WO2015163262A1 - Internal fixation device for bone fracture treatment - Google Patents

Abstract

The purpose of the present invention is to reliably prevent a back out phenomenon, and alleviate the burden on the patient by reducing the size of a surgical wound. In the present invention, a steel wire (Kirschner steel wire (20)) pierces the site to be treated (patella (40)) so as to span the bone fracture site (cracked part (40c)) and steel wire holding assemblies (staplers (10)) for holding the ends (one end (20a), other end (20b)) of the steel wire (Kirschner steel wire (20))are fixed to points sandwiching the bone fracture site (cracked part (40c)) of the site to be treated (patella (40)) while the ends (one end (20a), other end (20b)) of the steel wire (Kirschner steel wire (20)) are fixed at the steel wire holding assemblies (stapler (10)) by steal wire fixation assemblies (screw sets (30)).

Description

Fracture fixator

The present invention relates to a surgical treatment for a fracture of a portion of the patella, distal femur, radius, etc., which can be clamped from both directions (both ends of the bone), specifically, both ends of the bone across the fracture site. The present invention relates to an internal fixation device for fracture treatment, which is used in a treatment method that tightens at a starting point.

For example, in patella fractures, there are usually many fractures that split into two upper and lower bone fragments (lateral fractures) and fractures that split into two left and right bone fragments (longitudinal fractures). As a treatment method for such a fracture, a tension banding method as shown in Non-Patent Document 1 is used. Further, in the case where there is no metastasis (bone displacement), a conservative treatment shown in Non-Patent Document 2, specifically, a treatment method that is fixed by Gibbs or the like is also employed. Conservative therapy is limited to cases where there is no bone displacement, which is relatively mild, and there are problems such as a large limitation of exercise and a long period of time for adhesion, and surgical treatment by tension band wiring is the mainstream It has become.

Here, the outline of the tension band wiring method will be described. For example, as shown in FIG. 19, from the end of one bone piece 1 a to the other so as to be orthogonal to the crack direction of the crack portion 1 c of the patella 1. To the end 1b of the bone fragment, two rod-like bodies (hereinafter referred to as a steel wire for convenience) 2 made of metal called a titanium or stainless steel Kirschner steel wire are penetrated in parallel. Further, the distal end 2a of the steel wire 2 exposed from the ends of both bone fragments 1a and 1b is bent toward the rear of the patella 1 so that there are 8 pieces between the distal end 2a and the rear end 2c of the steel wire 2. Wrap the wire 3 made of stainless steel around the brush so as to draw a letter. And by tightening the wire 3, the crack part 1c is closed and both bone pieces 1a and 1b are fixed. Reference numeral 3 a indicates a knot of the wire 3.

Campbell Orthopedic Surgery (11 volumes in total) Katsuyuki Fujii (general translator) Elsevier Japan KK Volume 7 “Bone Fractures and Dislocations” P134-137, P376-377, September 2004 “Explanation of Symptoms / Diagnosis / Treatment of Patella Fracture” Internet <http: // allout. co. jp / gm / gc / 420213 />

In the tension band wiring method in Non-Patent Document 1 described above, the bone pieces 1a and 1b of the patella 1 can be fixed by winding the wire 3 around the Kirschner steel wire 2 passed through the patella 1 and tightening it. Since it is performed reliably, relatively good surgical results are obtained.

However, in such a tension band-wiring method, the patella 1 is weak in the bones of elderly people with advanced osteoporosis, and the steel wire 2 is displaced while the legs are moved. There is a problem that a back-out phenomenon that the tension due to 3 is weakened or the wire 3 is detached from the front end 2a or the rear end 2c of the steel wire 2 may occur. Such a back-out phenomenon is sometimes seen after the operation, and when the back-out occurs, the operation is forced to be performed again, and the burden on the patient is great.

Further, two steel wires 2 are penetrated in parallel so as to be orthogonal to the crack direction of the crack portion 1c of the patella 1, and further, the figure 8 is formed between the front end portion 2a and the rear end portion 2c of the steel wire 2. It is necessary to wrap the wire 3 made of stainless steel around the brush so as to draw. Therefore, a wide incision (approx. 10cm) necessary for at least wiping the wire 3 is required in front of the knee joint, and the surgical wound becomes large and not only cosmetically superior, but also limits the range of motion of the pain and knee joint. There was also a problem that caused it.

Furthermore, the treatment time also takes a relatively long time, and there is also a problem that the burden on the patient is increased from this aspect.

The present invention has been made in view of such a situation, and is capable of reliably preventing the back-out phenomenon, reducing the surgical wound, and reducing the burden on the patient. The purpose is to provide.

