阅读说明：本技术 使用锁定到环绕锚定件的钉来进行骨固定的系统和方法 (Systems and methods for bone fixation using staples locked to surrounding anchors ) 是由 马克·B·索默斯 罗伊·维尔纳·桑德斯 詹姆斯·G·福克纳 卡莱布·亚伯拉罕·马丁 扎卡里· 于 2018-10-05 设计创作，主要内容包括：使用锁定到包括套管和锁定构件的环绕锚定件的髓内钉来固定骨的系统和方法。示例性系统可以包括钉、一个或更多个套管、一个或更多个锁定构件、引导套管安装的器械、至少一个钻子和附接到套管的驱动器的任意组合。该器械可以界定引导轴线,并且被配置为联接到骨,使得引导轴线延伸跨过骨。该器械可以用于沿着引导轴线将钻子、套管和/或锁定构件引导到骨中。钉可以被配置为沿着骨的骨髓管放置,使得钉延伸穿过套管,并且锁定构件可以被配置为将钉锁定到套管。(Systems and methods for fixation of bone using an intramedullary nail locked to a surrounding anchor including a sleeve and a locking member. An exemplary system may include any combination of a nail, one or more sleeves, one or more locking members, a device to guide the installation of a sleeve, at least one drill, and a driver attached to a sleeve. The instrument may define a guide axis and be configured to be coupled to a bone such that the guide axis extends across the bone. The instrument may be used to guide a drill, a cannula and/or a locking member into a bone along a guide axis. The nail may be configured to be placed along an intramedullary canal of a bone such that the nail extends through the cannula, and the locking member may be configured to lock the nail to the cannula.)

1. A system for bone fixation, the system comprising:

an instrument defining a guide axis and configured to be coupled to a bone such that the guide axis extends across the bone;

a cannula configured to be placed at least partially into at least one hole drilled in the bone along the guide axis;

a nail configured to be placed along a medullary canal of a bone such that the nail extends through the cannula; and

a locking member configured to lock the staple to the sleeve.

2. The system of claim 1, wherein the instrument comprises a guide portion and a pair of jaws, wherein the guide portion defines the guide axis, and wherein the jaws are coupled to the guide portion and configured to engage a bone such that the instrument is coupled to the bone.

3. The system of claim 2, wherein the guide axis continues to lie in a central plane positioned between and equidistant from the jaws as the jaws open and close.

4. A system according to claim 3, wherein the jaws are movable relative to each other about a pivot axis located in the central plane.

5. The system of claim 3, wherein the instrument has a pair of levers pivotally connected to each other, wherein the guide portion is coupled to the pair of levers via a holder for the guide portion, wherein the levers are coupled to the holder by respective link members having pivotable connections to each other, and wherein the pivotable connections of the link members move along slots defined by the holder as the jaws open and close, thereby ensuring that the guide portion remains equidistant from the jaws regardless of the degree to which the jaws are open.

6. The system of claim 2, wherein the guide portion is configured to be movable from a first position to at least one second position while the jaws remain engaged with bone, wherein the guide portion is coupled to the jaws in each of the first and second positions, wherein the guide axis in the first position of the guide portion lies within a central plane between the jaws, and wherein the guide axis in each second position of the guide portion is parallel to but offset from the central plane and the guide axis in the first position of the guide portion.

7. The system of claim 6, wherein the guide portion is configured to be movable from the first position to each second position while the guide portion remains coupled to the jaw.

8. The system of claim 6, wherein the guide portion is movable to at least one third position, and wherein the guide axis in each second position of the guide portion and the guide axis in each third position of the guide portion are parallel to each other, but offset from the central plane in opposite directions.

9. The system of claim 6, wherein the guide portion is movable to produce a plurality of offsets of the guide axis from the central plane, wherein the guide portion is coupled to the jaw via a retainer, and wherein the plurality of offsets are predefined by features of the guide portion and the retainer that are complementary to one another.

10. The system of claim 9, wherein the plurality of offsets includes predetermined offsets of one and two millimeters from the central plane.

11. The system of claim 6, wherein the instrument has a gauge to indicate a current offset of the guide axis from the central plane.

12. The system of claim 6, wherein the guide portion is configured to rotate relative to the jaw about an axis parallel to but spaced from the guide axis to move the guide portion from the first position to each second position.

13. The system of claim 1, wherein the instrument is at least predominantly radiolucent.

14. The system of claim 13, wherein the instrument has a guide portion defining the guide axis, and wherein the guide portion includes a radiopaque member centered on the guide axis.

15. The system of claim 14, wherein the radiopaque member is a radiopaque ring, and wherein the guide portion comprises a pair of radiopaque rings each centered on and spaced apart from each other along the guide axis.

16. The system of claim 1, wherein the instrument defines a wire receiving channel configured to guide a wire member into a bone to couple the instrument to the bone with the wire member.

17. The system of claim 16, wherein the instrument defines a pair of wire receiving channels configured to guide a pair of wire members into the bone on non-parallel trajectories to couple the instrument to the bone with each of the wire members.

18. The system of claim 16, wherein the wire-receiving channel is configured to guide a wire member through the bone on a trajectory that avoids a space in the medullary canal to be occupied by the nail.

19. The system of claim 16, wherein the instrument comprises a pair of levers pivotally connected to each other, wherein each lever provides one of the jaws, wherein the guide portion is connected to the lever via a retainer for the guide portion, wherein the retainer defines the wire receiving channel, and wherein optionally a distal end of the guide portion is flush with a distal end of the retainer.

