CN213821674U - Bridge-connection dissection locking bone fracture plate for fixing comminuted fracture of humeral shaft at back and outer side - Google Patents

Bridge-connection dissection locking bone fracture plate for fixing comminuted fracture of humeral shaft at back and outer side Download PDF

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CN213821674U
CN213821674U CN202020735291.XU CN202020735291U CN213821674U CN 213821674 U CN213821674 U CN 213821674U CN 202020735291 U CN202020735291 U CN 202020735291U CN 213821674 U CN213821674 U CN 213821674U
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area
locking
screw holes
fixing
fixing area
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孙大辉
王子航
刘岩
林童
赵天昊
杨光
刘哲闻
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First Hospital Jinlin University
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First Hospital Jinlin University
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Abstract

The utility model provides a bridge-connection anatomy locking bone fracture plate for fixing the comminuted fracture of humeral shaft at the back outer side, the inner surface of the plate body of the bone fracture plate is attached to the surface of the back side of the epicondyle of humeral shaft and humerus, and the anatomy structure is matched with the inner surface; the bone fracture plate body sequentially comprises a gradually conical periosteum stripping area, a first fixing area, a radial nerve decompression area and a second fixing area from the near end to the far end, the longitudinal section of the gradually conical periosteum stripping area is a right-angled triangle, and one right-angled side of the right-angled triangle is attached to the surface of the humeral stem; the first fixing area is provided with a plurality of locking screw holes and locking pressure combination screw holes which are vertical to the surface of the attached humeral shaft; the outer surface of the radial nerve decompression area is provided with a groove, and the edge of the groove is an arc-shaped transition area; the shape of the second fixing area is matched with the anatomical structure of the external epicondyle of the distal humerus, and a plurality of locking screw holes are formed in the length direction of the second fixing area. Realizes the process of fixing the comminuted fracture of humeral shaft without damaging the blood supply at the fracture end and damaging nerves and has short operation time.

Description

Bridge-connection dissection locking bone fracture plate for fixing comminuted fracture of humeral shaft at back and outer side
Technical Field
The utility model belongs to the field of medical equipment for bone surgery, concretely relates to bridging dissection locking coaptation board of fixed humeral shaft comminuted fracture in back outside.
Background
In comminuted fracture of humeral shaft, especially fracture with fracture line extending to the distal end 1/3 of humerus, the bone fracture plate has small holding space for the distal end of fracture and is very difficult to fix. The posterior aspect of the middle part of the humeral shaft is provided with a bony radial sulcus, in which the radial nerve passes, and the distal humerus is flattened, widened, triangular and inclined forward to form an angle. Although the existing minimally invasive bone plate technology (MIPO) of humerus medial approach, anterior approach and posterior approach is adopted to treat comminuted fracture of humerus shaft, the ulnar nerve and accompanying blood vessels pass through the inner side of the humerus, the median nerve, the brachial artery and the distal coronary fossa exist on the anterior side, the radial nerve trunk passes through the outer side, and the olecranal fossa exists on the posterior side, so that the bone plate is placed on the inner side, the anterior side, the lateral side and the posterior side of the humerus, which has higher operation difficulty and operation risk, and is easy to damage important blood vessels and nerves. The anatomical structure of the posterior lateral side of the distal humerus is flat, and no important nerve or blood vessel passes through the anatomical bone plate, so that the anatomical bone plate is the best position for placing the anatomical bone plate, the proximal end of the bone plate can be fixed behind the humerus shaft, and the distal end of the bone plate is fixed on the radial lateral column behind the distal humerus.
The existing bone fracture plate is mainly used for fixing the comminuted fracture of the humeral shaft and has the following two problems: firstly, extensive soft tissue needs to be stripped, and the damage to the blood circulation of periosteum around a fracture block often causes higher fracture nonunion rate; second, the radial nerve after internal fixation is positioned on the surface of the coaptation plate, so that the radial nerve is rubbed and extruded for a long time, the radial nerve is easy to be damaged in a long term, the radial nerve is a mixed nerve, and the damage can cause 'wrist drop', the palmar-phalangeal joints of all fingers can not stretch back and forth, the supination disorder of the forearm, the hypoesthesia or disappearance of the skin sensation on the radial side of the arm and the like, and severe patients can cause the obvious reduction of the life quality of patients.
