, for the sake of simplicity only the use of an embodiment of the implant for the operative care of a femoral neck fracture in the form of a slide screw according to the invention is described below. However, the invention is not limited to this.
Die operative Versorgung eines Schenkelhalsbruches erfolgt dergestalt, dass zunächst die Fraktur reponiert wird und ein Kirschnerdraht im geplanten Verlauf des anzulegenden Schraubkanals zwischen dem Hüftkopf und dem Oberschenkelknochen eingebracht wird. Wurde der Kirschnerdraht in richtiger Lage eingebracht, dann wird mit einem Zwei-Stufen-Bohrer der Kirschnerdraht überbohrt und in dem sich so ergebenden Bohrkanal wird die zweiteilige Gleitschraube eingesetzt.The surgical treatment of a fracture of the femoral neck is carried out in such a way that the fracture is first reduced and a Kirschner wire is inserted between the femoral head and the femur in the planned course of the screw channel to be created. Once the Kirschner wire has been inserted in the correct position, the Kirschner wire is drilled through with a two-step drill and the two-part sliding screw is inserted into the resulting drilling channel.
Der vordere Teil der Gleitschraube weist hierbei ein Schraubengewinde auf, mit dem diese in den Hüftkopf eingeschraubt wird. Auf der gegenüberliegenden Seite zur Frakturfläche wird eine Gleithülse verwendet, welche das schraubenbolzenseitige Ende der Gleitschraube aufnimmt, und die Gleitschraube in dieser Gleithülse mit axialem Spiel gelagert ist.The front part of the sliding screw has a screw thread with which it is screwed into the femoral head. On the opposite side to the fracture surface, a sliding sleeve is used, which receives the bolt-side end of the sliding screw, and the sliding screw is supported in this sliding sleeve with axial play.
Hierbei ist es lediglich bekannt, die Gleithülse mittels einer daran befestigten Platte seitlich am Knochen anzuschrauben, um so das Führungslager für die am gegenüberliegenden Knochen Gleitschraube zu bilden.It is only known to screw the sliding sleeve laterally to the bone by means of a plate attached to it, in order to form the guide bearing for the sliding screw on the opposite bone.
Die Befestigung einer Gleithülse mittels einer Platte ist jedoch bei Verwendung einer minimal-invasiven Technik nicht möglich.However, the attachment of a sliding sleeve by means of a plate is not possible when using a minimally invasive technique.
BESTATIGUNGSKOPIE Außerdem besteht der weitere Nachteil, dass wegen des ständig vorhandenen axialen Spiels der Gleitschraube in der Gleithülse die Frakturflächen nicht komprimiert werden, was die Heilung verzögert.CONFIRMATION COPY There is also the further disadvantage that the fracture surfaces are not compressed due to the constant axial play of the sliding screw in the sliding sleeve, which delays healing.
Der Erfindung liegt deshalb die Aufgabe zugrunde, ein Implantat der eingangs genannten Art so weiterzubilden, dass es unter Verwendung einer minimal-invasiven Technik gelegt werden kann und dass eine verbesserte Heilung gegeben ist.The invention is therefore based on the object of developing an implant of the type mentioned at the outset in such a way that it can be placed using a minimally invasive technique and that there is improved healing.
Zur Lösung der gestellten Aufgabe dient die technische Lehre des Anspruches 1 und/oder 2.The technical teaching of claim 1 and / or 2 is used to solve the problem.
Wesentliches Merkmal des Erfindungsgedankens nach Anspruch 1 ist, dass die Gleithulse nun mindestens teilweise am Außenumfang ein Außengewinde trägt, mit dem die Gleithülse in den Bohrkanal eingeschraubt werden kann.An essential feature of the inventive concept according to claim 1 is that the sliding pulse now at least partially has an external thread on the outer circumference with which the sliding sleeve can be screwed into the drilling channel.
Es wird also auf die aufwendige Befestigung der Gleithülse mittels einer Lochplatte am Knochen verzichtet, und die Gleithülse wird unmittelbar in den Bohrkanal eingeschraubt.There is therefore no need for an expensive attachment of the sliding sleeve to the bone by means of a perforated plate, and the sliding sleeve is screwed directly into the drilling channel.
Die Erfindung umfasst hierbei sowohl eine Ausführung der Gleitschraube mit am Außenumfang umlaufend vorgesehenen Gewinde als auch eine andere Ausführungsform, bei der das Schraubgewinde nur teilweise am Außenumfang vorhanden ist.The invention includes both a design of the sliding screw with a circumferentially provided thread on the outer circumference and another embodiment in which the screw thread is only partially present on the outer circumference.
