Patellar fracture closed reduction and internal fixation surgical kit and its usage

Abstract

This invention provides a closed reduction and internal fixation surgical kit for patellar fractures and its method of use, relating to the field of orthopedic instrument technology. It solves the technical problem of lacking matching surgical instruments to perform minimally invasive closed reduction and internal fixation surgery for patellar fractures. The kit includes a percutaneous patellar reduction clamp, a coronal plane guide, internal fixation screws, and a suture feeder. This invention makes closed reduction and internal fixation surgery for patellar fractures simpler and more efficient, and allows for more convenient closed reduction and internal fixation of complex comminuted patellar fractures without sacrificing the quality of reduction and fixation.

Description

Technical Field

[0001] This invention relates to the field of orthopedic instrument technology, and in particular to the updating of surgical instruments and improvement of surgical procedures for closed reduction and internal fixation of patellar fractures. Background Technology

[0002] The patella, the largest sesamoid bone in the human body, is located in front of the knee joint and serves to protect it. The quadriceps femoris muscle attaches to the upper edge of the patella, and part of its fascia continues across the front of the patella to form the patellar ligament, which inserts into the tibial tuberosity. The patella plays a crucial role in knee movement. For example, as an intermediate structure in the knee extensor mechanism, it transmits the force generated by the quadriceps femoris muscle to the patellar tendon; the patella acts as a lever during knee extension, effectively increasing the leverage arm of the knee extensor mechanism at the knee joint flexion-extension axis; and the sliding of the patella on the femoral trochlea reduces friction between the quadriceps femoris muscle and the lower front of the femur.

[0003] Patellar fracture is a common intra-articular fracture in clinical practice, mostly seen in young adults. It is often caused by violent contraction of the quadriceps femoris muscle or direct impact. Patellar fracture involves the articular surface and is often accompanied by tearing of the quadriceps femoris muscle expansion and intra-articular hematoma. It is prone to knee joint dysfunction and traumatic arthritis. The treatment of patellar fracture requires anatomical reduction, reliable fixation and early functional exercise.

[0004] Minimally invasive surgery, represented by closed reduction and internal fixation, is the mainstream direction of surgical development today. Compared with traditional open surgery, closed reduction and internal fixation for patellar fractures causes less trauma to patients, less intraoperative bleeding, and faster postoperative recovery of knee joint function. It also avoids the risk of poor wound healing or even infection caused by extensive soft tissue stripping and destruction.

[0005] However, the current bottleneck lies in the fact that closed reduction and internal fixation of the patella is still quite difficult to achieve due to the lack of appropriate surgical instruments. The surgical procedures are rather complicated, and the operation and anesthesia time are relatively long. Moreover, for more complex comminuted fractures of the patella, closed reduction and internal fixation are currently difficult to achieve due to the lack of effective intraoperative reduction and fixation instruments.

[0006] The original intention of this invention is to make closed reduction and internal fixation surgery for patellar fractures simpler and more efficient, and to achieve closed reduction and internal fixation for complex comminuted patellar fractures more conveniently without sacrificing the quality of reduction and fixation. Summary of the Invention

[0007] The purpose of this invention is to provide a surgical kit for closed reduction and internal fixation of patellar fractures and its method of use, so as to solve the technical problem in the prior art that it is difficult to complete the minimally invasive surgery of closed reduction and internal fixation of patellar fractures due to the lack of matching surgical instruments.

[0008] To achieve the above objectives, the present invention provides the following technical solution:

[0009] This invention provides a surgical kit for closed reduction and internal fixation of patellar fractures, comprising a percutaneous patellar reduction clamp, a coronal plane guide, internal fixation screws, and a suture feeder, wherein:

[0010] The head end of the patellar percutaneous reduction clamp has two clamping parts arranged opposite each other. When the two clamping parts are closed, they can form a clamping ring that matches the shape of the patella, which is used to reduce and temporarily fix the displaced fracture ends.

[0011] The coronal plane guide can be engaged with the clamping part to position the entry and exit points of the internal fixation screw that will penetrate the temporarily fixed patella.

[0012] The internal fixation nail penetrates the patella from the coronal plane position through the coronal plane guide to form internal fixation of the fractured patella;

[0013] The suture feeder is used to create a subcutaneous tunnel on the posterior surface of the patella, and through this tunnel, guides the high-strength cable exposed at one end of the internal fixation nail to the other end of the internal fixation nail or one end of another internal fixation nail, facilitating the final cable knotting and tension band fixation. The high-strength cable is any clinically available cable with high tensile strength that can be permanently implanted in the human body; the material can be either a polymer braided material or an alloy cable. The high-strength cable is pre-inserted into the internal fixation nail, and both ends are exposed outside the pinholes after the internal fixation nail penetrates the patella.

[0014] Furthermore, the patellar percutaneous reduction clamp has a cloth clamp-like structure, including a first clamp arm and a second clamp arm hinged to each other. The first clamp arm has a first clamping part at its head end, and the second clamp arm has a second clamping part at its head end. The first clamping part and the second clamping part have the same structure and are arranged opposite to each other. The cross-sectional shape of the first clamping part or the second clamping part is adapted to the shape of half of the patella. The tail ends of the first clamp arm and the second clamp arm are provided with finger rings. It also includes a locking structure disposed between the first clamp arm and the second clamp arm.

