Femoral intramedullary nail non-contact pressing rod adjusting device
By designing a contactless compression rod adjustment device for femoral intramarrow nails, the problem of the difficulty in accurately inserting the pressure rod intramarrow nails is solved, effectively adjusting the compression rod and accurate pressing of the intramedullary nails is achieved, ensuring the correct placement of the locking screws.
Patent Information
- Application Number
- CN202510210829.2
- Authority / Receiving Office
- CN · China
- Patent Type
- Applications(China)
- Current Assignee / Owner
- Filing Date
- 2025-02-25
- Publication Date
- 2025-05-30
- Estimated Expiration
- Not applicable · inactive patent
AI Technical Summary
The internal fixing press rod of the femoral intramarrow nail is difficult to accurately press the metal intramedullary nail in the femoral marrow cavity, resulting in the distal locking screw being unable to accurately screw into the locking position, and the insertion depth is too shallow or too deep.
A contactless compression rod adjustment device for femoral intramarrow nail nails is designed, including a compression rod support module, a compression rod, a first adjustment member and a second adjustment member. By adjusting the connection position between the first adjusting member and the second adjusting member, the insertion depth of the press rod is adjusted to avoid the problem of too shallow insertion depth.
Effectively adjust the insertion depth of the pressure rod to ensure that the pressure rod can accurately press the intramedullary nails, thereby ensuring the effective placement of the locking screws and reducing the operation time and risks.
Smart Images
Figure CN120053047A_ABST
Abstract
Description
Technical Field
[0001] The present invention relates to the field of medical devices, and in particular to a non-contact pressure rod adjusting device for femoral intramedullary nails. Background Art
[0002] In clinical practice, femoral fractures are usually treated with intramedullary nailing of the femur. However, the pressure rod for intramedullary nailing of the femur usually cannot accurately press on the metal intramedullary nail in the femoral medullary cavity. There are two situations where the pressure rod can accurately press on the intramedullary nail of the femur: First, the depth of insertion of the pressure rod into the femoral medullary cavity is too shallow, and the pressure rod does not press on the metal intramedullary nail in the femoral medullary cavity; Second, the depth of insertion of the pressure rod into the distal femoral medullary cavity is too deep. Due to the wide distal femoral medullary cavity and the elasticity of the femoral intramedullary nail, the femoral intramedullary nail will be squeezed, and the position of the femoral intramedullary nail will shift left and right under the excessive pressing of the pressure rod, resulting in the pressure rod being unable to effectively and accurately press on the intramedullary nail. Both of the above situations will cause the distal locking screw to not be accurately screwed into the locking position, so there is a problem of difficulty in inserting the distal locking nail of the femoral intramedullary nail in clinical work.
[0003] Therefore, it is necessary to provide at least a non-contact pressure rod adjusting device for femoral intramedullary nails that can effectively adjust the insertion depth of the pressure rod to avoid the problem of the pressure rod having too shallow an insertion depth. Summary of the Invention
[0004] The purpose of the present invention is to provide a non-contact pressure rod adjusting device for femoral intramedullary nails that can effectively adjust the insertion depth of the pressure rod to avoid the problem of the pressure rod having too shallow an insertion depth.
[0005] To achieve the above purpose, the present invention provides a non-contact pressure rod adjusting device for femoral intramedullary nails, including an intramedullary nail pressure rod mechanism. The intramedullary nail pressure rod mechanism has a pressure rod support module and a pressure rod penetrating through the pressure rod support module in the up and down direction. The pressure rod is used to penetrate into the femur and press on the intramedullary nail. The non-contact pressure rod adjusting device for femoral intramedullary nails further includes a first adjusting member and a second adjusting member. The first adjusting member is provided with a downward-opening slot, and the first adjusting member is arranged above the pressure rod support module and is clamped on the pressure rod support module through the slot. The second adjusting member is arranged below the first adjusting member. The side of the first adjusting member is connected to the side of the second adjusting member in a vertically adjustable manner, and a receiving space for accommodating the leg is defined between the first adjusting member and the second adjusting member.