Disclosure of Invention
The utility model aims at providing a bridging dissection locking coaptation board of fixed humerus shaft comminuted fracture in back outside, structural design is reasonable, has realized that the process of fixed humerus shaft comminuted fracture bleeding is few, do not destroy fracture broken ends blood supply, do not harm nerve, operation time is short, the wound is little and the incision is pleasing to the eye.
The purpose of the utility model is realized through the following technical scheme:
a bridge-connection anatomy locking bone fracture plate for fixing comminuted fracture of humeral shaft at the back and outside comprises a bone fracture plate body, wherein the inner surface of the bone fracture plate body is attached to the back side surface of the humeral shaft and the external epicondyle of humerus, and the anatomy structure is matched with the bone fracture plate body; the bone fracture plate is characterized in that the bone fracture plate body sequentially comprises a gradually conical periosteum stripping area 1, a first fixing area 2, a radial nerve decompression area 3 and a second fixing area 4 from the near end to the far end, the longitudinal section of the gradually conical periosteum stripping area 1 is a right-angled triangle, and one right-angled side of the right-angled triangle is attached to the surface of a humeral shaft; a plurality of locking screw holes and locking and pressurizing combination screw holes which are vertical to the surface of the attached humeral shaft are formed in the length direction of the first fixing area 2; a groove 7 is formed in the outer surface of the radial nerve decompression area 3, and the edge of the groove 7 is an arc-shaped transition area; the shape of the second fixing area 4 is matched with the anatomical structure of the external epicondyle of the distal humerus, and a plurality of locking screw holes are formed in the length direction of the second fixing area.
As a more excellent technical solution of the utility model: the length of the bone plate body is 220mm, 240mm or 260 mm.
As a more excellent technical solution of the utility model: the first fixing area 2 is sequentially provided with two locking screw holes, a locking pressure combination screw hole and a locking screw hole which are vertical to the surface of the attached humeral shaft from the near end to the far end;
as a more excellent technical solution of the utility model: the second fixing area 4 is provided with five locking screw holes, the five locking screw holes are sequentially from the near end to the far end, the front three locking screw holes at the near end are vertical to the surface of the attached humeral shaft, the angular direction of the fourth locking screw hole at the near end points to the humeral tackle, and the angular direction of the locking screw hole at the farthest end points to the humeral capitulum.
As a more excellent technical solution of the utility model: the inner surface of the first fixing area 2 is provided with a decompression groove 5, and the decompression grooves 5 are arranged on adjacent edges between every two screw holes and are symmetrical in position.
As a more excellent technical solution of the utility model: the pressure reducing groove 5 is an arc-shaped groove, the length of the arc-shaped groove is 7mm, the depth of the arc-shaped groove is 1.2mm, and the width of the arc-shaped groove is 4 mm.
As a more excellent technical solution of the utility model: the hole spacing between adjacent screw holes of the first fixing area 2 is 20 mm; the second fixing area 4 locking screw hole interval be 10mm, the locking screw and the locking pressurization of first fixing area 2 and second fixing area 4 combine the screw to be 3.5 mm's locking screw and locking pressurization and combine the screw, and its supporting locking screw and cortex screw are the hexagon socket head cap tapping screw of diameter 3.5mm, tapping screw length is 12 to 60 mm.
As a more excellent technical solution of the utility model: the gradually-tapered periosteum peeling area 1 is gradually tapered with a thin proximal end and a thick distal end, the thickness of the gradually-tapered periosteum peeling area is gradually increased from 1mm to 4mm, the width of the gradually-tapered periosteum peeling area is gradually increased from 6mm to 12mm, and the length of the gradually-tapered periosteum peeling area is 20 mm. The thickness of the first fixing area 2 is 4mm, the width is 12mm, and the length is 70 mm; the second fixing area 4 has a length of 50mm, a width gradually narrowing from the proximal end to the distal end, a width of 12mm to 11mm, a thickness gradually thinning from the proximal end to the distal end, and a thickness of 4mm to 2 mm.
