CN104586495B - A kind of steel wire guider for fixation of bone fragments of femoral shaft fracture - Google Patents

Abstract

A steel wire guide for femoral shaft fracture bone fragment fixation relates to the fixation of femoral shaft fracture free bone fragments and solves the problem of closed reduction, binding and fixing of femur and free bone fragments with steel wires or sutures. After closed reduction and interlocking intramedullary nailing for comminuted fractures of the femoral shaft, under C-arm fluoroscopy, the outer tube is passed through the muscle, and the free bone fragments are hooked to make it close to the femoral shaft. The inner tube rotates around its own center of circle. After the inner tube protrudes from the outer tube, it cooperates with the outer tube to enclose the free bone fragment and the femoral shaft. At this time, the steel wire can be pulled out from the inner tube and the outer tube with nucleus pulposus forceps; Fixed with suture, the suture can be fixed at the end of the steel wire and pulled out with the steel wire. Knot the steel wire or suture to achieve closed reduction, binding and fixation of free bone fragments and femur. The guide is easy to operate, and compared with open reduction and fixation, it can avoid destroying the blood supply of free bone fragments, significantly reduce the incision, reduce operation time, and relieve pain of patients.

Description

A kind of steel wire guider for fixation of bone fragments of femoral shaft fracture

technical field

The invention relates to the technical field of minimally invasive internal fixation of comminuted femur fractures, in particular to a steel wire guide for closed reduction, binding and fixing of femur and free bone fragments by using steel wires or sutures.

Background technique

Due to the rapid development of transportation, construction and other industries, the incidence of femoral shaft comminuted fractures caused by high-energy injuries is very high. Closed reduction and interlocking intramedullary nailing is the gold standard for the treatment of such injuries. Comminuted fractures often have relatively large free bone fragments, and the reduction and fixation of free bone fragments are still very challenging issues: large free bone fragments are far away from the femoral shaft, which not only makes the postoperative image unsightly, but also prolongs the healing time; Open reduction and fixation will not only destroy the blood supply of the bone block and interfere with healing, but also increase the amount of bleeding, prolong the operation time and increase the pain of the patient.

Contents of the invention

The purpose of the present invention is to provide a steel wire guide for femoral shaft fracture bone fragment fixation, which can solve the problem of using steel wires or sutures to close, reduce, and bind the free bone fragments of the femur when it is applied to the fixation of free bone fragments in femoral shaft fractures.

The technical solution adopted by the present invention to solve the technical problem is: a wire guide for femoral shaft fracture bone fragment fixation, which is characterized in that it includes a handle, a joint, an outer tube, an inner tube, a transmission mechanism, a first gear and a second gear. gear,

An arc-shaped hollow joint is detachably installed at one end of the handle, and a semi-arc-shaped outer tube is detachably installed at the other end of the joint, and a semi-arc-shaped inner tube is provided in the outer tube Placement cavity, the section of the inner tube placement cavity is circular, an inner tube that moves in a circle around the center of its own circle is arranged in the inner tube placement cavity, and a steel wire placement cavity for placing steel wires is provided in the inner tube; A gear slot is provided in the outer tube outside the inner tube placement cavity, and a plurality of first gears and second gears are arranged in the gear slot, and a plurality of first gears and second gears are also arranged in the inner cavity of the joint. Two gears, the first gear and the second gear are arranged at intervals, and every adjacent first gear and second gear are externally meshed, and each of the first gears located in the gear groove is respectively connected to the teeth on the outside of the inner tube. Mesh fit, there is a space between each second gear in the gear groove and the outer wall of the inner tube; an end cover is provided at the end of the inner tube away from the handle, and the installation end of the end cover and the inner tube can be a disassembled connection, the free end of said end cap is spherical;

A transmission mechanism is provided in the inner cavity of the joint, and the output end of the transmission mechanism is connected with the first gear located at the initial position in the inner cavity of the joint.

Further, a steel wire lead-out hole is provided on the inner side of the inner tube, and two semi-arc-shaped elastic sealing strips are arranged oppositely on the inner wall of the steel wire lead-out hole, and the mounting ends of the two sealing strips are fixed on the steel wire. On the inner wall of the lead-out hole, the free ends of the two sealing strips are in contact with each other; a gap corresponding to the steel wire lead-out hole is provided on the inner side of the outer tube.

