Patent Grant
10143503
The present invention relates to a bone plate and a bone plate system.
As a bone plate that secures portions of a broken long bone, including the femur or tibia, there is a known strip-shaped bone plate that has screw holes that are fastened to male screws provided at head portions of a plurality of screws that are fastened to the long bone (for example, see Patent Literature 1).
In the case in which the bone plate of Patent Literature 1 is used in high tibial osteotomy of knee osteoarthritis, a cut made on an inner surface of the tibia is opened; a wedge-shaped artificial bone is inserted thereinto; the bone plate is placed at an anterior inner position of the tibia so as to bridge the cut and so as to avoid soft tissue connected to the tibia, such as medial collateral ligament or the like; and the bone plate is secured to the tibia by means of screws on either side of the cut. At this time, the two portions separated by the cut are supported at three points, namely, a hinge portion positioned on an outer side of the tibia, the artificial bone positioned rearward on an inner side, and the bone plate positioned at the anterior inner side.
{PTL 1} Publication of Japanese Patent No. 5230697
With the bone plate of Patent Literature 1, because a longitudinally long portion that is secured to an oblique anterior inner surface of the tibia below the cut along the longitudinal direction of the tibia and a transverse portion that is secured to an oblique anterior inner surface of the tibia above the cut are placed along substantially the same plane, there is a case of the bone plate is bent so as to lean rearward when a vertical load is exerted to the joint in an upright state.
The present invention is a bone plate and a bone plate system with which it is possible to prevent dislodging of an artificial bone and an increase in retroversion angle of a joint surface, even if a vertical load is exerted on a joint in an upright state after surgery.
An aspect of the present invention is a bone plate including: a strip-shaped main-body portion that is secured, along a longitudinal direction of a tibia, to an oblique anterior inner surface of the tibia below a cut formed in an inner surface of the tibia; a transverse portion that is secured to an inner surface of the tibia above the cut along a direction that intersects the longitudinal direction of the tibia; and a joining portion that joins the main-body portion and the transverse portion, wherein the transverse portion and the main-body portion are provided with a plurality of screw holes that are arrayed with spaces between each other and that pass therethrough in plate-thickness directions.
In the above-described aspect, the main-body portion, the joining portion, and the transverse portion may have a continuous curved-surface shape so as to be twisted about an axis parallel to the longitudinal axis of the main-body portion.
In addition, another aspect of the present invention is a bone plate system including: any one of the above-described bone plates; and screws that have head portions including first male screws to be fastened to the screw holes of the bone plate, that have threaded portions including second male screws to be fastened to the tibia, and that secure the bone plate to the tibia.
In the above-described aspect, the screws to be fastened to the screw holes provided in the main-body portion may be fastened in an oblique lateral direction from an oblique anterior inner side of the tibia toward an oblique posterior outer side thereof, and the screws to be fastened to the screw holes provided in the transverse portion may be fastened nearly in the lateral direction from the inner surface of the tibia toward an outer surface thereof.
In addition, in the above-described aspect, when projected onto a joint surface of the tibia, the screws to be fastened to the screw holes provided in the main-body portion and the screws to be fastened to the screw holes provided in the transverse portion may intersect each other in an area that occupies 50% to 80% of the total length of the tibia from the inner surface to the joint surface.
In addition, in the above-described aspect, the screws may be hollow screws having through-holes through which guide pins can pass.
Because the main-body portion and the transverse portion are placed in a twisted manner, the fastening directions of the screws are not uniform, and thus, the securing directions of the screws tend to be mistaken even if preparation holes are provided.
In addition, the above-described aspect may be provided with a wedge-shaped artificial bone member that is inserted into the cut, wherein top and bottom surfaces of the artificial bone member that come into contact with cut surfaces of the cut may be inclined in one direction in the width direction so that the thickness of the artificial bone member gradually decreases.
By doing so, it is possible to facilitate making the top and bottom surfaces of the artificial bone member fit with the cut surfaces of the cut in the tibia.
A bone plate 1 and a bone plate system 2 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in
The bone plate 1 according to this embodiment is a long, thin strip-shaped member that is secured to an upper side surface of the tibia X after performing osteotomy in high tibial osteotomy of knee osteoarthritis, and has a subtle curved shape in accordance with the typical surface shape so that the bone plate 1 can be made to conform to the curved surface shape of a side surface of the tibia X at a position at which the shaft portion of the tibia X shifts toward an end portion thereof.
As shown in
The main-body portion 1a of the bone plate 1 is provided with a plurality of screw holes 5 with spaces therebetween in the longitudinal direction thereof. In addition, the transverse portion 1b is provided with a plurality of, for example, three, screw holes 6 with spaces therebetween in a direction that intersects the longitudinal direction of the main-body portion 1a and one screw hole 7 with spaces relative to the screw holes 5 and 6 in the aforementioned longitudinal direction.
As shown in
As shown in
Because the main-body portion 1a and the transverse portion 1b are placed at mutually twisted positions when the tapered screws 9 of the head portions 10 of the screws 3 are fastened to the screw holes 5 formed in the main-body portion 1a of the bone plate 1 and the screw holes 6 formed in the transverse portion 1b thereof, as shown in
As shown in
The operation of the thus-configured bone plate 1 and bone plate system 2 according to this embodiment will be described below.