[0015] Furthermore, the locking structure is a slot device, or the locking structure includes an adjusting screw and a nut, the head end of the adjusting screw is fixed on the first clamp arm, and a through hole is provided at a corresponding position on the second clamp arm, and the adjusting screw passes through the through hole and is connected to the nut.

[0016] Furthermore, the first clamping part includes an inner ring and an outer ring, both of which are semi-circular structures, and are arranged side by side with intervals, with their ends fixed together to form the first clamping part having a middle slide; two Kirschner wire sleeves are symmetrically arranged on the first clamping part corresponding to the slide position; the inner cavity of the Kirschner wire sleeve is connected to the slide.

[0017] Furthermore, the coronal plane guide has a C-shaped structure, including a straight arm, a transverse arm, and a guide sleeve, wherein:

[0018] The straight arm has an adjustable length structure;

[0019] The horizontal arm is vertically disposed at both ends of the straight arm;

[0020] The guide sleeve is disposed opposite to the inner side of the two cross arms, and a connecting hole is provided on the cross arm corresponding to the inner cavity of the guide sleeve;

[0021] The specifications of the guide sleeve are adapted to the specifications of the slide rail so that the guide sleeve can be inserted into the slide rail for positioning the coronal plane needle insertion position.

[0022] Furthermore, the straight arm is a split structure, including a first arm and a second arm; the length adjustment structure includes an adjustment column, an adjustment cylinder, an adjustment hole, and a locking screw; wherein:

[0023] The adjustment column is a solid structure and is located at one end of the first arm;

[0024] The adjusting cylinder is a hollow structure and is located at one end of the second arm, with most or all of the adjusting cylinder embedded inside the second arm;

[0025] The cross-sectional shape of the regulating cylinder and the regulating column is a non-circular cross-section, and the inner cavity specifications of the regulating cylinder are adapted to the specifications of the regulating column;

[0026] The adjustment hole is a through threaded hole, which is provided on the second arm and communicates with the inner cavity of the adjustment cylinder;

[0027] The locking screw is screwed into the threaded hole, and its end abuts against the adjusting post.

[0028] Furthermore, the internal fixation pin has a segmented structure, including a head segment, a middle segment, and a tail segment, wherein:

[0029] The number of head sections is one, the side facing the middle section is a hollow structure with a threaded section inside, and the side away from the middle section is a nail tip;

[0030] The tail section is one in number, and the side facing the middle section is hollow. The outer wall of the tail section has a threaded section, and the side away from the middle section is a clamping section with a flat-angle design on the outer wall of its cross section, which is convenient for clamping by the power drill.

[0031] The intermediate segment is a hollow structure, and there are several intermediate segments of different lengths. Each intermediate segment has a protruding section on the side facing the head segment, and the protruding section is provided with a threaded section. The inner wall of the intermediate segment facing the tail segment is provided with a threaded section. The inner side of the threaded section in the inner cavity of the intermediate segment has an internal hexagonal groove, which facilitates the surgeon to further adjust the depth of the intermediate segment of the internal fixation nail in the bone tunnel and remove the internal fixation nail after the fracture has healed using a universal hollow external hexagonal screwdriver.

[0032] The head section, the middle section, and the tail section are all connected by threads, and the rotation direction of the threads is the same as the rotation direction when the internal fixing nail is drilled in.

[0033] The outer wall of the protruding section in the middle section and the outer wall of the left end are respectively provided with threaded sections with different pitches.

[0034] Furthermore, the wire feeder includes a handle, an extension rod, and a wire feeding hole; wherein:

[0035] One end of the extension rod is connected to the handle, and the other end has a flat head with a certain curvature;

[0036] The number of wire feeding holes is two, which are spaced apart at the flat head.

[0037] The patellar fracture closed reduction and internal fixation surgical kit provided by this invention makes the closed reduction and internal fixation surgery for patellar fractures simpler and more efficient, and allows for more convenient closed reduction and internal fixation of complex comminuted patellar fractures without sacrificing the quality of reduction and fixation.

[0038] The present invention provides a method for using the closed reduction and internal fixation surgical kit for patellar fractures, the method of use being as follows:

[0039] Step S1: After satisfactory anesthesia, the patellar percutaneous reduction clamp is used to reduce and clamp the fracture fragments. The reduction is then adjusted under the monitoring of a fluoroscopic machine to achieve anatomical reduction of the patellar articular surface.

[0040] Step S2: According to the direction of the fracture line, place the two guide sleeves of the coronal plane guide into the slide and lock them in place, and make the direction of the guide sleeves as perpendicular as possible to the main fracture line;

[0041] Step S3: First, use a Kirschner wire with a diameter of 1.5 mm to penetrate the patella along the guide sleeve and measure the length of the bone tunnel in the patella.

[0042] Step S4: Select the middle section of the internal fixation nail of the appropriate length according to the measured length of the patellar bone tunnel, and assemble it into a complete internal fixation nail by matching thread connection. During assembly, pass the high-strength cable through the middle section and place the two ends of the high-strength cable into the cavities of the head section and tail section respectively.

[0043] Step S5: Remove the 1.5mm Kirschner wire used to measure the length of the bone tunnel, and drill the assembled internal fixation nail into the patellar bone tunnel entrance along the guide sleeve. Monitor the drilling depth using a fluoroscopy machine to ensure that the head and tail ends of the middle section of the internal fixation nail are exactly at the edge of the patella.

[0044] Step S6: Insert another internal fixation screw as parallel as possible using the same method as in step S5, with a distance of 2-3 cm between the two internal fixation screws.

