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WO2015139550A1 - 一种可自动送丝的四肢长骨骨折髓内复位器 - Google Patents

一种可自动送丝的四肢长骨骨折髓内复位器 Download PDF

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Publication number
WO2015139550A1
WO2015139550A1 PCT/CN2015/073268 CN2015073268W WO2015139550A1 WO 2015139550 A1 WO2015139550 A1 WO 2015139550A1 CN 2015073268 W CN2015073268 W CN 2015073268W WO 2015139550 A1 WO2015139550 A1 WO 2015139550A1
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WIPO (PCT)
Prior art keywords
wire
reset
guide wire
feeding
rotating shaft
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Ceased
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PCT/CN2015/073268
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English (en)
French (fr)
Inventor
张英泽
陈伟
王娟
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Individual
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Individual
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Priority to US14/894,763 priority Critical patent/US10299846B2/en
Publication of WO2015139550A1 publication Critical patent/WO2015139550A1/zh
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8897—Guide wires or guide pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary devices, e.g. pins or nails
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8872—Instruments for putting said fixation devices against or away from the bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices

Definitions

  • the invention relates to the field of medical instruments, in particular to an intramedullary resetter for long bone fractures of the extremities which can automatically feed the silk to reduce the fracture of the long bones of the extremities.
  • the advantage of open reduction and internal fixation is that the fracture is restored under direct vision.
  • the quality of the fracture reduction is high, and then the plate is fixed by bone plate or intramedullary nail.
  • the disadvantage is that it requires open surgery, large surgical trauma, and high blood loss.
  • the hematoma surrounding the fracture containing the fracture healing factor is removed during surgery, which is not conducive to fracture healing.
  • due to the incision of the skin, subcutaneous tissue and the separation of muscles around the fracture the incidence of complications such as infection is high.
  • the advantage of closed reduction and internal fixation is that the hematoma with small trauma, low blood loss, and factors surrounding the fracture that promote fracture healing can be preserved.
  • the incidence of complications such as postoperative infection and fracture nonunion is relatively low; Because the closed reduction has high requirements for the doctor's reduction and fixation techniques, the fracture reduction is difficult, especially the fracture reduction with severe comminution or lateral displacement is more difficult, the operation time is long, and the X-ray fluoroscopy dose is large.
  • the technical problem to be solved by the present invention is to provide an intramedullary reduction device for long bone fractures of the extremities which can automatically feed the wire.
  • the reducer can perform rapid minimally invasive reduction of the long bone fracture with lateral displacement, and improve the accuracy of the reduction and The quality of the operation; at the same time, it can complete the automatic wire feeding, avoiding the shortcomings such as slow wire feeding speed and unstable wire feeding length caused by manual wire feeding.
  • an intramedullary resetter for automatic limb feeding and long bone fracture of the present invention comprises: a bracket having a front portion, a rear portion and a middle portion connected to the front and rear side surfaces; a tube mounted on the front portion of the bracket; a reset head having a rear side rotatably mounted to the front end portion of the reset sleeve through a rotating shaft; a guide wire tube mounted to the front portion of the bracket, and The reset sleeve is parallel; the reset rod is disposed in the reset sleeve, and the front end of the reset rod is connected to the other side of the rear portion of the reset head, and can be driven when the reset rod moves back and forth
  • the resetting head rotates around the rotating shaft; the fixed handle is fixed to the rear of the bracket; the wire feeding handle is rotatably connected to the fixed handle through the rotating shaft; the guide wire pushing plate is disposed at the front of the bracket and Between the rear portions, the guide wire push plate is provided with a wire feed hole
  • the guidewire push plate is perpendicular to the axis of the guidewire tube.
  • the method further includes: a reset head holder mounted to the front end portion of the reset sleeve, and a rear side of the reset head rotatably mounted to the reset head base.
  • the lower surface of the rear portion of the reset head is connected to the side wall of the reset head base by a horizontal rotating shaft, and the upper surface of the rear portion of the reset head is connected to the front end of the reset lever through the rotating shaft.
  • a drive transmission mechanism that can move the reset lever forward and backward is further included.
  • the drive transmission mechanism includes: a gear box disposed at a front portion of the bracket, the reset pull rod and the guide wire tube are mounted to the gear box, and the guide wire is disposed In front of the gearbox a rear end portion, the rear portion of the resetting rod is disposed in the gear box, and is provided with a rack; a gear is disposed in the gear box and meshes with a rack at a rear portion of the resetting rod; Outside the gearbox, a common rotating shaft with the gear can drive the gear to rotate.