Unabhängig von der besonderen Befestigung der Gleitschraube, soll die Erfindung auch eine besondere Arretiervorrichtung für Implantate schützen. Für diese Arretiervorrichtung wird Schutz in Form des selbständigen Nebenanspruches 2 nachgesucht.Regardless of the special fastening of the sliding screw, the invention is also intended to protect a special locking device for implants. Protection in the form of independent independent claim 2 is sought for this locking device.
Das Grundprinzip der Arretiervorrichtung nach diesem Erfindungsmerkmal beruht darauf, dass durch die geführte Gleitmöglichkeit des Implantats die Fraktur bei Gewichtsbelastung beim Gehen unter Kompression gesetzt wird. Wird jedoch das Bein entlastet, so lässt die Kompression in unerwünschter Weise wieder nach. Hier setzt die Erfindung ein, die gewährleistet, dass die einmal durch Belastung erreichte Kompression auf Dauer gesichert bleibt. Dies wird durch die Arretiervorrichtung an dem Implantat erreicht. Das Prinzip der Anordnung einer Arretiervorrichtung kann demnach auf sämtliche Implantate, die eine sogenannte dynamische Kompression erlauben, angewendet werden.The basic principle of the locking device according to this feature of the invention is based on the fact that the guided sliding possibility of the implant causes the fracture to be subjected to compression when walking under weight. However, if the leg is relieved, the compression will undesirably decrease again. This is where the invention comes in, which ensures that the compression once achieved by loading remains secured in the long run. This is achieved by the locking device on the implant. The principle of the arrangement of a locking device can therefore be applied to all implants that allow a so-called dynamic compression.
Als Anwendungsbereich sieht die Erfindung über die beschriebene Gleitschraube hinaus, auch selbst-arretierbare, interfragmentäre Zugschrauben oder Marknägel vor.In addition to the sliding screw described, the invention also provides an area of application which also includes self-locking interfragmentary tension screws or intramedullary nails.
Ein derartiger Marknagel besteht aus einem Vollmaterial (z.B. Implantatstahl oder Titan) mit an beiden Enden angeordneten Querbohrungen. Er wird zur Stabilisierung von Brüchen langer Röhrenknochen (z.B. Oberschenkel oder Unterschenkel) in die Markhöhle des Knochens eingesetzt. Der Marknagel schient damit den Bruch und erlaubt eine axiale Kompression der zusammengeführten und durch den Marknagel geschienten Knochenfragmente. Es muss allerdings die Rotation der Knochenfragmente durch eine Drehsperre am Marknagel verhindert werden. Hierzu sind in Querbohrungen des Marknagels senkrecht zu seiner Längsachse angeordnete Bolzen vorgesehen, die als Drehsperre wirken. Um eine axiale Kompression des Knochens im Bereich der Bruchstelle zu erlauben, ist es bekannt, dass die Querbohrungen jeweils als in axialer Richtung ausgerichtetes Langloch ausgebildet sind. Die Bolzen sind also mit Spiel in dem jeweiligen Langloch der Querbohrung geführt.Such an intramedullary nail consists of a solid material (e.g. implant steel or titanium) with cross holes arranged at both ends. It is used to stabilize fractures of long tubular bones (e.g. thigh or lower leg) in the medullary cavity of the bone. The intramedullary nail splits the fracture and allows axial compression of the bone fragments brought together and splinted through the intramedullary nail. However, the rotation of the bone fragments must be prevented by a turnstile on the intramedullary nail. For this purpose, bolts are provided in transverse bores of the intramedullary nail perpendicular to its longitudinal axis and act as a turnstile. In order to allow axial compression of the bone in the area of the fracture point, it is known that the transverse bores are each designed as an elongated hole oriented in the axial direction. The bolts are therefore guided with play in the respective elongated hole in the transverse bore.
Hierbei ist nachteilig, dass eine auf den Bruch wirkende (und erwünschte) Kompression nur während der Dauer der Belastung aufgebracht ist, aber nicht dauerhaft aufrecht erhalten bleibt. Hier setzt die Erfindung ein, die vorschlägt, die erfindungsgemässe Arretierung auch bei einem solchen Implantat zu verwenden.It is disadvantageous here that compression (and desired) acting on the fracture is only applied during the duration of the load, but is not permanently maintained. This is where the invention comes in, which proposes to use the locking device according to the invention also with such an implant.
