阅读说明：本技术 一种髌骨下极骨折内固定装置及螺钉固定方法 (Internal fixing device for patellar lower-pole fracture and screw fixing method ) 是由 刘曦 马会旭 张晓宇 杨华 田力 张琴 于 2020-05-20 设计创作，主要内容包括：本发明公开了一种髌骨下极骨折内固定装置及螺钉固定方法,包括弧形固定板,所述弧形固定板与髌骨贴合；有效包绕固定髌骨下极粉碎骨折块并限制其移位,同时将髌骨体与髌骨下极骨折块紧密接触并加压固定；螺钉和钢板间的锁定可有效提高螺钉的抗拔出能力,进一步加强骨折块及内固定装置的稳定性,降低内固定的松动及失效；另外,还可以起到缝合线减张保护,将缝线减张受力与髌韧带牵拉骨折块受力保持动态平衡,有效避免早期屈膝活动时骨折块移位或内固定失效,同时可减轻对髌腱的损伤干扰,兼顾张力带原则,更加符合力学原理,为治疗髌骨下极骨折尤其粉碎性髌骨下极骨折提供更为有效的内固定选择。(The invention discloses an internal fixing device for patellar lower fracture and a screw fixing method, comprising an arc-shaped fixing plate, wherein the arc-shaped fixing plate is attached to a patella; effectively wrapping and fixing the patella lower pole crushing fracture block and limiting the displacement of the fracture block, and simultaneously closely contacting and pressurizing and fixing the patella body and the patella lower pole fracture block; the locking between the screw and the steel plate can effectively improve the anti-pulling-out capacity of the screw, further strengthen the stability of the fracture block and the internal fixing device, and reduce the looseness and the failure of the internal fixation; in addition, the tension-reducing device can play a role in tension-reducing protection of a suture line, keeps dynamic balance between tension-reducing stress of the suture line and stress of a patellar ligament traction fracture block, effectively avoids displacement or internal fixation failure of the fracture block during early knee bending activities, can reduce damage interference on a patellar tendon, considers the principle of a tension band, better accords with the mechanical principle, and provides more effective internal fixation selection for treating patellar lower-pole fracture, particularly comminuted patellar lower-pole fracture.)

1. An internal fixing device for patellar lower fracture and a screw fixing method are characterized in that: the patella fixing device comprises an arc-shaped fixing plate, wherein the arc-shaped fixing plate is attached to a patella; the middle part of the arc-shaped fixing plate in the upward extending direction is connected with a main fixing part, two sides symmetrical to the main fixing part are respectively connected with auxiliary fixing parts, fixing holes are formed in the tail ends of the main fixing part and the auxiliary fixing parts, a fixing bolt is connected in each fixing hole in a threaded manner, and the tail end of each auxiliary fixing part is inclined and turned upwards so that the axial lead of the fixing hole in each auxiliary fixing part is inclined upwards and drawn inwards; the middle part of the direction extending downwards along the arc-shaped fixing plate is connected with a main fixing claw, the two symmetrical sides of the main fixing claw are respectively connected with an auxiliary fixing claw, and the main fixing claw and the auxiliary fixing claws are bent at an angle inwards to form a structure for embracing the patella.

2. The internal fixation device and the screw fixation method for patellar lower pole fracture according to claim 1, wherein: and internal threads are processed in the fixing holes.

3. The internal fixation device and the screw fixation method for patellar lower pole fracture according to claim 1, wherein: the length of the main fixing claw body is longer than that of the auxiliary fixing claw.

4. The internal fixation device and the screw fixation method for patellar lower pole fracture according to claim 1, wherein: the whole material of the fixing device is medical alloy material.

5. The internal fixation device and the screw fixation method for patellar lower pole fracture according to claim 1, wherein: the fixing bolt comprises a nail head part and a rod part; the nail head is provided with a thread passing hole along the diameter direction, threads are machined on the periphery of the nail head below the thread passing hole, a containing groove is machined on the top surface of the nail head at the upper part of the thread passing hole along the axial direction of the thread passing hole, the intersecting surface of the containing groove and the thread passing hole is a smooth curved surface, and the rod part is a threaded rod with a self-tapping end at the top end.

Technical Field

The invention relates to the technical field of medical instruments, in particular to a patella lower pole fracture internal fixation device and a screw fixation method.