20. The system of claim 19, wherein the retainer has a proximal surface area facing away from the distal end of the retainer, and wherein each wire-receiving channel extends through the retainer from the proximal surface area of the retainer to the distal end of the retainer.

21. The system of claim 19, wherein the retainer surrounds at least an axial region of the guide portion.

22. The system of claim 17, wherein the pair of wire receiving channels are configured such that the non-parallel trajectories are closest to each other before reaching a bone from the instrument.

23. The system of claim 22, wherein the pair of wire-receiving channels are configured such that the non-parallel trajectories are closest to each other inside the instrument.

24. The system of claim 16, further comprising the wire member, wherein the wire member is a k-wire.

25. The system of claim 1, wherein the at least one hole comprises a wider hole and a narrower hole, the system further comprising one or more drills configured to drill the wider hole along the guide axis in a near cortex of a bone and drill the narrower hole along the guide axis in a far cortex of a bone, the cannula comprising a tail portion having a diameter corresponding to the wider hole and a front portion having a diameter corresponding to the narrower hole.

26. The system of claim 25, wherein the one or more drills include a first drill that drills the wider hole and a second drill that drills the narrower hole.

27. The system of claim 26, wherein the first drill includes a drilling portion to drill the wider hole, and further comprising a stop member configured to contact the instrument to prevent the drilling portion from advancing axially to a far cortex of a bone.

28. The system of claim 26, wherein the second drill includes a drilling portion to drill the narrower hole and a reaming portion to enlarge a region of the medullary canal adjacent to the narrower hole.

29. The system of claim 1, wherein the cannula has an external thread configuration to engage bone at an aperture in the at least one aperture.

30. The system of claim 1, wherein the cannula is configured to be advanced along the guide axis through a guide portion of the instrument and into a bone.

31. The system of claim 1, wherein the cannula includes a body having a shoulder, and further comprising a post projecting distally from the shoulder.

32. The system of claim 31, wherein the shoulder has a rounded profile resulting from a proximal-to-distal reduction in diameter of a leading end region of the body.

33. The system of claim 31, wherein the column is cylindrical.

34. The system of claim 1, wherein the cannula defines a long axis and further defines a transverse aperture through which the spike is configured to extend, and wherein the transverse aperture is elongated parallel to the long axis of the cannula.

35. The system of claim 34, wherein the transverse aperture has a slanted entrance.

36. The system of claim 1, wherein the locking member comprises a set screw having external threads complementary to internal threads of the sleeve.

37. The system of claim 36, wherein the cannula defines a transverse aperture and an axial opening that intersect one another, wherein the nail is configured to extend through the transverse aperture, and wherein the set screw is configured to be advanced into the cannula along the axial opening.

38. The system of claim 36, wherein the set screw is configured to be disposed in threaded engagement with the sleeve and advanced against the nail until the nail is cooperatively clamped by the sleeve and the set screw.

39. The system of claim 38, wherein at least one of the sleeve and the set screw has a protruding portion configured to contact and deform a surface region of the nail when the set screw is tightened against the nail.

40. The system of claim 39, wherein the at least one of the sleeve and the set screw having the protruding portion comprises a harder material than the nail.

41. The system of claim 39, wherein the set screw has a protruding portion configured to contact and deform a surface area of the nail, and wherein the protruding portion of the set screw protrudes distally from an axis of the set screw and forms a distal edge of the set screw.

42. The system of claim 41, wherein the distal edge is annular.

43. The system of claim 39, wherein the sleeve has a protruding portion configured to contact and deform a surface region of the staple, and wherein the protruding portion of the sleeve is positioned in a transverse aperture of the sleeve.

44. The system of claim 36, wherein the external threads of the set screw are configured to deform the sleeve to create a distal extension of the internal threads in the sleeve.

45. The system of claim 44, wherein the set screw comprises a harder material than the cannula.

46. The system of claim 45, wherein each of the bushing and the set screw comprises a metal alloy, and wherein the metal alloy of the set screw is harder than the metal alloy of the bushing.

47. The system of claim 46, wherein the set screw comprises a cobalt chromium alloy, and wherein the sleeve comprises a titanium alloy.

48. The system of claim 44, wherein the external thread of the set screw has a greater axial length than the internal thread of the sleeve prior to creating the distal extension of the internal thread.

49. The system of claim 1, wherein a forward region of the staple is configured to extend through a transverse aperture of the cannula, wherein the forward region of the staple has an elongate main portion and a distal tip, and wherein the distal tip is radially offset from the main portion.

50. The system of claim 49, wherein a central axis of the distal tip is substantially parallel to and offset from a longitudinal axis of the main portion.

51. The system of claim 49, wherein the main portion has a uniform diameter, and wherein the tip is tapered.

52. The system of claim 49, wherein a tail region of the staple is curved in a staple plane, and wherein the tip is radially offset from the main portion in the staple plane.

53. The system of claim 49, wherein the terminal end is less than half of the length of the main portion.

54. A system for bone fixation, the system comprising:

a cannula configured for placement across a medullary canal of a long bone, the cannula including a body having an external threaded configuration and defining a transverse aperture, and a post projecting from a shoulder provided by a leading end region of the body;

a nail configured to be placed along a medullary canal of a bone such that the nail extends through the transverse aperture of the cannula; and

a set screw configured to be advanced into the sleeve and against the nail such that the set screw and the sleeve cooperatively clamp the nail.