Bei der Ausbildung der Gleitschraube als Marknagel ist also vorgesehen, dass dieser teleskopartig ausgebildet ist und eine Arretiervorrichtung aufweist, mit der eine einmal erzielte Kompression gesichert wird und damit die Wundheilung wesentlich verbessert werden kann.When the sliding screw is designed as an intramedullary nail, provision is therefore made for it to be telescopic and to have a locking device with which once compression is ensured and wound healing can thus be significantly improved.
Eine derartiges, zweiteiliges Implantat besteht aus einer Gleitschraube und der dazugehörenden Gleithülse. Es kann nun mittels einer minimalen-invasiven Operationstechnik verlegt werden, denn die Gleitschraube wird über das Aussengewinde direkt in den Knochen verankert. Eine Anschraubplatte entfällt. Nach dem erstmaligen Vorbohren mittels eines Kirschnerdrahtes und nach erfolgter Kontrolle, kann mit einem Zwei-Stufen-Bohrer über den liegenden Kirschnerdraht der endgültige Bohrkanal gebohrt werden und die zweiteilige Gleitschraube kann sofort über einen Hautschnitt in den Bohrkanal eingeschraubt werden. Hierbei erfolgt das Einschrauben dergestalt, dass sowohl die Gleitschraube selbst als auch die die Gleitschraube umgreifende Gleithülse zusammen mit einem Werkzeug eingeschraubt werden. Es wird damit in einem einzigen Arbeitsvorgang sowohl die Gleitschraube in den Hüftkopf eingeschraubt und gleichzeitig - mit der gleichen Drehung - wird auch die Gleithülse in den gegenüberliegenden Oberschenkelknochen eingeschraubt, weil mittels des Werkzeuges die beiden Teile drehfest miteinander verbunden sind und deshalb gleichzeitig die Einschraubbewegungen im Schraubkanal durchführen.Such a two-part implant consists of a sliding screw and the associated sliding sleeve. It can now be installed using a minimally invasive surgical technique because the sliding screw is anchored directly into the bone via the external thread. There is no screw-on plate. After the first pre-drilling with a Kirschner wire and after checking, the final drill channel can be drilled with a two-step drill over the lying Kirschner wire and the two-part sliding screw can be used immediately be screwed into the drilling channel via a skin incision. The screwing in is carried out in such a way that both the sliding screw itself and the sliding sleeve encompassing the sliding screw are screwed in together with a tool. This means that both the sliding screw is screwed into the femoral head in a single operation and at the same time - with the same rotation - the sliding sleeve is also screwed into the opposite femur, because the two parts are non-rotatably connected to each other by means of the tool and therefore the screwing movements in the screwing channel carry out.
Nach dem zweiten Erfindungsgedanken ist vorgesehen, dass das zweiteilige Implantat mit einer Arretiervorrichtung zwischen dem einen und dem anderen Teil versehen ist. Diese Arretiervorrichtung erlaubt lediglich eine axiale Verschiebung der beiden Teile in der Richtung, in der die beiden Teile auf Schub beansprucht werden. Werden hingegen die beiden Teile auf Zug beansprucht, ist die Verschiebung arretiert.According to the second inventive concept, it is provided that the two-part implant is provided with a locking device between one and the other part. This locking device only allows an axial displacement of the two parts in the direction in which the two parts are subjected to thrust. However, if the two parts are subjected to tension, the shift is locked.
In der Ausbildung des Implantats als Gleitschraube ist es wesentlich, dass die Frakturfläche komprimiert wird, d. h. die Gleitschraube soll ständig auf Zug beansprucht werden, um eine Komprimierung der Frakturflächen zu ermöglichen. In entgegengesetzter Richtung soll jedoch ein axiales Spiel der Gleitschraube in der Gleithülse gewährleistet sein. Es ist bekannt, dass es während des Heilungsprozesses zu einer Sinterung im Bereich der Frakturflächen kommt, die sich deshalb aufeinander zu bewegen und verzahnen, wodurch die Gleitschraube auf Schub beansprucht wird. Dieser Schub soll von der Arretiervorrichtung aufgenommen werden und diese sorgt dafür, dass keine auf die Frakturflächen trennend wirkenden Schubkräfte auftreten können.When designing the implant as a sliding screw, it is essential that the fracture surface is compressed, i. H. the slide screw should be constantly subjected to tension to allow compression of the fracture surfaces. In the opposite direction, however, axial play of the sliding screw in the sliding sleeve should be ensured. It is known that sintering occurs in the area of the fracture surfaces during the healing process, which therefore move and interlock with one another, as a result of which the sliding screw is subjected to thrust. This thrust is to be absorbed by the locking device and this ensures that no thrust forces acting on the fracture surfaces can occur.