[0006] Preferably, the non-contact pressure bar adjusting device of the femoral intramedullary nail further includes a first locking member. A connecting hole is further provided on the side of the first adjusting member, and a plurality of adjusting holes arranged at intervals are provided on the side of the second adjusting member in the up and down direction. By passing the first locking member through the connecting hole and one of the adjusting holes, the positions of the first adjusting member and the second adjusting member are locked.
[0007] Preferably, the non-contact pressure bar adjusting device of the femoral intramedullary nail further includes a second locking member. A first locking hole communicating with the card slot is provided on the side of the first adjusting member. The second locking member passes through the first locking hole and abuts against the pressure bar support module to lock the first adjusting member and the pressure bar support module together.
[0008] Preferably, the non-contact pressure bar adjusting device of the femoral intramedullary nail further includes a third locking member. A second locking hole communicating with the card slot is provided on the upper part of the first adjusting member. The third locking member passes through the second locking hole and abuts against the pressure bar support module to lock the first adjusting member and the pressure bar support module together.
[0009] Preferably, the first adjusting member includes a first cross bar portion and a first side bar portion formed by bending and extending downward from one end of the first cross bar portion. Two protrusions arranged at intervals are provided on the bottom surface of the first cross bar portion, and the card slot is formed between the two protrusions.
[0010] Preferably, the second adjusting member includes a second side bar portion, a second cross bar portion and a third side bar portion. The second side bar portion and the third side bar portion are respectively arranged in the up and down direction, the second cross bar portion is arranged in the horizontal direction, and one end of the second cross bar portion is connected to the lower end of the second side bar portion, and the other end of the second cross bar portion is connected to the lower end of the third side bar portion.
[0011] Preferably, the non-contact pressure bar adjusting device of the femoral intramedullary nail further includes a first sleeve and a second sleeve. The first sleeve and the second sleeve are sleeved on the pressure bar in an up and down arrangement, and the upper end of the first sleeve abuts against the pressure bar support module. The lower end of the first sleeve is threadedly connected to the upper end of the second sleeve, and the lower end of the second sleeve is used to abut against the surface of the femur.
[0012] Preferably, an external thread is provided on the outer surface of the lower end of the first sleeve, and an internal thread is provided on the inner wall of the upper end of the second sleeve. The lower end of the first sleeve is inserted into the upper end of the second sleeve and threadedly connected together.
[0013] Preferably, a plurality of reference holes are provided at intervals along the up and down direction of the second sleeve, and a length reference structure is formed between the reference holes.
[0014] Preferably, the reference holes are distributed at the lower end of the second sleeve.
[0015] Compared with the prior art, the non-contact lever adjusting device for femoral intramedullary nail of the present invention can accommodate the patient's leg in the accommodating space enclosed between the first adjusting member and the second adjusting member by adding the first adjusting member and the second adjusting member, and the card slot of the first adjusting member is clamped on the lever support module. When the depth of the lever inserted into the distal femoral medullary cavity is too shallow, by adjusting the connection position of the side edge of the first adjusting member on the side edge of the second adjusting member up and down, the first adjusting member moves downward relative to the second adjusting member and presses down the lever support module, thereby driving the lever to move downward, so as to effectively adjust the insertion depth of the lever, avoid the phenomenon that the insertion depth of the lever is too shallow, ensure that the lever effectively and accurately presses on the intramedullary nail, and further ensure that the locking screw can be effectively inserted. Description of the Drawings
[0016] Figure 1 is a three-dimensional structure diagram of the non-contact lever adjusting device for femoral intramedullary nail of the present invention.
[0017] Figure 2 is a front view of the non-contact lever adjusting device for femoral intramedullary nail of the present invention.
[0018] Figure 3 is a connection structure diagram of the first adjusting member and the second adjusting member of the non-contact lever adjusting device for femoral intramedullary nail of the present invention.
[0019] Figure 4 is a structure diagram of the first adjusting member of the non-contact lever adjusting device for femoral intramedullary nail of the present invention.