[0045] Step S7: Unscrew the head and tail sections of the two internal fixation screws by rotating them in opposite directions, and pull both ends of the high-strength cable out of the skin screw holes. If necessary, pass the tail end of the high-strength cable through the matching hollow hexagonal screwdriver and insert the hollow hexagonal screwdriver into the inner hexagonal groove on the tail side of the middle section and rotate it clockwise or counterclockwise so that the middle section of the internal fixation screw is at the ideal depth in the bone tunnel.

[0046] Step S8: Release the patellar percutaneous reduction clamp, and pass the proximal end of the high-strength cable in the first internal fixation nail through the two feed holes of the suture feeder in sequence. Use the tip of the suture feeder to perform soft tissue undermining dissection close to the periosteum on the back of the patella, create a subcutaneous tunnel on the back of the patella, and pass the proximal end of the cable through the tunnel from the proximal skin screw hole of the first internal fixation nail to the distal skin screw hole of the second internal fixation nail, where it meets the distal end of the second high-strength cable.

[0047] Step S9: Using the same method as in step S8, connect the proximal end of the second high-strength cable with the distal end of the first high-strength cable, and tighten and knot the cables at the two meeting points in sequence to finally form a cross-shaped tension band on the back of the patella.

[0048] Step S10: Suture the skin incision and apply a sterile dressing.

[0049] Furthermore, when the patellar fracture is highly comminuted or the fracture fragments are significantly displaced, step S1 further includes:

[0050] Step S1.5: Insert a Kirschner wire into the patella through the Kirschner wire sleeve on the percutaneous patellar reduction holder to enhance the holding force of the percutaneous reduction holder on the bone fragment during the reduction process. Attached Figure Description

[0051] To more clearly illustrate the technical solutions in the embodiments of the present invention or the prior art, the drawings used in the description of the embodiments or the prior art will be briefly introduced below. Obviously, the drawings described below are only some embodiments of the present invention. For those skilled in the art, other drawings can be obtained based on these drawings without creative effort.

[0052] Figure 1 This is a front view schematic diagram of the patellar percutaneous reduction clamp in the patellar fracture closed reduction and internal fixation surgical kit of the present invention during use;

[0053] Figure 2 This is a side view of the patellar percutaneous reduction clamp in the patellar fracture closed reduction and internal fixation surgical kit of the present invention during use;

[0054] Figure 3 This is a cross-sectional schematic diagram of the coronal plane guide in the closed reduction and internal fixation surgical kit for patellar fractures of the present invention;

[0055] Figure 4 This is a front view of the coronal plane guide in the closed reduction and internal fixation surgical kit for patellar fractures of the present invention;

[0056] Figure 5 This is an exploded view of the internal fixation nails in the closed reduction and internal fixation surgical kit for patellar fractures of the present invention;

[0057] Figure 6 This is a schematic diagram of the suture feeder in the closed reduction and internal fixation surgical kit for patellar fractures of the present invention;

[0058] Figure 7 This is a three-dimensional structural diagram of the clamping part in the patellar percutaneous reduction clamp of the present invention;

[0059] Figure 8 This is a cross-sectional view of the proximal end of the middle section of the internal fixation nail of the present invention.

[0060] In the figure: 1. Patellar percutaneous reduction clamp; 11. Clamping part; 12. Locking structure; 13. Finger ring; 14. Inner ring; 15. Outer ring; 16. Slide rail; 17. Kirschner wire sleeve; 2. Coronal plane guide; 21. Straight arm; 22. Transverse arm; 23. Guide sleeve; 24. Connecting hole; 25. Adjusting post; 26. Adjusting cylinder; 27. Adjusting hole; 3. Internal fixation screw; 31. Head section; 32. Middle section; 33. Tail section; 34. Clamping section; 4. High-strength cable; 5. Wire feeder; 51. Handle; 52. Extension rod; 53. Wire feed hole; 100. Patella. Detailed Implementation

[0061] To make the objectives, technical solutions, and advantages of this invention clearer, the technical solutions of this invention will be described in detail below. Obviously, the described embodiments are merely some embodiments of this invention, and not all embodiments. Based on the embodiments of this invention, all other implementation methods obtained by those skilled in the art without creative effort are within the scope of protection of this invention.

[0062] like Figures 1-6 As shown, this invention provides a surgical kit for closed reduction and internal fixation of patellar fractures, including a percutaneous patellar reduction clamp 1, a coronal plane guide 2, an internal fixation nail 3, and a suture feeder 5. The percutaneous patellar reduction clamp 1 resembles a large towel clamp commonly used in operating rooms. This surgical kit can perform minimally invasive closed reduction and internal fixation of patellar fractures. The surgical steps are simple, the operation time is short, the trauma to the patient is less, the intraoperative bleeding is less, the patient's knee joint function recovers faster after surgery, and it avoids the risk of poor wound healing or even infection due to extensive soft tissue stripping and destruction.

[0063] The percutaneous patellar reduction clamp 1 is used to clamp and temporarily reduce the patella; the coronal plane guide 2 is used to engage the percutaneous patellar reduction clamp 1 after the patella 100 is clamped and temporarily reduced by the percutaneous patellar reduction clamp 1, thereby positioning the internal fixation nail that is about to pass through the temporarily fixed patella in the coronal plane, so that the internal fixation nail can be inserted through the position and direction indicated by the coronal plane guide 2; the internal fixation nail 3 is used to penetrate the patella to complete the internal fixation of the fracture; the high-strength cable 4 pre-installed in the internal fixation nail is used to form a tension band structure under the skin on the dorsal side of the patella, so that the tensile stress on the dorsal side of the patella is converted into compressive stress between the fracture ends when the patient flexes the knee after surgery, thereby enhancing the fixation effect; the suture feeder 5 is used to push the high-strength cable 4 to the ideal position through the subcutaneous tunnel, so as to quickly complete the cross tension band structure of the high-strength cable 4.