Hierbei soll das axiale Verstellspiel der Gleitschraube in der Gleithülse so gewählt sein, dass die Gleithülse mit ihrem hinteren, lateralen Ende nicht aus der Gleithülse heraustritt und zu Weichteilreizungen führt.The axial adjustment play of the sliding screw in the sliding sleeve should be selected so that the sliding, lateral end of the sliding sleeve does not come out of the sliding sleeve and leads to soft tissue irritation.
Für die Ausbildung der Arretiervorrichtung gibt es verschiedene Ausführungsformen, die sämtliche vom Erfindungsgedanken umfasst sein sollen.There are various embodiments for the design of the locking device, all of which are intended to be encompassed by the inventive concept.
In einer ersten Ausführungsform besteht die Arretiervorrichtung aus einem Klinkengesperre und dieses ist wiederum aus einem Ring, der radial einwärts in der Gleithülse befestigt ist und der mit einer zugeordneten, sägezahnartigen Verrastung auf dem Außenumfang der Gleitschraube zusammenwirkt.In a first embodiment, the locking device consists of a ratchet and this in turn consists of a ring that is radially inward in the Sliding sleeve is attached and which cooperates with an associated sawtooth-like catch on the outer circumference of the sliding screw.
In einer zweiten Ausführungsform ist statt des Rastrings eine Rastklinge vorgesehen, welche ebenfalls mit einer sägezahnartigen Außenverzahnung der Gleitschraube zusammenwirkt.In a second embodiment, a locking blade is provided instead of the locking ring, which also interacts with a sawtooth-like external toothing of the sliding screw.
In einer dritten Ausführungsform ist statt der sägezahnartigen Außenverzahnung auf der Gleitschraube Schlitze angeordnet, in welche der Rastring oder die Rastklinge eingreifen.In a third embodiment, instead of the sawtooth-like external toothing, slots are arranged on the sliding screw, into which slots the locking ring or the locking blade engage.
In einer weiteren Ausgestaltung ist in kinematischer Umkehrung der vorher genannten Ausführungsformen vorgesehen, dass die sägezahnartige Verzahnung am Innenumfang der Gleithülse angeordnet ist, während der Rastring oder die Rastklinge mit der Gleitschraube verbunden ist.In a further embodiment, a kinematic reversal of the aforementioned embodiments provides that the sawtooth-like toothing is arranged on the inner circumference of the sliding sleeve, while the locking ring or the locking blade is connected to the sliding screw.
Auch bei diesem, letztgenannten Ausführungsbeispiel können statt der sägezahnförmigen Verrastung am Innenumfang der Gleithülse entsprechende Schlitze eingearbeitet sein.In this latter embodiment as well, corresponding slots can be incorporated on the inner circumference of the sliding sleeve instead of the sawtooth-shaped latching.
Statt der beschriebenen Rastklinge oder des Rastringes können auch gefederte Bolzen oder andere bekannte Maschinenelemente verwendet werden, die ein derartiges Klingengesperre verwirklichen.Instead of the locking blade or locking ring described, spring-loaded bolts or other known machine elements can also be used, which implement such a locking mechanism.
Der Erfindungsgegenstand der vorliegenden Erfindung ergibt sich nicht nur aus demThe subject matter of the present invention results not only from the
Gegenstand der einzelnen Patentansprüche, sondern auch aus der Kombination der einzelnen Patentansprüche untereinander.Subject of the individual claims, but also from the combination of the individual claims with each other.
Alle in den Unterlagen, einschließlich der Zusammenfassung, offenbarten Angaben und Merkmale, insbesondere die in den Zeichnungen dargestellte räumlicheAll information and features disclosed in the documents, including the summary, in particular the spatial depicted in the drawings
Ausbildung, werden als erfindungswesentlich beansprucht, soweit sie einzeln oder in Kombination gegenüber dem Stand der Technik neu sind.Education are claimed as essential to the invention, insofar as they are new compared to the prior art, individually or in combination.