The fracture treatment internal fixation device of the present invention is a fracture treatment internal fixation device used for fracture treatment, and a steel wire penetrated across the fracture site with respect to the treatment site, and the treatment site A pair of steel wire holders that are fixed by being inserted into both ends of the bone sandwiching the fracture site, and holding both ends of the steel wire, and both ends of the steel wire on the steel wire holder by mechanical means It comprises a steel wire fixture for fixing.
Here, each part which comprises the internal fixation device for fracture treatment of this invention is demonstrated. The steel wire constituting the fixture is a linear rod-like body, and it is sufficient if it can maintain sufficient strength against patient movement when placed in operation, and is not particularly limited. Absent. Specifically, as the material, iron such as steel, which is a metal, copper (though preferably annealed to give strength (hardness)), stainless alloy, titanium, titanium alloy, etc. are exemplified. High strength resins and the like are also exemplified, but stainless steel alloys, titanium alloys and the like are recommended as preferable materials from the viewpoints of corrosivity, strength, brittleness, biocompatibility and the like.
In addition, the shape is a long, straight, rod-like shape, and the thickness should be such that it does not significantly impede movement when placed in the body after surgery, or destroy the surrounding bone part during placement. Therefore, it can be selected as appropriate depending on the bone shape of the indwelling site, the surrounding situation, the magnitude of the load such as external force at the site, and the like.
If the thickness is too thin, fixing with a steel wire holder may be difficult, so it is necessary to avoid being too thin. Therefore, it is recommended that the maximum cross-sectional diameter is 0.5 to 8 mm, preferably 0.8 to 5 mm when used for, for example, a patella fracture. In addition, the shape may be a columnar shape, a prismatic shape such as a triangular prism, a quadrangular prism, or the like, but generally a cylindrical shape is preferable.
Furthermore, it is also preferable that the one end portion (tip portion) of the steel wire has a sharp shape so that the steel wire can easily penetrate the bone during the treatment. Examples of the sharp form include a conical shape, a pyramidal shape, a screw screw shape, and a tip notch shape. Further, in the case of a cylindrical shape, it is also possible to use a shape in which a part or all of the outer side surface is processed into a male screw shape.
In addition, after such a steel wire is treated and fixed, if both ends are too long, it is recommended that the steel wire be appropriately cut to remove unnecessary portions. In particular, with regard to the above-described distal end portion, it is recommended that the sharp portion is cut and removed after penetrating the bone, and that the steel wire is easily fixed.
In the present invention, these materials, shapes and the like are not particularly limited, but any commercially available Kirschner steel wire can sufficiently satisfy these shapes.
Further, the steel wire holder includes a substrate portion in which a first through-hole for penetrating the steel wire is formed, and a wedge portion provided in the substrate portion along the direction of the first through-hole. And the wedge portion is capable of biting into the treatment target site.
Here, as the shape of the substrate portion, any shape can be used as long as the above functions can be performed, such as a circle, an ellipse, a square, a rectangle, etc., but it is adapted to the shape of the bone surface with which the steel wire holder is in contact. A shape is recommended. For example, when applying to a patella, it is recommended that it is a rectangle or an ellipse from the shape of the bone part which contacts.
The size and thickness (standard) differ depending on the material strength (for external force applied to the substrate, etc.) and the indwelling location (target bone site). For example, the target bone is the patella. In this case, a rectangular or elliptical substrate is recommended, and the length in the longitudinal direction is preferably about 1 to 10 cm, and more preferably about 1.5 to 5 cm.
The length in the width direction is preferably about 0.3 to 2 cm, and more preferably about 0.5 to 1.5 cm. The thickness is preferably 0.1 to 1 cm, and more preferably about 0.2 to 0.7 cm.
Further, since the steel wire penetrates through the substrate as described above, a hole for penetrating the steel wire is provided. The standard of the hole is required to be a size through which the steel wire can penetrate, and it is recommended that the size should be such that it can penetrate without being subjected to extreme resistance. Moreover, if the hole is too large, it is not preferable because it is necessary to extremely increase the standard of the steel wire fixture described later.
Furthermore, the function of the wedge part provided in the steel wire holder according to the present invention is that the wedge part is driven into the target bone (inserted, pushed in, stabbed, etc.), and can be substantially integrated with the substrate after the treatment. It is.
Here, in the present invention, substantially integrated means that the wedge part is integrated with the substrate by welding, bonding or screwing, etc. Further, the wedge portion may be a nail shape, a wood screw shape, a wedge shape, or the like, and may be separated from the substrate portion. Also, the substrate portion has a hole that penetrates the separated wedge portion, and the hole is penetrated, inserted into the target hole, and fixed to the substrate portion, so that it is substantially integrated. .
In such a case, the shape of the end of the portion that comes into contact with the substrate portion, rather than the side to be inserted into the bone, is made larger by the wedge portion by making it larger than the hole provided to penetrate the wedge portion of the substrate portion It is a shape which can hold down a substrate part.
In addition, as the overall shape of the wedge portion, it is necessary to enter the target bone by inserting, pushing, or piercing. For this reason, at least the tip on the side to be inserted into the bone must have a sharp shape. Specific examples include triangular prisms (right triangular prisms and isosceles triangular prisms), conical shapes, and truncated cone shapes. Further, a cylindrical shape with a sharp tip such as a nail shape or a wood screw shape or a wedge shape, or a polygonal column shape with a sharp tip is exemplified.
Further, in the case of being integrally molded with the substrate portion, for example, the both ends in the longitudinal direction of the substrate portion can be bent, and the bent portion can be used as a wedge portion. In this case, the tip of the wedge portion can be partially cut out by chamfering, cutting, or the like to sharpen the tip. Specifically, by cutting away from the tip to the base (substrate part contact portion) along the diagonal in the thickness direction of the plate, it becomes a right triangular prism shape or an isosceles triangle in the thickness direction. The tip can be sharpened.
The length of the wedge portion in the internal fracture fixator for fracture treatment according to the present invention is appropriately adapted depending on the target bone and the magnitude of the external force applied to the bone, and is sufficiently fitted into the bone. It must be long enough not to come off. For example, when applied to the patella, it is preferably about 0.5 to 4 cm, and more preferably about 1 to 3 cm.
Moreover, the material of the wedge part is exemplified by the same material as that used for the substrate part. In particular, when it is integrally formed with the substrate portion, it is preferable that the material is the same as that of the substrate portion. Also, when it is integrated with the board part by welding, bonding, etc., or when it is inserted into the hole of the board part with wood screws or nails, etc., and is substantially integrated with the board part, the material is different from that of the board part. There is no problem.
Next, the steel wire fixture will be described. The action of the steel wire fixing tool in the present invention is to hold the steel wire by a mechanical action on the steel wire by the fixing tool, for example, a tightening action, and to substantially integrate and fix the steel wire. At the same time, the steel wire and the steel wire holder are integrated and fixed so as not to come off. Specifically, the fixing by the fastening action to the steel wire by the fixing tool is accomplished by, for example, fastening to the mechanical steel wire by a screwing method or a pressing method. In particular, fixing by integration using a tightening action by a screw is preferable.
Specific examples of the means for embodying these functions and the structure of the steel wire fixture will be given below. However, the steel wire fixture in the present invention is not limited to the following examples. Any fixture that satisfies the function can be used.
As a first example of the steel wire fixture, there is a bolt having a screw part and a head part, and a nut screwed into the screw part, and the screw part penetrates the steel wire. Two through holes are formed so as to be orthogonal to the axial direction of the threaded portion, and the end of the steel wire is fixed between the nut and the head of the bolt by screwing the nut. It is characterized by.
The second through hole is provided at a position close to the head.
The bolt is a bolt having a polygonal head.
In this case, by tightening the nut and pressing the steel wire with the bolt-side head inner surface and the nut surface, fixing of the steel wire, fixing of the fixture and the steel wire is achieved, and further, the steel wire holder Is also fixed. Here, the steel wire fixed by the fixing tool is a polygonal body located at the end (head) of the bolt in order to almost completely hold down the fractured portion or cracked portion when tightening from both ends of the bone. (Hereinafter referred to as a bolt end polygon) It is preferable that the side surface portion and the substrate surface of the steel wire holder abut (adhere), and for this purpose, the outer diameter of the nut is the bolt end polygon. Smaller than the outside diameter. This facilitates tightening with a nut, and the end of the steel wire is fixed in a state where the end surface (side surface) of the bolt end polygon is in contact with the substrate portion of the steel wire holder.
At this time, the distance between the side surface of the bolt end polygon of the steel wire fixture and the side surface of the nut polygon and the steel wire holder base plate surface to which the steel wire is fixed is somewhat (in the case of patella surgery, Even if a gap of up to about 1 cm is generated, there is a case where the problem is not substantially caused in the treatment effect. In this case, the outer diameter of the bolt end polygon and the outer diameter of the nut may be the same.
On the contrary, there is a case that the polygonal body diameter of the bolt may be smaller than the outer diameter of the nut. However, it is not preferable that the difference in size between these diameters is too large. For example, it is recommended that the difference in outer diameter when applied to the patella is 1 cm or less, preferably 0.5 cm or less.
At this time, it is also recommended to provide a recess in the inner surface of the through hole provided in the bolt portion of the fixture. The dent mentioned here is a shallow dent provided on the surface in a line shape. By forming such a depression, the frictional force between the bolt surface and the steel wire that have been machined increases, and the effect of fixing and holding the steel wire due to the pressing force on the groove surface is increased. It has a preventive effect. Such a depression is preferably a sharp groove shape such as a triangular shape or a quadrangular shape.
Next, as a second example of the steel wire fixture, the threaded portion of the bolt tapers from the portion joined to the bolt end polygon to the tip (bolt end portion into which the tightening nut is inserted). A taper shape is formed at the center of the threaded portion, which is notched along the long axis direction of the bolt from the tip to the bolt end, and a groove for dividing the bolt threaded portion penetrates the bolt in the first example. Instead of the hole, one or more are formed along the long axis direction of the bolt, and the groove can pass through the steel wire and has a width that is slightly larger than the outer diameter of the steel wire (preferably 1 mm or less). Have.
By tightening the taper screw by screwing the nut, the width interval of the groove is narrowed, and by tightening the screw strongly, the steel wire passed through the groove is tightened by the pressing force from the inner surface of the groove. As a result, the end portion of the steel wire fitted in the groove is fixed in the groove. At this time, in the groove, a portion in contact with the steel wire may be formed along the major axis direction of the steel wire for tightening the same recess as described in the first example. In other words, the recess is formed so as to be orthogonal to the major axis direction of the bolt.
As an example of the groove for dividing the bolt screw portion, the groove is provided so as to divide the bolt in a tapered screw (male screw) shape into two. The width of the groove is a width that allows the steel wire to pass through before tightening with the nut, and a width that allows the steel wire to be sufficiently pressed down when the nut is tightened.
A recess is formed on the inner surface of the groove thus provided. As described above, the depression is provided on the inner surface of the groove along the direction in which the steel wire penetrates. At this time, as the shape of the groove, a width slightly smaller than the outer diameter of the steel wire, a notch in a triangular or quadrangular shape, or a plurality of (on the inner surface of the groove along the penetration direction of the steel wire ( It is also recommended to provide 2 or more, preferably 5 or more) linear depressions for each groove surface.
In this way, the steel wire is suppressed and fixed by tightening a bolt having a tapered screw shape and a groove with a nut. Further, when two or more grooves are provided, it is essential to provide the grooves so that the steel wires can be penetrated because the steel wires must be penetrated. Specifically, for example, when the bolts are installed so as to be equally divided, it is necessary to install grooves such as 2-division, 4-division, and 8-division, but from the standpoint of contact efficiency, it may be 2-division. preferable.
Further, as a third example of the steel wire fixture, as in the second example, there is a bolt having a screw part and a head (an end polygon), and a nut screwed into the screw part. The screw portion of the bolt has a tapered shape that tapers toward the tip. A notched groove is formed at the center of the screw portion so as to divide the bolt screw portion from the tip to the head, as in the second example, and the bolt end polygon is provided with the screw portion polygon. A hole is formed along the axial direction and communicated with the groove, and the nut is screwed in a state where a top portion of the head of the bolt is in contact with a base plate portion of the steel wire holder. The end of the wire is fixed by being tightened on the inner surface side of the groove.
Specifically, after passing the steel wire through the steel wire holder, the holder is pierced into the bone, and the end faces (planar bottom faces) of the bolt end polygon pairs are in the plane of the holder base part. The steel wire is passed through the fixture so as to come into contact, and then a nut is attached to the bolt thread and tightened. By tightening with the nut, the groove interval of the bolt is narrowed, and by tightening the steel wire, the steel wire and the fixture, and further, the steel wire holder are integrated and fixed.
Here, the form of the groove in the third example is preferably provided so as to equally divide the screw portion of the bolt (excluding the head). For example, if the shape is divided into two, the inner surface of the groove that contacts the steel wire is planar, but if the groove is divided equally into three or more, the portion that contacts the steel wire is the apex of the core. Contact at the part (that is, linear contact).