As a more excellent technical solution of the utility model: the radial nerve decompression area 3 at the middle section comprises a groove 7 which is positioned at the near end and used for placing a radial nerve and a telescopic blank area 6 which is positioned at the far end, the total length of the radial nerve decompression area 3 is 80mm to 120mm, wherein the length of the groove 7 is 70mm, the thickness of the lowest point of the groove 7 is 2mm, and the length of the telescopic blank area 6 is 10mm to 50 mm; the thickness of flexible blank region 6 is 4mm, and recess 7 and first fixed area 2 and the junction of flexible blank region 6 are the gentle transition, and the width of radial nerve decompression district 3 is 12 mm.
As a more excellent technical solution of the utility model: the bone fracture plate body is made of titanium alloy.
The utility model provides a locking coaptation board is dissected in bridging beneficial effect as follows:
the humerus posterior-lateral minimally invasive approach internal fixation device is used for achieving internal fixation of humerus shaft comminuted fracture, the gradually conical design enables soft tissue irritation to be minimized and meanwhile can directly play a role in periosteum stripping in an operation, the implantation mode is simple and easy to operate, after implantation, the structure of the radial nerve decompression area of the device plays an effective protection role on the radial nerve, and the strength of a steel plate is kept unchanged while the radial nerve is protected.
Structural design is reasonable, and the screw is small in quantity and only need a locking pressurization to combine the screw, realizes the minimal access operation, and to a great extent has reduced the risk of intraoperative hemorrhage volume and nerve injury, has protected the blood supply of fracture broken ends. The incision in the fixing process is smaller than other surgical incisions, and is positioned on the rear outer side of the upper arm, so that the fixing device is more attractive and hidden.
Drawings
FIG. 1 is a schematic view of a bridging anatomic locking bone plate according to the present invention;
fig. 2 is a side view of the bridging anatomic locking bone plate of the present invention.
Fig. 3 is a view of the bridge anatomical locking bone plate of the present invention in use.
Fig. 4 is a schematic diagram of the posterior side of the upper arm.
Detailed Description
The present invention will be described in further detail with reference to the following embodiments and drawings.
As shown in fig. 1 and 2, the utility model provides a bridge-connection anatomical locking bone fracture plate for fixing comminuted fracture of humeral shaft at the back and outside, which comprises a bone fracture plate body, wherein the inner surface of the bone fracture plate body is attached to the back side surface of the epicondyle of humeral shaft and humerus, and the anatomical structure is matched with the bone fracture plate body; the bone fracture plate is characterized in that the bone fracture plate body sequentially comprises a gradually conical periosteum stripping area 1, a first fixing area 2, a radial nerve decompression area 3 and a second fixing area 4 from the near end to the far end, the longitudinal section of the gradually conical periosteum stripping area 1 is a right-angled triangle, and one right-angled side of the right-angled triangle is attached to the surface of a humeral shaft; a plurality of locking screw holes and locking and pressurizing combination screw holes which are vertical to the surface of the attached humeral shaft are formed in the length direction of the first fixing area 2; a groove 7 is formed in the outer surface of the radial nerve decompression area 3, and the edge of the groove 7 is an arc-shaped transition area; the shape of the second fixing area 4 is matched with the anatomical structure of the external epicondyle of the distal humerus, and a plurality of locking screw holes are formed in the length direction of the second fixing area.
In some embodiments, the length of the bone plate body is 220mm, 240mm or 260 mm.