Further, the outer tube includes a first arc-shaped body and a second arc-shaped body that are integrally formed into a semicircular arc, and the sides of the first arc-shaped body and the second arc-shaped body are detachably connected; The side surfaces of the first arc body and the second arc body are respectively provided with semicircular arc grooves, and the two arc grooves form an inner tube placement chamber; the first and second arc grooves outside the arc grooves Gear grooves are respectively arranged on the body.

Further, the first gear is a large gear, and the second gear is a small gear, and the first gear and the second gear are co-circumferentially arranged on the gear groove.

Further, an end cap installation hole is provided at one end of the inner tube, and an end cap connecting portion threadedly fitted with the end cap installation hole is provided at the bottom of the end cap.

Further, the transmission mechanism includes a running wheel, a driven gear, a driving bevel gear, a driven bevel gear, a worm and a worm gear, the worm gear is coaxially arranged with the first gear in the inner cavity of the joint, and the inner cavity of the joint is provided with There is a vertical worm meshing with the worm gear, the worm is arranged coaxially with a driven bevel gear, and the driven bevel gear is meshed and matched with the driving bevel gear rotatably installed in the inner cavity of the joint, and the driving bevel gear It is arranged coaxially with a driven gear, and the driven gear meshes with a running wheel rotatably installed on the top of the inner cavity of the joint.

Further, an annular groove is provided on the outer side of the inner tube, and teeth engaged with the first gear are arranged in the annular groove.

Further, an insertion hole is provided on the first arc-shaped body, and an insertion strip matched with the insertion hole is arranged on the second arc-shaped body.

Further, the sealing strip is a rubber part.

Further, the joint includes a first clamping part and a second clamping part, and the side surfaces of the first clamping part and the second clamping part contact and fit together to form an elbow.

The beneficial effects of the present invention are: the present invention provides a steel wire guide for bone fragment fixation of femoral shaft fractures. After femoral shaft comminuted fractures are fixed with interlocking intramedullary nails, under C-arm fluoroscopy, the semicircle-shaped outer tube is passed through. Through the muscle, it is half-set on the outside of the femur, hooking the free bone and making it close to the femoral shaft. Then, by turning the wheel, the inner tube in the inner cavity of the outer tube moves in a circle around its own center of circle. After the inner tube protrudes from the outer tube, it cooperates with the outer tube to wrap around the femur and the free bone block. At this time, The steel wire can be pulled out from the inner tube and the outer tube through the nucleus pulposus forceps. If it is fixed with suture, the suture can be fixed at the end of the steel wire and pulled out with the steel wire. Knot the steel wire or suture to achieve closed reduction, binding and fixation of free bone fragments and femur. The present invention is convenient and simple to operate, and compared with open reduction and fixation, it can avoid destroying the blood supply of free bone blocks, significantly reduce the incision, reduce operation time, and relieve pain of patients.

Description of drawings

Fig. 1 is a three-dimensional diagram of the present invention;

Fig. 2 is the front view of Fig. 1;

Fig. 3 is a schematic diagram of Fig. 2 after removing the second arc-shaped body and the first clamping part;

Fig. 4 is a partial enlarged view of A place in Fig. 3;

Fig. 5 is a partial enlarged view of B in Fig. 3;

Fig. 6 is a partial enlarged view at C in Fig. 3;

Fig. 7 is the three-dimensional diagram of the first curved body;

Fig. 8 is the front view of Fig. 7;

Fig. 9 is a partial enlarged view of D in Fig. 7;

Fig. 10 is the E-E sectional view among Fig. 8;

Fig. 11 is the front view of the second arc body;

Fig. 12 is the F-F sectional view among Fig. 11;

Figure 13 is a schematic front view of the inner tube;

Figure 14 is a top view of Figure 13;

Fig. 15 is a partial enlarged view of G in Fig. 13;

Fig. 16 is a partial enlarged view of H in Fig. 14;

Fig. 17 is a three-dimensional diagram of the transmission mechanism;

Figure 18 is a partial view from I in Figure 1;

Figure 19 is a schematic diagram of pulling out the steel wire from the inner tube;