  • the method further includes: a locking hook rotatably mounted on the outside of the gear box by a rotating shaft, the locking hook having a hook portion and a wrench portion on both sides of the rotating shaft; and a pressure spring piece connected to the wrench And contacting the knob, the elastic force of the compression spring pressing the hook portion of the hook to the reset rod rack.
  • the apparatus further includes: a baffle, the upper end of the baffle being rotatably coupled to the rear of the bracket by a rotating shaft; the rear portion of the bracket and the baffle and the guide A wire guide hole is provided at a position opposite to the wire tube for the guide wire to pass through, and a guide spring is mounted on the guide wire between the baffle and the rear portion of the bracket.
  • the diameter of the wire feed hole of the guide wire push plate matches the diameter of the guide wire
  • the diameter of the guide wire hole of the baffle matches the diameter of the guide wire
  • the beneficial effects of the present invention are: in the present invention, the reduction sleeve can be implanted in the medullary cavity of one end of the fractured long bone, and the resetting head is lifted by pulling the resetting rod in the resetting sleeve, and the front end of the resetting head passes through the fracture to enter the fracture end.
  • the resetting lever In the opposite side of the medullary cavity, the resetting lever is pushed in the opposite direction to make the resetting head straight, and the opposite medullary cavity is moved to reset the opposite side of the broken bone; after the reduction, the guide wire is sent to the opposite medullary cavity through the wire feeding portion. Then, the fracture site is reset and fixed by the intramedullary nail matching tool.
  • the invention can not only complete the fracture reduction with lateral displacement, but also reset the lateral displacement and the rotation fracture, and can correct the lateral displacement and the rotational displacement at the same time.
  • the invention adopts the mechanical wire feeding device, can complete the automatic wire feeding action, makes the guide wire feeding fast, convenient, stable and easy to control, and avoids the shortcomings such as slow wire feeding speed and unstable wire feeding length caused by manual wire feeding.
  • the invention has the advantages of simple structure and convenient use, and can rapidly and minimally invasively reduce long bone fractures with lateral displacement and rotational displacement, improve the accuracy of resetting and the quality of surgery, solve the problem that has not been solved for a long time, and is a method for closed reduction.
  • FIG. 1 is a schematic structural view of an embodiment of an intramedullary resetter for long bone fracture of a limb with automatic wire feeding according to the present invention
  • FIG. 2 is a driving transmission machine in an embodiment of an intramedullary resetter for limb long bone fractures capable of automatic wire feeding according to the present invention; Schematic diagram of the structure.
  • bracket 1 reset sleeve 2, reset head 3, reset head base 4, reset rod 5, handle 6, guide wire tube 7, guide wire 8, guide wire push plate 9, push plate return spring 10,
  • the fixed handle 11 the wire feed handle 12, the baffle 13, the baffle spring 14, the gear case 15, the knob 16, the lock hook 17, the wrench portion 18, and the pressure spring piece 19.
  • an embodiment of the intramedullary resetter for the long-limb bone fracture of the present invention can be automatically fed, including a stent 1, a fixed handle 11, a reset portion and a wire feeding portion.
  • the fixed handle 11 is integrally connected to the rear of the bracket 1.
  • the bracket 1 may be of a unitary structure having a front portion, a rear portion, and a middle portion connected to the front and rear side surfaces.
  • the middle portion of the bracket 1 may be one or more connecting ribs.
  • the reset portion includes a reset sleeve 2, a reset head 3, a reset head holder 4, a reset lever 5, and a drive transmission mechanism.
  • the rear end of the reset sleeve 2 is connected to the front end of the bracket 1, and the rear side of the reset head 3 is rotatably mounted in the reset head base 4 by a rotating shaft, and the reset head base 4 is fixed to the front end of the reset sleeve 2.
  • the reset rod 5 is passed through the reset sleeve 2, and the front end of the reset rod 5 is connected to the other side of the rear portion of the reset head 3.
  • the lower portion of the rear portion of the reset head 3 is connected to the side wall of the reset headstock 4 by a horizontal rotating shaft, and the upper portion of the rear end of the reset head 3 is connected to the front end of the reset lever 5 via a rotating shaft.
  • the reset head 3 can be directly disposed at the front end portion of the reset sleeve 2.
  • the drive transmission mechanism that can move the reset lever 5 back and forth includes a gear box 15, a gear, and a knob 16.
  • the gear case 15 can be fixed to the front of the bracket 1, in which case the reset lever 5 and the guide wire tube 7 are mounted to the gear case 15.
  • the guide wire 8 is bored at the front and rear ends of the gear case 15, and the rear portion of the reset link 5 is bored through the gear case 15, and is provided with a rack.