Im folgenden wird die Erfindung anhand von mehrere Ausführungswege darstellenden Zeichnungen näher erläutert. Hierbei gehen aus den Zeichnungen und ihrer Beschreibung weitere erfindungswesentliche Merkmale und Vorteile der Erfindung hervor. Es zeigen:In the following, the invention will be explained in more detail with reference to drawings showing several possible embodiments. Here, from the drawings and their description, further features and advantages of the invention that are essential to the invention emerge. Show it:
Figur 1 : schematisiert einen Schenkelhalsbruch mit Erläuterung der Teile;Figure 1: schematically shows a femoral neck fracture with explanation of the parts;
Figur 2: der durch die zweiteilige Gleitschraube nach der Erfindung versorgteFigure 2: the supplied by the two-part slide screw according to the invention
Schenkelhalsbruch;Femoral neck fracture;
Figur 3: eine zweiteilige Gleitschraube in einer ersten Ausführungsform imFigure 3: a two-part sliding screw in a first embodiment in
Schnitt;Cut;
Figur 4: eine zweite Ausführungsform einer zweiteiligen Gleitschraube;Figure 4: a second embodiment of a two-part sliding screw;
Figur 5: die Stirnansicht eines Ausführungsbeispiels einer Gleitschraube;Figure 5: the front view of an embodiment of a sliding screw;
Figur 6: eine gegenüber Figur 4 abgewandelte Ausführungsform derFIG. 6: an embodiment of FIG. 4 modified from FIG
Arretiervorrichtung;Locking device;
Figur 7: eine gegenüber Figur 5 abgewandelte Ausführungsform einerFIG. 7: an embodiment of a modified compared to FIG. 5
Gleitschraube;Sliding screw;
Figur 8: eine gegenüber Figur 6 abgewandelte Ausführungsform der8 shows an embodiment of the FIG
Arretiervorrichtung;Locking device;
Figur 9: eine weitere Ausführungsform einer Arretiervorrichtung.Figure 9: another embodiment of a locking device.
In Figur 1 ist ein typischer Oberschenkelhalsbruch dargestellt, wobei vom Oberschenkelknochen 1 der Hüftkopf 2 abgebrochen ist. Die sich bildenden Frakturflächen sind mit 3 und 4 bezeichnet.A typical fracture of the femur is shown in FIG. 1, the femoral head 2 being broken off from the femur 1. The fracture surfaces that form are labeled 3 and 4.
Es wird der Bruch zunächst reponiert, um die Frakturflächen 3, 4 gemäß Figur 2 zusammenzuführen, so dann wird von Position 21 aus zunächst ein Kirschnerdraht im Verlauf des geplanten Schraubenverlaufs eingebohrt und die Lage geprüft. Mit einem Zwei-Stufen-Bohrers wird dann der Kirschnerdraht überbohrt und die zweiteilige Gleitschraube 5, 7 wird jeweils in die angelegte Bohrung eingeschraubt. Im Ausführungsbeispiel nach Figur 2 sind also zwei zweiteilige Gleitschrauben nebeneinander angeordnet. Sie besteht aus der Gleitschraube 7 selbst und der dazu gehörenden Gleithülse 5. Gemäß Figur 3 besteht die Gleithülse 7 aus einem Schraubenbolzen 9 mit einem vorderen Gewindekopf 8, der in den Hüftkopf 2 eingeschraubt ist. Das hintere Teil des Schraubenbolzens 9 ist axial verschiebbar in der Aufnahmebohrung 10 einer Gleithülse 5 gelagert, die erfindungsgemäß mit einem Außengewinde 6 versehen ist.The fracture is first repositioned in order to bring the fracture surfaces 3, 4 together as shown in FIG. 2, then a Kirschner wire is first drilled from position 21 in the course of the planned course of the screw and the position is checked. The Kirschner wire is then drilled through with a two-stage drill and the two-part sliding screw 5, 7 is screwed into the bore in each case. In the exemplary embodiment according to FIG. 2, two two-part sliding screws are thus arranged next to one another. It consists of the sliding screw 7 itself and the associated sliding sleeve 5. According to Figure 3, the sliding sleeve 7 consists of a screw 9 with a front threaded head 8, which is screwed into the femoral head 2. The rear part of the screw bolt 9 is axially displaceably mounted in the receiving bore 10 of a sliding sleeve 5, which according to the invention is provided with an external thread 6.
Es ist vorgesehen, dass sich die Gleitschraube 7 in den Pfeilrichtungen 11 axial verschiebbar in der Aufnahmebohrung 10 verschieben kann, wobei eine Gleitstrecke 12 vorgesehen ist, die dafür sorgt, dass die hintere Stirnseite des Schraubbolzens 9 nicht aus der hinteren Stirnseite der Gleithülse 5 herausragt, weil dies andernfalls zu Weichteilreizungen führen würde.It is provided that the sliding screw 7 can move axially displaceably in the receiving bore 10 in the direction of the arrows 11, a sliding section 12 being provided which ensures that the rear end face of the screw bolt 9 does not protrude from the rear end face of the sliding sleeve 5, because otherwise this would lead to soft tissue irritation.