Background

The inferior pole of the patella refers to the part of the patella 1/4 without articular cartilage coverage, is about 1.5cm long, and does not participate in the patellofemoral joint. The patella lower pole is hidden in a patellar ligament (patellar tendon) and a patellar lower fat pad, is connected with the patellar tendon, and conducts the muscle force of the quadriceps femoris muscle to the tibial tuberosity, thereby completing the knee stretching movement. Very cancellous bone under the patella, the fracture is mostly comminuted fracture, and the light person of crushing degree can have several big fracture pieces, and serious person's fracture piece is tiny numerous, still adheres to through the patellar tendon and gathers together, and very patellar tendon dead point under the patella, stress relatively concentrates, and the selection direct influence knee joint function of fracture characteristic and operation mode resumes, and its treatment principle mainly is: the knee stretching device is recovered in continuity, the length of the patella is kept as much as possible, and the knee stretching device is effectively and reliably fixed in the interior to achieve early functional exercise. The operation method adopted at present mainly comprises fracture incision reduction internal fixation, and the internal fixation material mainly comprises devices such as a Kirschner wire tension band, a wire steel cable, a patella claw, a basket net steel plate and the like.

However, the above structure has major problems:

1. the kneecap is extremely for smashing the fracture down, and the fracture piece is less, more, can't effectively be fixed through the whole effective of ke shi needle, and the fracture piece falls into the knee joint chamber and becomes the trip body probably appears, seriously influences knee joint function. The broken bone pieces are removed and crushed, which can cause patella defect, short length, and the dislocation of the patella and the femoral joint, and the biomechanics of the broken bone pieces are changed, thereby accelerating the process of traumatic arthritis and degenerative change of the knee joint. In addition, the inferior pole of the patella is the patellar tendon stop point, excessive broken fracture blocks are removed, the patellar tendon loses excessive attachment points, tendon-bone healing is poor, and the separation of the patellar tendon and the patella is easy to occur due to early movement after operation.

2. The inferior pole comminuted fracture of patella, the fragment is many, fracture block is small, the patella claw and basket net steel plate often can't reach effective, reliable, firm internal fixation, carry on the rehabilitation function exercise too early, may appear internal fixation is loose, shifted and the re-shift of fracture block, need to operate again when serious; if the knee joint is braked for a long time and then the function is exercised, the function stiffness of the knee joint and the venous thrombosis of the lower limb are easy to appear, and the rehabilitation function exercise of the patient after the operation is seriously influenced.

3. After the fracture is smashed to utmost point under the patella, the kneecap tendon attachment stability is poor, and ke shi needle and screw can't effectively reset fixedly, and simple steel wire or steel cable cerclage are fixed can't restrict the separation of the in-process fracture piece that bends knee and shift, and the steel wire or steel cable is walked around patella and kneecap tendon or shin bone tubercle do the protection of reducing tension and can help early function exercise, but steel wire or steel cable exist and disturb obvious to the damage of kneecap tendon.

4. In the process of flexion and extension of the knee joint, the directions of the long axis of the patella and the long axis of the quadriceps femoris are dynamically changed, and the shearing force of the lower pole of the patella is increased when the knee joint is bent, so that internal fixation is easy to loosen or break.

Disclosure of Invention

Aiming at the defects in the prior art, the invention provides a patella lower pole fracture internal fixation device and a screw fixation method, so that the stability is improved, and the looseness of the fixation device is avoided.

The invention provides a patella lower fracture internal fixation device and a screw fixation method, comprising an arc-shaped fixing plate, wherein the arc-shaped fixing plate is attached to a patella; the middle part of the arc-shaped fixing plate in the upward extending direction is connected with a main fixing part, two sides symmetrical to the main fixing part are respectively connected with auxiliary fixing parts, fixing holes are formed in the tail ends of the main fixing part and the auxiliary fixing parts, a fixing bolt is connected into each fixing hole, and the tail end of each auxiliary fixing part is inclined and turned upwards so that the axial lead of each fixing hole in each auxiliary fixing part is inclined upwards and drawn inwards; the middle part of the direction extending downwards along the arc-shaped fixing plate is connected with a main fixing claw, the two symmetrical sides of the main fixing claw are respectively connected with an auxiliary fixing claw, and the main fixing claw and the auxiliary fixing claws are bent at an angle inwards to form a structure for embracing the patella.

Preferably, the fixing holes are all internally threaded.

Preferably, the main fixing jaw has a longer body length than the auxiliary fixing jaw.

Preferably, the whole material of the fixing device is a medical alloy material.