  • the gear is mounted in the gear case 15 and meshes with the rack at the rear of the reset lever 5.
  • the knob 16 is disposed outside the gear case 15 for easy screwing.
  • the knob 16 and the gear have a common rotating shaft so as to drive the gear to rotate.
  • a handle 6 can also be mounted on the knob 16.
  • the length of the handle 6 is larger than the diameter of the knob 16, so that turning the knob 16 is more labor-saving.
  • the drive transmission mechanism is not limited to the above-described configuration, and other mechanisms for moving the reset lever 5 back and forth can also be applied to the present invention.
  • the knob 16 When in use, the knob 16 is rotated clockwise, and the knob 16 rotates together with the gear having the common rotating shaft.
  • the gear pulls the reset rod 5 backward through the rack on the reset rod 5, and the reset rod 5 pulls the reset head 3 around the lower portion of the reset head 3
  • the rotation shaft connected to the reset head base 4 rotates to lift the front end of the reset head 3; the front end of the reset head 3 passes through the fracture portion into the medullary cavity opposite to the fracture end; then the knob 16 is turned counterclockwise, and the gear pushes the reset rod 5 forward.
  • the reset head 3 is rotated counterclockwise around the rotating shaft, and the reset head 3 is rotated counterclockwise and gradually straightened, and the splitting force of the resetting head 3 and the resetter main body are used to complete the contralateral lateral bone fracture by the force of the contralateral medullary cavity. .
  • the reset head 3 can be fixed at a suitable angle on the basis of the above process, and then the whole of the resetter can be rotated to complete the reset, while correcting the lateral displacement and the rotational shift. Bit.
  • a lock hook 17 is attached to the lower portion of the gear case 15.
  • the lock hook 17 is rotatably mounted outside the gear case 15 via a rotating shaft.
  • the lock hook 17 has a hook portion and a wrench portion 18 on both sides of the rotating shaft, and the spring portion 19 is mounted on the wrench portion 18.
  • the hook portion at the front end of the lock hook 17 can be inserted into the gear case 15 through a hole in the gear case 15 and embedded in the rack of the reset pull rod 5, and the pressure spring piece 19 is in contact with the knob 16, and the elastic force of the pressure spring piece 19 causes the said The hook portion of the lock hook 17 is pressed against the rack of the reset lever 5.
  • the compression spring piece 19 engages the hook portion at the front end of the lock hook 17 in the rack by the rotation shaft, and locks the rack so that it cannot move back and forth.
  • the gear has a tendency to push the rack to move.
  • the turning knob 16 generates a pushing force greater than the pressing force provided on the rack by the pressure spring 19, the lock The front end of the hook 17 is pushed outward by the rack to release the locking of the rack, and the reset lever 5 can be moved back and forth.
  • the compression spring 19 can re-press the front end of the locking hook 17 through the rotating shaft, so that the rack cannot move freely and realize automatic locking.
  • the wire feeding portion includes a wire guide 7, a guide wire 8, a guide wire push plate 9, a push plate return spring 10, and a wire feed handle 12.
  • the guide wire tube 7 is connected in parallel to the upper surface of the reset sleeve 2, and the rear end of the guide wire tube 7 is connected to the front end of the bracket 1.
  • the guide wire tube 7 has a guide wire push plate 9 at the rear, the guide wire push plate 9 can be perpendicular to the axis of the guide wire tube 7, the guide wire push plate 9 has a wire feed hole, and the guide wire 8 enters the guide wire tube through the wire feed hole. 7 in.
  • the upper portion of the wire feeding handle 12 is rotatably coupled to the fixed handle 11 by a rotating shaft.
  • the end of the wire feeding handle 12 above the rotating shaft is located behind the guide wire pushing plate 9, and the push plate return spring 10 is located at the guide wire.
  • the front of the push plate 9 is between the front end of the guide wire tube 7.
  • the wire feeding handle 12 After the wire feeding handle 12 completes one wire feeding stroke, the wire feeding handle 12 is released, and the pushing plate return spring 10 pushes the wire pushing plate 9 and the wire feeding handle 12 back to the starting position, since the wire pushing plate 9 is backward There is no compression of the guide wire 8 when moving, so there is no friction to push the guide wire 8 to move backward, and then continue the next wire feed stroke until the desired length is reached.
  • the wire feeding handle 12 of one embodiment of the present invention has a wire feeding stroke of about 5 mm, and the operator can perform multiple times of pulling according to the site requirements to achieve the required wire feeding length.
  • a baffle 13 and a baffle spring 14 are also included.
