阅读说明：本技术 肱骨外固定器 (Humerus external fixator ) 是由 胡屹峰 王志娟 张大森 阎景铁 陈宏坤 许桂东 陈壮壮 于 2019-11-27 设计创作，主要内容包括：一种肱骨外固定器,其中包括：上护臂和下护臂,上护臂和下护臂中部带有像外凸的凹槽,上护臂和下护臂均开有多个贯穿孔,下护臂上的贯穿孔带有内螺纹,上护臂和下护臂的贯穿孔内安装有紧固螺栓和螺杆,紧固螺栓和螺杆的外螺纹与下护臂上的内螺纹相对应。本发明的优点是：本发明可以在术中有效且牢靠的固定肱骨骨折近端,两人甚至一人即可顺利完成手术；且术中仅需要调节C形臂的位置进行透视即可,可节约手术时间。在小儿外科医师匮乏的今天,该固定器可有效的节省人力,并减少术中透视对人体的危害。(An external humeral fixator comprising: the upper and lower armguards have concave grooves with convex middle parts, the upper and lower armguards have a plurality of through holes, the through holes on the lower armguard have internal threads, the through holes on the upper and lower armguards have fastening bolts and screws, and the external threads of the fastening bolts and screws correspond to the internal threads on the lower armguard. The invention has the advantages that: the invention can effectively and firmly fix the proximal end of the humerus fracture in the operation, and two persons or even one person can smoothly complete the operation; and the position of the C-shaped arm is only required to be adjusted for fluoroscopy during the operation, so that the operation time can be saved. In the present day that the pediatric surgeons are deficient, the fixator can effectively save labor and reduce the harm of perspective to human bodies in the operation.)

1. An external humeral fixator comprising: go up armguard (1) and armguard (2) down, its characterized in that: the middle parts of the upper protective arm (1) and the lower protective arm (2) are provided with convex grooves, a plurality of through holes are formed in the upper protective arm (1) and the lower protective arm (2), the through holes in the lower protective arm (2) are provided with internal threads, fastening bolts (3) and screw rods (5) are installed in the through holes in the upper protective arm (1) and the lower protective arm (2), and external threads of the fastening bolts (3) and the screw rods (5) correspond to the internal threads in the lower protective arm (2).

2. The external humeral fixator according to claim 1, wherein: the number of the through holes in the upper guard arm (1) and the lower guard arm (2) is 4.

3. The external humeral fixator according to claim 1 or 2, wherein: the groove is internally provided with a protection pad.

4. The external humeral fixator of claim 3, wherein: the distance between the arc vertex of the groove and the circle center is 1.5 cm.

5. The external humeral fixator of claim 2, wherein: the diameter of the through holes at the two ends is 1.5 cm.

6. The external humeral fixator of claim 2, wherein: the diameter of the through hole at the inner sides of the two ends is 1 cm.

7. The external humeral fixator of claim 2, wherein: the distance between the through holes at the two ends and the through holes at the inner sides of the two ends is 3 cm.

8. The external humeral fixator of claim 5, 6, or 7, wherein: the arc length of the groove is 6 cm.

Technical Field

The invention relates to an orthopedic medical instrument, in particular to an external humerus fixator.

Background

Supracondylar fractures of the humerus are the second most common fracture in children, accounting for nearly 60% of all pediatric elbow fractures. The supracondylar portion of the humerus refers to the junction between the cancellous bone and the cortical bone, which is 2 cm above the inner and outer condyles of the lower humerus. The front and the back of the position are flat and thin, and the position is weak and easy to fracture. Supracondylar fractures of the humerus are one of the most common fracture types of children, the incidence rate is about 16.6%, and the supracondylar fractures of the humerus are particularly common in children under the age of 7-8 and are also the most common elbow fractures. The ulnar varus and valgus deformity is postoperative late complication easy to occur on the supracondylar fracture of humerus, and the treatment is improper, so that the deformity can be caused for the whole life.