Figure 20 is a schematic diagram of the cooperation between the handle and the joint;

Figure 21 is one of the transmission schematic diagrams of the transmission mechanism;

Figure 22 is the second schematic diagram of the transmission mechanism;

Figure 23 is step 1 when the present invention is used;

Figure 24 is step 2 when the present invention is used;

Figure 25 is step three when the present invention is used;

Fig. 26 is step 4 when the present invention is used;

In the figure: 1 handle, 11 handle connection part, 2 joint, 21 first clamping part, 22 second clamping part, 3 first arc-shaped body, 31, 31' arc-shaped groove, 32 gear groove, 321, 321 'Axle hole, 33 block, 34, 34' arc transition, 35 socket, 4 second arc body, 41 insert, 5 inner tube, 51 steel wire placement cavity, 52 end cover mounting hole, 53 teeth, 54 Sealing strip, 55 steel wire outlet hole, 6 end cover, 61 end cover connecting part, 71 first gear, 72 second gear, 8 runner, 81 driven gear, 82 driving bevel gear, 83 driven bevel gear, 84 worm , 85 worm gears, 9 femurs, 91 free bone fragments, 10 steel wires or sutures, 101 folded edges, 102 knotted, 12 threaded connections, 13 gaps.

detailed description

As shown in Figures 1 to 26, the present invention includes a handle 1, a joint 2, an outer tube, an inner tube 5, an end cover 6, a first gear 71, a second gear 72 and a transmission mechanism, and the present invention will be described in detail below in conjunction with the accompanying drawings describe.

As shown in Figures 1 and 2, the handle 1 is a holding part, and the handle is provided with a non-slip rubber cover, which can ensure comfort when holding the handle. One end of the handle is a handle connecting portion 11, which is essentially a cylindrical piece manufactured integrally with the handle. As shown in Figure 20, an external thread is provided on the handle connecting portion. The joint 2 includes a first clamping part 21 and a second clamping part 22. After the first and second clamping parts are butted together, they form an elbow shape, and internal threads are provided on the inner cavity wall of the joint. As shown in FIG. 20 , when installing, thread the handle connection part and the joint 12 . The two parts of the joint are manufactured separately and then fixedly connected together, and the first and second clamping parts are manufactured separately to facilitate the installation of the transmission mechanism. The joint is a connecting part, which is used to connect the handle and the outer pipe, and the outer pipe is detachably installed at the other end of the joint; when the joint is connected with the outer pipe, it should be ensured that the connection between the two is firm.

The outer tube includes a first arc-shaped body 3 and a second arc-shaped body 4 that are clamped and connected. As shown in FIGS. The cross-section of the first arc-shaped body is semicircular, and a semicircular arc-shaped groove 31 is provided on the first arc-shaped body. The cross-section of the arc-shaped groove is semicircular. A gear groove 32 is arranged on the first arc-shaped body outside the arc-shaped groove, and the inner side of the gear groove communicates with the arc-shaped groove, and the overall gear groove is semicircular arc-shaped. A plurality of axle holes 321 are arranged at the bottom of the gear groove, and the effect of the axle holes is for installing the gear shaft, and several axle holes are evenly arranged along the circumferential direction. One end of the first arc-shaped body is provided with a stopper 33, which is located at one end of the gear groove, so as to block one end of the gear groove. And one end of the first arc-shaped body provided with a stopper is provided with an arc-shaped transition 34, so that the end of the first arc-shaped body becomes streamlined to reduce the resistance when the first arc-shaped body penetrates the muscle. The side of the first arc-shaped body outside the gear groove is provided with several jacks 35, and the jacks are used to cooperate with the insertion strips on the second arc-shaped body to realize the insertion and fixing of the first arc-shaped body and the second arc-shaped body .