In such a case, by chamfering the formed apex portion, when the groove and the steel wire come into contact, the flat surface of the groove comes into contact with the steel wire, and the effect of tightening the steel wire is expected to increase. Is done. In addition, it is recommended that a recess (preferably a plurality) be provided on the surface formed in the groove along the long axis direction of the steel wire. Providing the recess increases the frictional force between the steel wire and the flat surface portion in the groove, thereby fixing the steel wire more effectively.
It is recommended that the shape as the depression is the same as in the first and second examples. In addition, it is recommended that a plurality of shallow groove-like depressions linearly in the same direction as the major axis direction of the steel wire be provided at equal intervals, preferably 3 or more, more preferably 5 or more. By installing the depression, the frictional force between the steel wire side surface and the groove surface increases, and loosening due to rotation of the fixture can be further prevented.
The fourth example is an example in which the function of a one-side union or a sleeve, which is used when connecting a general tube (tube or the like), is applied. The steel wire fixing tool has a so-called hole-penetrating sleeve having a threaded part on the outer periphery and a through-hole inside, and a so-called donut-type fastening tool having a through-hole inside. A ferrule or an O-ring and a cap nut having a space capable of accommodating the ferrule, the O-ring and the like inside the through mold, and having a through-hole communicating with the space from the top. By tightening into a threaded union type sleeve, the ferrule, O-ring, etc. are pushed into the space formed between the steel wire and the inner surface of the union type sleeve with one side thread. The end of the steel wire is fixed by biting into the part and the space.
Specifically, the sleeve referred to in the present invention is a polygonal column (usually having a through hole through which a steel wire can penetrate in the long axis direction at the center of the diameter, a male screw, and a certain thickness. Is a union type sleeve of a bolt-shaped hollow hole penetration type having one end (hereinafter referred to as a head) of a hexagonal prism. As described above, the sleeve is provided with through holes in the long axis direction (linear through holes extending in the long axis direction from the head end surface of the bolt to the bolt front end surface). In terms of external shape, the shape is usually only on one side of a union joint used for joining the pipes.
Moreover, it is preferable that the head end surface (surface perpendicular to the bolt major axis direction) of the bolt is a flat surface so as to be in good contact with the steel wire holder substrate surface. Furthermore, the bolt head end surface and the steel wire holder substrate surface may be joined, and the bolt-shaped union type sleeve and the steel wire holder may be integrated. In this case, the through-hole formed in the holder substrate surface and the through-hole provided in the sleeve are arranged so that the steel wire can penetrate both through-holes simultaneously. At this time, the integration of the holder and the union is not particularly limited in the present invention. For example, by welding, adhesion, or cutting, cutting out, forging, or the like in which the holder and the union are made of the same material. Can be achieved.
The shape of the through hole provided in the sleeve is not particularly limited as long as it is a shape that can fully exert the tightening effect by the ferrule and can penetrate the steel wire even if it is a circular, elliptical or polygonal hole Any shape is acceptable, but a circular shape is recommended from the viewpoint of processing, the shape of the steel wire and the effect of ferrule.
Further, the size of the diameter of the through hole is not particularly specified in the present invention, but the preferred size depends on the size of the diameter of the steel wire and the size and shape of the outer diameter of the ferrule. Specifically, it is preferable that the inner diameter of the portion where the ferrule contacts the outer diameter of the steel wire is preferably several percent to several tens of percent larger, but the diameter of the through hole in the portion where the ferrule does not contact is large as described above. The diameter is preferably such that the steel wire can penetrate without being subjected to extreme resistance. That is, it is preferable that it is about several percent larger than the outer diameter of the steel wire.
Therefore, in such a case, a certain depth (for example, a range within a few millimeters when used for a patella) from the front end surface in contact with the union cap nut is a wide caliber. A two-stage through-hole, such as reducing the diameter of the through-hole to the surface, is preferable from the viewpoint of the effect of fastening the steel wire by the ferrule.
It is also recommended that the diameter of the union through hole be such that the steel wire can be penetrated without being subjected to extreme resistance as described above, and that the tip of the portion in contact with the ferrule is chamfered in a tapered shape. . By chamfering in a tapered shape, as will be described later, the ferrule is pushed by the cap nut, and the gap between the through hole and the steel wire is easily bitten, so that a strong steel wire can be fixed.
At this time, it is recommended that the depth of the tapered surface be in the same range as the depth of the above-mentioned two-stage hole and the hole having a large diameter, or to be somewhat shallower than that. Further, as a fifth example, a normal pipe having the same structure as that of the fourth example, but having a polygonal part on both sides, a union part on the bolt on both sides, and a through hole in the major axis direction Even a joint type union can be a component of the steel wire fixture of the present invention. In this case, the steel wire is fixed at two upper and lower portions in the same manner as described above by two pairs of cap nuts and ferrules or O-rings similar to the above at two upper and lower end portions of the union.
In this case, it is preferable that the structure of the end portion of the hole contacting the through hole or ferrule provided in the steel wire fixture is the same as the shape of the hole in the fixture of the fourth example described above. Thus, compared to the fourth example, the steel wire fixture is longer along the major axis direction of the steel wire, and the fixture itself is likely to be excessive. It is recommended to take measures to shorten it.
Next, the ferrule in the steel wire fixture illustrated in the fourth example and the fifth example has a shape used for a normal union joint, and is a cap nut, hole (through hole in the present instrument). Any shape and standard determined in association with the shape such as. Specifically, the ferrule has a donut shape with a hole in the center so that it can pass through the steel wire, and the donut body has a narrow end at the end that enters the union hole. It is recommended to use a so-called hollow frustoconical column shape in which one end in contact with the surface is thick, or a so-called abacus ball shape in which the central portion of the side surface of the ferrule swells.
In addition, double bite type ferrules are often used for ordinary union joints, but it is also recommended to use double bite type ferrules as a pair of ferrules in this steel wire fixture. In some cases, the steel wire can be fixed more firmly. In addition, it is recommended to use an O-ring instead of a ferrule.
The inner diameter of such ferrules or O-rings must be large enough to allow the steel wire to be used to pass through. However, if the inner diameter is too large, the steel wire is inserted into the through hole of the union. The ferrule or O-ring cannot substantially bite into the space formed between the inner wall of the through-hole (especially the end on the nut contact side) and the steel wire that can be inserted. It becomes difficult to fix.
Accordingly, it is preferable that the inner diameter of the ferrule or O-ring has a diameter that can pass a steel wire. However, if it is too large compared to the steel wire, there is a possibility that it is substantially impossible to tighten and fix the steel wire. Further, when the material of the ferrule or O-ring is a flexible material (for example, Viton or silicone), the inner diameter is preferably slightly smaller than the outer diameter of the steel wire. In this case, the steel wire is effectively fixed by expanding the O-ring and attaching it to the steel wire while sandwiching it, and then pressing it with a cap nut.
Further, regarding the maximum outer diameter of the ferrule or O-ring, the inner diameter of the end portion of the through hole located on the end surface of the union mounting portion of the union (in the case of a two-stage type hole, the hole diameter of the end portion is increased and tapered. When chamfered, the diameter is preferably larger than the diameter of the tapered opening.
Particularly, in the case of hollow type truncated cone pillar type or abacus ball type ferrules, if the maximum outer diameter is smaller than the inner diameter of the end of the union through hole, there is a possibility that tightening with a cap nut may not be effective at the time of fixing. At this time, the thickness width of the ferrule to be used (the so-called height width, not the difference between the outer diameter and the inner diameter) is large. For example, as described above, when the structure of the union bolt hole opening is two-stage or tapered, It may be smaller than the maximum inner diameter of the opening of the union through hole. However, it is not preferable that the maximum diameter of the ferrule or O-ring is smaller than the minimum diameter of the union through hole.
Further, it is recommended that the maximum outer diameter of the ferrule or O-ring be smaller than the outer diameter of the male screw portion and the inner diameter of the cap nut screw portion of the bolt type union. This means that if the ferrule is made of a hard material such as metal, it is practically impossible to screw it with a cap nut. This is because the ferrule or O-ring may be threaded.
Moreover, about the material of the union part of a steel wire fixture in the 4th and 5th example, and the material of a nut part, iron, copper, etc. (however, copper of a metal etc.) like the material of the steel wire mentioned above In some cases, those annealed to give strength (hardness) are preferred.), Stainless steel alloys, titanium, titanium alloys, etc. are exemplified, and high strength resins are also exemplified, but corrosiveness, strength, brittleness, biological From the viewpoint of affinity and the like, stainless steel alloy, titanium alloy and the like are recommended as preferable materials. It is also recommended to use a fluorine-based resin (trade name: Teflon: registered trademark) such as perfluoropolyethylene or a hard resin.
In addition, regarding the material such as ferrule or O-ring, in addition to the above-described metal material or hard resin, it is also possible to use a flexible resin such as Viton or silicone resin as described above. At this time, when the metal material described above is used as a ferrule or O-ring material, the ferrule or O-ring is firmly attached to the steel wire when the fastening steel wire is fastened to the union part with a cap nut. Occasionally, it can be integrated and cannot be removed from the steel wire.
As described above, when the internal fracture fixator for fracture treatment of the present invention is removed from the patient after the treatment is completed, if the ferrule or O-ring cannot be removed from the steel wire and cannot be removed, the shape of the ferrule or O-ring described above is used. If the size is too large, there is a high possibility that the ferrule cannot pass through the through hole of the union portion even though the cap nut portion can be substantially removed.
If the ferrule or O-ring cannot be removed from the steel wire, the steel wire cannot be removed through the union through hole. In such a case, it is necessary to remove the ferrule or O-ring by cutting or the like, or to cut the steel wire between the ferrule contact portion and the union portion or between the union head portion and the bone. It is very difficult to substantially cut the steel wire at the portion, and it is preferable to remove the ferrule and the O-ring.
When the material of the ferrule is the above-described metal material, it is difficult to break such as cutting. In such a case, the ferrule is made of a flexible resin material such as Teflon (registered trademark) (general name: perfluoropolyethylene), the general name Viton, or silicone resin, and a material that can be cut with a knife such as a cutter knife is used. It is preferable to select. However, in the case of ferrules, it is preferable that the viton material and the silicone material are not soft but hard.
The cap nut used for the steel wire fixture in the fourth and fifth examples is a nut that is screwed into the bolt portion of the union, and has a cover surface so as to cover the front end surface of the bolt portion and the ferrule or O-ring. Yes.
On the lid surface, the nut is screwed into the union, and when installed, the position is concentric with the through hole provided in the union, that is, a straight bar-shaped steel wire penetrates the hole of the union, and the bag A through hole is provided so as to be able to penetrate the hole of the nut. At this time, the size of the through hole is required to be a size through which the steel wire can be penetrated. Furthermore, the diameter is smaller than the maximum outer diameter of the ferrule attached with the union.
If it is a standard within this range, attach the union part of the steel wire, the steel wire holder through which the steel wire penetrates, and the steel wire fixture through which the steel wire penetrates, and then pass through the steel wire to the end face of the bolt part of the union part. Tighten the installed ferrule with the cap nut, and push the ferrule into the gap formed between the inner surface of the bolt part of the union part and the steel wire by the inner surface of the cap nut lid of the cap nut. Fixing with the steel wire fixture is achieved.
Further, as a sixth example, a male screw part is provided along the axial direction on the outer periphery of the steel wire, and the steel wire fixture has a nut screwed into the male screw part, and the nut The end of the steel wire is fixed by the nut by screwing. In this example, the end portion of the steel wire is fixed by the nut by engaging the male screw portion of the steel wire with the female screw portion of the nut. At this time, the male screw provided on the steel wire may be provided on the entire steel wire, or may be provided only on a portion extending in front and rear of the portion where the nut is screwed.
Therefore, the nut itself can be a steel wire fixture in the present invention. In this case, depending on the target bone part, a thick steel wire may not be used, and threading a thin steel wire into a male screw may cause a problem in durability and processing of the steel wire. At this time, it is also recommended to further use a nut between the nut and the holder in order to increase the tightening effect.
In short, in the fracture internal fixation device of the present invention, the steel wire holder that holds the end of the steel wire is penetrated so that the steel wire straddles the fracture site with respect to the treatment target site, and the fracture site of the treatment site The end of the steel wire is fixed on the steel wire holder by the steel wire fixture.
In addition, since the steel wire is penetrated so as to straddle the fracture site with respect to the treatment target site, the incision may be about the size of the steel wire holder that is fixed at a location sandwiching the fracture site of the treatment target site. become.
In addition to the above, in the first and sixth examples of the steel wire fixtures described above, by using a washer together with a nut, the bolt part and the nut part can be tightened better. Also, it can be expected that an effect of fixing by an effect such as prevention of loosening of the nut can be obtained. In addition, when a nut is used in the steel wire fixture according to the present invention, it is effective to prevent loosening of the nut by performing double nut pressing using two nuts.