The extension type of the supracondylar fracture of the humerus of the child accounts for about 95 percent, the flexion type accounts for about 5 percent, the common reduction modes comprise incision reduction and closed reduction, the common fixing modes comprise simple plaster or splint fixation, the internal fixation of a kirschner wire combined with plaster auxiliary fixation and the like,

the closed reduction kirschner wire internal fixation has the characteristics of small wound and good reduction effect. The complications of closed reduction are less (such as infection of the needle channel of the kirschner wire, serious loss of function and the like); research shows that the operation time of the closed reduction is shorter; the closed reduction avoids the formation of scars so as to obtain better joint function, and the open reduction hospitalization time is relatively long; some studies suggest that open reduction is more likely to cause joint stiffness.

According to the wilkins modified Gartland classification, type IIb and III fractures of humeral class fractures are unstable, and closed reduction and percutaneous pinning by surgical treatment are the gold criteria for treating the disease. The technology was first developed in 1948.

Gartland type iii fractures are difficult to obtain and maintain stable anatomic reduction, which is the key to achieving therapeutic goals, and the final appearance and functional outcomes are closely related to scar tissue formation, blood transport destruction around the fracture, developmental imbalance, neurovascular injury, functional exercise, and other factors. The fixation of the kirschner wire in the maintaining reset has more advantages than the fixation of a splint and plaster.

The operation mode of the humerus on class for fluoroscopy descending closed reduction of fracture and percutaneous kirschner wire fixation has higher requirements, three persons are needed in the standard operation mode, two persons respectively pull the upper arm and the forearm, one person is responsible for reduction of fracture and percutaneous kirschner wire fixation, and if the fracture reduction is difficult, the operation mode is a strict test for the physical strength of an operator and an assistant.

Disclosure of Invention

The invention aims to provide an external humeral fixator which can successfully complete supracondylar fracture surgery of humerus by two persons or even one person.

In order to achieve the purpose, the technical scheme adopted by the invention is as follows:

an external humeral fixator comprising: go up armguard and armguard down, its characteristics lie in: the middle parts of the upper and lower guard arms are provided with convex grooves, the upper and lower guard arms are provided with a plurality of through holes, the through holes on the lower guard arm are provided with internal threads, the through holes of the upper and lower guard arms are internally provided with fastening bolts and screw rods, and the external threads of the fastening bolts and the screw rods correspond to the internal threads on the lower guard arm.

The external humeral fixator of claim, wherein: the through holes on the upper and lower guard arms are 4.

The external humeral fixator of claim, wherein: the groove is internally provided with a protection pad.

The external humeral fixator of claim, wherein: the distance between the arc vertex of the groove and the circle center is 1.5 cm.

The external humeral fixator of claim, wherein: the diameter of the through holes at the two ends is 1.5 cm.

The external humeral fixator of claim, wherein: the diameter of the through hole at the inner sides of the two ends is 1 cm.

The external humeral fixator of claim, wherein: the distance between the through holes at the two ends and the through holes at the inner sides of the two ends is 3 cm.

The external humeral fixator of claim, wherein: the arc length of the groove is 6 cm.