In order to perform high tibial osteotomy of knee osteoarthritis by using the bone plate system 2 according to this embodiment, a cut is formed outward from an inner surface of the tibia X in a direction inclined with respect to the longitudinal axis of the tibia X, and the cut surfaces Y are separated by using predetermined equipment. Then, as shown in
At this time, the preparation holes are formed along the axial directions of the individual screw holes 5, 6, and 7. Then, the male threaded portions 8a of the screws 3 are fastened to the preparation holes after being made to pass through the individual screw holes 5, 6, and 7, and, finally, the tapered screws 9 provided in the head portions 10 of the screws 3 are fastened to the screw holes 5, 6, and 7.
By doing so, the bone plate 1 is secured to the tibia X in a state in which the bone plate 1 is placed along the surface of the tibia X. Because the individual screw holes 5, 6, and 7 and the first male screws 9 of the head portions 10 of the screws 3 are formed of the tapered screws, securing forces are increased as fastening proceeds, and thus, it is possible to more reliably secure the bone plate 1 to the surface of the tibia X.
Then, the wedge-shaped artificial bone 4 is subsequently inserted into the cut. By doing so, a vertical load exerted in the direction that closes the cut can be supported by the tibia X above and below the opened cut at three points, namely, at a hinge portion 11 provided on the outside, the bone plate 1 secured from the oblique anterior inner surface to the inner surface, bridging the cut, and the artificial bone 4 sandwiched between the cut surfaces Y.
In this case, with the bone plate 1 according to this embodiment, the main-body portion 1a and the transverse portion 1b that are secured to the tibia X, bridging the cut, are placed at mutually twisted positions by the joining portion 1c, and thus, the main-body portion 1a is secured to the oblique anterior inner surface of the tibia X, whereas the transverse portion 1b is secured to the inner surface of the tibia X. As a result, even if a vertical load acts on the tibia X from the femur via the joint surface of a patient standing upright after surgery, it is possible to prevent the vertical load from generating a moment that bends the bone plate 1 in the plate-thickness direction.
In other words, with a conventional bone plate 12 in which the main-body portion 1a and the transverse portion 1b are placed on substantially the same plane, a vertical load generates a moment that bends the bone plate 12 in the plate-thickness direction when the vertical load acts on the joint surface. As a result, there is a problem in that, when the bone plate 12 is bent in the plate-thickness direction, the artificial bone 4 is expelled (dislodged) from the cut, which closes the opened cut, and thus, the joint surface is inclined rearward (retroverted) and the bone is healed in this state.
In contrast, with the bone plate 1 according to this embodiment, by twisting the joining portion 1c, because the vertical load acts between the bone plate 1 and the hinge portion 11 and is reliably received by the two points on both sides, a moment that bends the bone plate 1 in the plate-thickness direction is not generated, and thus, it is possible to more reliably prevent dislodging of the artificial bone 4 and retroversion of the joint surface.
In addition, although it is possible to achieve the same effects so long as the main-body portion 1a can be secured to the inner surface of the tibia X, because soft tissue, such as the medial collateral ligament or the like, is connected to the tibia X below the cut, it is not possible to secure the main-body portion 1a to the inner surface of the tibia X.
By securing the main-body portion 1a to the oblique anterior inner surface of the tibia X and by securing only the transverse portion 1b to the inner surface of the tibia X by twisting the joining portion 1c, there is an advantage in that it is possible to more reliably prevent dislodging of the artificial bone 4 and retroversion of the joint surface while avoiding the soft tissue, such as medial collateral ligament or the like.
In addition, by placing the transverse portion 1b at the inner surface of the tibia X, the screws 3 to be secured to the transverse portion 1b are fastened so as to move laterally straight toward the hinge portion 11 across the tibia X on the joint-surface side, as shown in
In addition, with the bone plate system 2 according to this embodiment, the screws 3 can be fastened in the oblique posterior direction with the main-body portion 1a placed at the oblique anterior inner surface of the tibia X, and the screws 3 can be fastened straight in the horizontal direction with the transverse portion 1b placed at the inner surface of the tibia X.
According to
In the state in which the patient is standing upright, the centers of the resultant forces of loads exerted on the joint from the femur are generally placed at positions occupying 60% or more of the total length from the inner surface to the joint surface. Therefore, by aligning the positions at which the screws 3 intersect with the positions of the centers of the resultant forces of the loads, there is an advantage in that it is possible to facilitate capturing of the loads exerted on the tibia X from the femur by using the bone plate 1.
In addition, because the artificial bone 4 is not only formed in a wedge shape in which the size thereof decreases toward the tip in the longitudinal direction but also has an inclined surface in which the thickness thereof decreases in one direction also in the width direction, the bone plate system 2 according to this embodiment affords the following advantages.