According to the internal fracture fixator for fracture treatment of the present invention, a steel wire holder that penetrates the fracture site so that the steel wire straddles the fracture site and holds the end of the steel wire is a fracture site of the treatment site. Since the end of the steel wire is fixed on the steel wire holder by the steel wire fixing device, the backout phenomenon is observed even in elderly people with high osteoporosis and weak bones. This can be surely prevented, and the surgical wound can be made smaller.

It is a perspective view for demonstrating 1st Embodiment (specific example of the 1st example of the said steel wire fixing tool) of the internal fixing device for fracture treatment of this invention. It is a side view which shows the internal fixation device for fracture treatment of FIG. It is a perspective view which shows the stapler of the internal fixation device for fracture treatment of FIG. It is a figure for demonstrating the various shapes of the wedge part of the stapler of FIG. It is a top view for demonstrating the steel wire fixing tool (screw set) of the internal fixation device for fracture treatment of FIG. 1 shows a second embodiment in which the configuration of the steel wire fixture of the fracture internal fixation device of FIG. 1 is changed (the outer shape of the nut in the specific example of the first example of the steel wire fixture is reduced). (Example of use) is a diagram for explaining a state in which the internal fracture fixator for fracture treatment is viewed from the side, and (b) in FIG. It is a figure which shows the state which looked at the internal fixation device for fracture treatment from the right direction. It is a figure for demonstrating the steel wire fixing tool (screw set) of FIG. 6, Comprising: The figure (a) is a top view which shows a screw set. It is a figure for demonstrating 3rd Embodiment (specific example of the 2nd example of the said steel wire fixing tool) at the time of changing the structure of the internal fracture fixator of a fracture treatment of FIG. (a) is a figure which shows the state which looked at the internal fixation device for fracture treatment from the side, and the figure (b) is a figure which shows the state which looked at the internal fixation device for fracture treatment of the figure (a) from the right direction. is there. It is a figure for demonstrating an effect | action of the steel wire fixing tool (screw set) of FIG. 8, Comprising: The figure (a) is a figure which shows the state before a nut is screwed together by a volt | bolt, FIG. ) Is a view showing a state in which the nut is screwed into the bolt. It is a figure for demonstrating 4th Embodiment (specific example of the 3rd example of the said steel wire fixing tool) at the time of changing the structure of the internal fracture fixator of a fracture treatment of FIG. (a) is a figure which shows the state which looked at the internal fixation device for fracture treatment from the side surface, (b) is a figure which shows the state which looked at the internal fixation device for fracture treatment of the figure (a) from the front. FIG. 5C is a view showing a state in which the internal fracture fixator for fracture treatment is viewed from directly above. It is a figure for demonstrating the effect | action of the steel wire fixing tool (screw set) of FIG. 10, Comprising: The figure (a) is a figure which shows the state before a nut is screwed together by a volt | bolt, FIG. ) Is a view showing a state in which the nut is screwed into the bolt. It is a figure for demonstrating 5th Embodiment (specific example of the 4th example of the said steel wire fixing tool) at the time of changing the structure of the steel wire fixing device of the internal fixation device for fracture treatment of FIG. The figure (a) is a top view of the cap nut of the steel wire fixture (cap nut sleeve set) of the fracture internal fixation device, and (b) is a side view of the cap nut of Fig. (A). (C) is a plan view of the ferrule, FIG. (D) is a side view of the ferrule of FIG. (C), and (e) is a plan view of the sleeve. Fig. (F) is a side view of the sleeve of Fig. (E). It is a figure for demonstrating the effect | action of the steel wire fixing tool (cap nut sleeve set) of FIG. 12, Comprising: The figure (a) is before fixing of the steel wire by a steel wire fixing tool (cap nut sleeve set) to a stapler. FIG. 4B is a view showing a state in which a steel wire is passed through the sleeve, and FIG. 4C is a view showing a state in which a ferrule is attached to the sleeve. FIG. () Is a figure which shows the state which attached the cap nut to the sleeve, and the figure (e) is a figure which shows the state which fixed the steel wire. It is a figure for demonstrating the improvement of the steel wire fixing tool (cap nut sleeve set) of FIG. 12, Comprising: The figure (a) is a figure which shows the state which fixed the steel wire, The figure (b) It is a figure for demonstrating the effect | action of a ferrule. It is a figure for demonstrating the improvement of the steel wire fixing tool (cap nut sleeve set) of FIG. 12, Comprising: The figure (a) is a figure which shows the state which fixed the steel wire, The figure (b) It is a figure for demonstrating the effect | action of a ferrule, The figure (c) is a figure which shows the state by which fixation of the steel wire was released. FIG. 12 illustrates a sixth embodiment (specific example of the fifth example of the steel wire fixture) in which the configuration of the steel wire fixture (cap nut sleeve set) of the internal fracture fixator for fracture treatment in FIG. 12 is changed. The figure (a) is a figure which shows the steel wire fixing tool at the time of using a union type sleeve, and the figure (b) is the steel wire at the time of using a union type sleeve It is a figure which shows the state which fixed the steel wire with the fixing tool. It is a figure for demonstrating 7th Embodiment (specific example of the 6th example of the said steel wire fixing device) at the time of changing the structure of the steel wire fixing device of the internal fixation device for fracture treatment of FIG. The figure (a) is a figure showing the state before the nut is screwed to the end of the steel wire, and the figure (b) shows the state where the nut is screwed to the end of the steel wire. FIG. It is a figure which shows an example of the washer (washer) used for 1st, 2nd and 7th embodiment. It is a figure for demonstrating an example (tension band wiring method) of the conventional internal fixation device for fracture treatment.

In the embodiment of the present invention, a case where various steel wire fixtures are used will be described by taking patella fracture treatment as an example. In addition, as a steel wire, Kirschner steel wire shall be used in each embodiment. Moreover, as a steel wire holder, the stapler shown in FIG. 3 shall be used. However, the Kirschner steel wire used in the seventh embodiment is a steel wire in which both ends or the whole has a male screw shape.

(First embodiment)
Hereinafter, a first embodiment of the internal fracture fixator for fracture treatment according to the present invention (a specific example of the first example of the steel wire fixture) will be described with reference to FIGS. In addition, the treatment target demonstrated below shall be a patella, for example. First, as shown in FIG. 1 and FIG. 2, the fracture internal fixation device (hereinafter referred to as an internal fixation device) according to the first embodiment includes an osteosynthesis stapler 10, a Kirschner steel wire 20, and a backout phenomenon prevention. A screw set 30 is provided. 1 and 2, reference numeral 40 indicates a patella, reference numeral 40a indicates one bone fragment, reference numeral 40b indicates the other bone fragment, and reference numeral 40c indicates a crack portion.

The stapler 10 is for holding the end portion of the Kirschner steel wire 20 and joining the crack portion 40c of the patella 40, and has a U-shape as shown in FIG. 3, for example. That is, the stapler 10 has a substrate portion 11 and a wedge portion 12. The wedge portion 12 extends from both ends of the substrate portion 11 in parallel to a direction orthogonal to the longitudinal direction of the substrate portion 11.

The substrate portion 11 varies depending on the treatment target, but when the patella 40 is taken as an example, the length is about 1 to 10 cm, preferably about 1.5 to 5 cm. The width of the substrate portion 11 is about 0.3 to 2 cm, preferably about 0.5 to 1.5 cm. The thickness of the substrate portion 11 is about 0.1 to 1.0 cm, preferably about 0.2 to 0.7 cm. In particular, when the thickness of the substrate portion 11 is too thin, the holding force is weakened and the substrate portion 11 may be bent. Conversely, if it is too thick, the patient may feel uncomfortable. Therefore, what is necessary is just to select the thickness of the board | substrate part 11 suitably according to the condition of a treatment.

Further, a through-hole 13 facing the extending direction of the wedge portion 12 is formed in the central portion of the substrate portion 11. The diameter of the through hole 13 is set to a size that allows the Kirschner steel wire 20 to pass therethrough. The diameter of the through-hole 13 is about 0.5 to 50% increase, preferably about 1 to 25% increase of the diameter of the Kirschner steel wire 20.

The wedge portion 12 has such a length that it can be securely fixed without biting into the bone and causing displacement or detachment. That is, the length of the wedge portion 12 is about 0.5 to 4 cm, preferably about 1 to 3 cm.

The wedge portion 12 may have various shapes as shown in FIG. 4A, 4 </ b> C, and 4 </ b> E show the wedge portions 12 having various shapes as viewed from the front. FIGS. 4B, 4D, and 4F show a state in which each wedge portion 12 is viewed from the side.

First, the wedge portion 12 shown in FIGS. 4A and 4B has a rectangular side surface, but the front surface has a tapered shape in which the distance between both sides becomes narrower toward the tip. 4C and 4D, the wedge portion 12 has a rectangular side surface, but the front surface has a tapered shape in which one side is narrower toward the tip. Moreover, the wedge part 12 shown to FIG.4 (e) (f) is made into the taper shape where the space | interval of both sides becomes narrow in both the shape of a side surface and a front surface. As described above, since the tip of each wedge portion 12 has a tapered shape, the bite into the bone is sufficient and reliable.

Further, the Kirschner steel wire 20 described above has a diameter of about 2 mm at the maximum. The screw set 30 which is a steel wire fixture is for preventing back-out phenomena such as a decrease in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20, and as shown in FIG. It has a hexagonal bolt 31 and a nut 32. The bolt 31 has a head portion 31a and a screw portion 31b. A through hole 31c is formed at a position near the head 31a side of the screw portion 31b. The diameter of the through hole 31c is approximately the same as the diameter of the through hole 13 of the substrate portion 11 of the stapler 10 described above. The through hole 31 c is formed in a direction orthogonal to the end surface 31 d of the head portion 31 a of the bolt 31.

The nut 32 is formed with a female screw portion (not shown) that is screwed into the screw portion 31 b of the bolt 31. The diameter of the head 31a of the bolt 31 and the diameter of the nut 32 are both the same (same standard). The Kirschner steel wire 20 that has passed through the through hole 31c of the screw portion 31b is screwed (tightened by pinching) the nut 31 to the screw portion 31b of the bolt 32, so that the nut 32 and the head portion 31a of the bolt 31 are connected. It is supposed to be fixed between.

Next, treatment by the internal fixation device having the above configuration will be described. In the following description, it is assumed that the length of the substrate portion 11 of the stapler 10 is about 2 cm. First, the upper and lower portions of the patella 40 shown in FIGS. 1 and 2 are incised horizontally. That is, the upper part of one bone piece 40a of the patella 40 and the lower part of the other bone piece 40b are cut in parallel along the crack part 40c of the patella 40, respectively. In this case, the incision widths at the upper and lower portions of the patella 40 may be about the length of the base plate portion 11 of the stapler 10 and about 2 cm.

Next, one Kirschner is directed from the end (upper part) of one bone piece 40a toward the end (lower part) of the other bone piece 40b so as to be orthogonal to the crack direction of the crack part 40c of the patella 40. The steel wire 20 is penetrated. In this case, a rotating jig (rotary drill type) is attached to one end 20a or the other end 20b of the Kirschner steel wire 20, and the Kirschner steel wire 20 is rotated and penetrated. In the penetration direction of the Kirschner steel wire 20, the end portion (lower portion) of the other bone piece 40b may be directed to the end portion (upper portion) of one bone piece 40a. In any case, it may be performed according to the state of treatment. In addition, the penetration of the Kirschner steel wire 20 is the same as the method in the normal tension band wiring method.

Next, the other end portion 20 b side of the Kirschner steel wire 20 is passed through the through hole 13 of the substrate portion 11 of the stapler 10. In this case, the distal end side of the wedge portion 12 of the stapler 10 is directed to the patella 40 side. Further, the wedge portion 12 of the stapler 10 is brought into contact with the other bone piece 40b. In this state, the stapler 10 is pushed into the other bone piece 40b with a jig (such as a hammer) that can be pressed, and is bitten.

Next, the other end 20 b side of the Kirschner steel wire 20 is passed through the through hole 31 c formed in the screw portion 31 b of the bolt 31 of the screw set 30, and the nut 32 is screwed into the screw portion 31 b of the bolt 31. When the nut 32 is tightened, the other end 20 b side of the Kirschner steel wire 20 is fixed between the nut 32 and the head 31 a of the bolt 31.

Here, as described above, the through hole 31c is formed in a direction orthogonal to the end surface 31d of the head portion 31a of the bolt 31. Therefore, when the other end portion 20 b side of the Kirschner steel wire 20 is fixed, the end surface 31 d faces the substrate portion 11 of the stapler 10. In this state, an excess part on the other end 20b side of the Kirschner steel wire 20 exposed from the screw set 30 is cut. However, the excess portion of the Kirschner steel wire 20 may be cut after both ends of the Kirschner steel wire 20 are fixed by the screw set 30.

Next, the one end portion 20a side of the Kirschner steel wire 20 is passed through the through hole 13 of the substrate portion 11 of the stapler 10 in the same manner as described above. In this case, similarly to the above, the distal end side of the wedge portion 12 of the stapler 10 is directed toward the patella 40 side. Further, the wedge portion 12 of the stapler 10 is brought into contact with one bone piece 40a. In this state, similarly to the above, the stapler 10 is pushed into one bone piece 40a with a jig (such as a hammer) that can be pressed, and is bitten.