Zum Einschrauben der zweiteiligen Gleitschraube nach Figur 3 ist ein Werkzeug vorgesehen, welches sowohl an der hinteren Stirnseite der Gleithülse 5 als auch an der Stirnseite des Schraubenbolzens 9 angreift und beide Teile drehfest miteinander verbindet.To screw in the two-part sliding screw according to FIG. 3, a tool is provided which engages both on the rear face of the sliding sleeve 5 and on the face of the screw bolt 9 and connects the two parts to one another in a rotationally fixed manner.
Auf diese Weise können die beiden Teile gleichzeitig von Position 21 her in Figur 2 in die zueinander fluchtenden Schraubkanäle eingeschraubt werden.In this way, the two parts can be screwed simultaneously from position 21 in FIG. 2 into the screw channels aligned with one another.
Um nun zusätzlich zu ermöglichen, dass die Frakturflächen 3, 4 unter Kompression stehen, ist eine Arretiervorrichtung vorgesehen, die in mehreren Ausführungsbeispielen in den Figuren 4 bis 9 dargestellt ist.In order to additionally enable the fracture surfaces 3, 4 to be under compression, a locking device is provided, which is shown in several exemplary embodiments in FIGS. 4 to 9.
In einer ersten Ausgestaltung der Arretiervorrichtung besteht diese aus einem Rastring 13, der fest mit der Gleithülse 15 verbunden ist, wobei der radial innenliegende Teil des Rastringes 13 auf einer widerhakenartigen Rastzähnung 14 aufsitzt. Auf diese Weise wird gewährleitstet, dass der Schraubenbolzen 9 unter Zugspannung steht, denn bei einer Sinterung der Frakturflächen 3, 4 kommt es zu einer Verschiebung des Schraubenbolzens in Pfeilrichtung 11' in die Gleithülse 15 hinein, wodurch der Rastring 13 einen Vorsprung der Rastzähnung 14 überspringt, und in die nächstliegende Rastzähnung eingreift.In a first embodiment of the locking device, it consists of a locking ring 13 which is fixedly connected to the sliding sleeve 15, the radially inner part of the locking ring 13 being seated on barb-like locking teeth 14. In this way, it is ensured that the screw bolt 9 is under tension, because when the fracture surfaces 3, 4 are sintered, the screw bolt is displaced in the direction of arrow 11 'into the sliding sleeve 15, whereby the locking ring 13 jumps over a projection of the locking teeth 14 , and engages in the nearest locking teeth.
Die Figur 5 zeigt hierbei, dass die Rastzähnung 14 nicht am Umfang umlaufend angeordnet sein muss, es kann auch vorgesehen sein, die Rastzähnung 14a lediglich teilweise am Umfang des Schraubenbolzens 9 vorzusehen.FIG. 5 shows that the locking teeth 14 need not be circumferentially arranged, it can also be provided that the locking teeth 14a are only partially provided on the circumference of the screw bolt 9.
Figur 5 zeigt auch angedeutete Kanülen 19, die am Außenumfang der Gleitschraube 7 angeordnet und die nach außen geöffnet sind, um den Kirschnerdraht aufzunehmen. In Figur 6 ist als abgewandeltes Ausführungsbeispiel dargestellt, dass statt eines Rastringes 13 ein oder mehrere Rastklinken 16 verwendet werden können.FIG. 5 also shows indicated cannulas 19 which are arranged on the outer circumference of the sliding screw 7 and which are open to the outside in order to receive the Kirschner wire. FIG. 6 shows as a modified exemplary embodiment that one or more latches 16 can be used instead of a latching ring 13.
Die jeweilige Rastklinke ist hierbei in der eigenen Richtung angeschrägt und wirkt mit der jeweils steilen Flanke der Rastzähnung 14 zusammen.The respective locking pawl is chamfered in its own direction and interacts with the steep flank of the locking teeth 14.
Es ist hierbei möglich, z. B. zwei einander gegenüberliegende Rastklinken 16 zu verwenden und eine nicht-umlaufende Rastzähnung 14a gemäß Figur 5. In der einen Drehlage zwischen der Gleitschraube 17 und der Gleithülse 5 sind damit die Rastklinken 16 außer Eingriff mit der Rastzähnung 14a, während in der anderen Drehlage diese Rastklinken 16 in Eingriff mit der Rastzähnung 14a sind.It is possible here, for. B. to use two opposing locking pawls 16 and a non-rotating locking teeth 14a according to Figure 5. In one rotational position between the sliding screw 17 and the sliding sleeve 5, the locking pawls 16 are out of engagement with the locking teeth 14a, while in the other rotational position this Latches 16 are in engagement with the locking teeth 14a.