[0020] Figure 5 is a partial structure diagram of the non-contact lever adjusting device for femoral intramedullary nail of the present invention.
[0021] Figure 6 is a structure diagram of the femur. Detailed Description of the Invention
[0022] In order to elaborate on the technical content and structural features of the present invention in detail, the following further description is provided in conjunction with the embodiments and the accompanying drawings.
[0023] Please refer to Figures 1 to 6, the non-contact bar adjusting device 100 for femoral intramedullary nail of the present invention includes a bar mechanism 1 for femoral intramedullary nail. The bar mechanism 1 for femoral intramedullary nail has a bar support module 11 and a bar 12 passing through the bar support module 11 in the up and down direction. The bar 12 is used to penetrate into the femur 200 and press against the intramedullary nail. The non-contact bar adjusting device 100 for femoral intramedullary nail further includes a first adjusting member 4 and a second adjusting member 5. The first adjusting member 4 is provided with a card slot 41 with an opening facing downwards. The first adjusting member 4 is arranged above the bar support module 11 and is clamped on the bar support module 11 through the card slot 41. The second adjusting member 5 is arranged below the first adjusting member 4. The side of the first adjusting member 4 is connected to the side of the second adjusting member 5 in a vertically adjustable manner, and a receiving space 6 for receiving the leg is defined between the first adjusting member 4 and the second adjusting member 5. Among them, the specific structure and principle of the bar support module 11 are well-known to those skilled in the art, so they will not be elaborated here.
[0024] When the insertion depth of the bar 12 into the distal medullary cavity 201 of the femur 200 is too shallow, by vertically adjusting the connection position of the side of the first adjusting member 4 on the side of the second adjusting member 5, the first adjusting member 4 moves downward relative to the second adjusting member 5 and presses down the bar support module 11, thereby driving the bar 12 to move downward, so as to effectively adjust the insertion depth of the bar 12, avoid the phenomenon that the insertion depth of the bar 12 is too shallow, and ensure that the bar 12 effectively and accurately presses on the intramedullary nail.
[0025] Please refer to Figures 1 to 4 , in an embodiment, the non-contact bar adjusting device 100 for femoral intramedullary nail of the present invention further includes a first locking member 7. The side of the first adjusting member 4 is further provided with a connection hole 42, and a plurality of adjusting holes 51 arranged at intervals are provided on the side of the second adjusting member 5 in the up and down direction; by passing the first locking member 7 through the connection hole 42 and one of the adjusting holes 51, the positions of the first adjusting member 4 and the second adjusting member 5 are locked. When it is necessary to vertically adjust the first adjusting member 4, the first adjusting member 4 and the second adjusting member 5 can be unlocked through the first locking member 7, so that the first adjusting member 4 can be vertically adjusted relative to the second adjusting member 5, so that the connection hole 42 corresponds to another adjusting hole 51, and then the first locking member 7 is passed through the connection hole 42 and one of the adjusting holes 51 to lock the adjusted position of the first adjusting member 4. Specifically, the first locking member 7 can be a bolt member. The first locking member 7 is threadedly connected to the connection hole 42. By screwing the first locking member 7, the first locking member 7 is disengaged from the connection hole 42 and the adjusting hole 51 to adjust the position of the first adjusting member 4. The first locking member 7 is re-passed through the connection hole 42 and another adjusting hole 51 and threadedly locked, so as to lock the positions of the first adjusting member 4 and the second adjusting member 5. In other alternative embodiments, the first locking member 7 can also be threadedly connected to the adjusting hole 51, but not limited thereto.
[0026] Please refer toFigures 1 to 4 In one embodiment, the non-contact pressure rod adjusting device 100 of the femoral intramedullary nail of the present invention further includes a second locking member 8. A first locking hole 43 communicating with the card slot 41 is provided on the side of the first adjusting member 4. The second locking member 8 passes through the first locking hole 43 and abuts against the pressure rod support module 11 to lock the first adjusting member 4 and the pressure rod support module 11 together. By providing the second locking member 8, the first adjusting member 4 is stably positioned on the pressure rod support module 11 in the horizontal direction. Specifically, the second locking member 8 is a bolt member, and the second locking member 8 is threadedly connected to the first locking hole 43, but it is not limited thereto.