As shown in FIG. 11 and FIG. 12 , the second arc-shaped body 4 is also a metal piece in the shape of a semicircle as a whole, and the cross-section of the second arc-shaped body is also semicircular. A semicircular arc-shaped groove 31 ′ is provided on the second arc-shaped body, and the arc-shaped grooves on the first and second arc-shaped bodies cooperate to accommodate the inner tube and provide guidance for the movement of the inner tube. A semicircular gear groove 32 ′ is provided on the second arc body outside the arc groove, and the inner side of the gear groove communicates with the arc groove. The gear grooves on the second arc-shaped body and the first arc-shaped body cooperate to install the first gear and the second gear. A plurality of axle holes 321' are arranged at the bottom of the gear groove 32', and the axle holes are arranged at equal intervals along the circumference, and the axle holes on the first and second arc-shaped bodies correspond one-to-one. On the side of the second arc-shaped body outside the gear groove, there are several insertion strips 41, which are used for plugging and matching with the jacks on the first arc-shaped body, so as to realize the relative relationship between the first arc-shaped body and the second arc-shaped body. fixed. A stopper is also provided at one end of the second arcuate body, and one end of the second arcuate body provided with the stopper is provided with a circular arc transition 34'.

As shown in Figure 1, when installing, butt the sides of the first arc-shaped body and the second arc-shaped body together, insert the cutting strip into the socket, and realize the relative fixation of the first arc-shaped body and the second arc-shaped body connected, at this moment, the first arc-shaped body and the second arc-shaped body form a semicircular arc-shaped metal pipe. The arc-shaped grooves of the first arc-shaped body and the second arc-shaped body enclose a semicircular arc-shaped inner tube placement cavity, as shown in FIG. 3 , an inner tube 5 is placed in the inner tube placement cavity. As shown in Fig. 13 and Fig. 14, the inner tube is an arc-shaped metal tube as a whole, its cross-section is circular, and the central angle of the inner tube is an obtuse angle less than 180 degrees, which can pass through the semi-arc-shaped metal tube. Cut off a part of one end to get the inner tube. The inner cavity of the inner tube is a steel wire placement cavity 51, as shown in Figure 15 and Figure 16, a steel wire lead-out hole 55 is provided on the inner side wall of the inner tube, and the two ends of the steel wire lead-out hole extend to the two ends of the inner tube respectively, and the steel wire The lead-out hole runs through the inner tube wall, and since the inner tube is located in the arc-shaped groove, the setting of the steel wire lead-out hole makes the inner cavity of the inner tube communicate with the inner cavity of the outer tube. In order to prevent the steel wire from coming out of the inner tube by itself, two relative sealing strips 54 are fixed in the steel wire lead-out hole. The end is inclined, and the free ends of the two sealing strips are in contact with each other to realize the restriction on the steel wire and prevent the steel wire from coming out of the inner tube by itself. The two sealing strips form a cone, and the sealing strips are made of rubber, as shown in Figure 19, pulling the two ends of the steel wire makes the steel wire escape from the inner tube between the free ends of the two sealing strips. In order to realize the detachment of the steel wire from the outer tube, as shown in Figure 18, a gap 13 is provided between the inner side of the first arc-shaped body and the second arc-shaped body, which corresponds to the steel wire lead-out hole, and is protruded from the inner cavity of the inner tube The steel wire can pass through the gap and come out of the outer tube. One end surface of the inner tube is provided with an end cap mounting hole 52, and the end cap mounting hole is a threaded hole.

The inner tube can slide in the arc-shaped groove. In order to drive the inner tube to slide in the arc-shaped groove, as shown in Figures 3 to 5, several first gears 71 and some second gears 72 are installed in the gear groove. The first gear is a large gear, the second gear is a small gear, and the first gear and the second gear are arranged at intervals and are externally engaged with each other. Since the rotation directions of the external meshing gears are opposite, every two adjacent first gears rotate in the same direction, and every two adjacent second gears rotate in the same direction. A number of first gears and second gears on the outer tube are arranged along the circumference, and the first gears and second gears are also arranged at intervals in the joint, and are externally meshed with the first gear or the second gear in the outer tube . When the first gears at both ends rotate, the first gear and the second gear between the two ends can drive the first gears at the other end to rotate in the same direction; that is, all the first gears rotate in the same direction. As shown in Figure 13, an annular groove is provided on the outside of the inner tube, and a tooth 53 is arranged in the annular groove, and the tooth 53 can mesh with the teeth on the first gear, and at the same time, there is a certain interval. When the first gear rotates, it can drive the inner tube to rotate relative to the arc groove, and the relationship between the inner tube and the outer tube is equivalent to the relationship between the inner ring and the outer ring of the bearing.