The invention has the advantages that: when the device is used, the lower end of the screw is fixed in the operating table sliding block for fixing the anesthesia frame, then the fastening bolt and the upper protection arm are dismounted, the arm of a patient child is placed in the groove of the lower protection arm, then the upper protection arm is covered, then the upper protection arm and the arm of the patient child are fixed through the fastening bolt, after the patient is anesthetized in the whole body, the patient child lies on the back on the operating table, and the humerus of the patient child is fixed firmly by the fixator; the conventional disinfection is used for laying a sheet, the C-shaped arm X-ray fluoroscopy confirms the fracture displacement condition, an operator holds the forearm of the affected limb with hands and interrupts the forearm, the forearm and the fixator are mutually resisted for traction, and the operator rotates the forearm in the opposite direction according to the rotation condition of the far end of the fracture after traction. Rotating the former distally to rotate the forearm of the affected arm backward, and rotating the latter distally to rotate the forearm of the affected arm forward. The elbow extending position is fully drawn, and the rotation displacement and the overlapping displacement are corrected. The surgeon continues traction with one hand, presses the medial epicondyle of the humerus with the thumb of the other hand to push the distal end of the fracture to the radial side, and pulls the proximal end of the fracture to the ulnar side with the remaining four fingers. The radial deviation type reduction direction is opposite to the radial deviation type reduction direction. The elbow joint of the affected limb is bent to 120 degrees by a hand maintaining traction while pressing a palm, the reset state is maintained, after the C-shaped arm perspective positive side position is reset satisfactorily, the C-shaped arm penetrates the opposite side cortical bone through a fracture line by using one Kirschner wire with the diameter of 1.5 mm before the external humeral condyle, the insertion angle is that the coronal plane and the longitudinal axis of the humerus are about 40-50 degrees, the sagittal plane is about 10 degrees backwards, then the elbow joint part is straightened to touch the internal upper humeral condyle and the ulnar sulcus, the ulnar sulcus is shielded by using one finger to protect the ulnar nerve, and the internal humeral condyle penetrates the opposite side cortical bone through the fracture line by using 1 Kirschner wire with the diameter of 1.5 mm. When the Kirschner wire is inserted into the bone of the medial humeral condyle through the skin, the patient observes whether the little finger of the affected limb ring moves, and if the little finger of the affected limb ring moves, the needle insertion point is changed. After the C-shaped arm fluoroscopy confirms that the fracture reduction and the Kirschner wire position are satisfied, the needle tail of the Kirschner wire is bent and left outside the skin by about 0.5 cm. The affected finger was observed to have normal blood circulation and radial artery pulsation.

Post-operative treatment

The patient's elbow was fixed in 60 ° flexion-80 ° neutral position using a cast. After the X-ray film is rechecked 4-6 weeks after the operation of the two groups of children patients, the plaster is removed and the Kirschner wire is pulled out, so as to guide the children patients to do functional exercise of the walking elbow joint.

The external humerus fixator can effectively and firmly fix the proximal humerus fracture in the operation, and two persons or even one person can smoothly complete the operation; and the position of the C-shaped arm is only required to be adjusted for fluoroscopy during the operation, so that the operation time can be saved. In the present day that the pediatric surgeons are deficient, the fixator can effectively save labor and reduce the harm of perspective to human bodies in the operation.

Drawings

FIG. 1 is a schematic view of the structure of the present invention.

In the attached drawings

1. An upper guard arm; 2. a lower guard arm; 3. fastening a bolt; 4. fixing grooves; 5. a screw.

Detailed Description

The invention is further described with reference to the following detailed description of embodiments in conjunction with the accompanying drawings:

an external humerus fixator is shown in fig. 1, and includes: go up armguard 1 and armguard 2 down, go up armguard 1 and 2 middle parts of armguard have like the recess of evagination down, go up armguard 1 and 2 all division of armguard have a plurality of through holes down, the through hole on the armguard 2 down has the internal thread, goes up armguard 1 and installs fastening bolt 3 and screw rod 5 in the through hole of armguard 2 down, and the external screw thread of fastening bolt 3 and screw rod 5 corresponds with the internal thread on the armguard 2 down.

In the present embodiment, the number of the through holes on the upper guard arm 1 and the lower guard arm 2 is 4.

In this embodiment, the groove is provided with a protection pad.

In this embodiment, the arc apex of the groove is 1.5 cm from the center of the circle.

The diameter of the through-hole at both ends is 1.5 cm in this example.

In this embodiment, the diameter of the through hole inside the two ends is 1 cm.

