An implant for fixing tomisaka part of the bone
The invention relates to medicine, namely to traumatology and orthopedics. The invention provides simple and reliable fixation tomisaka part of the bone. The implant includes a plate in which the holes for the screws. This plate has a guide entries for screws in the humeral head, holding the said screws stably at an angle to the plate. The plate has a clamping device that secures, preferably with the ability of the connector, the screw head of the humerus against displacement in the direction of the rods of these screws. 8 C.p. f-crystals, 9 Il. The invention relates to an implant for fixing tomisaka part of the humerus in the area of the humeral head with or without tubercle containing the plate, which made the screw holes, and the plate has a guide entries for screws in the humeral head, holding the said screws stably at an angle to the plate.The known implant in the form of a T-shaped plate, which in his leg has three spaced one above the other holes, and in its upper transverse part has two adjacent holes. This disc Phi who eat the most recorded both pieces of bones relative to each other. Additionally, also known L-shaped plate and the T-shaped plate for fixation of small bone fragments, intended for the treatment of fractures of the humerus.These plates for osteosynthesis of bones function as a typical anchor plate. This means that as part of the diaphysis of the shoulder, and a fragment of the head arm trapped. Therefore, the prerequisites for a stable simulation, in the sense of exercise, osteosynthesis bone suture is good resistant screws as in the fragment of the head of the bone, and sterjnevye body bones and sharedinstance bone odpiranje (landing) both of the main fragments with respect to each other. In particular, in the bones of older people used bone screws still very often do not have sufficient support that then subsequently results when conducted during treatment therapeutic gymnastic exercises, by loosening these screws. In addition, in most cases, you will have a very wide exposure of the bone in the fracture area, which can lead to the disruption of blood flow in fragments and thus to the corresponding violation in the treatment of bone fracture.This leads to the fact that often conducted conservative treatment, in which the tip is moved. However, it also leads to sharp movements in the gap of the bone fragments, which are visible due to audible bone crepitate and because of severe pain. This fact complicates therapy development movement and requires patient enough patience to tolerable pain, but from a physical therapist is a sufficiently large power of persuasion to achieve mobility of the shoulder joint. However, in many cases, significant deficiencies mobility of the shoulder joint remains.Therefore, the basis of the invention is to create such an implant of the type specified above, which would provide a simple and reliable fixation tomisaka part of the bone.The problem is solved due to the fact that the plate has a clamping device that secures, preferably with socket head screws of the humerus in relation to the displacement in the direction of Serena these screws.Use two screws for the head of the humerus provides not only a stable angular fixation of the fragments of the head and the diaphysis of the bone relative to each other, but, in addition, rotational stability is achieved, which prepyatstvuyushchee.According to one form of execution directing the entries made in the quality of the drilled holes, the cross-section corresponding to the diameter of the shank of the screws for the head of the humerus.This guide bushings are angled relative to the longitudinal axis of the diaphysis of the shoulder between the 35oand the 40oand is, preferably, a 37.5o.As the fixture plate is located between the guide entries for screws in the humeral head gap with transverse hole.The axis of the guide bushing screw head of the humerus lie in the same plane with the longitudinal axis of the diaphysis of the shoulder.Plate provided parallel to its upper and lower sides of the holes.In another form of execution, the plate has a maximum thickness lying in the range from 4 mm to 9.5 mm, preferably from 6 to 8 mm.This plate has a maximum width equal to 12 mmVarious examples of the invention are described below in more detail with reference to the drawings, in which: Fig.1 depicts a longitudinal section of the plate with a fixed shoulder bone screws, Fig.2 - multiple exploded views of the plate and the alternative possibility of a tightening screw for the head of the humerus in the landing zone of the plate, Fig.5 is another view depicting another alternative, the possibility of tightening of the screw head through the thread, Fig.6 is a view in partial section of the screw head of the humerus, Fig. 7 is a view of part of the thread of the screw head of the humerus, is performed according to Fig.6, Fig.8 is a