  • the upper end portion of the baffle 13 is rotatably attached to the rear portion of the bracket 1 via a rotating shaft.
  • the upper end of the baffle 13 is connected to the rear portion of the bracket 1 through a rotating shaft, and the rear portion of the bracket 1 and the baffle 13 have opposite guide wire holes.
  • a baffle spring 14 is mounted between the baffle 13 and the bracket 1, and the guide wire 8 passes through the guide wire hole of the baffle 13 and the guide wire hole of the bracket 1 from the rear to the wire feed hole of the guide wire push plate 9.
  • the baffle spring 14 pushes the baffle 13 rearwardly, and the guide wire hole of the baffle 13 tops the guide wire 8 upward. Before the guide wire 8 is inserted, the baffle 13 is pulled downward to penetrate the guide wire 8 from the guide wire hole.
  • the lock hook 17 is first unlocked, the reset head 3 is placed in a straight position, and then the baffle 13 is pressed downward, and the guide wire 8 is pulled back.
  • the present invention withdraws the resetter from the broken bone marrow cavity, and then uses the intramedullary nail matching tool to reset and fix the fracture site.
  • the reduction sleeve can be implanted in the medullary cavity at one end of the long bone of the fracture, and the resetting head is lifted by pulling the resetting rod in the reduction sleeve, and the front end of the reduction head passes through the fracture into the medullary cavity on the opposite side of the fracture end. Reverse again Push the reset lever to make the reset head straight, and push the contralateral medullary cavity to reset the contralateral side.
  • the guide wire is sent to the contralateral medullary cavity through the wire feeding part, and then the intramedullary nail matching tool is used to fracture the bone. The part is reset and fixed.
  • the invention can not only complete the fracture reduction with lateral displacement, but also reset the lateral displacement and the rotation fracture, and can correct the lateral displacement and the rotational displacement at the same time.