[0064] Specifically, in this embodiment:

[0065] like Figure 1 and Figure 2As shown, the percutaneous patellar reduction clamp 1 has two opposing clamping parts 11 at its head end. When the two clamping parts 11 are closed, they form a clamping ring that conforms to the shape of the patella, used for reduction and temporary fixation of the fractured patella. It should be noted that the two clamping parts 11 of the percutaneous patellar reduction clamp 1 can be spaced apart to prepare for clamping the patella; the two clamping parts 11 can also be brought closer together to close, forming a circular clamping ring, allowing for dynamic reduction of the patella during closure and temporary fixation after closure. It should be noted that the shape of the clamping parts 11 and the shape of the clamping ring are not strictly regular semicircles or circles, but rather similar to semicircles or circles, and can be designed according to the shape of the human patella, as long as the two clamping parts 11, when closed together, form a complete clamping ring that conforms to the shape of the patella, thus achieving reduction and fixation of the patella.

[0066] Furthermore, such as Figure 1 As shown, the patellar percutaneous reduction clamp 1 has a cloth clamp-like structure, including a first clamp arm and a second clamp arm that are hinged to each other. The head end of the first clamp arm has an L-shaped structure and a first clamping part is provided at the end. The head end of the second clamp arm has an L-shaped structure and a second clamping part is provided at the end. The first clamping part and the second clamping part have the same structure and are arranged opposite to each other, so that the first clamping part can be closed or released when the first clamp arm and the second clamp arm are close to or far away from each other.

[0067] Specifically, the cross-sectional shape of the first or second clamping part is adapted to the shape of half of the patella. This structural design allows for the formation of a clamping ring that conforms to the shape of the patella when the first and second clamping parts are nearly closed, facilitating fixation after reduction of the fractured patella. In other words, the first and second clamping parts, when clamped, resemble a closed ring (two semicircles of the same diameter combined) that approximates the shape of the patella. This ring is characterized by two parallel metal rings, namely an inner ring 14 and an outer ring 15, with a sliding track 16 formed between them. The spacing between the sliding tracks is 3-5 mm, preferably 4 mm. This track ensures that the coronal plane of the pin is determined when the clamping device clamps the patella, and it also features a Kirschner wire sleeve for inserting temporary fixation Kirschner wires, enhancing the clamping force on the bone fragment during percutaneous reduction.

[0068] like Figure 1 As shown, finger rings 13 are provided at the tail ends of both the first and second clamp arms;

[0069] To maintain clamping stability, a locking structure 12 is also included, which is disposed between the first clamp arm and the second clamp arm.

[0070] It should be noted here that, as an optional embodiment of the present invention, the locking structure 12 in the present invention can be implemented using a structure in the prior art. For example, the locking structure 12 can be a slot device on a cloth clamp in the prior art. Since the slot device on the cloth clamp is the prior art, it is not specifically limited here.

[0071] It should be noted that, as another optional embodiment of the present invention, the locking structure 12 can also be implemented using the following structure: Specifically, the locking structure 12 includes an adjusting screw and a nut, the head end of the adjusting screw is fixed on the first clamp arm, and a through hole is provided at a corresponding position on the second clamp arm, through which the adjusting screw passes and is connected to the nut.

[0072] In practical use, the adjusting screw can be loosely connected to the nut after passing through the through hole. Then, after the clamping part 11 clamps and fixes the patella, the nut can be tightened to lock the locking structure 12. In addition, it should be noted that the nut can be placed separately and removed each time it is used, or the nut can be fixed to the second clamp arm in a rotatable manner. The present invention does not specifically limit which form is adopted.

[0073] Furthermore, to facilitate the positioning of the coronal plane guide 2, in this invention, the first clamping part and the second clamping part are not solid structures, but hollow structures with a central slide rail. Specifically, as shown in the figure... Figure 2 and Figure 7 As shown, the first clamping part includes an inner ring 14 and an outer ring 15. Both the inner ring 14 and the outer ring 15 are semi-circular structures, and the inner ring 14 and the outer ring 15 are arranged side by side with intervals, and the two ends are fixed together to form a first clamping part with a middle slide 16 between them. Two Kirschner wire sleeves 17 are symmetrically arranged on the first clamping part corresponding to the position of the slide 16. The Kirschner wire sleeves 17 are hollow cylindrical structures, and their inner cavities are connected to the slide 16.

[0074] Furthermore, two Kirschner needle sleeves 17 are respectively provided on the first clamping part and the second clamping part.

[0075] like Figure 3 and Figure 4As shown, the coronal plane guide 2 can be engaged with the clamping part 11 to perform coronal plane positioning of the temporarily fixed patella. Specifically, the coronal plane guide 2 is structurally shaped like a capital "C" when viewed from the side. By engaging the coronal plane guide 2 with the clamping part 11, the entry and exit points of the internal fixation screw that will penetrate the temporarily fixed patella are located. Then, the internal fixation screw 3 is drilled into the patella from the position of the coronal plane guide 2 to achieve the positioning of the internal fixation screw 3 in the patella and the entry and exit points. Specifically, the coronal plane guide 2 can be engaged with the slide 16. For example, in this embodiment, the width of the slide 16 is 4 mm, and the width of the guide sleeve 23 of the coronal plane guide 2 engaging with the slide 16 should not be greater than 4 mm to ensure that it can be engaged normally and fixed in the slide 16.