Specifically, because the size of the artificial bone 4 decreases toward the tip along the longitudinal direction, by inserting, from the inner-surface side, the wedge-shaped artificial bone 4 into the cut formed in a shape that, by being opened, expands toward an opening end on the inner-surface side, it is possible to bring the top and bottom surfaces of the artificial bone 4 into close contact with the cut surfaces Y above and below.
Furthermore, with the artificial bone 4 in this embodiment, because at least one of the top and bottom surfaces thereof is inclined so that the thickness decreases in one direction also in the width direction, in the state in which the artificial bone 4 is inserted into the cut, it is possible to place the artificial bone 4 so that the thickness thereof becomes large rearward and low forward, as shown in
Note that, in this embodiment, as shown in
As shown in
In addition, in this embodiment, as shown in
|θ|−|A|±1.5,
5≤A≤20 mm,
5≤B≤20 mm, and
10≤C≤50 mm,
where θ is the angle at the tip of the wedge shape in the artificial bone 4, A is the maximum height of the artificial bone 4, B is the width of the artificial bone 4, and C is the length of the artificial bone 4. By configuring the artificial bone to have such dimensions, it is possible to provide a wedge shape having the dimensions that fit the dimensions of the human tibia X.
It is more preferable that the dimensions be:
|θ|≈|A|,
6≤A≤15 mm,
8≤B≤15 mm, and
25≤C≤50 mm.
In addition, it is preferable that the artificial bone 4 be formed of a calcium-phosphate-based ceramic having a porosity of 30% to 80%. Examples thereof include βTCP, αTCP, OCP, hydoroxyapatite, bio-derived materials, calcium sulfate cement, and so forth.
In addition, in this embodiment, although the artificial bone 4 has inclined surfaces both in the top and bottom surfaces thereof, alternatively, as shown in
As mentioned above, by the bone plate of the present invention, when the strip-shaped main-body portion is placed, along the longitudinal direction of the tibia, at the oblique anterior inner surface of the tibia below the cut formed in the inner surface of the tibia, the transverse portion is placed at a position extending along the inner surface of the tibia above the cut. It is possible to hold the opened cut by individually securing the main-body portion and the transverse portion to the tibia on either side of the cut by using the screws fastened to the screw holes.
In this case, because the main-body portion and the transverse portion that are joined by the joining portion are respectively secured to the oblique anterior inner surface and the inner surface of the tibia in a twisted manner, it is possible to prevent the bone plate from bending and collapsing, even if a vertical load is exerted to the joint in an upright state, as does happen with a conventional bone plate that is secured along substantially the same plane. As a result, it is possible to prevent dislodging of the artificial bone that is inserted into the cut and bone healing in a retroverted state.
When the bone plate is placed at a side surface of the tibia, the bone plate is placed so as to conform to the side-surface shape of the tibia, and thus, the bone plate does not become a hindrance by greatly protruding when subcutaneously implanted.
The bone plate is placed at an upper side surface of the tibia; the screws are individually made to pass through the plurality of screw holes that are provided in the main-body portion and the transverse portion, respectively; the threaded portions having the second male screws are fastened to the tibia; and, finally, the head portions having the first male screws are fastened to the screw holes; and thus, it is possible to hold the cut in an open state by reliably securing the bone plate to the tibia on either side of the cut.
The screws are fastened to the tibia closer to the joint surface located above the cut in nearly the lateral direction toward the outer surface from the inner surface of the tibia by utilizing the screw holes of the transverse portion placed at the inner surface. In the case of the related art in which a bone plate is secured to an oblique anterior inner surface of the tibia, screws must be diagonally fastened toward the oblique posterior outer surface from the oblique anterior inner surface, and, in the case in which the bone quality is poor, it is not only impossible to achieve sufficient securing forces but the screws also move in the cancellous bone in some cases, thus cutting the cancellous bone. As compared with this, by fastening the screws nearly in the lateral direction in which the lateral cross-sectional dimension of the tibia is large, it is possible to employ longer screws, and thus, it is possible to maintain the health of the cancellous bone by achieving high securing forces.
When loads from the femur are exerted on the joint in an upright state after surgery, the centers of resultant forces of the loads projected onto the joint surface of the tibia are generally placed at positions occupying 60% or more of the total length of the tibia from the inner surface to the joint surface. Doing so facilitates capturing of the loads exerted on the tibia from the femur by using the bone plate.
Because the main-body portion and the transverse portion are placed in a twisted manner, the fastening directions of the screws are not uniform, and thus, the securing directions of the screws tend to be mistaken even if preparation holes are provided.
By utilizing the through-holes provided in the screws, it is possible to fasten the screws by using the guide pins inserted into preparation holes in advance as guides, and thus, it is possible to enhance the workability of the fastening procedure.
It is possible to facilitate making the top and bottom surfaces of the artificial bone member fit with the cut surfaces of the cut in the tibia.
This is a continuation of International Application PCT/JP2015/058633, with an international filing date of May 20, 2015, which is hereby incorporated by reference herein in its entirety. This application is based on U.S. Design Pat. Application No. 61/970,445, filed on Mar. 26, 2014, the contents of which are incorporated herein by reference.
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| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2015/058633 | Mar 2015 | US |
| Child | 15271530 | US |