  • the invention adopts the mechanical wire feeding device, can complete the automatic wire feeding action, makes the guide wire feeding fast, convenient, stable and easy to control, and avoids the shortcomings such as slow wire feeding speed and unstable wire feeding length caused by manual wire feeding.
  • the invention has the advantages of simple structure and convenient use, and can rapidly and minimally invasively reduce long bone fractures with lateral displacement and rotational displacement, improve the accuracy of resetting and the quality of surgery, solve the problem that has not been solved for a long time, and is a method for closed reduction.

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Abstract

一种可自动送丝的四肢长骨骨折髓内复位器，包括：支架（1）；安装于支架（1）前部的复位套管（2）；可转动地安装于复位套管（2）前端部的复位头（3）；安装于支架（1）前部的导丝管（7）；穿设于复位套管（2）的复位拉杆（5），复位拉杆（5）与复位头（3）连接，复位拉杆（5）能带动复位头（3）绕转轴转动；固定于支架（1）后部的固定手柄（11）；可转动地连接于固定手柄（11）的送丝手柄（12）；设于支架（1）的前部和后部之间的导丝推板（9）；穿设于导丝管（7）的导丝（8），在导丝推板（9）与支架（1）的前部之间的导丝（8）上套有推板复位弹簧（10），送丝手柄（12）上部能推动导丝推板（9）和导丝（8）向前移动。本发明能够对存在侧方移位和旋转位移的长骨骨折进行快速复位，导丝送入快捷、稳定、易于控制，提高了复位的准确性和手术质量，解决了人工送丝存在的问题。

Description

一种可自动送丝的四肢长骨骨折髓内复位器 技术领域
本发明涉及医疗器械领域，具体涉及一种对四肢长骨骨折进行复位的可自动送丝的四肢长骨骨折髓内复位器。
背景技术
在骨科治疗中，四肢长骨骨折是临床常见损伤，在治疗四肢长骨骨折的手术方案中主要有切开复位内固定和闭合复位内固定两种。
切开复位内固定治疗手术方案的优点是在直视下进行骨折复位，骨折复位的质量高，然后采用接骨板或髓内钉固定；其缺点是需开放手术，手术创伤大，患者失血量多，骨折周围含有促进骨折愈合因子的血肿术中被清除，不利于骨折愈合；此外，由于切开皮肤、皮下组织并分离骨折周围的肌肉等组织，感染等并发症发生率高。
闭合复位内固定手术方案的优点是创伤小、患者失血量少、骨折周围含有促进骨折愈合的因子的血肿可被保留，术后感染、骨折不愈合等并发症发生率相对较低；其缺点是由于闭合复位对医生的复位和固定技术要求高，骨折复位难度大，尤其是粉碎或侧方移位严重的骨折复位更加困难，手术时间长，X线透视剂量大。
目前，随着医疗技术的发展，微创手术在各种手术中的比例快速增长，为提高手术质量、加快恢复过程、减少患者痛苦提供了新的手段。因此，在骨科手术中，采用闭合复位的方法治疗四肢长骨骨折是今后发展的方向，但是目前在闭合复位的手术过程中，对于存在侧方移位的骨折复位困难，没有专用的器具，影响了复位的准确性和手术质量，成为四肢长骨骨折治疗中的难题，至今没有解决。
再有，骨折复位后需要送入导丝到对侧的骨折断端的髓腔内，然后利用髓内钉配套工具对骨折部位进行复位固定。而目前采用的是人工送丝，由于手术现场有大量的血液沾染在器械和操作者手套上，产生打滑，不但速度慢，而且送丝长度不稳定，难以控制，因此改进送丝方法也是亟待解决的问题。
在所述背景技术部分公开的上述信息仅用于加强对本发明的背景的理解，因此它可以 包括不构成对本领域普通技术人员已知的现有技术的信息。
发明内容
本发明所要解决的技术问题是提供一种可自动送丝的四肢长骨骨折髓内复位器，这种复位器能够对存在侧方移位的长骨骨折进行快速微创复位，提高复位的准确性和手术质量；同时可以完成自动送丝，避免人工送丝导致的送丝速度慢、送丝长度不稳定等缺点。
本发明的额外方面和优点将部分地在下面的描述中阐述，并且部分地将从描述中变得显然，或者可以通过本发明的实践而习得。