[0076] Specifically, in this embodiment, such as Figure 3 As shown, the coronal plane guide 2 has a C-shaped structure, including a straight arm 21, a transverse arm 22, and a guide sleeve 23, wherein:

[0077] The straight arm 21 has an adjustable length structure;

[0078] The horizontal arm 22 is vertically disposed at both ends of the straight arm 21; the straight arm 21 and the horizontal arm 22 can be integrally machined.

[0079] like Figure 2 and Figure 3 As shown, the guide sleeves 23 are positioned opposite each other on the inner side of the two transverse arms 22, and the transverse arms 22 are provided with connecting holes 24 corresponding to the inner cavity of the guide sleeves 23. It should be noted that the directions of the two guide sleeves 23 are always aligned with each other. When the two guide sleeves 23 are locked onto the slide 16 of the patellar percutaneous reduction clamp 1, the placement direction of the internal fixation nail 3 is determined.

[0080] The specifications of the guide sleeve 23 are adapted to the specifications of the slide rail 16 so that the guide sleeve 23 can be inserted into the slide rail 16 for positioning the coronal plane needle insertion position.

[0081] Specifically, such as Figure 4 As shown, the straight arm 21 is a split structure, including a first arm and a second arm; the length adjustment structure includes an adjusting column 25, an adjusting cylinder 26, an adjusting hole 27, and a locking screw; wherein:

[0082] The adjusting column 25 is a solid structure and is located at one end of the first arm;

[0083] The adjusting cylinder 26 is a hollow structure, located at one end of the second arm, and most or all of the adjusting cylinder 26 is embedded in the second arm;

[0084] The cross-sectional shape of the adjusting cylinder 26 and the adjusting column 25 is a non-circular cross-section, for example, it can be square, rectangular, triangular, etc.; the inner cavity of the adjusting cylinder 26 is adapted to the specifications of the adjusting column 25 to ensure that the adjusting column 25 can be inserted into the adjusting cylinder 26 and the gap is not too large; in use, the adjusting column 25 is inserted into the adjusting cylinder 26, and then the length of the straight arm 21 is adjusted by adjusting the insertion depth of the adjusting column 25.

[0085] The adjusting hole 27 is a through threaded hole, which is provided on the second arm. The threaded hole extends vertically through the surface of the second arm to the adjusting cylinder 26 and communicates with the inner cavity of the adjusting cylinder 26.

[0086] The locking screw is screwed into the threaded hole, and its end abuts against the adjusting column 25.

[0087] Once the adjusting column 25 is in place, the locking screw can be screwed in and engaged with the adjusting column 25 to lock the length of the straight arm 21.

[0088] Of course, the length adjustment structure of the straight arm 21 can also adopt other structural forms, as long as the length adjustment of the straight arm 21 can be realized. The length adjustment structure of the present invention is not limited to the above embodiments.

[0089] like Figure 3 As shown, the guide sleeve 23 has a stepped structure, including a snap-in section and a support section. The width of the snap-in section is adapted to the width of the slide 16. In this embodiment, when the width of the slide 16 is 4mm, the width of the snap-in section can be 3.7mm. The diameter of the support section should be greater than the width of the slide 16 to achieve the supporting effect when the snap-in section is snapped into the slide 16.

[0090] like Figure 5 As shown, the internal fixation nail 3 can penetrate the patella from any direction in the coronal plane through the coronal plane guide 2 to form internal fixation of the fractured patella. It should be noted that when in use, after the guide sleeve 23 of the coronal plane guide 2 passes through the slide 16 and the positions of the nail entry point and the nail exit point are located, the internal fixation nail 3 can be drilled into the patella through the guide sleeve 23 using a power drill to achieve internal fixation of the patella.

[0091] Furthermore, the internal fixation nail 3 is a modular segmented structure, comprising three parts: a head segment 31, a middle segment 32, and a tail segment 33. These three parts can be connected by threads in the same direction, which we call matching threads. The tip of the head segment 31 is similar to the Kirschner wires currently used in orthopedic operating rooms. The tail of the head segment 31 (facing the middle segment 32) is hollow and contains matching threads that match the middle segment 32. The middle segment 32 of the internal fixation nail 3 is also a hollow nail body, with 1-2 sufficiently long high-strength cables pre-installed inside for tension band 4 fixation after the internal fixation nail 3 is implanted. On the surface of the middle segment 32, there are two external threads distributed at the proximal end (facing the tail segment 33) and distal end (facing the head segment 32) of the matching threads, with the pitch of the distal thread being greater than that of the proximal thread, facilitating the application of pressure to the fracture ends after the nail is screwed into the bone tunnel. The inner wall near the proximal end of the intermediate section 32 (the inner cavity of the intermediate section 32 facing the tail section 33) also has a matching thread that matches the matching thread of the tail section 33, such as... Figure 8 As shown, an internal hexagonal groove is provided on the inner side of the matching thread, which facilitates the surgeon to further adjust the depth of the middle section of the internal fixation nail in the bone tunnel using a universal hollow external hexagonal screwdriver, and to facilitate the removal of the internal fixation nail after fracture healing. The tail section 33 of the internal fixation nail 3 is mainly the force-bearing part of the power drill. Its proximal end (the side away from the middle section 32) is solid, and its distal end (the side facing the middle section 32) is hollow. The inner wall of the distal end has matching threads corresponding to the middle section 32, and the outer wall of the proximal end has a groove to facilitate clamping by the power drill. The middle section 32 of the internal fixation nail 3 can be divided into various models according to different lengths, and the length can be selected and assembled according to the actual measured length during surgery.