In order to drive the rotation of the first gear and the second gear, as shown in Figure 6 and Figure 17, a runner 8 is installed on the top of the joint, the upper part of the runner protrudes from the joint, and a driven gear is installed under the runner 81. The driven gear meshes with the running wheel, and the running wheel is essentially a gear. A driving bevel gear 82 is arranged coaxially with the driven gear, and the driving bevel gear meshes with a driven bevel gear 83. The driven bevel gear is installed on a vertically placed worm screw 84 shaft, and the worm shaft is rotatably connected with the joint. The worm is meshed with a worm wheel 85, and the worm wheel is installed in rotation on the joint, and the worm wheel and the first gear at the end of the joint are coaxially arranged. As shown in Figures 21 and 22, when the runner is turned, it can drive the driven gear to rotate in the opposite direction, and then drive the driving bevel gear to rotate in the same direction, and then drive the driven bevel gear to rotate, and the driven bevel gear drives the worm in the same direction Rotate, and finally realize the co-rotation of the worm wheel and the first gear. The worm gear has self-locking properties, and the setting of the worm gear can prevent the first gear from rotating by itself. The running wheel, driven gear, driving bevel gear, driven bevel gear, worm wheel and worm constitute the transmission mechanism.

One end of the inner tube is provided with an end cap 6, the end cap is a conical metal piece, the bottom of the end cap is an end cap connecting part 61, the end cap connecting part is inserted into the end cap mounting hole, and one end of the steel wire is fixed on the end cap superior. One end of the end cap is spherical, which can reduce the resistance when piercing the muscle. The split structure of the outer tube facilitates the installation of the first gear and the second gear, and the first arc body and the second arc body are manufactured separately.

Insert the steel wire or suture 10 into the inner cavity of the inner tube. One end of the steel wire is provided with a folded edge 101, and the folded edge is fixed on the end cap to prevent the steel wire from slipping into the inner tube. As shown in Figure 23, after the interlocking intramedullary nail is fixed, under C-arm fluoroscopy, the semi-circular outer tube is passed through the muscle, half-covered on the outside of the femur, and the free bone is hooked to make it close to the femoral shaft. As shown in Figure 24, push the roller forward, and the inner tube will rotate clockwise until the end cap is close to the joint, then stop turning the roller. At this moment, the inner tube and the outer tube ring are wrapped around the femur and the outside of the free bone. As shown in Figure 25, remove the end cap, pull out a section of steel wire, and then reversely turn the roller to make the inner tube rotate counterclockwise until the inner tube is completely retracted into the outer tube. As shown in FIG. 26 , the outer tube is pulled out from the muscle. At this time, the steel wire is wrapped around the outside of the femur, and the steel wire can be knotted 102 . If it is fixed with suture, the suture can be fixed at the end of the steel wire and pulled out with the steel wire, and then tied and fixed. For the convenience of passing the steel wire into the inner cavity of the inner tube, a circular hole is provided on the joint, which corresponds to the inner cavity of the inner tube, through which the steel wire or suture is inserted into the inner cavity of the inner tube. After the inner tube is pushed out from the lumen of the outer tube, one end of the inner tube is placed at the incision of the skin to facilitate knotting of steel wires or sutures. At the same time, a plurality of steel wires or sutures can be stuffed into the inner cavity of the inner tube, and the plurality of steel wires or sutures can be tied to the femur and the free bone to achieve firm fixation of the free bone. Steel wire or suture can also be drawn out from the gap between the steel wire outlet hole on the inner tube and the outer tube.

The design of the circular section of the outer tube can avoid trauma to the soft tissue when the outer tube is punctured. The radii of the outer tube and the inner tube can be set to various models, so as to adapt to the use of people with different body shapes, and ensure that the outer tube and the inner tube can smoothly surround the femur.