Preferably, the fixing bolt comprises a head portion and a shaft portion; the nail head is provided with a thread passing hole along the diameter direction, threads are machined on the periphery of the nail head below the thread passing hole, a containing groove is machined on the top surface of the nail head at the upper part of the thread passing hole along the axial direction of the thread passing hole, the intersecting surface of the containing groove and the thread passing hole is a smooth curved surface, and the rod part is a threaded rod with a self-tapping end at the top end.

The invention has the beneficial effects that: the invention can effectively wrap and fix the patella lower pole comminuted fracture block and limit the displacement thereof, and meanwhile, the patella body and the patella lower pole fracture block are tightly contacted and pressurized and fixed; the locking between the screw and the steel plate can effectively improve the anti-pulling-out capacity of the screw, further strengthen the stability of the fracture block and the internal fixing device, and reduce the looseness and the failure of the internal fixation; in addition, the tension-reducing protection of a suture line can be realized, the tension-reducing stress of the suture line and the stress of a patellar ligament traction fracture block are kept in dynamic balance, the fracture block is effectively prevented from shifting or failing to be fixed internally during early knee bending activities, the damage interference on the patellar tendon can be reduced, the tension belt principle is considered, the mechanical principle is better met, and more effective internal fixation selection is provided for treating patellar lower-pole fracture, particularly comminuted patellar lower-pole fracture; finally, the device only operates on the patella lower pole and the patella body part, and does not operate on the patella upper pole, so that the interference on the patella upper pole, the patella upper capsule and the quadriceps femoris muscle can be effectively reduced, the pain degree during postoperative flexion and extension activities is reduced, and the postoperative rapid rehabilitation is promoted.

Drawings

In order to more clearly illustrate the detailed description of the invention or the technical solutions in the prior art, the drawings that are needed in the detailed description of the invention or the prior art will be briefly described below. Throughout the drawings, like elements or portions are generally identified by like reference numerals. In the drawings, elements or portions are not necessarily drawn to scale.

Fig. 1 is an overall structural view of a fixing device according to an embodiment of the present invention;

FIG. 2 is a front view of the present invention with a fixing bolt installed;

FIG. 3 is a view of a fixing bolt structure according to an embodiment of the present invention;

fig. 4 is a schematic view showing the effect of the present invention on fixing on the patella.

In the drawing, an arc-shaped fixing plate 1, a main fixing part 2, an auxiliary fixing part 3, a fixing hole 4, a main fixing claw 5, an auxiliary fixing claw 6, a fixing bolt 7, a nail head part 71, a sinking groove 72, a wire passing hole 73 and a receiving groove 74.

Detailed Description

Embodiments of the present invention will be described in detail below with reference to the accompanying drawings. The following examples are only for illustrating the technical solutions of the present invention more clearly, and therefore are only examples, and the protection scope of the present invention is not limited thereby.

It is to be noted that, unless otherwise specified, technical or scientific terms used herein shall have the ordinary meaning as understood by those skilled in the art to which the invention pertains.

As shown in fig. 1, an internal fixation device for patellar lower pole fracture and a screw fixation method thereof comprise an arc-shaped fixing plate 1, wherein the arc-shaped fixing plate 1 is attached to the patella; the middle part of the upward extending direction of the arc-shaped fixing plate 1 is connected with a main fixing part 2, two sides symmetrical to the main fixing part 2 are respectively connected with auxiliary fixing parts 3, fixing holes 4 are respectively processed at the tail ends of the main fixing part 2 and the auxiliary fixing parts 3, a fixing bolt 7 is arranged in each fixing hole 4, as shown in fig. 2, the tail ends of the auxiliary fixing parts 3 are obliquely and upwards turned for a certain angle, and the angle is set so that the axial lead is upwards and is close to the central line of the whole body when the fixing bolt 7 is subsequently used, the fixing stability of the fixing is improved, and the axial lead of the fixing holes 4 on the auxiliary fixing parts 3 is obliquely upwards and inwards close; be connected with main stationary dog 5 along the middle part of the direction of 1 downwardly extending of arc fixed plate, with be connected with supplementary stationary dog 6 on the both sides of main stationary dog 5 symmetry respectively, main stationary dog 5 and supplementary stationary dog 6 become the structure that the angular bend inwards formed the embracing patella, the radian of arc fixed plate 1 and the radian laminating of patella for laminate with the patella when using, the platelike structure of freely stretching out of the embodiment of main fixed part 2 and supplementary fixed part 3 among the foretell, all processed fixed orifices 4 at its end, and it is gapped to process between main fixed part 2 and the supplementary fixed part 3, makes main fixed part 2 and supplementary fixed part 3 can cover whole patella.