In this embodiment, the distance between the through holes at the two ends and the through holes at the inner sides of the two ends is 3 cm.

The arc length of the groove is 6 cm in this embodiment.

The research method comprises the following steps:

the humerus external fixator is designed and manufactured, is used in the closed reduction kirschner wire fixation of supracondylar fracture of humerus, and gradually improves the molding according to the use experience. After the humerus fixator is improved and determined to be shaped, the humerus fixator is used for assisting the fixation of the closed reduction kirschner wire of the supracondylar fracture of the humerus and the infant who is not used for operation, and the operation time, the operation participants, the bleeding amount, the fracture healing time, the curative effect evaluation and the like are compared, analyzed and summarized in random classification.

1 data and method

1.1 general data

The humeral supracondylar fracture infant diagnosed in the recent hospital is collected as a research object, and the following conditions are met: (1) the age is 2-10 years old; (2) all the fractures are fresh closed fractures, and the injury time is less than 5 days; (3) the Gartland supracondylar fracture of humerus is classified into II type and III type; (4) the patients with vascular and nerve injuries after fracture or elbow joint dysfunction before operation are excluded. The treatment method can be divided into observation group and control group. The data such as age, sex, fracture type, etc. of the observation group and the control group are compared, and the difference has no statistical significance. The operation is completed by the same group of doctors, the patient has clear contact way, the data is complete, and the follow-up visit is convenient.

1.2 methods of treatment

I.2.1 Observation group

After general anesthesia, the patient lies on the operating bed, is disinfected and paved by a conventional way, and the fracture displacement condition is confirmed by C-shaped arm X-ray fluoroscopy. The assistant holds the middle part of the upper arm and the forearm of the affected limb to mutually resist traction, and the operator rotates the forearm in the opposite direction according to the rotation condition of the distal end of the fracture after traction. Rotating the former distally to rotate the forearm of the affected arm backward, and rotating the latter distally to rotate the forearm of the affected arm forward. The elbow extending position is fully drawn, and the rotation displacement and the overlapping displacement are corrected. The surgeon continues traction with one hand, presses the medial epicondyle of the humerus with the thumb of the other hand to push the distal end of the fracture to the radial side, and pulls the proximal end of the fracture to the ulnar side with the remaining four fingers. The radial deviation type reduction direction is opposite to the radial deviation type reduction direction. The elbow joint of the affected limb is bent to 120 degrees by a hand maintaining traction while pressing a palm, the reset state is maintained, after the C-shaped arm perspective positive side position is reset satisfactorily, the C-shaped arm penetrates the opposite side cortical bone through a fracture line by using one Kirschner wire with the diameter of 1.5 mm before the external humeral condyle, the insertion angle is that the coronal plane and the longitudinal axis of the humerus are about 40-50 degrees, the sagittal plane is about 10 degrees backwards, then the elbow joint part is straightened to touch the internal upper humeral condyle and the ulnar sulcus, the ulnar sulcus is shielded by using one finger to protect the ulnar nerve, and the internal humeral condyle penetrates the opposite side cortical bone through the fracture line by using 1 Kirschner wire with the diameter of 1.5 mm. When the Kirschner wire is inserted into the bone of the medial humeral condyle through the skin, the patient observes whether the little finger of the affected limb ring moves, and if the little finger of the affected limb ring moves, the needle insertion point is changed. After the C-shaped arm fluoroscopy confirms that the fracture reduction and the Kirschner wire position are satisfied, the needle tail of the Kirschner wire is bent and left outside the skin by about 0.5 cm. The affected finger was observed to have normal blood circulation and radial artery pulsation.