为实现上述目的，本发明所设计的可自动送丝的四肢长骨骨折髓内复位器，它包括：支架，具有前部、后部以及连接于所述前部和后部侧面的中部；复位套管，安装于所述支架前部；复位头，其后部一侧通过一转轴可转动地安装于所述复位套管前端部；导丝管，安装于所述支架前部，并与所述复位套管平行；复位拉杆，其穿设于所述复位套管中，所述复位拉杆的前端与所述复位头后部另一侧相连接，当所述复位拉杆前后移动时能带动所述复位头绕转轴转动；固定手柄，固定于所述支架的后部；送丝手柄，其上部通过转轴可转动地连接于所述固定手柄；导丝推板，设于所述支架的前部和后部之间，所述导丝推板上对应于所述导丝管位置设有送丝孔；导丝，通过所述导丝推板的送丝孔穿设于导丝管，在所述导丝推板与所述支架的前部之间的导丝上套设有推板复位弹簧，所述送丝手柄上部位于导丝推板的后方，当所述送丝手柄绕转轴转动时，能推动所述导丝推板和所述导丝向前移动。
根据本发明的一实施方式，所述导丝推板垂直于所述导丝管的轴线。
根据本发明的一实施方式，还包括：复位头座，安装于所述复位套管前端部，所述复位头后部一侧可转动地安装于所述复位头座。
根据本发明的一实施方式，所述复位头后部的下面由水平的转轴连接在复位头座的侧壁上，复位头后部的上面通过转轴与复位拉杆的前端相连接。
根据本发明的一实施方式，还包括能使所述复位拉杆前后移动的驱动传动机构。
根据本发明的一实施方式，所述驱动传动机构包括：齿轮箱，设于所述支架的前部，所述复位拉杆和所述导丝管安装于所述齿轮箱，所述导丝穿设于所述齿轮箱的前 后端部，所述复位拉杆后部穿设于所述齿轮箱，并设有齿条；齿轮，设于所述齿轮箱内，并与所述复位拉杆后部的齿条啮合；旋钮，设于所述齿轮箱外，与所述齿轮具有共同的转轴，能带动所述齿轮转动。
根据本发明的一实施方式，还包括：锁钩，通过转轴可转动地安装于所述齿轮箱外，所述锁钩具有位于转轴两侧的钩部和扳手部；压簧片，连接于扳手部，并与所述旋钮接触，所述压簧片的弹力使所述锁钩的钩部压紧于所述复位拉杆齿条。
根据本发明的一实施方式，还包括：挡板，所述挡板的上端通过转轴可转动地连接于所述支架的后部；所述支架的后部与所述挡板上与所述导丝管相对位置设有导丝孔以供所述导丝穿设，所述挡板与支架的后部之间的导丝上安装有挡板弹簧。
根据本发明的一实施方式，所述导丝推板的送丝孔的直径与导丝的直径相匹配，所述挡板的导丝孔的直径与导丝的直径相匹配。
本发明的有益效果是：本发明中，复位套管可以植入在骨折长骨的一端髓腔内，通过拉动复位套管内的复位拉杆使复位头翘起，复位头前端通过骨折处进入骨折断端对侧的髓腔内，再反向推动复位拉杆，使复位头伸直，拨动对侧的髓腔将对侧折断骨复位；复位后通过送丝部分将导丝送入对侧的髓腔，再利用髓内钉配套工具对骨折部位进行复位固定。本发明不但可以完成有侧方移位的骨折复位，而且对于同时存在侧方移位和旋转的骨折进行复位，能同时纠正侧方移位和旋转移位。本发明采用机械送丝装置，可以完成自动送丝动作，使导丝送入快捷、方便、稳定、易于控制，避免了人工送丝导致的送丝速度慢、送丝长度不稳定等缺点。本发明结构简单、使用方便，能够对存在侧方移位和旋转位移的长骨骨折进行快速微创复位，提高复位的准确性和手术质量，解决了长期没有解决的问题，是闭合复位的方法治疗四肢长骨骨折的十分有效的器具。
本发明中通过以下参照附图对优选实施例的说明，本发明的上述以及其它目的、特征和优点将更加明显。
附图说明
图1是本发明可自动送丝的四肢长骨骨折髓内复位器一实施方式的结构示意图；
图2是本发明可自动送丝的四肢长骨骨折髓内复位器一实施方式中的驱动传动机 构的结构示意图。
图中标记如下：支架1、复位套管2、复位头3、复位头座4、复位拉杆5、手柄6、导丝管7、导丝8、导丝推板9、推板复位弹簧10、固定手柄11、送丝手柄12、挡板13、挡板弹簧14、齿轮箱15、旋钮16、锁钩17、扳手部18、压簧片19。
具体实施方式
现在将参考附图更全面地描述示例实施方式。然而，示例实施方式能够以多种形式实施，且不应被理解为限于在此阐述的实施方式；相反，提供这些实施方式使得本发明将全面和完整，并将示例实施方式的构思全面地传达给本领域的技术人员。图中相同的附图标记表示相同或类似的结构，因而将省略它们的详细描述。
如图1和图2显示，本发明可自动送丝的四肢长骨骨折髓内复位器一实施方式，包括支架1、固定手柄11、复位部分和送丝部分。固定手柄11与支架1的后部连接为一体。
支架1可以为一体结构，具有前部、后部以及连接于前部和后部侧面的中部。支架1的中部可以是一根或多根连接筋。
复位部分包括复位套管2、复位头3、复位头座4、复位拉杆5以及驱动传动机构。
复位套管2的后端与支架1前端相连接，复位头3的后部一侧由转轴可转动地安装在复位头座4中，复位头座4固定在复位套管2的前端。复位拉杆5穿在复位套管2中，复位拉杆5的前端与复位头3的后部另一侧相连接。详细来说，复位头3后部的下面由水平的转轴连接在复位头座4的侧壁上，复位头3后端的上部通过转轴与复位拉杆5的前端相连接。在不设置复位头座4情况下，复位头3可以直接设置于复位套管2的前端部。
如图2显示，本实施方式中，能使复位拉杆5前后移动的驱动传动机构包括：齿轮箱15、齿轮和旋钮16。