longitudinal section of another version of the execution plates that are fastened with screws in the humerus, Fig.9 is a separate view from Fig.8, on an enlarged scale.In Fig. 1 shown with proximal humerus fracture, type III Neher. Shown in the drawing, the broken part of the humerus consists of the head 2 of the humerus and the proximal part of the diaphysis 3 shoulder. Plate 4 adjacent to the proximal humerus and its configuration adapted to the anatomical proportions of the proximal shoulder. The total length of the plate is 95 cm, its thickness in the zone of proximal part of the diaphysis of the shoulder is about 4 mm, and in the area of the head of the humerus enhanced to 9.5 mm, the Width of the plate is a maximum of 12 mmThis plate in its lower part are screwed to the proximal portion 3 of the diaphysis shoulder ordinary, in other words, a commercially available, articlename screws 5, 6, 7. Foster nests for special screws 8 and 9 of the humeral head Of 8, 9 the head of the humerus in the plate 4.In Fig. 2 shows the plate 4 with the diversity of its parts. On the lower portion 11 of the plate 4 on one line made three holes 12, 13, 14, of which the middle hole 13 made in the form of a longitudinally elongated holes. These openings are designed to receive (install) mentioned above corticalis screws 5, 6, 7. Between these holes and the plate has a narrowed neck 15, 16, which results in an even distribution of tension in the plate. Bearing surface 17 is made not flat, but concave, so the plate fits better to the surface of the humerus.Lines 18 and 19 represent the edges of openings of the narrowed necks 15 and 16, which are formed due to the concave configuration of the plate. While we are not talking about any recesses, the plate is superimposed exactly on the surface.The upper part 20 of the plate 4 has a guide bushings 21, 22 for the reception of screws 8 and 9 of the humeral head. These glands are located at an angle 23, equal to 37.5orelative to the longitudinal axis of the humerus. This angle corresponds approximately physiological angle of the humeral head. These guide bushings made in the form of prosumer for planting thickened part of the rod 25 of the screw. The depth of these inputs 21, 22 and, thereby, the thickness of the plate 4 in this zone are selected so that the length of the above-mentioned input will be just sufficient to create a reliable pillar of the screw 8, and accordingly the screw 9 in its predetermined angular position.In Fig. 2 also shows a top view of the upper portion 20 of the plate 4, which shows that between employees as inputs holes 21, 22 and the plate 4 has a gap. Transversely in relation to this gap has a hole 26, which may be screwed into the clamping screw 27.The clamping screws 8 and 9, and in particular their thickened section 25, a clamping screw 28 shown in Fig.3. The screwing of the screw 27 into the threaded holes 26 located on both sides of the gap 29 plots plates 4 are moved towards each other so that the gap 29 is narrowed. Thanks to this cross-section of the guide bushings 21, 22 is slightly deformed so that the walls of these inputs are pressed to alastname section 25 of the rod screws 8, 9. Due to this, the screws 8, 9 additional fixed under the corresponding fixed angular position, this is done in order to avoid twisting around the axis 30 of the screw and its displacement in the axial direction.Allow 8 and 9 of the humeral head in the plate 4 and the head 32 of the screw is provided with a slot (slot), and there is a tapered hole 33 and the thread 34. To the inner end of the thread 34 is adjacent to the screw 8, the inner hexagon 35, to which the screw 8 can be screwed into the head of the humerus. After screwing the screw 8 conical screw 36 can be threaded hexagon socket 37 in the thread 33 of the screw 8. Because of this provided with a slot head 32 of the screw 8 of the humeral head expands and thereby rigidly clamped in the plate 4.Another alternative execution clamping device 38 shown in Fig. 5. In this type of tightening of the screw 8 of the humeral head bordering the head 39 of the screw rod is made with an external thread 40, and serves as a bracket 41 to screw guide input plate 4 is made with a corresponding internal thread. The diameter of the light thread in the plate 4, at least, has such a size as the diameter of the bone thread of the screw 8 at the end of it. The thread 40 of the screw head and step spongy threads on the end of the screw should be approximately equal, so that the screw 8 of the humeral head could be introduced. In addition, the thread pitch of 40 should be selected so as to ensure the braking. When screwing in the screw 8 head shoulder coast is in the plate 4.This example perform the clamping device in comparison with the other two above examples does not allow or tolerate very little iframename compression. Such a device in a functional sense, acts as a latch inside the head