1.2.2 control group

After general anesthesia, the patient lies on the operating bed in a supine position, and the humerus of the patient is firmly fixed by the fixator; the conventional disinfection is used for laying a sheet, the C-shaped arm X-ray fluoroscopy confirms the fracture displacement condition, an operator holds the forearm of the affected limb with hands and interrupts the forearm, the forearm and the fixator are mutually resisted for traction, and the operator rotates the forearm in the opposite direction according to the rotation condition of the far end of the fracture after traction. Rotating the former distally to rotate the forearm of the affected arm backward, and rotating the latter distally to rotate the forearm of the affected arm forward. The elbow extending position is fully drawn, and the rotation displacement and the overlapping displacement are corrected. The surgeon continues traction with one hand, presses the medial epicondyle of the humerus with the thumb of the other hand to push the distal end of the fracture to the radial side, and pulls the proximal end of the fracture to the ulnar side with the remaining four fingers. The radial deviation type reduction direction is opposite to the radial deviation type reduction direction. The elbow joint of the affected limb is bent to 120 degrees by a hand maintaining traction while pressing a palm, the reset state is maintained, after the C-shaped arm perspective positive side position is reset satisfactorily, the C-shaped arm penetrates the opposite side cortical bone through a fracture line by using one Kirschner wire with the diameter of 1.5 mm before the external humeral condyle, the insertion angle is that the coronal plane and the longitudinal axis of the humerus are about 40-50 degrees, the sagittal plane is about 10 degrees backwards, then the elbow joint part is straightened to touch the internal upper humeral condyle and the ulnar sulcus, the ulnar sulcus is shielded by using one finger to protect the ulnar nerve, and the internal humeral condyle penetrates the opposite side cortical bone through the fracture line by using 1 Kirschner wire with the diameter of 1.5 mm. When the Kirschner wire is inserted into the bone of the medial humeral condyle through the skin, the patient observes whether the little finger of the affected limb ring moves, and if the little finger of the affected limb ring moves, the needle insertion point is changed. After the C-shaped arm fluoroscopy confirms that the fracture reduction and the Kirschner wire position are satisfied, the needle tail of the Kirschner wire is bent and left outside the skin by about 0.5 cm. The affected finger was observed to have normal blood circulation and radial artery pulsation.

1.2.3 post-operative treatment

The patient's elbow was fixed in 60 ° flexion-80 ° neutral position using a cast. After the X-ray film is rechecked 4-6 weeks after the operation of the two groups of children patients, the plaster is removed and the Kirschner wire is pulled out, so as to guide the children patients to do functional exercise of the walking elbow joint.

1.3 evaluation of therapeutic Effect

And evaluating the curative effect after 6 months of operation, and evaluating by using a Flynn elbow joint function score. And (3) excellent: the elbow joint carrying angle is reduced by degrees, and the elbow joint flexion and extension is reduced by 0-5 degrees; good: the elbow joint carrying angle is reduced by degrees, and the elbow joint flexion and extension is reduced by 6-10 degrees; can be as follows: the elbow joint carrying angle is reduced by degrees, and the elbow joint flexion and extension is reduced by degrees of 10-15 degrees: difference: the angle of the elbow joint is reduced by degrees and the degree of the elbow joint is reduced by more than 15 degrees.

1.4 Observation index

Observing and recording the bleeding amount in operation, the operation time, the fracture healing time and the occurrence conditions of postoperative ulnar nerve injury, kirschner wire loosening and displacement, infection and other complications of two groups of children patients. All cases were followed for 6 months.

The invention has the beneficial effects that: the external humerus fixator can effectively and firmly fix the proximal humerus fracture in the operation, and two or even one person can smoothly complete the operation; and the position of the C-shaped arm is only required to be adjusted for fluoroscopy during the operation, so that the operation time can be saved. In the present day that the pediatric surgeons are deficient, the fixator can effectively save labor and reduce the harm of perspective to human bodies in the operation.

The above-mentioned embodiments are merely illustrative of the preferred embodiments of the present invention, and do not limit the concept and the protection scope of the present invention, and various modifications and improvements made to the technical solution of the present invention by those skilled in the art without departing from the design concept of the present invention shall fall within the protection scope of the present invention.