Next, similarly to the above, the end portion 20a side of the Kirschner steel wire 20 is passed through the through hole 31c formed in the screw portion 31b of the bolt 31 of the screw set 30, and the nut 32 is screwed into the screw portion 31b of the bolt 31. To do. At this time, the one end 20a side of the Kirschner steel wire 20 is pulled strongly to bring the crack 40c of the patella 40 into close contact. However, since the degree of close contact of the crack portion 40c can be adjusted by adjusting the tension, etc., the degree of tension can be appropriately adjusted to a desired sensation.

Here, as described above, the through hole 31c is formed in a direction orthogonal to the end surface 31d of the head portion 31a of the bolt 31. Therefore, when the nut 32 is screwed into the screw portion 31b of the bolt 31, the end surface 31d of the head portion 31a of the bolt 31 can be faced to the base plate portion 11 of the stapler 10, and the nut 32 is tightened. It can be done stably. And after fixing the other end part 20b side of the Kirschner steel wire 20, the excess part by the side of the other end part 20b of the Kirschner steel wire 20 exposed from the screw set 30 is cut | disconnected.

This makes it possible to prevent back-out phenomena such as a decrease in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20. At this time, a washer such as a circular washer 33 shown in FIG. 18A or a twisted circular washer 34 shown in FIG. 18B is interposed between the head 31 a of the bolt 31 and the nut 32. May be. As a result, the Kirschner steel wire 20 can be efficiently fixed by tightening. Moreover, the space | interval between the volt | bolt 31 and the nut 32 becomes narrow by this, and it can anticipate increasing the effect of clamping | tightening of the Kirschner steel wire 20. FIG.

Thus, in 1st Embodiment, with respect to a treatment object site | part (patella 40), a steel wire (Kirschner steel wire 20) is penetrated so that a fracture site | part (crack part 40c) may be straddled, and a steel wire (Kirschner steel wire 20) The steel wire holder (stapler 10) that holds the end portions (one end portion 20a, the other end portion 20b) is fixed to a portion sandwiching the fracture portion (crack portion 40c) of the treatment target portion (patella 40). The ends (one end 20a, the other end 20b) of the steel wire (Kirschner steel wire 20) were fixed on the steel wire holder (stapler 10) by the fixture (screw set 30).

Specifically, the stapler 10 includes a substrate portion 11 in which a first through hole (through hole 13) that allows the Kirschner steel wire 20 to penetrate is formed, and the substrate portion 11 extends along the direction of the through hole 13. And a wedge portion 12 that can bite into the treatment target site (patella 40).

The screw set 30 includes a bolt 31 having a screw portion 31b and a head portion 31a, and a nut 32 screwed into the screw portion 31b. The screw portion 31b is a second portion through which the Kirschner steel wire 20 passes. The through hole (31c) is formed so as to be orthogonal to the axial direction of the screw portion 31b, and the end portion (one end portion 20a, the other end portion 20b) of the Kirschner steel wire 20 is screwed with the nut 32 and the bolt by screwing of the nut 32. It is made to fix between 31 head parts 31a. Moreover, the 2nd through-hole (31c) is provided in the position close | similar to the head 31a in the range which can be processed.

As described above, the ends (one end portion 20a and the other end portion 20b) of the Kirschner steel wire 20 are formed between the nut 32 of the screw set 30 and the head portion 31a of the bolt 31 on the steel wire holder (stapler 10). Therefore, backout phenomena such as a drop in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20 can be reliably prevented.

Further, since the Kirschner steel wire 20 is penetrated so as to straddle the fracture site (crack 40c) with respect to the treatment target site (patella 40), the incision is the fracture site (crack 40c) of the treatment site (patella 40). The size of the stapler 10 that is fixed to a portion sandwiching the tape is sufficient. That is, as described above, the upper part of one bone piece 40a of the patella 40 and the lower part of the other bone piece 40b are cut in parallel along the crack part 40c of the patella 40, respectively. In this case, the incision width at the upper and lower portions of the patella 40 may be about the length of the substrate portion 11 of the stapler 10. Incidentally, if the length of the substrate portion 11 of the stapler 10 is about 2 cm, the incision width may be about 2 cm. Therefore, since an incision of about 2 cm is made in the upper and lower portions of the patella 40, the surgical wound can be made small, and it is excellent in cosmetics.

Further, since the inner fixator in the first embodiment is configured by the stapler 10, the Kirschner steel wire 20, and the screw set 30, the configuration is simple, and it can be manufactured at low cost. In addition, since the configuration is simple, it is possible to reduce the risk even for patients with strong osteoporosis, which have increased risks such as conventional wire cutout and backout. Further, conventionally, a tension band wiring method or a screw fixing method has been used for pulverized fractures or fractures of the patella lower pole, but it is difficult to obtain a reliable fixing force in any case. Also in this case, it is possible to obtain a reliable fixing force by using the internal fixing device having a simple configuration in the first embodiment.

Note that the screw set 30 in the first embodiment has hexagonal bolts 31 and nuts 32 of the same standard. Therefore, in particular, when the nut 32 is screwed into the screw portion 31b of the bolt 31 in a state where the one end portion 20a side of the Kirschner steel wire 20 is strongly pulled and the crack portion 40c of the patella 40 is in close contact, the substrate portion of the stapler 10 11, a space for rotating the nut 32 is required. In this case, when the one end portion 20 a side of the Kirschner steel wire 20 is fixed by the screw set 30, a predetermined gap is generated between the screw set 30 and the substrate portion 11 of the stapler 10.

However, such a gap does not need to be strictly zero, and even if it is about 1 cm, there is no problem in treatment. Conversely, even if the gap is 0, no particular problem occurs. The configuration when the gap is 0 will be described below.

(Second Embodiment)
Next, a second embodiment (a specific example of the first example of the steel wire fixture) will be described with reference to FIGS. 6 and 7 in which the gap is eliminated. In the second embodiment, the case where the configuration of the steel wire fixture in the first embodiment is changed will be described. The outer diameter of the nut 32 is set to the outside of the head 31 a of the bolt 31. It is smaller than the size of the diameter. Moreover, Fig.6 (a) shows the state which looked at the inner fixing device from the side, and FIG.6 (b) has shown the state which looked at the inner fixing device of Fig.6 (a) from the right direction. Also, in the drawings described below, the same reference numerals are given to portions common to FIGS. 1 to 5, and overlapping description will be given as appropriate.

First, as can be seen from FIGS. 6 (a) and 6 (b), the diameter of the nut 32 of the screw set 30, which is a steel wire fixture, is smaller than the diameter of the bolt 31. As shown in FIG. 7A, the through hole 31c formed in the threaded portion 31b of the bolt 31 is formed in a direction orthogonal to the end surface 31d of the head portion 31a of the bolt 31 as described above. ing.

In the internal fixing device having such a configuration, as described with reference to FIGS. 1 and 2, after one Kirschner steel wire 20 is passed through the patella 40, the other end 20 b side of the Kirschner steel wire 20 is connected to the stapler 10. It passes through the through hole 13 of the substrate part 11. In this state, as in the first embodiment, the stapler 10 is pushed into the other bone piece 40b with a jig that can be pressed (such as a hammer) and is bitten.

Next, the other end 20 b side of the Kirschner steel wire 20 is passed through the through hole 31 c formed in the screw portion 31 b of the bolt 31 of the screw set 30, and the nut 32 is screwed into the screw portion 31 b of the bolt 31. At this time, the through hole 31 c formed in the screw portion 31 b of the bolt 31 is formed in a direction orthogonal to the end surface 31 d of the head portion 31 a of the bolt 31. The diameter of the nut 32 is smaller than the diameter of the bolt 31. Therefore, even when the end surface 31 d of the head portion 31 a of the bolt 31 is in contact with the substrate portion 11 of the stapler 10, a rotation space of the nut 32 is secured between the bolt 31 and the substrate portion 11 of the stapler 10.

And after fixing the other end part 20b side of the Kirschner steel wire 20 between the nut 32 and the head part 31a of the volt | bolt 31, the other end part 20b side of the Kirschner steel wire 20 exposed from the screw set 30 similarly to the above. Cut off the excess part. However, the excess portion of the Kirschner steel wire 20 may be cut after both ends of the Kirschner steel wire 20 are fixed by the screw set 30 as described above.

Next, the one end portion 20a side of the Kirschner steel wire 20 is passed through the through hole 13 of the substrate portion 11 of the stapler 10 in the same manner as described above. In this state, similarly to the above, the stapler 10 is pushed into one bone piece 40a with a jig (such as a hammer) that can be pressed, and is bitten.

Next, the one end 20 a side of the Kirschner steel wire 20 is passed through the through hole 31 c formed in the screw portion 31 b of the bolt 31 of the screw set 30, and the nut 32 is screwed into the screw portion 31 b of the bolt 31. In the same manner as described above, the nut 32 is screwed into the screw portion 31b of the bolt 31 in a state where the one end portion 20a side of the Kirschner steel wire 20 is pulled strongly and the crack portion 40c of the patella 40 is in close contact.

Here, as described above, the through hole 31c formed in the screw portion 31b of the bolt 31 is formed in a direction orthogonal to the end surface 31d of the head portion 31a of the bolt 31. The diameter of the nut 32 is smaller than the diameter of the bolt 31. Therefore, even when the end surface 31d of the head portion 31a of the bolt 31 is in contact with the substrate portion 11 of the stapler 10, a rotation space of the nut 32 is ensured between the staple portion 10 and the substrate portion 11 as described above. Is done. Thereby, the base | substrate part 11 of the stapler 10 and the end surface 31d of the head 31a of the volt | bolt 31 can be stuck, and can be fixed.

In addition, this makes it possible to pull the nut 32 and the head 31 a of the bolt 31 while pulling the one end 20 a side of the Kirschner steel wire 20 in a state where the end surface 31 d of the head 31 a of the bolt 31 is in contact with the substrate portion 11 of the stapler 10. Can be fixed between. In this case, back-out phenomena such as a decrease in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20 can be prevented while eliminating a gap between the substrate portion 11 and the substrate portion 11. Moreover, you may adjust suitably the space | interval of the base part 11 of the stapler 10 and the end surface 31d of the head 31a of the volt | bolt 31 which leads to adjustment of the space | interval of the crack part 40c similarly to 1st Embodiment. And the excess part by the side of the one end part 20a of the Kirschner steel wire 20 exposed from the screw set 30 is cut | disconnected.

Here, since the diameter of the nut 32 of the screw set 30 is made smaller than the diameter of the bolt 31, a reduction in the tightening force on the Kirschner steel wire 20 can be considered. In this case, washers such as the circular washer 33 shown in FIG. 18A or the twisted circular washer 34 shown in FIG. 18B may be interposed. Thereby, similarly to the above, the Kirschner steel wire 20 can be efficiently fixed by tightening. Thereby, the space | interval between the volt | bolt 31 and the nut 32 becomes narrow, and it can be anticipated that the effect of the clamping | tightening of the Kirschner steel wire 20 is increased similarly to the above.