[0092] Specifically, in this embodiment:

[0093] There is one head section 31. The side facing the middle section 32 is hollow and has a threaded section inside. The side away from the middle section 32 is the nail tip.

[0094] There is one tail section 33. The side facing the middle section 32 is hollow. The outer wall of the tail section 33 has a threaded section. The side away from the middle section 32 is a clamping section 34, which is used for clamping the power drill. The clamping section 34 has a groove structure.

[0095] The intermediate section 32 is a hollow structure, and there are several intermediate sections 32. The length of all intermediate sections 32 can be different, and each intermediate section 32 has a protruding section on the side facing the head section 31, and a threaded section is provided on the protruding section; a threaded section is provided on the inner wall of the cavity on the side facing the tail section of the intermediate section 32, and the inner side of the threaded section in the cavity of the intermediate section has an internal hexagonal groove.

[0096] The head section 31, the middle section 32 and the tail section 33 are all connected by threads, and the rotation direction of the threads is the same as the rotation direction when the internal fixing nail 3 is drilled in.

[0097] The outer wall of the protruding section of the middle section 32 and the outer wall of the left end (towards the tail section 33) are respectively provided with threaded sections with different pitches, so as to use the threaded sections with different pitches to apply pressure between the fracture ends.

[0098] Specifically, the thread pitch of the threaded section on the outer wall of the left end is less than the thread pitch of the threaded section on the outer wall of the inner side of the protruding section. That is, the threaded section on the side of the middle section 32 closer to the tail section 33 is a close threaded section, while the threaded section on the side closer to the head section 31 is a loose threaded section.

[0099] It should be noted that in this invention, the hollow structure of the head section 31 and the hollow structure of the tail section 33 are both cavity structures. The cavity structure has two functions: first, it is used to set the internal thread section so as to facilitate the threaded connection with the middle section 32; second, it is used to accommodate the two ends of the high-strength cable 4 so that when the head section 31 and the tail section 33 are removed after the internal fixation nail 3 penetrates the patella, the two ends of the cable can be exposed.

[0100] The high-strength cable 4 is pre-installed inside the internal fixation nail 3, and both ends can be exposed outside the nail hole after the internal fixation nail 3 passes through the patella;

[0101] The high-strength cable 4 used in this invention can be any cable with high tensile strength that can be permanently implanted into the human body and is currently used clinically. The material can be either a polymer braid or an alloy cable. Since this is existing technology, this invention does not impose specific limitations; any high-strength cable 4 used in surgery in the prior art can be used.

[0102] like Figure 6 As shown, the suture feeder 5 is used to create a subcutaneous tunnel on the back of the patella, and through this tunnel, guides the high-strength cable 4 exposed at one end of the internal fixation nail 3 to the other end of the internal fixation nail 3 or one end of another internal fixation nail 3, facilitating the final cable knotting and tension band fixation. Specifically, the suture feeder 5 is similar in shape to the miniature periosteal elevator used in orthopedic surgery, the difference being that it has two additional suture feed holes 53 with a diameter of 2.0 mm at the distal end of the elevator.

[0103] Furthermore, such as Figure 6 As shown, the wire feeder 5 includes a handle 51, an extension rod 52, and a wire feeding hole 53;

[0104] in:

[0105] One end of the extension rod 52 is connected to the handle 51, and the other end has a flat head with a certain curvature;

[0106] There are two wire feeding holes 53, which are spaced apart at the flat head.

[0107] The patellar fracture closed reduction and internal fixation surgical kit provided by this invention makes the closed reduction and internal fixation surgery for patellar fractures simpler and more efficient, and allows for more convenient closed reduction and internal fixation of complex comminuted patellar fractures without sacrificing the quality of reduction and fixation.

[0108] This invention provides a surgical kit for closed reduction and internal fixation of patellar fractures, suitable for closed reduction and internal fixation of patellar fractures. Its usage is as follows:

[0109] Step S1: After satisfactory anesthesia, the patellar percutaneous reduction clamp is used to reduce and clamp the fracture fragments. The reduction is then adjusted under the monitoring of a fluoroscopic machine to achieve anatomical reduction of the patellar articular surface.

[0110] Step S2: According to the direction of the fracture line, place the two guide sleeves of the coronal plane guide into the slide and lock them in place, and make the direction of the guide sleeves as perpendicular as possible to the main fracture line;

[0111] Step S3: First, use a Kirschner wire with a diameter of 1.5 mm to penetrate the patella along the guide sleeve and measure the length of the bone tunnel in the patella. It should be noted that the length can be measured by observing with a fluoroscopy machine, or by placing a new Kirschner wire at the insertion point and then calculating the penetration length, which is the length of the bone tunnel.

[0112] Step S4: Select the middle section of the internal fixation nail according to the measured length of the patellar bone tunnel, and assemble it into a complete internal fixation nail by matching thread connection. During assembly, pass the high-strength cable through the middle section, and then put the two ends into the cavities of the head section and tail section respectively.