齿轮箱15可固定于支架1的前部，该种情况下，复位拉杆5和导丝管7安装于齿轮箱15。导丝8穿设于齿轮箱15的前后端部，复位拉杆5后部穿设于齿轮箱15，并设有齿条。齿轮安装于齿轮箱15内，并与复位拉杆5后部的齿条啮合。旋钮16设于齿轮箱15外，以方便旋拧。旋钮16与齿轮具有共同的转轴，从而能带动齿轮转动。 为了方便转动旋钮16，还可以在旋钮16上安装一手柄6，手柄6的长度大于旋钮16直径，因此转动旋钮16更加省力。
驱动传动机构不限于上述举例的结构，其他能使复位拉杆5前后移动的机构也可适用于本发明。
使用时，顺时针转动旋钮16，旋钮16带动与其具有共同转轴的齿轮一同转动，齿轮通过复位拉杆5上的齿条向后拉动复位拉杆5，复位拉杆5拉动复位头3绕复位头3下部与复位头座4连接的转轴转动，使复位头3前端翘起；使复位头3前端通过骨折处进入骨折断端对侧的髓腔内；然后逆时针转动旋钮16，齿轮向前推动复位拉杆5，使复位头3绕转轴逆时针转动，复位头3逆时针转动而逐渐伸直的过程中，利用复位头3的撬拨力量和复位器主体通过对侧髓腔的力量完成对侧折断骨复位。
对于同时存在侧方移位和旋转移位的骨折，可以在上述过程的基础上，固定复位头3在一个合适的角度，然后旋转复位器整体来完成复位，同时纠正侧方移位和旋转移位。
如图1和图2显示，为了使复位头3翘起或伸直后能够自动锁定，在齿轮箱15的下部安装有锁钩17。详细来说，锁钩17通过转轴可转动地安装于齿轮箱15外，锁钩17具有位于转轴两侧的钩部和扳手部18，扳手部18上安装有压簧片19。锁钩17前端的钩部能通过齿轮箱15上的孔伸入齿轮箱15内并嵌在复位拉杆5的齿条中，压簧片19与旋钮16接触，压簧片19的弹力使所述锁钩17的钩部压紧于复位拉杆5的齿条。
通常情况下，压簧片19通过转轴使锁钩17前端的钩部嵌入在齿条中，锁定齿条，使其不能前后移动。当转动旋钮16时，无论是顺时针还是逆时针旋转，齿轮有推动齿条移动的趋势，当转动旋钮16产生的推动力大于压簧片19提供的在齿条上的压紧力时，锁钩17的前端即被齿条向外顶开，解除对齿条的锁定，复位拉杆5即可前后移动。而一旦停止转动旋钮16，压簧片19即可通过转轴使锁钩17的前端重新压紧齿条，使齿条不能自由移动，实现自动锁定。
如图1显示，送丝部分包括导丝管7、导丝8、导丝推板9、推板复位弹簧10和送丝手柄12。
导丝管7平行连接在复位套管2的上面，导丝管7的后端与支架1前端相连接， 导丝管7的后方有导丝推板9，导丝推板9可以与导丝管7的轴线垂直，导丝推板9上有送丝孔，导丝8通过送丝孔进入导丝管7中。
如图1显示，送丝手柄12的上部由转轴可转动地连接在固定手柄11上，转轴上方的送丝手柄12的端部位于导丝推板9的后方，推板复位弹簧10位于导丝推板9前面与导丝管7后端之间。送丝时，向后扳动送丝手柄12的下部，送丝手柄12绕转轴转动，送丝手柄12的端部从导丝推板9的后面向前推动导丝推板9向前移动，导丝推板9的导丝孔向上顶在导丝8上，导丝推板9在向前移动时依靠摩擦力推动导丝8向前移动，完成送丝动作。
送丝手柄12完成一次送丝行程后，松开送丝手柄12，推板复位弹簧10向后推动导丝推板9和送丝手柄12恢复到起始位置，由于导丝推板9向后移动时没有对导丝8有压迫，因此没有摩擦力推动导丝8向后移动，然后继续下一次送丝行程，直至达到需要的长度。
本发明的一个实施例的送丝手柄12的每一次送丝行程为5mm左右，操作者可以根据现场需要进行多次扳动，达到需要的送丝长度。
如图1显示，在一实施方式中，还包括挡板13和挡板弹簧14。挡板13上端部通过转轴可转动地安装于支架1的后部。挡板13的上端通过转轴与支架1的后部相连接，支架1后部与挡板13上有相对的导丝孔。挡板13与支架1之间安装有挡板弹簧14，导丝8从后方向前穿过挡板13的导丝孔和支架1的导丝孔到达导丝推板9的送丝孔。正常情况下，挡板弹簧14向后推动挡板13，挡板13的导丝孔向上顶紧导丝8。在插入导丝8前，向下扳动挡板13可以从导丝孔中穿入导丝8。
需要抽出导丝8时，首先将锁钩17解锁，使复位头3处于平直位置，然后向下压挡板13，再向后抽出导丝8即可。
本发明在插入导丝8到对侧的骨折断端的髓腔内之后，从断骨髓腔内撤出复位器，再利用髓内钉配套工具对骨折部位进行复位固定。
工业实用性
本发明中，复位套管可以植入在骨折长骨的一端髓腔内，通过拉动复位套管内的复位拉杆使复位头翘起，复位头前端通过骨折处进入骨折断端对侧的髓腔内，再反向 推动复位拉杆，使复位头伸直，拨动对侧的髓腔将对侧折断骨复位；复位后通过送丝部分将导丝送入对侧的髓腔，再利用髓内钉配套工具对骨折部位进行复位固定。本发明不但可以完成有侧方移位的骨折复位，而且对于同时存在侧方移位和旋转的骨折进行复位，能同时纠正侧方移位和旋转移位。本发明采用机械送丝装置，可以完成自动送丝动作，使导丝送入快捷、方便、稳定、易于控制，避免了人工送丝导致的送丝速度慢、送丝长度不稳定等缺点。本发明结构简单、使用方便，能够对存在侧方移位和旋转位移的长骨骨折进行快速微创复位，提高复位的准确性和手术质量，解决了长期没有解决的问题，是闭合复位的方法治疗四肢长骨骨折的十分有效的器具。