Thus, in the second embodiment, for example, as shown in FIG. 6, the diameter of the nut 32 of the screw set 30 is made smaller than the diameter of the hexagonal bolt 31 that is a polygon. In addition, as shown in FIG. 7A, the through hole 31 c formed in the screw portion 31 b of the bolt 31 is formed in a direction orthogonal to the end surface 31 d of the head portion 31 a of the bolt 31. .

Thereby, even when the end surface 31d of the head portion 31a of the bolt 31 is in contact with the substrate portion 11 of the stapler 10, a rotation space of the nut 32 is ensured between the substrate 31 and the stapler 10. Therefore, the gap between the screw set 30 and the substrate portion 11 of the stapler 10 can be eliminated as well as the prevention of the backout phenomenon of the Kirschner steel wire 20 described above.

(Third embodiment)
Next, referring to FIG. 8 and FIG. 9, a third embodiment (specific example of the second example of the steel wire fixture described above) in which the shape of the bolt 31 of the screw set 30 which is a steel wire fixture is further changed. Example) will be described. 3rd Embodiment has shown the case where the structure of the screw part 31b of the volt | bolt 31 of the screw set 30 shown, for example in Fig.7 (a) in 2nd Embodiment is changed. FIG. 8A shows a state of the inner fixer viewed from the side, and FIG. 8B shows a state of the inner fixer of FIG. 8A viewed from the right.

That is, as shown in FIGS. 8A and 8B, the threaded portion 31e of the bolt 31 has a tapered shape that tapers toward the tip. On the other hand, the female screw portion (not shown) of the nut 32 is a female screw having the same pitch as the screw portion 31 e of the bolt 31. When the nut 32 is screwed into the threaded portion 31e of the bolt 31, the nut 32 can be advanced toward the head 31a along the threaded portion 31e of the bolt 31. In addition, the female screw portion (not shown) of the nut 32 may have a tapered shape similar to the tapered shape of the screw portion 31e of the bolt 31 so that the nut 32 can easily advance on the screw portion 31e of the bolt 31.

Further, a groove 31f cut out from the tip to the head 31a of the bolt 31 is formed at the center of the screw portion 31e. In other words, the groove 31f has a one-letter configuration by dividing the screw portion 31e into two along the axial direction of the screw portion 31e of the bolt 31. Further, as shown in FIG. 9A, the groove 31 f has a tapered shape in which the width gradually decreases from the tip toward the head 31 a of the bolt 31. That is, the front end side of the groove 31f is formed slightly wider than the diameter of the Kirschner steel wire 20, and the rear end side (the side close to the head 31a of the bolt 31) of the groove 31f is formed slightly narrower than the diameter of the Kirschner steel wire 20. Has been. Accordingly, the Kirschner steel wire 20 can be easily fitted into the groove 31f, and the Kirschner steel wire 20 can be temporarily fixed on the rear end side of the groove 31f.

Further, as can be seen from FIG. 8, the outer diameter of the nut 32 of the screw set 30 is made smaller than the outer diameter of the head portion 31 a of the bolt 31 as described above. In this case, as in the second embodiment, even when the end surface 31 d of the head portion 31 a of the bolt 31 is in contact with the substrate portion 11 of the stapler 10, the nut 32 is interposed between the nut 31 and the substrate portion 11 of the stapler 10. Rotation space is secured.

Thereby, not only the back-out phenomenon of the Kirschner steel wire 20 can be prevented, but also the gap between the screw set 30 and the substrate portion 11 of the stapler 10 can be eliminated. Note that the groove 31f is not limited to a single character, but may be a cross. In this case, at least one groove 31f may be formed in a direction orthogonal to the end surface 31d of the head portion 31a of the bolt 31 as described above.

In the inner fixing device having such a configuration, as shown in FIG. 9A, the groove 31f formed in the head portion 31a of the bolt 31 is on the one end 20a (or other end 20b) side of the Kirschner steel wire 20. Fit. At this time, since the tip end side of the groove 31f is formed slightly wider than the diameter of the Kirschner steel wire 20, the Kirschner steel wire 20 can be easily fitted into the groove 31f. Further, since the rear end side of the groove 31f (side closer to the head 31a of the bolt 31) is formed slightly narrower than the diameter of the Kirschner steel wire 20, one end portion 20a (or the other end portion 20b) of the Kirschner steel wire 20 is formed. ), The one end portion 20a (or the other end portion 20b) of the Kirschner steel wire 20 is temporarily fixed on the rear end side of the groove 31f. Here, the one end portion 20a (or the other end portion 20b) of the Kirschner steel wire 20 is temporarily fixed, so that the position difference between the bolt 31 and the one end portion 20a (or the other end portion 20b) side of the Kirschner steel wire 20 or the like. Can be avoided.

Also, the diameter of the nut 32 is smaller than the diameter of the bolt 31. Therefore, similarly to the above, even when the end surface 31d of the head portion 31a of the bolt 31 is in contact with the substrate portion 11 of the stapler 10, a rotation space of the nut 32 is ensured between the stapler 10 and the substrate portion 11. Is done. (However, in some cases, the outer diameter of the nut 32 of the screw set 30 and the outer diameter of the head 31a of the bolt 31 may be the same.

When the nut 32 is smaller than the diameter of the bolt 31 and the nut 32 is screwed into the threaded portion 31e of the bolt 31, the nut 32 rotates and the screw 31e of the bolt 31 moves in the direction of the head 31a of the bolt 31. Move forward. As a result, as shown in FIG. 9A, a tightening force acts on the screw portion 31e in the direction of the solid line arrow, and the gap on the tip side of the groove 31f is gradually narrowed. And as shown in FIG.9 (b), the one end part 20a (or other end part 20b) of the Kirschner steel wire 20 is fixed by the groove | channel 31f of the screw part 31e of the volt | bolt 31. FIG. In addition, when fixing the one end part 20a side of the Kirschner steel wire 20, in the state which pulled the one end part 20a side of the Kirschner steel wire 20 strongly, and made the crack part 40c of the patella 40 closely_contact | adhered similarly to the above. A nut 32 is screwed into the screw portion 31b. In this case, as described above, the degree of close contact of the crack portion 40c can be adjusted by adjusting the tension, etc., so that the degree of pulling may be appropriately adjusted to a desired feeling.

As a result, similarly to the above, it is possible to prevent a back-out phenomenon such as a decrease in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20. And after fixing the one end part 20a (or other end part 20b) side of the Kirschner steel wire 20 with the groove | channel 31f of the screw part 31e of the volt | bolt 31, the one end part 20a (or others) of the Kirschner steel wire 20 exposed from the screw set 30 Cut off the excess part on the end 20b) side.

As described above, in the third embodiment, the screw portion 31e of the bolt 31 has a tapered shape that tapers toward the tip, and a groove 31f cut out from the tip to the head portion 31a at the center of the screw portion 31e. Since one end 20a (or the other end 20b) of the Kirschner steel wire 20 fitted in the groove 31f is fixed in the groove 31f by screwing the nut 32, the Kirschner steel wire 20 Of course, the gap between the screw set 30 and the substrate portion 11 of the stapler 10 can be eliminated as well as the prevention of the back-out phenomenon described above.

In addition, the one end 20a (or the other end 20b) side of the Kirschner steel wire 20 is attached to the screw portion 31e of the bolt 31 by fitting into the screw portion 31e, so that it is extremely effective in shortening the treatment time. It becomes.

(Fourth embodiment)
Next, referring to FIG. 10 and FIG. 11, a fourth embodiment in which the shape of the bolt 31 of the screw set 30 that is a steel wire fixture is further changed (specific example of the third example of the steel wire fixture described above). Example) will be described. In the fourth embodiment, the configuration of the bolt 31 of the screw set 30 in the third embodiment is changed. FIG. 10 (a) shows the state of the inner fixing device viewed from the side, FIG. 10 (b) shows the state of the inner fixing device viewed from the front, and FIG. 10 (c) shows the inner fixing device directly above. The state seen from.

That is, as shown in FIGS. 10A to 10C, the threaded portion 31e of the bolt 31 has a taper that tapers toward the tip, similar to that described in FIGS. 8 and 9 in the third embodiment. It is made into a shape. In addition, a single-letter groove 31f cut out from the tip to the head 31a of the bolt 31 is formed in the central portion of the screw portion 31e as in the case described with reference to FIGS. However, in the fourth embodiment, a round hole 31g is formed in the head portion 31a of the bolt 31 in addition to the groove 31f.

That is, a round hole 31g is formed in the central portion of the head portion 31a of the bolt 31 along the axial direction of the screw portion 31e. Further, the round hole 31g communicates with the groove 31f. The round hole 31g is formed slightly wider than the diameter of the Kirschner steel wire 20 like the groove 31f. Thereby, the one end part 20a (or other end part 20b) side of the Kirschner steel wire 20 can be inserted into the round hole 31g of the head part 31a of the bolt 31 and the groove 31f of the screw part 31e. Note that the groove 31f is not limited to a single character shape as described above, but may be a cross character shape, but is preferably a single character shape divided into two. In the case of a cross shape, it is preferable to chamfer the corners of the groove inner surface to form a flat shape.

Further, as can be seen from FIG. 10, the diameter of the nut 32 of the screw set 30 is smaller than the diameter of the bolt 31. Moreover, since the one end part 20a (or other end part 20b) side of the Kirschner steel wire 20 is inserted into the round hole 31g of the head part 31a of the bolt 31 and the groove 31f of the screw part 31e, the top part 31h of the bolt 31 is connected to the stapler 10 It can be brought into contact with the substrate part 11. In addition, since the top portion 31h of the head portion 31a of the bolt 31 is in contact with the substrate portion 11 of the stapler 10, the one end portion 20a (or the other end portion 20b) side of the Kirschner steel wire 20 is pulled out to the outside. The diameter of the nut 32 may be the same as or larger than the diameter of the bolt 31.

In the inner fixer having such a configuration, as shown in FIG. 11A, the one end 20a (or the other end 20b) side of the Kirschner steel wire 20 passed through the through hole 13 of the substrate portion 11 of the stapler 10 is disposed. The bolt 31 passes through the round hole 31g of the head portion 31a and the groove 31f of the screw portion 31e. At this time, the round hole 31 g and the groove 31 f are formed slightly wider than the diameter of the Kirschner steel wire 20. Therefore, the one end 20a (or the other end 20b) side of the Kirschner steel wire 20 can be easily passed through the round hole 31g and the groove 31f.