In the above embodiment, there are two auxiliary fixing parts 3, and the two auxiliary fixing parts 3 are respectively symmetrically disposed on two sides of the main fixing part 2 and completely cover the whole patella; and the aforesaid supplementary fixed part 3 overturn upwards make supplementary fixed part 3 terminal fixed orifices 4 city certain angle for when installing the bolt through fixed orifices 4, firm degree is higher, and is more stable.

Preferably, all process the internal thread in the fixed orifices 4, need penetrate fixing bolt 7 through fixed orifices 4 and fix when in actual use, and process threaded on fixing bolt 7 for fixing bolt 7 makes it fixed with the internal thread cooperation in the fixed orifices 4, has improved fixed stability.

Preferably, the length of the main fixing claw 5 is longer than that of the auxiliary fixing claw 6, so that the fixing claws can clamp the patella.

Preferably, the whole material of the fixing device is medical alloy material, and the main fixing claw 5 and the auxiliary fixing claw 6 can finely adjust the bending angle of the fixing claws by external force when in use, so that the fixing claws are more fit to the patella and provide better holding force.

In one embodiment of the fixing bolt 7 shown in fig. 3, the fixing bolt 7 comprises a head portion 71 and a shaft portion; a thread passing hole 73 is processed on the nail head 71 along the diameter direction, threads are processed on the periphery of the nail head 71 below the thread passing hole 73, a containing groove 74 is processed on the top surface of the nail head 71 above the thread passing hole 73 along the axial direction of the thread passing hole 73, the intersecting surface of the containing groove 74 and the thread passing hole 73 is a smooth curved surface, the rod part is a threaded rod with a self-tapping end at the top end, a sinking groove 72 convenient for applying torsion is further processed on the top surface of the nail head 71, when in use, the fixing bolt 7 is fixed by rotating a tool such as a screwdriver, and the intersecting surface is a smooth curved surface, namely, the intersecting part of the end surface of the thread passing hole 73 and the end surface of the containing groove 74 is processed into a curved surface, so that the thread passes through the thread passing hole and cannot be scratched, in the actual operation, the two ends of the thread are wound to realize the closed fixation of the two ends of the thread, and the containing groove 74 can be used for placing a wound, the regularity of winding joint has been guaranteed, makes it can not protruding influence the involution of follow-up soft tissue again, has ensured the quality of treatment, and setting up through fixing bolt 7 of above-mentioned structure makes arc fixed plate 1 fixed more firm reliable, and on the other hand can also make the soft tissue to patella department fix through the special strip line structure of fixing bolt 7, has guaranteed the tendon fracture piece.

As shown in fig. 4, the bolt fastening method includes the steps of:

s1, the arc-shaped fixing plate 1 is arranged to be tightly attached to the patella, so that the main fixing claw 5 and the auxiliary fixing claw 6 completely grasp the patella, broken fracture blocks are encircled and gathered by the main fixing claw 5 and the auxiliary fixing claw 6, and the whole plate body is fixed on the main body of the patella by the main fixing part 2 and the auxiliary fixing part 3 on the arc-shaped fixing plate 1;

s2, screwing the fixing bolt 7 into the fixing hole 4, and completely fixing the fixing device on the patella main body through the threaded matching of the fixing bolt 7 and the fixing hole 4;

s2, after arc fixed plate 1 is fixed in the cooperation, connect through the tendon stylolite between fixing bolt 7, further press patellar tendon and tendon fracture piece admittedly through fixing bolt 7, after the stylolite end winding and make the line closed, bury the joint department of stylolite end and accomodate the groove 74 in, it can not be protruding to have guaranteed line end joint department, and the fixed advantage of giving full play to the tension area is taken into account further in the fixed of stylolite is fixed, can effectively reach the firm stable fixed of fracture, avoid the not hard up of internal fixation, the fracture.

Finally, it should be noted that: the above embodiments are only used to illustrate the technical solution of the present invention, and not to limit the same; while the invention has been described in detail and with reference to the foregoing embodiments, it will be understood by those skilled in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some or all of the technical features may be equivalently replaced; such modifications and substitutions do not depart from the spirit and scope of the present invention, and they should be construed as being included in the following claims and description.