In some embodiments, the first fixing region 2 is sequentially provided with two locking screw holes, one locking compression combination screw hole and one locking screw hole from the proximal end to the distal end, which are perpendicular to the surface of the attached humeral shaft;
in some embodiments, the second fixing region 4 defines five locking screw holes, the five locking screw holes are sequentially from the proximal end to the distal end, the first three locking screw holes at the proximal end are perpendicular to the surface of the attached humeral shaft, the fourth locking screw hole at the proximal end is angled to point to the humeral pulley, and the distal locking screw hole is angled to point to the humeral capitulum.
In some embodiments, the inner surface of the first fixing section 2 is provided with relief grooves 5, and the relief grooves 5 are provided on adjacent edges between every two screw holes and are symmetrical in position.
In some embodiments, the pressure relief groove 5 is an arc-shaped groove having a length of 7mm, a depth of 1.2mm, and a width of 4 mm.
In some embodiments, the hole pitch between adjacent screw holes of the first fixing area 2 is 20 mm; the second fixing area 4 locking screw hole interval be 10mm, the locking screw and the locking pressurization of first fixing area 2 and second fixing area 4 combine the screw to be 3.5 mm's locking screw and locking pressurization and combine the screw, and its supporting locking screw and cortex screw are the hexagon socket head cap tapping screw of diameter 3.5mm, tapping screw length is 12 to 60 mm.
In some embodiments, the tapered periosteal detachment zone 1 is tapered with a thin proximal end and a thick distal end, and has a thickness of 1mm to 4mm, a width of 6mm to 12mm, and a length of 20 mm. The thickness of the first fixing area 2 is 4mm, the width is 12mm, and the length is 70 mm; the second fixing area 4 has a length of 50mm, a width gradually narrowing from the proximal end to the distal end, a width of 12mm to 11mm, a thickness gradually thinning from the proximal end to the distal end, and a thickness of 4mm to 2 mm.
In some embodiments, the medial radial nerve decompression zone 3 comprises a groove 7 for placing a radial nerve at the proximal end and a blank telescopic zone 6 at the distal end, the total length of the radial nerve decompression zone 3 is 80mm to 120mm, wherein the length of the groove 7 is 70mm, the thickness of the groove 7 at the lowest point is 2mm, and the length of the blank telescopic zone 6 is 10mm to 50 mm; the thickness of flexible blank region 6 is 4mm, and recess 7 and first fixed area 2 and the junction of flexible blank region 6 are the gentle transition, and the width of radial nerve decompression district 3 is 12 mm.
As shown in fig. 3 and 4, the bridging anatomic locking bone plate of the present invention has the following steps:
firstly, taking a rear outer side incision at the far end of the upper arm, wherein the length of the rear outer side incision is about 3 cm, incising the skin, the subcutaneous tissues and the deep fascia layer by layer, entering along the outer gap of the tendon of the triceps brachii, and exposing a flat bone surface at the rear of the far-end outer column of the humerus.
Then, the proximal posterior midline incision of the upper arm is taken, the length is about 3 cm, the skin, subcutaneous tissue and deep fascia are incised layer by layer, and the skin, subcutaneous tissue and deep fascia enter the gap between the long head and the lateral head of the triceps brachii, and the initial part of the radial nerve trunk is exposed and protected. Then, the fracture end is reduced under fluoroscopy.
Finally, use the utility model discloses the gradual toper periosteum stripping plate of near-end gets into from the distal end incision, cross the broken end of fracture, peel off to near-end incision department in radial nerve below, establish outer side periosteum outer passageway behind the humerus, notice that slowly male need protect radial nerve when going against the way, make the coaptation board distal end dissect attached on the flat bone surface in humerus outer column rear side, with a piece of screw temporary fixation, near-end incision department protects radial nerve under looking straight, utilize the fracture board principle that resets of dissecting, the homeopathic traction resets, make the coaptation board near-end dissect attached in the humerus rear side position between two parties, a screw in piece of lag screw is fixed. And the C-arm machine is used for verifying the good alignment of the fracture by fluoroscopy again, and then all the other locking screws are screwed in from the near end to the far end of the fracture for fixation.