Then, one end portion 20a (or the other end portion 20b) side of the Kirschner steel wire 20 passed through the round hole 31g and the groove 31f is passed through the female screw portion (not shown) of the nut 32 similar to that of the third embodiment, and Kirschner steel. The nut 32 is screwed onto the threaded portion 31 e of the bolt 31 while grasping the one end portion 20 a (or the other end portion 20 b) of the wire 20. At this time, as shown in FIG. 11B, the nut 32 advances toward the head portion 31a of the bolt 31 with respect to the screw portion 31e. As a result, a tightening force acts on the groove 31f of the bolt 31 in the direction of the solid line arrow, and the gap on the tip side of the groove 31f is gradually narrowed. Then, the one end 20 a (or the other end 20 b) of the Kirschner steel wire 20 is fixed by being sandwiched at the tip end side of the groove 31 f of the screw portion 31 e of the bolt 31.

In addition, when fixing the one end part 20a side of the Kirschner steel wire 20, in the state which pulled the one end part 20a side of the Kirschner steel wire 20 strongly, and made the crack part 40c of the patella 40 closely_contact | adhered similarly to the above. A nut 32 is screwed into the screw portion 31e. Thereby, similarly to the above, it is possible to prevent a back-out phenomenon such as a decrease in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20. And after fixing the one end part 20a (or other end part 20b) side of the Kirschner steel wire 20 with the groove | channel 31f of the screw part 31e of the volt | bolt 31, the one end part 20a (or others) of the Kirschner steel wire 20 exposed from the screw set 30 Cut off the excess part on the end 20b) side. In this case, as described above, the degree of close contact of the crack portion 40c can be adjusted by adjusting the tension, etc., so that the degree of pulling may be appropriately adjusted to a desired feeling.

As described above, in the fourth embodiment, the screw portion 31e of the bolt 31 is formed with the single-letter groove 31f cut out from the tip to the head portion 31a of the bolt 31, and further along the axial direction of the screw portion 31e. A round hole 31 g is formed in the head 31 a of the bolt 31. The one end 20a (or the other end 20b) of the Kirschner steel wire 20 is screwed by the screwing of the nut 32 with the top 31h of the head 31a of the bolt 31 in contact with the base plate 11 of the stapler 10. It is fixed on the tip side of the groove 31f of 31e.

As a result, the gap between the screw set 30 and the substrate portion 11 of the stapler 10 can be eliminated as well as the prevention of the back-out phenomenon of the Kirschner steel wire 20 as described above. Moreover, since the top part 31h of the head part 31a of the bolt 31 contacts the substrate part 11 of the stapler 10, the joining of the bolt 31 to the stapler 10 is further stabilized.

(Fifth embodiment)
Next, a fifth embodiment (specific example of the fourth example of the steel wire fixture) described above in which the screw set 30 is changed to a cap nut sleeve set will be described with reference to FIGS. 12 (a) shows the state when the cap nut is viewed from right above, FIG. 12 (b) shows the state when the cap nut is viewed from the side, and FIG. 12 (c) shows the ferrule as viewed from directly above. (D) shows the state when the ferrule is viewed from the side, FIG. (E) shows the state when the sleeve is viewed from directly above, and (f) shows the sleeve from the side. It shows the state as seen.

That is, the cap nut sleeve set 30A in the fifth embodiment includes a cap nut 36 shown in FIGS. 12 (a) and 12 (b), a ferrule 37 shown in FIGS. 12 (b) and 12 (c), and FIG. and a sleeve 35 shown in f). Here, the cap nut 36 has a space 36 c having a size larger than the outer diameter of the ferrule 37 inside. A female screw portion 36a is formed around the space 36c. The cap nut 36 is formed with a through hole 36b that communicates with the space 36c. The through hole 36b is formed to be orthogonal to the top portion 36d. Further, the through hole 36 b is formed slightly wider than the diameter of the Kirschner steel wire 20.

The ferrule 37 has a tapered shape on the tip 37a side. In addition, the distal end portion 37a side is slightly smaller than a later-described through hole 35d of the sleeve 35. As a result, the tip end 37 a side can be fitted into a through-hole 35 d described later of the sleeve 35. Further, a through hole 37 b is formed inside the ferrule 37. The through hole 37 b has the same size as the through hole 36 b of the cap nut 36. The ferrule 37 is made of metal, for example, and bites into a later-described through hole 35d of the Kirschner steel wire 20 and the sleeve 35 when the cap nut 36 is tightened.

The sleeve 35 is made of metal, for example, and has a flange portion 35a and a shaft portion 35b. Further, through holes 35c and 35d are formed in the flange portion 35a and the shaft portion 35b. These through holes 35c and 35d communicate with each other. The diameter of the shaft portion 35 b is approximately the same as the space 36 c of the cap nut 36. Further, a screw portion 35e into which the female screw portion 36a of the cap nut 36 is screwed is formed at the distal end portion of the shaft portion 35b. The bottom surface of the flange portion may be joined to the stapler substrate, and the sleeve and the stapler may be integrated.

In the inner fixer having such a configuration, as shown in FIGS. 13A and 13B, one end 20a (or the other end 20b) of the Kirschner steel wire 20 passed through the through hole 13 of the substrate portion 11 of the stapler 10. ) Side is passed through the through holes 35 c and 35 d of the sleeve 35. At this time, the through holes 35 c and 35 d are formed slightly wider than the diameter of the Kirschner steel wire 20. Therefore, the one end 20a (or the other end 20b) side of the Kirschner steel wire 20 can be easily passed through the through holes 35c and 35d. At this time, the flange portion 35 a of the sleeve 35 is directed toward the substrate portion 11 side of the stapler 10.

Next, as shown in FIG. 13C, the tip end 37 a side of the ferrule 37 that is tapered is directed toward the sleeve 35, and one end portion 20 a (or the end portion 20 a) of the Kirschner steel wire 20 is inserted into the through hole 37 b of the ferrule 37. Pass the other end 20b) side. Since the through hole 37b has the same size as the through hole 36b of the cap nut 36, the one end 20a (or the other end 20b) side of the Kirschner steel wire 20 can be easily passed through the through hole 37b. it can. Then, the tip end 37 a side of the ferrule 37 that is tapered is fitted into the through hole 35 d of the sleeve 35.

Next, as shown in FIGS. 13D and 13E, the space 36c side of the cap nut 36 is directed to the sleeve 35, and the screw portion of the shaft portion 35b of the sleeve 35 is accommodated in the space 36c while the ferrule 37 is accommodated therein. Threaded onto 35e. Then, by tightening the cap nut 36, the distal end portion 37 a of the ferrule 37 bites into one end portion 20 a (or the other end portion 20 b) of the Kirschner steel wire 20 and the through hole 35 d of the sleeve 35. Thereby, similarly to the above, it is possible to prevent a back-out phenomenon such as a decrease in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20. Further, since the cap nut 36 can be screwed in a state in which the flange portion 35a of the sleeve 35 is in contact with the substrate portion 11 of the stapler 10, similarly to the above, a gap between the staple portion 10 and the substrate portion 11 is formed. It can be lost.

Here, by tightening the cap nut 36, the distal end portion 37 a of the ferrule 37 bites into the one end 20 a (or the other end 20 b) of the Kirschner steel wire 20 and the through hole 35 d of the sleeve 35, or is firmly attached to the Kirschner steel wire 20. Consider the phenomenon of close fixation and disengagement. That is, as shown in FIG. 14A, the Kirschner steel wire 20 is fixed in a state where the flange portion 35 a of the sleeve 35 is in contact with the substrate portion 11 of the stapler 10.

Therefore, after complete cure, it is considered that there is no room for pulling out the tip 37a of the ferrule 37 from the through hole 35d of the sleeve 35, and it is difficult to pull out unless the ferrule 37 is removed. In this case, in particular, when the gap between the crack portions 40c is completely adhered and there is no clearance, no gap is generated between the ferrule 37 and the bottom surface of the flange portion 35a of the sleeve 35. Therefore, as shown by the dotted arrow in FIG. 14B, it is necessary to cut the ferrule 37 at a position passing through the tip 37a. However, when the gap of the crack part 40c etc. is adjusted and the clearance gap has arisen about 1 cm, it is not impossible to cut a steel wire from this clearance gap with a cutter.

When there is no gap as described above, the sleeve 35 must be cut at a position passing through the tip 37a of the ferrule 37 as shown in FIG. 14B, but the sleeve 35 is made of metal to maintain strength. Therefore, it is considered that cutting at the position indicated by the dotted arrow in FIG. 14B becomes difficult in consideration of the burden on the patient. In this case, it is recommended that the ferrule 37 be made of a hard resin such as hard resin or hard perfluoroethylene (trade name: Teflon: registered trademark), or a flexible resin ferrule such as silicone resin or Viton. Is done.

And after removing the cap nut 36 shown to Fig.15 (a), the ferrule 37 is cut | disconnected with a cutter etc. in the position shown by the dotted line arrow of FIG.15 (b), and it removes as shown in FIG.15 (c). If the ferrule 37 is made of hard resin such as hard silicone or Teflon (registered trademark), the ferrule 37 can be cut and then pulled out from the through hole 35d of the sleeve 35 with tweezers.

Furthermore, with the above resin, the ferrule 37 can be cut and removed by fusing, baking, or the like with a heating element having a sharp tip (for example, a soldering iron having a sharp tip). Such an operation of cutting and removing the ferrule 37 can extract the Kirschner steel wire 20 by cutting and removing the ferrule 37 of one steel wire fixture of the pair of steel wire fixtures. The ferrule 37 may be a double bite type ferrule, and an O-ring may be used instead of the ferrule.

Thus, in 5th Embodiment, the cap nut sleeve set 30A which is a steel wire fixing tool has the thread part 35e on the outer periphery, and the sleeve 35 which has a 3rd through-hole (through-hole 35d) inside, The front end side is tapered, has a fourth through hole (through hole 37b) inside, a ferrule 37 into which the front end side is fitted into the third through hole (through hole 35d), and accommodates the ferrule 37 inside. A cap nut 36 having a possible space 36c and having a fifth through hole (through hole 36b) communicating with the space 36c from the top 36d. Then, by tightening the cap nut 36 in a state where the flange portion 35a of the sleeve 35 is in contact with the base plate portion 11 of the stapler 10, the ferrule 37 is connected to one end portion 20a (or the other end portion 20b) of the Kirschner steel wire 20. The one end 20a (or the other end 20b) of the Kirschner steel wire 20 is fixed by biting into the through hole 35d of the sleeve 35.

As a result, the gap between the cap nut sleeve set 30 </ b> A and the substrate portion 11 of the stapler 10 can be eliminated as well as the prevention of the back-out phenomenon of the Kirschner steel wire 20 as described above. Further, since the flange portion 35a of the sleeve 35 contacts the substrate portion 11 of the stapler 10, the joining of the sleeve 35 to the stapler 10 is further stabilized. Further, since the ferrule 37 bites into the one end 20a (or the other end 20b) of the Kirschner steel wire 20 and the through hole 35d of the sleeve 35, the one end 20a (or the other end 20b) of the Kirschner steel wire 20 is more fixed. It is done firmly.