of the humerus.Transversely to the direction described above, the guide bushing screw head of the humerus in the plate has holes 42, 43, designed to accommodate wire cerclage or PDS-kotovych cords to resume fixing broken tubercle.The screw 8 by design to the length corresponding to the screw 9, as shown in Fig. 6. This screw comprises a head 44, the rod 45 of the screw thread 52. The rod 45 of the screw in the direction closer to the cylinder 44 is made conical so that it is in the area of the head 44 thickens. This is made on the plot thickened stem portion 46 of the rod has a diameter of 47, enlarged relative to the diameter 48 of the rest of the rod. The outer diameter 49 of the thread 52 is larger than the diameter 48 of the portion 45 of the rod. But nevertheless, it is the same size or smaller than the diameter 47 of the thickened portion 46 of the rod. The screw 8 is provided with a Central hole 50, so that it could be accurately aimed at a special montenovo is to provide for adjustment of the desired length of the screw, the length of these screws are provided in the range between 40 mm and 80 mm in 5-mm intervals. This provides the possibility of selecting the appropriate correct screw length for different fractures and various bones.The screws supplied with a bone thread. The image of this type of thread shown in Fig.7. For applications according to the invention provides not usually available for sale for the screw 6.5 mm - bone carvings, and screws with 8.5 mm - bone carvings. Such screws create a markedly elevated support efforts in the bone and therefore find application also in highly altered osteoporosis bones.It is shown in Fig.8 design of the plate essentially corresponds to the construction plate according to Fig.1. However, in the area of the receiving slots of the screw head of the humerus plate is made substantially shorter. The screws 53 and 54 do not have now more semisecret head, as shown in Fig.1, and the end of the guide rod 55, ACC. 56. In order to create the screw 53, ACC. 54 contrator in the plate 57, as shown in Fig.9, the hole 58 in the plate 57 is made blind, and decreasing the adhesion to the bone 59 at an angle of 60 approximately 15o.Due to tilting the screw 54, ACC. 53. Spongy thread 61 of the screws 53, ACC. 54 for the head of the humerus can either have such a small outer diameter that it can easily be inserted through the tapered hole 58, or "nose" and spongy thread can be so matched to each other that the screws for the head of the humerus can be easily screwed in the area of the narrowing of the openings 58.Thanks to this preferred form of execution the plate 57 may be performed at approximately 25-30% narrower than the plate 4. Its maximum width is only 7 mm In comparison with that corticalis screws 62, 63, 64 at the tail end plates 57 are approximately 6 mmDue to the nature of this design thread clamping screw 65 reduced from M5 to M4, and a hole for receiving the PDS cordovero cord, wire respectively, shifted to the upper end of the plate 57.
1. An implant for fixing tomisaka part of the humerus in the area of the head of the bone with or without tubercle containing plate (4), in which the holes (12, 13, 14) screw (5, 6, 7), and the plate has a guide entries for screws in the humeral head, holding the size (28, 31, 38), which fixes preferably with connector screws (8, 9) of the humeral head in relation to the displacement in the direction of the rods of these screws.2. The implant according to p. 1, characterized in that the plate (4) has a guide bushings (21, 22) preferably two screws (8, 9) of the humeral head.3. The implant under item 1 or 2, characterized in that the guide entries made in the quality of the drilled holes, cross-sections which correspond to the diameter (47) rod bolts (8, 9) for the head of the humerus.4. The implant according to one of paragraphs.1-3, characterized in that the guides glands are located at an angle (23) relative to the longitudinal axis of the diaphysis of the shoulder in the range of 35-40° and is preferably of 37.5°.5. The implant according to one of paragraphs.1-4, characterized in that the plate as the mounting bracket is located between the guide bushings (21, 22) for screws (8, 9) of the humeral head clearance (29) with the transverse bore (26).6. The implant according to one of paragraphs.1-5, characterized in that the axis of the guide bushing (21, 22) screw (8, 9) of the humeral head lie in the same plane with the longitudinal axis of the diaphysis of the shoulder.7. The implant according to one of paragraphs.1-6, characterized in that the plate (4) made of PP.1-7, characterized in that the plate (4) has a maximum thickness of about 6-8 mm9. The implant according to one of paragraphs.1-8, characterized in that the plate (4) has a maximum width of 12 mm.
SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.
EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.
3 cl, 3 dwg