Auf diese Weise ist es durch einfache Verdrehung der beiden Teile 5, 17 zueinander möglich, die Rastzähnung in Funktionsstellung und Außer-Funktionsstellung zu bringen.In this way, by simply rotating the two parts 5, 17 relative to one another, it is possible to bring the locking teeth into the functional position and the non-functional position.
Im Vergleich zu der Gleitschraube 17 nach den Figuren 4 und 6 kann auch eine Gleitschraube 27 dadurch gebildet werden, dass statt der Rastzähnung 14 Schlitze 18 in der Oberfläche des Raumbolzens 9 eingearbeitet sind, in welche der Rastring 13 oder die Rastklinken 16 eingreifen.In comparison to the sliding screw 17 according to FIGS. 4 and 6, a sliding screw 27 can also be formed in that, instead of the locking teeth 14, slots 18 are machined in the surface of the space bolt 9, into which the locking ring 13 or the locking pawls 16 engage.
Selbstverständlich muss der Schraubenbolzen 9 nicht voll ausgebildet sein, er kann auch aus einem Hohl-Material bestehen, so dass die zweiteilige Gleitschraube über den liegenden Kirschnerdraht eingesetzt werden kann.Of course, the bolt 9 does not have to be fully formed, it can also consist of a hollow material, so that the two-part sliding screw can be inserted over the lying Kirschner wire.
Die Figur 9 zeigt die kinematische Umkehrung der Funktion der Arretiervorrichtung im Vergleich zu den vorher beschriebenen Arretiervorrichtungen nach Figuren 4 bis 8. Dort ist dargestellt, dass mit dem Schraubenbolzen der Gleitschraube 17 der Rastring 13 oder die Rastklinken 16 verbunden sein können, die mit zugeordneten Rastzähnen 24 oder Schlitzen am Innenumfang einer Gleithülse 25 zusammenwirken.FIG. 9 shows the kinematic reversal of the function of the locking device compared to the locking devices according to FIGS. 4 to 8 described there. It is shown that the locking ring 13 or the locking pawls 16, which are associated with the locking teeth, can be connected to the screw bolt of the sliding screw 17 24 or slits cooperate on the inner circumference of a sliding sleeve 25.
Wichtig bei allen Ausführungsformen ist jedoch, dass am Außenumfang der jeweiligen Gleithülse 5, 15, 25 ein Schraubgewinde 20 angeordnet ist, mit dem es gelingt, durch einen minimal-invasiven Eingriff die zweiteilige Gleitschraube einzusetzen und wieder zu entfernen. ZeichnunqslegendeIt is important in all embodiments, however, that a screw thread 20 is arranged on the outer circumference of the respective sliding sleeve 5, 15, 25, with which it is possible to insert and remove the two-part sliding screw by a minimally invasive intervention. Drawing legend
1. Hüftknochen1. hip bone
2. Hüftkopf2. femoral head
3. Frakturfläche (Hüftkopf)3. fracture surface (femoral head)
4. Frakturfläche (Hüftknochen)4. Fracture surface (hip bone)
5. Gleithülse5. Sliding sleeve
6. Außengewinde6. Male thread
7. Gleitschraube7. Slide screw
8. Gewindekopf8. Threaded head
9. Schraubbolzen9. Bolt
10. Aufnahmebohrung10. Location hole
11. Pfeilrichtung 11'11. Arrow direction 11 '
12. Gleitstrecke12. Glide route
13. Rastring13. Locking ring
14. Rastzähnung14. Latching teeth
15. Gleithülse15. Sliding sleeve
16. Rastklinke16.Latch
17. Gleitschraube17. Slide screw
18. Schlitz18th slot
19. Kanüle19. Cannula
20. Schraubgewinde20.Screw thread
21. Position21st position
22.22.
23.23rd
24.24th
25. Gleithülse25. Sliding sleeve
26.26th
27. Gleitschraube 27. Slide screw

Claims

Patentansprüche claims
1. Implantat zur operativen Versorgung von z. B. Schenkelhalsbrüchen mit einer Gleitschraube (7,17,27), welche am vorderen Ende einen Gleitkopf (8) aufweist, der in das eine Knochenteil (z. B. den Hüftkopf 2) eingeschraubt ist und deren Schraubenbolzen (9) die Frakturfläche (3, 4) durchsetzt und in einer im anderen Knochenteil (z. B. dem Hüftknochen 1) verankerten Gleithülse (5, 15) mit axialem Spiel eingreift, dadurch gekennzeichnet, dass die Gleithülse (5, 15) mindestens teilweise am Außenumfang mit einem Schraubgewinde (20) versehen ist.1. Implant for the operative care of z. B. fractures of the femoral neck with a sliding screw (7, 17, 27), which has a sliding head (8) at the front end, which is screwed into one of the bone parts (e.g. the femoral head 2) and the screw bolts (9) of which fracture surface ( 3, 4) penetrates and engages with axial play in a sliding sleeve (5, 15) anchored in the other bone part (e.g. the hip bone 1), characterized in that the sliding sleeve (5, 15) at least partially on the outer circumference with a screw thread (20) is provided.