The traditional method for fixing humeral shaft comminuted fracture is as follows: the anterior approach of the upper arm is specifically to perform an anterior median incision on the middle section of the upper arm, separate a muscle gap between the biceps brachii and the brachial muscle by using a longitudinal incision with the fracture end as the center, retract the biceps brachii to the inner side, and split the brachial muscle to expose the fracture end; the upper arm anterolateral approach is specifically an anterolateral incision along the middle and lower segments of the humerus, can extend to the external humeral epicondyle towards the far end, and the proximal condyle extends to the humeral stop of the deltoid muscle, so that the biceps brachii is retracted towards the inner side, the triceps brachii is retracted towards the outer side, the radial nerve is exposed and dissociated between the brachial muscle and the brachial radialis, and the broken end of the fracture is exposed by longitudinal incision between the two muscles through rubber strip traction protection; the posterior approach of the upper arm is specifically to incise the tenosynovium of the triceps brachii in the posterior midline of the upper arm, separate the long head and the lateral head of the triceps brachii, incise part of the medial head and periosteum of the triceps brachii, and expose the broken end of the fracture.
The bone fracture plate provided by the utility model adopts the back outer side minimally invasive incision 2, the back outer side bridging dissection locking bone fracture plate is inserted in the muscle gap in a retrograde manner after humeral shaft comminuted fracture, the implantation mode is simple and easy, and the structure of the bone fracture plate plays an effective protection role on the radial nerve; the bridge type anatomical bone plate has fewer screw holes than the traditional bone plate, and the strength of the bone plate is not reduced while the radial nerve is protected; and because of the characteristics of minimally invasive operation, the risk of bleeding and nerve injury in the operation is greatly reduced, the blood supply of the fracture broken end is protected, and the satisfactory clinical treatment effect and the satisfactory postoperative function recovery can be achieved.
Furthermore, the terms "first", "second", etc. are used for descriptive purposes only and are not to be construed as indicating or implying relative importance or implicitly indicating the number of technical features indicated. Thus, a feature defined as "first" or "second" may explicitly or implicitly include at least one such feature.
In the description of the present specification, the terms "proximal" and "distal" are used for limbs, and the portion close to the trunk is the proximal end, and the portion far from the trunk is the distal end. The inner surface is the side attached to the humeral shaft, and the outer surface is the side opposite to the inner surface.
In the description herein, references to the description of the term "one embodiment," "some embodiments," "an example," "a specific example," or "some examples," etc., mean that a particular feature, structure, material, or characteristic described in connection with the embodiment or example is included in at least one embodiment or example of the invention. In this specification, the schematic representations of the terms used above are not necessarily intended to refer to the same embodiment or example. Furthermore, the particular features, structures, materials, or characteristics described may be combined in any suitable manner in any one or more embodiments or examples. Furthermore, various embodiments or examples and features of different embodiments or examples described in this specification can be combined and combined by one skilled in the art without contradiction.
Although embodiments of the present invention have been shown and described, it is understood that the above embodiments are exemplary and should not be construed as limiting the present invention, and that variations, modifications, substitutions and alterations can be made to the above embodiments by those of ordinary skill in the art without departing from the scope of the present invention.
The above description of the present invention does not limit the scope of the present invention. Any other corresponding changes and modifications made according to the technical idea of the present invention should be included in the protection scope of the claims of the present invention.

Claims (10)

1. A bridge-connection anatomy locking bone fracture plate for fixing comminuted fracture of humeral shaft at the back and outside comprises a bone fracture plate body, wherein the inner surface of the bone fracture plate body is attached to the back side surface of the humeral shaft and the external epicondyle of humerus, and the anatomy structure is matched with the bone fracture plate body; the humerus fracture fixation plate is characterized in that the bone fracture plate body sequentially comprises a gradually conical periosteum stripping area (1), a first fixing area (2), a radial nerve decompression area (3) and a second fixing area (4) from the near end to the far end, the longitudinal section of the gradually conical periosteum stripping area (1) is a right triangle, and one right-angle side of the right triangle is attached to the surface of a humerus shaft; a plurality of locking screw holes and locking and pressurizing combined screw holes which are vertical to the surface of the attached humeral shaft are formed in the length direction of the first fixing area (2); a groove (7) is formed in the outer surface of the radial nerve decompression area (3), and the edge of the groove (7) is an arc-shaped transition area; the shape of the second fixing area (4) is matched with the anatomical structure of the external epicondyle of the distal humerus, and a plurality of locking screw holes are formed in the length direction of the second fixing area.
2. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the length of the bone plate body is 220mm, 240mm or 260 mm.
3. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the first fixing area (2) is sequentially provided with two locking screw holes, a locking pressure combination screw hole and a locking screw hole from the near end to the far end, wherein the two locking screw holes are vertical to the surface of the attached humeral shaft.
4. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the second fixing area (4) is provided with five locking screw holes, the five locking screw holes are sequentially from the near end to the far end, the front three locking screw holes at the near end are vertical to the surface of the humerus shaft attached, the angular direction of the fourth locking screw hole at the near end points to the humeral tackle, and the angular direction of the locking screw hole at the far end points to the humeral capitulum.
5. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the inner surface of the first fixing area (2) is provided with a decompression groove (5), and the decompression grooves (5) are arranged on adjacent edges between every two screw holes and are symmetrical in position.
6. The bridge anatomical locking plate for posterior-lateral fixation of comminuted fracture of humeral shaft according to claim 5, characterized in that the pressure-reducing grooves (5) are arc-shaped grooves having a length of 7mm, a depth of 1.2mm and a width of 4 mm.
7. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the hole pitch of the adjacent screw holes of the first fixing area (2) is 20 mm; the second fixing area (4) is provided with locking screw holes with the distance of 10mm, the locking screw holes and the locking pressurizing combining screw holes of the first fixing area (2) and the second fixing area (4) are provided with locking screw holes and locking pressurizing combining screw holes of 3.5mm, the matching locking screws and the leather screws are all hexagon socket head tapping screws with the diameter of 3.5mm, and the length of each tapping screw is 12-60 mm.
8. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the gradually-tapered periosteum peeling area (1) is gradually tapered with a thin proximal end and a thick distal end, the thickness of the gradually-tapered periosteum peeling area is gradually 1mm to 4mm, the width of the gradually-tapered periosteum peeling area is gradually 6mm to 12mm, the length of the gradually-tapered periosteum peeling area is 20mm, the thickness of the first fixing area (2) is 4mm, the width of the first fixing area is 12mm, and the length of the first fixing area is 70 mm; the second fixing area (4) is 50mm in length, gradually narrows from the proximal end to the distal end in width, narrows from 12mm to 11mm in width, gradually thins from the proximal end to the distal end in thickness, and thins from 4mm to 2mm in thickness.
9. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the radial nerve decompression area (3) comprises a groove (7) which is positioned at the near end and used for placing a radial nerve and a telescopic blank area (6) which is positioned at the far end, the total length of the radial nerve decompression area (3) is 80mm to 120mm, the length of the groove (7) is 70mm, the thickness of the lowest point of the groove (7) is 2mm, and the length of the telescopic blank area (6) is 10mm to 50 mm; the thickness of flexible blank region (6) is 4mm, and recess (7) and first fixed area (2) and the junction of flexible blank region (6) are the gentle transition, and the width of radial nerve decompression district (3) is 12 mm.
10. A bridging anatomic locking bone plate for the posterior lateral fixation of comminuted fractures of the humerus shaft of claim 1, wherein: the bone fracture plate body is made of titanium alloy.
CN202020735291.XU 2020-04-10 2020-05-07 Bridge-connection dissection locking bone fracture plate for fixing comminuted fracture of humeral shaft at back and outer side Active CN213821674U (en)

Applications Claiming Priority (2)

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CN202020521321 2020-04-10
CN2020205213217 2020-04-10

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