[0113] Step S5: Drill the assembled internal fixation pins along the guide sleeve of the coronal plane guide, and monitor and determine the drilling depth using a fluoroscopy machine;

[0114] Step S6: Insert another internal fixation screw in parallel using the same method as in step S5, with the distance between the two internal fixation screws being 2-3 cm.

[0115] Step S7: Unscrew the head and tail sections of the two internal fixation screws in the opposite direction, and pull the two ends of the tension band out of the skin incision. If necessary, pass the tail end of the high-strength cable through the matching hollow hexagonal screwdriver, and insert the hollow hexagonal screwdriver into the inner hexagonal groove on the tail side of the middle section and rotate it clockwise or counterclockwise so that the middle section of the internal fixation screw is at the ideal depth in the bone tunnel.

[0116] Step S8: Release the patellar percutaneous reduction clamp, pass the proximal end of the high-strength cable in the first internal fixation nail through the two feed holes of the suture feeder in sequence, use the tip of the suture feeder to closely adhere to the periosteum on the back of the patella to perform soft tissue undermining, create a subcutaneous tunnel on the back of the patella, and pass it through the tunnel from the proximal skin screw hole of the first internal fixation nail to the distal skin screw hole of the second internal fixation nail, and meet with the distal end of the second high-strength cable;

[0117] Step S9: Using the same method as in step S8, the proximal end of the second high-strength cable is joined with the distal end of the first high-strength cable, and the cables at the two joining points are tightened and knotted in turn to form a cross-shaped tension band on the back of the patella. This transforms the tensile stress on the back of the patella into compressive stress between the fracture ends when the patient flexes the knee after surgery, thereby enhancing the fixation effect.

[0118] Step S10: Suture the skin nail holes and apply a sterile dressing.

[0119] Furthermore, when the patellar fracture is fragmented, step S1 includes the following:

[0120] S1.5. A Kirschner wire is drilled into the patella through the Kirschner wire sleeve on the percutaneous patellar reduction clamp to enhance the holding force of the percutaneous reduction clamp on the bone fragment during reduction. In other words, if there is a risk of bone fragment movement or rotation during fixation, step S1.5 can be added, which involves fixing the bone fragment with a Kirschner wire through the Kirschner wire sleeve 17 of the percutaneous patellar reduction clamp 1. This step can be omitted if the fracture is not severely comminuted or the displacement is small.

[0121] First, it should be noted that "inward" refers to the direction towards the center of the storage space, while "outward" refers to the direction away from the center of the storage space.

[0122] In the description of this invention, it should be understood that the terms "center," "longitudinal," "lateral," "length," "width," "thickness," "upper," "lower," "front," "rear," "left," "right," "vertical," "horizontal," "top," "bottom," "inner," "outer," "clockwise," "counterclockwise," "axial," "radial," and "circumferential" indicate the orientation or positional relationship based on the appendix. Figure 1 The orientations or positional relationships shown are for the purpose of facilitating and simplifying the description of the present invention, and are not intended to indicate or imply that the device or element referred to must have a specific orientation, or be constructed and operated in a specific orientation, and therefore should not be construed as limiting the present invention.

[0123] Furthermore, the terms "first" and "second" are used for descriptive purposes only and should not be construed as indicating or implying relative importance or implicitly specifying the number of technical features indicated. Thus, a feature defined as "first" or "second" may explicitly or implicitly include at least one of that feature. In the description of this invention, "a plurality of" means at least two, such as two, three, etc., unless otherwise explicitly specified.

[0124] In this invention, unless otherwise explicitly specified and limited, the terms "installation," "connection," "linking," and "fixing," etc., should be interpreted broadly. For example, they can refer to a fixed connection, a detachable connection, or an integral part; they can refer to a mechanical connection or an electrical connection; they can refer to a direct connection or an indirect connection through an intermediate medium; they can refer to the internal communication of two components or the interaction between two components, unless otherwise explicitly limited. Those skilled in the art can understand the specific meaning of the above terms in this invention according to the specific circumstances.

[0125] In this invention, unless otherwise explicitly specified and limited, "above" or "below" the second feature can mean that the first feature is in direct contact with the second feature, or that the first feature is in indirect contact with the second feature through an intermediate medium. Furthermore, "above," "over," and "on top" of the second feature can mean that the first feature is directly above or diagonally above the second feature, or simply that the first feature is at a higher horizontal level than the second feature. "Below," "below," and "under" the second feature can mean that the first feature is directly below or diagonally below the second feature, or simply that the first feature is at a lower horizontal level than the second feature.

[0126] In the description of this specification, the references to terms such as "one embodiment," "some embodiments," "example," "specific example," or "some examples," etc., indicate that a specific feature, structure, material, or characteristic described in connection with that embodiment or example is included in at least one embodiment or example of the present invention. In this specification, the illustrative expressions of the above terms do not necessarily refer to the same embodiment or example. Furthermore, the specific features, structures, materials, or characteristics described may be combined in any suitable manner in one or more embodiments or examples. Moreover, without contradiction, those skilled in the art can combine and integrate the different embodiments or examples described in this specification, as well as the features of different embodiments or examples.

[0127] The above description is merely a specific embodiment of the present invention, but the scope of protection of the present invention is not limited thereto. Any variations or substitutions that can be easily conceived by those skilled in the art within the technical scope disclosed in the present invention should be included within the scope of protection of the present invention. Therefore, the scope of protection of the present invention should be determined by the scope of the claims.