Further, if the ferrule 37 is made of hard resin such as hard silicone or Teflon (registered trademark), it can be cut by various means, or if it is a flexible material, the through hole 35d of the sleeve 35 or the steel wire with tweezers or the like. It is also possible to pull out or remove from the inner fixing device, and it is possible to easily remove the inner fixator after complete cure.

(Sixth embodiment)
Next, referring to FIG. 16, a sixth embodiment (fifth of the steel wire fixture described above) in which the configuration of the steel wire fixing device (cap nut sleeve set) of the fracture internal fixation device shown in FIG. A specific example) will be described.

That is, as shown to Fig.16 (a), the cap nut sleeve set 30B in 6th Embodiment has the cap nut 36 and the ferrule 37 which were demonstrated in 5th Embodiment. However, the sleeve 35A in the sixth embodiment is a union type having a shaft portion 35b extending vertically with the flange portion 35a interposed therebetween.

In such a configuration, as shown in FIG. 16B, the one end 20 a (or the other end 20 b) side of the Kirschner steel wire 20 passed through the through hole 13 of the substrate portion 11 of the stapler 10 is connected to the substrate portion 11. It passes through the through hole 36b of the cap nut 36 located on the side and the through hole 37b of the ferrule 37, and further passes through the through hole 35d of the sleeve 35A. Here, the Kirschner steel wire 20 is fixed in the same manner as described above by tightening the cap nut 36 located on the substrate part 11 side.

Further, the one end 20a (or the other end 20b) side of the Kirschner steel wire 20 is passed through the through hole 37b of the ferrule 37 and the through hole 36b of the cap nut 36 at a position away from the substrate part 11 side. The steel wire 20 is fixed.

In fixing the Kirschner steel wire 20, the cap nut 36 at a position away from the substrate portion 11 side may be tightened first, and then the cap nut 36 positioned at the substrate portion 11 side may be tightened. Moreover, it is recommended that the method of taking out the Kirschner steel wire 20 and the material of the steel wire fixture after the treatment is completed are the same as those in the fifth embodiment.

Thus, in 6th Embodiment, since the end part 20a (or other end part 20b) side of the Kirschner steel wire 20 is fixed in two places with the union-type sleeve 35A, compared with 5th Embodiment. The Kirschner steel wire 20 can be fixed more firmly.

(Seventh embodiment)
Next, a seventh embodiment (specific example of the sixth example of the steel wire fixture) will be described with reference to FIG. 17 when the bolt 31 of the screw set 30 is omitted. That is, as shown to Fig.17 (a), the external thread part 21 is provided in the outer periphery of the Kirschner steel wire 20 along the axial direction. In addition, in the external thread part 21, you may make it provide only in the one end part 20a (or other end part 20b) of the Kirschner steel wire 20. FIG. The nut 32 is formed with a female screw portion (not shown) that is screwed into the male screw portion 21 of the one end portion 20a (or the other end portion 20b) of the Kirschner steel wire 20.

In the internal fixing device having such a configuration, as shown in FIG. 17A, the one end 20 a (or the other end 20 b) side of the Kirschner steel wire 20 is passed through the through hole 13 of the substrate portion 11 of the stapler 10. And as shown in FIG.17 (b), the nut 32 is screwed by the external thread part 21 of the one end part 20a (or other end part 20b). At this time, the male screw portion 21 of the Kirschner steel wire 20 is engaged with the female screw portion (not shown) of the nut 32, whereby the one end portion 20 a (or the other end portion 20 b) of the Kirschner steel wire 20 is fixed by the nut 32. .

As a result, similarly to the above, it is possible to prevent a back-out phenomenon such as a decrease in tension due to the Kirschner steel wire 20 and a positional shift of the Kirschner steel wire 20. And after fixing the one end part 20a (or other end part 20b) side of the Kirschner steel wire 20 with the nut 32, the excess of the one end part 20a (or other end part 20b) side of the Kirschner steel wire 20 exposed from the nut 32 is carried out. Cut the part.

In addition, since the tension | tensile_strength with respect to the Kirschner steel wire 20 is adjusted by the screwing of the nut 32, it is preferable to fix the Kirschner steel wire 20 by appropriate screwing.

Thus, in 7th Embodiment, since the nut 32 is screwed together in the external thread part 21 of the one end part 20a (or other end part 20b) of the Kirschner steel wire 20, the bolt 31 mentioned above is unnecessary. Become.

As a result, the gap between the nut 32 and the substrate portion 11 of the stapler 10 can be eliminated as well as preventing the back-out phenomenon of the Kirschner steel wire 20 as described above. Further, since the nut 32 abuts against the substrate portion 11 of the stapler 10, the joining of the bolt 31 to the stapler 10 is further stabilized. Further, since the bolt 31 described above is not necessary, the time required for attaching the bolt 31 can be shortened.

Of the above-described embodiments, except for the fifth and sixth embodiments, a general nut 32 is used. When such a nut 32 is used, a similar nut 32 is further used. It is also possible to perform tightening with a plurality of nuts 32, such as. If it does in this way, since it has the effect which prevents the loosened nut 32, it becomes an effective means to maintain fixation of Kirschner steel wire 20.

Furthermore, in the first, second and seventh embodiments, as described above, washers such as the circular washer 33 shown in FIG. 18A or the twisted circular washer 34 shown in FIG. 18B. By interposing, it brings about a favorable effect for fixing the Kirschner steel wire 20.

In each of the above embodiments, the case where the treatment target site is the patella 40 has been described. However, the present invention is not limited to this example, and can be applied to an osteosynthesis site that requires bi-directional tightening. It can also be applied to bone fractures and rib fractures.

DESCRIPTION OF SYMBOLS 10 Stapler 11 Substrate part 12 Wedge part 13 Through hole 20 Kirschner steel wire 20a One end part 20b Other end part 30 Screw set 30A, 30B Cap nut sleeve set 31 Bolt 31a Head part 31b Screw part 31c Through hole 31d End face 31e Screw part 31f Groove 31g Round hole 31h Top part 32 Nut 33, 34 Washer 35, 35A Sleeve 35a Flange part 35b Shaft part 35c, 35d Through hole 35e Screw part 36 Cap nut 36a Female screw part 36b Through hole 36c Space 36d Top part 37 Feral 37a Tip part Hole 40 Patella 40a One bone piece 40b The other bone piece 40c Crack

Claims (15)

An internal fixation device for fracture treatment used for fracture treatment,
For the treatment target site, a steel wire that is penetrated so as to straddle the fracture site,
A pair of steel wire holders that are fixed by being inserted into both ends of the bone sandwiching the fracture site of the treatment target site, and holding both ends of the steel wire,
An internal fixation device for fracture treatment, comprising: a steel wire fixture for fixing both ends of the steel wire on the steel wire holder by mechanical means. The steel wire holder is
A substrate part formed with a first through-hole for penetrating the steel wire;
A wedge portion provided along the direction of the first through hole in the substrate portion,
The internal fixation device for fracture treatment according to claim 1, wherein the wedge portion is capable of biting into the treatment target site. The internal fixation device for fracture treatment according to claim 1 or 2, wherein the mechanical means is to press a steel wire by the action of a screw. The steel wire fixture is
A bolt having a threaded portion and a head;
A nut that is screwed onto the thread portion;
A second through-hole that allows the steel wire to pass through the threaded portion is formed to be orthogonal to the axial direction of the threaded portion;
The internal fixation device for fracture treatment according to claim 1, 2, or 3, wherein an end portion of the steel wire is fixed between the nut and a head portion of the bolt by screwing the nut. 5. The fracture internal fixator according to claim 4, wherein the second through hole is provided at a position close to the head. The bolt is a polygonal bolt;
The diameter of the nut is smaller than the diameter of the bolt,
The internal fixation for fracture treatment according to claim 4 or 5, wherein an end portion of the steel wire is fixed in a state in which an end surface of a head portion of the bolt is in contact with a substrate portion of the steel wire holder. vessel. The steel wire fixture is in the shape of a polygonal bolt; and
The threaded portion of the bolt has a tapered shape that tapers toward the tip, and
A groove cut out from the tip to the head is formed at the center of the screw so as to divide the bolt screw.
The end of the steel wire fitted in the groove is fixed in the groove by being pressed by the groove inner surface by screwing the nut to the bolt. The internal fixation device for fracture treatment according to claim 1, 2, or 3. The steel wire fixture is
A bolt having a threaded portion and a head;
A nut that is screwed onto the thread portion;
The threaded portion of the bolt has a tapered shape that tapers toward the tip,
A groove cut out from the tip to the head is formed in the center of the screw portion,
A round hole is formed in the head along the axial direction of the screw portion and communicated with the groove,
The end of the steel wire is pressed by the inner surface of the groove by screwing the nut in a state where the top of the head of the bolt is in contact with the substrate portion of the steel wire holder. It fixes at the front end side of the said groove | channel. The internal fixation device for fracture treatment of Claim 1, 2, or 3 characterized by the above-mentioned. The steel wire fixture is
A sleeve having a threaded portion on the outer periphery and a third through hole inside;
A ferrule or an O-ring having a fourth through hole therein, the tip of which is fitted into a gap formed between the third through hole and the penetrated steel wire;
A cap nut having a fifth through hole communicating with the space from the top having a space capable of accommodating the ferrule or O-ring therein;
By tightening the cap nut, the ferrule or O-ring bites into an end portion of the steel wire and a gap formed between the third through hole and the steel wire, so that the end portion of the steel wire is The internal fixation device for fracture treatment according to claim 1, wherein the fixation device is fixed. The steel wire fixture is
A union-type sleeve having a threaded portion on the outer periphery, a third through hole inside, a flange sandwiched between both sides, and a bolt portion that is a male thread on both sides;
A pair of ferrules having a fourth through-hole inside and having a tip end side fitted in a gap formed between the third through-hole at the end of both bolt portions and the steel wire that has passed therethrough, or An O-ring;
A pair of cap nuts having a space that can accommodate the ferrule or O-ring therein and having a fifth through hole communicating with the space from the top;
By tightening the cap nut, the ferrule or O-ring bites into an end portion of the steel wire and a gap formed between the third through hole and the steel wire, so that the end portion of the steel wire is The internal fixation device for fracture treatment according to claim 1, wherein the fixation device is fixed. 11. The internal fracture fixator for fracture treatment according to claim 9 or 10, wherein the ferrule or O-ring is made of a hard resin. 12. The internal fracture fixator for fracture treatment according to claim 11, wherein the hard resin is Teflon (registered trademark). 11. The internal fracture fixator for fracture treatment according to claim 9 or 10, wherein the ferrule or O-ring is made of a flexible resin. 14. The internal fracture fixator for fracture treatment according to claim 13, wherein the flexible resin is a silicone resin or a Viton resin. On the outer periphery of the steel wire, a male screw part is provided along the axial direction,
The steel wire fixture has a nut that is screwed into the male screw part,
The internal fixation device for fracture treatment according to claim 1, 2, or 3, wherein an end portion of the steel wire is fixed by the nut by screwing of the nut.

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