[0027] Please refer to Figures 1 to 4 In one embodiment, the non-contact pressure rod adjusting device 100 of the femoral intramedullary nail of the present invention further includes a third locking member 9. A second locking hole 44 communicating with the card slot 41 is provided on the upper part of the first adjusting member 4. The third locking member 9 passes through the second locking hole 44 and abuts against the pressure rod support module 11 to lock the first adjusting member 4 and the pressure rod support module 11 together. By providing the third locking member 9, the first adjusting member 4 is stably positioned on the pressure rod support module 11 in the up and down direction. Specifically, the third locking member 9 is a bolt member, and the third locking member 9 is threadedly connected to the second locking hole 44, but it is not limited thereto.
[0028] Please refer to Figures 2 to 4 In one embodiment, the first adjusting member 4 includes a first cross bar portion 45 and a first side bar portion 46 formed by bending and extending downward from one end of the first cross bar portion 45. Two spaced protrusions 451 are provided on the bottom surface of the first cross bar portion 45, and the card slot 41 is formed between the two protrusions 451. Specifically, the connection holes 42 are distributed on the first side bar portion 46, the first locking holes 43 are distributed on the protrusions 451 in the outer position, and the second locking holes 44 are distributed on the first cross bar portion 45. However, the structure of the first adjusting member 4 is not limited thereto.
[0029] Please refer to Figure 2 and Figure 3 In one embodiment, the second adjusting member 5 includes a second side bar portion 52, a second cross bar portion 53 and a third side bar portion 54. The second side bar portion 52 and the third side bar portion 54 are respectively arranged in the up and down direction, the second cross bar portion 53 is arranged in the horizontal direction, and one end of the second cross bar portion 53 is connected to the lower end of the second side bar portion 52, and the other end of the second cross bar portion 53 is connected to the lower end of the third side bar portion 54. Specifically, the adjusting holes 51 are distributed in the up and down direction on the second side bar portion 52. However, the structure of the second adjusting member 5 is not limited thereto.
[0030] Please refer to Figure 1 、 Figure 5 and Figure 6, in one embodiment, the non-contact pressure rod adjusting device 100 of the femoral intramedullary nail of the present invention further includes a first sleeve 2 and a second sleeve 3. The first sleeve 2 and the second sleeve 3 are sleeved on the pressure rod 12 in an up-and-down arrangement. The upper end of the first sleeve 2 abuts against the pressure rod support module 11, and the lower end of the first sleeve 2 is threadedly connected to the upper end of the second sleeve 3. The lower end of the second sleeve 3 is used to abut against the surface of the femur 200. When the depth of the pressure rod 12 inserted into the distal medullary cavity 201 of the femur 200 is too deep, since the lower end of the first sleeve 2 is threadedly connected to the upper end of the second sleeve 3, the relative rotation of the first sleeve 2 and the second sleeve 3 can be driven to extend the overall length of the first sleeve 2 and the second sleeve 3, so as to push the pressure rod support module 11 upward through the first conduit, drive the pressure rod 12 to move upward, and thus adjust the insertion depth of the pressure rod 12 to avoid overpressure of the pressure rod 12.
[0031] Please refer to Figure 1 , in one embodiment, the outer surface of the lower end of the first sleeve 2 is provided with an external thread, and the inner wall of the upper end of the second sleeve 3 is provided with an internal thread. The lower end of the first sleeve 2 is inserted into the upper end of the second sleeve 3 and threadedly connected together.
[0032] In another embodiment, the outer surface of the upper end of the second sleeve 3 is provided with an external thread, and the inner wall of the lower end of the first sleeve 2 is provided with an internal thread. The upper end of the second sleeve 3 is inserted into the lower end of the first sleeve 2 and threadedly connected together.