Claims (10)

1. A steel wire guide for femoral shaft fracture bone fragment fixation is characterized in that it comprises a handle, a joint, an outer tube, an inner tube, a transmission mechanism, a first gear and a second gear, An arc-shaped hollow joint is detachably installed at one end of the handle, and a semi-arc-shaped outer tube is detachably installed at the other end of the joint, and a semi-arc-shaped inner tube is provided in the outer tube Placement cavity, the section of the inner tube placement cavity is circular, an inner tube that moves in a circle around the center of its own circle is arranged in the inner tube placement cavity, and a steel wire placement cavity for placing steel wires is provided in the inner tube; A gear slot is provided in the outer tube outside the inner tube placement cavity, and a plurality of first gears and second gears are arranged in the gear slot, and a plurality of first gears and second gears are also arranged in the inner cavity of the joint. Two gears, the first gear and the second gear are arranged at intervals, and every adjacent first gear and second gear are externally meshed, and each of the first gears located in the gear groove is respectively connected to the teeth on the outside of the inner tube. Mesh fit, there is a space between each second gear in the gear groove and the outer wall of the inner tube; an end cover is provided at the end of the inner tube away from the handle, and the installation end of the end cover and the inner tube can be a disassembled connection, the free end of said end cap is spherical; A transmission mechanism is provided in the inner cavity of the joint, and the output end of the transmission mechanism is connected with the first gear located at the initial position in the inner cavity of the joint. 2. A kind of steel wire guide for femoral shaft fracture bone fragment fixation according to claim 1, is characterized in that, the inner side of described inner tube is provided with steel wire lead-out hole, is provided with on the inner wall of described steel wire lead-out hole Two semi-arc-shaped elastic sealing strips are arranged oppositely. The installation ends of the two sealing strips are fixed on the inner wall of the steel wire outlet hole, and the free ends of the two sealing strips are in contact with each other; The gap corresponding to the steel wire export hole. 3. A kind of steel wire guide for femoral shaft fracture bone fragment fixation according to claim 2, it is characterized in that, described outer tube comprises the first arc-shaped body and the second arc-shaped body that integrally form semicircular arc, so The sides of the first arc-shaped body and the second arc-shaped body are detachably connected; the sides of the first arc-shaped body and the second arc-shaped body are respectively provided with semi-circular arc-shaped grooves, and the two arc-shaped The inner tube is placed in a cavity formed by the shaped groove; gear grooves are respectively arranged on the first and second arc-shaped bodies outside the arc-shaped groove. 4. A kind of steel wire guide for femoral shaft fracture bone fragment fixation according to claim 3, it is characterized in that, the first gear is a large gear, the second gear is a small gear, and the first gear and the second gear are in the Co-circumferential setting on the gear groove. 5. A kind of steel wire guide for femoral shaft fracture bone fragment fixation according to claim 2, it is characterized in that, one end of said inner tube is provided with an end cap installation hole, and the bottom of said end cap is provided with The end cap connection portion where the end cap mounting holes are threaded. 6. A kind of steel wire guide for femoral shaft fracture bone fragment fixation according to claim 1, it is characterized in that, transmission mechanism comprises running wheel, driven gear, driving bevel gear, driven bevel gear, worm screw and worm gear, so The worm gear is set coaxially with the first gear in the inner cavity of the joint, and a vertical worm meshing with the worm gear is arranged in the inner cavity of the joint, and the worm is set coaxially with a driven bevel gear. The driving bevel gear meshes with the driving bevel gear rotatably installed in the inner cavity of the joint. The driving bevel gear is coaxially arranged with a driven gear, and the driven gear meshes with the runner rotatably installed on the top of the inner cavity of the joint. . 7. A kind of steel wire guide for femoral shaft fracture bone fragment fixation according to claim 5, it is characterized in that, an annular groove is provided on the outside of the inner tube, and a gear meshing with the first gear is provided in the annular groove. matching teeth. 8. A kind of steel wire guide for femoral shaft fracture bone fragment fixation according to claim 3, is characterized in that, be provided with socket on described first arc-shaped body, be provided with on described second arc-shaped body There are inserts that fit into the jacks. 9 . The wire guide for fixing femoral shaft fracture bone fragments according to claim 2 , wherein the sealing strip is a rubber part. 10 . 10. A wire guide for femoral shaft fracture bone fragment fixation according to claim 1, wherein the joint comprises a first clamping portion and a second clamping portion, and the first clamping portion and the second clamping portion The side surfaces of the second clamping part contact and fit together to form an elbow.