2. Implantat zur operativen Versorgung von z. B. Schenkelhalsbrüchen, das als längliches, mindestens zweiteiliges Teil ausgebildet ist, dessen einer Teil in dem einen Teil des Knochens und dessen anderer Teil in dem gegenüberliegenden, durch den Bruch getrennten, anderen Teil des Knochens verankert ist, dadurch gekennzeichnet, dass zwischen den beiden Teilen eine Arretier-2. Implant for the operative care of z. B. femoral neck fractures, which is designed as an elongated, at least two-part part, one part of which is anchored in one part of the bone and the other part in the opposite, separated by the fracture, other part of the bone, characterized in that between the two Share a locking
Vorrichtung (13, 16) angeordnet ist, welche lediglich eine axiale Verschiebung des einen Teils zum anderen in nur einer Richtung gestattet, (Fig. 4 bis 9).Device (13, 16) is arranged, which only allows an axial displacement of one part to the other in only one direction, (Fig. 4 to 9).
3. Implantat nach Anspruch 1 oder 2, dadurch gekennzeichnet, dass die Arretiervorrichtung als Klinkengesperre ausgebildet ist.3. Implant according to claim 1 or 2, characterized in that the locking device is designed as a ratchet mechanism.
4. Implantat nach Anspruch 3, dadurch gekennzeichnet, dass das Klinkengesperre aus einem Rastring (13) besteht, der radial einwärts gerichtet an der Gleithülse (15) befestigt ist und der mit einer zugeordneten, sägezahnartigen4. Implant according to claim 3, characterized in that the ratchet consists of a locking ring (13) which is fixed radially inward on the sliding sleeve (15) and which is associated with an associated sawtooth
Rastzähnung (14, 18) am Außenumfang der Gleitschraube (17, 27) zusammenwirkt.Locking teeth (14, 18) on the outer circumference of the sliding screw (17, 27) cooperates.
5. Implantat nach Anspruch 4, dadurch gekennzeichnet, dass die Rastzähnung (14) sich über den gesamten Umfang des Schraubenbolzens (9) erstreckt, (Fig.5. Implant according to claim 4, characterized in that the locking teeth (14) extend over the entire circumference of the screw bolt (9), (Fig.
4).4).
6. Implantat nach Anspruch 4, dadurch gekennzeichnet, dass die Rastzähnung (14a) sich nur teilweise am Umfang des Schraubenbolzens (9) erstreckt, (Fig. 5).6. Implant according to claim 4, characterized in that the locking teeth (14a) extend only partially on the circumference of the screw bolt (9) (Fig. 5).
7. Implantat nach Anspruch 4, dadurch gekennzeichnet, dass die Rastzähnung als Schlitze (18) im Schraubenbolzen ausgebildet ist. 7. Implant according to claim 4, characterized in that the locking teeth are designed as slots (18) in the screw bolt.
8. Implantat nach einem der Ansprüche 1 bis 7, dadurch gekennzeichnet, dass die Gleichschraube (7 17, 27) am Außenumfang ein oder mehrere in axialer Richtung verlaufende und radial außen geöffnete Kanülen (19) aufweist.8. Implant according to one of claims 1 to 7, characterized in that the equal screw (7 17, 27) has one or more cannulas (19) extending in the axial direction and open radially on the outer circumference.
9. Implantat nach einem der Ansprüche 1 bis 8, dadurch gekennzeichnet, dass es als Gleitschraube ausgebildet ist.9. Implant according to one of claims 1 to 8, characterized in that it is designed as a sliding screw.
10. Implantat nach einem der Ansprüche 1 bis 8, dadurch gekennzeichnet, dass es als Marknagel ausgebildet ist. 10. Implant according to one of claims 1 to 8, characterized in that it is designed as an intramedullary nail.
PCT/EP2000/004274 1999-05-11 2000-05-11 Implant for operative treatment of femoral neck fractures and the like WO2000067652A2 (en)

Priority Applications (1)

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DE29908360U DE29908360U1 (en) 1999-05-11 1999-05-11 Slide screw for the operative supply of e.g. Fractures of the femoral neck
DE29908360.8 1999-05-11

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WO2000067652A3 WO2000067652A3 (en) 2001-04-19
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