[0033] Please refer to Figure 1 , in one embodiment, the second sleeve 3 is provided with a plurality of reference holes 31 at intervals along its up-and-down direction, and a length reference structure is formed between the reference holes 31. In the actual application process, the lower end of the second sleeve 3 is located inside the body. Due to the magnification of fluoroscopy, when performing fluoroscopic X-rays, the length reference structure formed between the reference holes 31 can be used as a reference to facilitate knowing the length of the fluoroscopy, playing a role similar to a scale. Further, the reference holes 31 are distributed at the lower end of the second sleeve 3, so as to fully ensure that when the lower end of the second sleeve 3 abuts against the surface of the femur 200, at least a part of the reference holes 31 can be located inside the body.
[0034] Combined with Figures 1 to 6 , the specific working principle of the non-contact pressure rod adjusting device 100 of the femoral intramedullary nail of the present invention is as follows:
[0035] When it is found during the operation through X-ray fluoroscopy that the pressing rod 12 cannot effectively and accurately press on the intramedullary nail due to too shallow insertion, the gap length between the end of the pressing rod 12 and the intramedullary nail can be estimated according to the X-ray fluoroscopy situation. The gap length is, for example, x centimeters. The first adjusting member 4 is arranged above the pressing rod support module 11 and is clamped on the pressing rod support module 11 through the card slot 41, and the first adjusting member 4 is locked on the pressing rod support module 11 through the second locking member 8 and the third locking member 9. The second adjusting member 5 is arranged at the rear side of the operator's leg, compressing the soft tissue at the rear side of the leg. The first adjusting member 4 and the second adjusting member 5 are locked together by the first locking member 7, so that the operator's leg is located in the accommodating space 6. According to the estimated length by fluoroscopy, loosen the first locking member 7 to unlock the first adjusting member 4 and the second adjusting member 5, press down the first adjusting member 4, so as to drive the pressing rod support module 11 and the pressing rod 12 to move down by x centimeters together, and then lock the first adjusting member 4 and the second adjusting member 5 together again by the first locking member 7. Fluoroscope again to confirm that the pressing rod 12 has reached the upper edge of the intramedullary nail, and the pressing rod 12 accurately presses on the intramedullary nail. Finally, perform the subsequent operations of drilling and inserting locking nails.
[0036] When it is found during the operation through X-ray fluoroscopy that the pressing rod 12 cannot effectively and accurately press on the intramedullary nail due to too deep insertion, the over-depth length can be estimated according to the X-ray fluoroscopy situation. The over-depth length is, for example, x centimeters. The lower end of the second sleeve 3 is abutted against the distal bone cortex surface of the femur 200, and the upper end of the first sleeve 2 is abutted against the pressing rod support module 11. According to the estimated length by fluoroscopy, by means of screwing, drive the first sleeve 2 and the second sleeve 3 to rotate relatively, so as to extend the total length of the first sleeve 2 and the second sleeve 3. The extended total length is x centimeters, so as to push up the pressing rod support module 11 through the first conduit, so as to drive the pressing rod 12 to move up by x centimeters. Fluoroscope again to confirm that the pressing rod 12 has reached the upper edge of the intramedullary nail, and the pressing rod 12 accurately presses on the intramedullary nail. Finally, perform the subsequent operations of drilling and inserting locking nails.