Claims

1. A surgical kit for closed reduction and internal fixation of patellar fracture, characterized in that, The application relates to a percutaneous patella reduction clamp, a coronal plane guider, an internal fixation nail and a wire feeder. The head end of the percutaneous patella reduction clamp is provided with two clamping parts which are oppositely arranged and can form a clamping ring matched with the shape of a patella when the two clamping parts are closed, so as to reset and temporarily fix the fractured ends of the dislocated patella; the clamping part comprises an inner ring and an outer ring, the inner ring and the outer ring are both semicircular structures, the inner ring and the outer ring are arranged side by side and are fixed at two ends, so as to form a clamping part with a middle slide channel. The coronal plane guider can be clamped on the clamping part to position the nail entry point and the nail exit point of the internal fixation nail which is about to penetrate the temporarily fixed patella; the coronal plane guider is in a C-shaped structure and comprises a straight arm, a horizontal arm and a guide sleeve; the horizontal arm is vertically arranged at the two ends of the straight arm; the guide sleeves are oppositely arranged at the inner sides of the two horizontal arms, and the horizontal arms are provided with through holes corresponding to the inner cavities of the guide sleeves; the specifications of the guide sleeves are matched with the specifications of the slide channel, so that the guide sleeves can be clamped in the slide channel to position the coronal plane needle penetration position. The internal fixation nail is penetrated into the patella from the coronal plane position through the coronal plane guider to form the internal fixation of the fractured patella; the internal fixation nail is in a segmented structure and comprises a head segment, a middle segment and a tail segment. The high-strength cable is prearranged in the internal fixation nail and is exposed outside the nail hole after the internal fixation nail penetrates into the patella. The wire feeder is used to manufacture a subcutaneous tunnel on the back of the patella and guide the high-strength cable exposed at one end of the internal fixation nail to the high-strength cable exposed at the other end of the internal fixation nail or the other end of another internal fixation nail, so as to facilitate the final cable knot tension band fixation.

2. The closed reduction internal fixation surgical set for patella fracture according to claim 1, wherein, The percutaneous patella reduction clamp is in a cloth clamp structure and comprises first and second clamp arms which are hingedly connected to each other; the head end of the first clamp arm is provided with a first clamping part, the head end of the second clamp arm is provided with a second clamping part, the first and second clamping parts are the same in structure, are oppositely arranged and are matched with the shape of half of the patella in cross section; the tail ends of the first and second clamp arms are both provided with finger rings; and the clamp further comprises a locking structure arranged between the first and second clamp arms.

3. The closed reduction internal fixation surgical set for patella fracture according to claim 2, wherein, The locking structure is a clamping groove device or comprises an adjusting screw and a nut; the head end of the adjusting screw is fixed on the first clamp arm, the second clamp arm is provided with a penetrating hole at a corresponding position, and the adjusting screw is connected with the nut after penetrating through the penetrating hole.

4. The closed reduction internal fixation surgical set for patella fracture according to claim 2, wherein, Two Kirschner wire sleeves are symmetrically arranged on the first clamping part at positions corresponding to the slide channel; the inner cavities of the Kirschner wire sleeves are communicated with the slide channel.

5. The closed reduction internal fixation surgical set for patella fracture according to claim 4, wherein, The straight arm is a length-adjustable structure.

6. The closed reduction internal fixation surgical set for patella fracture according to claim 5, wherein, The straight arm is in a split structure and comprises first and second arms; the length-adjusting structure comprises an adjusting column, an adjusting cylinder, an adjusting hole and a locking screw; wherein: The adjusting column is in a solid structure and is arranged at one end of the first arm; The adjusting cylinder is a hollow structure, arranged at one end of the second arm, and most or all of the adjusting cylinder is embedded in the second arm; The adjusting cylinder and the adjusting column have a non-circular cross section, and the adjusting cylinder cavity is matched with the adjusting column; The adjusting hole is a through threaded hole, arranged on the second arm and communicated with the adjusting cylinder cavity; The locking screw is screwed on the threaded hole, and the end abuts against the adjusting column.

7. The closed reduction internal fixation surgical set for patella fracture according to claim 1, wherein, The head section is one, hollow structure towards one side of the middle section, with a threaded section inside, and a nail tip away from the middle section; The tail section is one, hollow structure towards one side of the middle section, with a threaded section on the outer wall of the tail section, and a clamping section away from the middle section, with a flat angle design of the cross section outer wall, facilitating power drill clamping; The middle section is a hollow structure, and the number of the middle section is several, all the middle sections have different lengths, and each middle section has a convex section towards the head section, with a threaded section arranged on the convex section; the inner cavity wall of the middle section towards the tail section is provided with a threaded section, and the inner hexagonal recess is arranged on the inner side of the threaded section in the middle section cavity, facilitating the surgeon to further adjust the depth of the middle section of the internal fixation nail in the bone channel and the internal fixation nail removal after fracture healing with a universal hollow outer hexagonal spanner; The head section, the middle section and the tail section are connected through threads, and the rotation direction of the threads is the same as the rotation direction of the internal fixation nail when drilling into the bone; The outer wall of the convex section of the middle section and the left end outer wall are respectively provided with threaded sections with different pitches.

8. The closed reduction internal fixation surgical set for patella fracture according to claim 1, wherein, The wire feeder comprises a handle, an extension rod and a wire feeding hole; wherein: One end of the extension rod is connected with the handle, and the other end has a flat head with a certain curvature; The wire feeding hole is two, arranged at the flat head.

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