虽然已参照几个典型实施例描述了本发明，但应当理解，所用的术语是说明和示例性、而非限制性的术语。由于本发明能够以多种形式具体实施而不脱离发明的精神或实质，所以应当理解，上述实施例不限于任何前述的细节，而应在随附权利要求所限定的精神和范围内广泛地解释，因此落入权利要求或其等效范围内的全部变化和改型都应为随附权利要求所涵盖。

Claims (9)

  1. 一种可自动送丝的四肢长骨骨折髓内复位器，其特征在于它包括：
    支架(1)，具有前部、后部以及连接于所述前部和后部侧面的中部；
    复位套管(2)，安装于所述支架(1)前部；
    复位头(3)，其后部一侧通过一转轴可转动地安装于所述复位套管(2)前端部；
    导丝管(7)，安装于所述支架(1)前部，并与所述复位套管(2)平行；
    复位拉杆(5)，其穿设于所述复位套管(2)中，所述复位拉杆(5)的前端与所述复位头(3)后部另一侧相连接，当所述复位拉杆(5)前后移动时能带动所述复位头(3)绕转轴转动；
    固定手柄(11)，固定于所述支架(1)的后部；
    送丝手柄(12)，其上部通过转轴可转动地连接于所述固定手柄(11)；
    导丝推板(9)，设于所述支架(1)的前部和后部之间，所述导丝推板(9)上对应于所述导丝管(7)位置设有送丝孔；
    导丝(8)，通过所述导丝推板(9)的送丝孔穿设于导丝管(7)，在所述导丝推板(9)与所述支架(1)的前部之间的导丝(8)上套设有推板复位弹簧(10)，所述送丝手柄(12)上部位于导丝推板(9)的后方，当所述送丝手柄(12)绕转轴转动时，能推动所述导丝推板(9)和所述导丝(8)向前移动。
  2. 根据权利要求1所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于：所述导丝推板(9)垂直于所述导丝管(7)的轴线。
  3. 根据权利要求1所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于还包括：
    复位头座(4)，安装于所述复位套管(2)前端部，所述复位头(3)后部一侧可转动地安装于所述复位头座(4)。
  4. 根据权利要求3所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于：所述复位头(3)后部的下面由水平的转轴连接在复位头座(4)的侧壁上，复位头(3)后部的上面通过转轴与复位拉杆(5)的前端相连接。
  5. 根据权利要求1所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于 还包括能使所述复位拉杆(5)前后移动的驱动传动机构。
  6. 根据权利要求5所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于：所述驱动传动机构包括：
    齿轮箱(15)，设于所述支架(1)的前部，所述复位拉杆(5)和所述导丝管(7)安装于所述齿轮箱(15)，所述导丝(8)穿设于所述齿轮箱(15)的前后端部，所述复位拉杆(5)后部穿设于所述齿轮箱(15)，并设有齿条；
    齿轮，设于所述齿轮箱(15)内，并与所述复位拉杆(5)后部的齿条啮合；
    旋钮(16)，设于所述齿轮箱(15)外，与所述齿轮具有共同的转轴，能带动所述齿轮转动。
  7. 根据权利要求6所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于还包括：
    锁钩(17)，通过转轴可转动地安装于所述齿轮箱(15)外，所述锁钩(17)具有位于转轴两侧的钩部和扳手部(18)；
    压簧片(19)，连接于扳手部(18)，并与所述旋钮(16)接触，所述压簧片(19)的弹力使所述锁钩(17)的钩部压紧于所述复位拉杆(5)的齿条。
  8. 根据权利要求1-7中任一项所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于还包括：
    挡板(13)，所述挡板(13)的上端通过转轴可转动地连接于所述支架(1)的后部；
    所述支架(1)的后部与所述挡板(13)上与所述导丝管(7)相对位置设有导丝孔以供所述导丝(8)穿设，所述挡板(13)与支架(1)的后部之间的导丝(8)上安装有挡板弹簧(14)。
  9. 根据权利要求8所述的可自动送丝的四肢长骨骨折髓内复位器，其特征在于：所述导丝推板(9)的送丝孔的直径与导丝(8)的直径相匹配，所述挡板(13)的导丝孔的直径与导丝(8)的直径相匹配。
PCT/CN2015/073268 2014-03-20 2015-02-25 一种可自动送丝的四肢长骨骨折髓内复位器 Ceased WO2015139550A1 (zh)

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