[0037] In summary, the non-contact pressure rod adjusting device 100 of the femoral intramedullary nail of the present invention can accommodate the patient's leg in the accommodating space 6 enclosed between the first adjusting member 4 and the second adjusting member 5 by adding the first adjusting member 4 and the second adjusting member 5, and the card slot 41 of the first adjusting member 4 is clamped on the pressure rod support module 11. When the insertion depth of the pressure rod 12 into the distal medullary cavity 201 of the femur 200 is too shallow, by adjusting the connection position of the side of the first adjusting member 4 on the side of the second adjusting member 5 up and down, the first adjusting member 4 moves downward relative to the second adjusting member 5 and presses down the pressure rod support module 11, thereby driving the pressure rod 12 to move downward to effectively adjust the insertion depth of the pressure rod 12, avoiding the phenomenon that the insertion depth of the pressure rod is too shallow, ensuring that the pressure rod 12 effectively and accurately presses on the intramedullary nail, and further ensuring that the locking screw can be effectively inserted. The non-contact pressure rod adjusting device 100 of the femoral intramedullary nail of the present invention also adds the first sleeve 2 and the second sleeve 3. By sleeving the first sleeve 2 and the second sleeve 3 on the pressure rod 12 in an up-and-down arrangement, the upper end of the first sleeve 2 is abutted against the pressure rod support module 11, the lower end of the first sleeve 2 is threadedly connected to the upper end of the second sleeve 3, and the lower end of the second sleeve 3 is abutted against the surface of the femur 200. When the insertion depth of the pressure rod 12 into the distal medullary cavity 201 of the femur 200 is too deep, the relative rotation of the first sleeve 2 and the second sleeve 3 can be driven to extend the total length of the first sleeve 2 and the second sleeve 3, thereby pushing up the pressure rod support module 11 through the first conduit to drive the pressure rod 12 to move upward, so as to adjust the insertion depth of the pressure rod 12, avoid the overpressure phenomenon of the pressure rod 12, ensure that the pressure rod 12 effectively and accurately presses on the intramedullary nail, and further ensure that the locking screw can be effectively inserted, avoid drilling holes multiple times to adjust the position of the pressure rod, reduce the bone injury of the patient, avoid iatrogenic fractures caused by multiple drillings, reduce the number of repeated fluoroscopies, effectively reduce the operation time, reduce the bleeding phenomenon, and reduce other risks such as infections and blood transfusions.
[0038] The above-disclosed are only the preferred examples of the present invention and cannot be used to limit the scope of the rights of the present invention. Therefore, equivalent changes made according to the claims of the present invention all fall within the scope covered by the present invention.
Claims
1. A contactless pressure rod adjustment device for a femoral intramedullary nail, comprising an intramedullary nail pressure rod mechanism, wherein the intramedullary nail pressure rod mechanism comprises a pressure rod support module and a pressure rod penetrating the pressure rod support module in the up-down direction, wherein the pressure rod is used to penetrate into the femur and press against the intramedullary nail, and wherein: The contactless pressure rod adjustment device for the femoral intramedullary nail also includes a first adjusting member and a second adjusting member. The first adjusting member is provided with a downward opening slot. The first adjusting member is arranged above the pressure rod support module and is clamped on the pressure rod support module through the slot. The second adjusting member is arranged below the first adjusting member. The side of the first adjusting member is connected to the side of the second adjusting member so that its position can be adjusted up and down, and an accommodating space for accommodating legs is surrounded by the first adjusting member and the second adjusting member.
2. The contactless pressure rod adjustment device for femoral intramedullary nail according to claim 1, characterized in that: It also includes a first locking piece, a connecting hole is provided on the side of the first adjusting piece, and a plurality of adjusting holes arranged at intervals are provided on the side of the second adjusting piece along the up and down directions; the first locking piece is passed through the connecting hole and one of the adjusting holes to lock the positions of the first adjusting piece and the second adjusting piece.
3. The contactless pressure rod adjustment device for femoral intramedullary nail according to claim 1, characterized in that: It also includes a second locking piece, the side of the first adjusting piece is provided with a first locking hole connected to the card slot, the second locking piece passes through the first locking hole and abuts against the pressure rod bracket module to lock the first adjusting piece and the pressure rod bracket module together.
4. The contactless pressure rod adjusting device for femoral intramedullary nail according to claim 1, characterized in that: It also includes a third locking piece. The upper part of the first adjusting piece is provided with a second locking hole connected to the card slot. The third locking piece passes through the second locking hole and abuts against the pressure rod support module to lock the first adjusting piece and the pressure rod support module together.
5. The contactless pressure rod adjusting device for femoral intramedullary nail according to claim 1, characterized in that: The first adjusting member includes a first crossbar portion and a first sidebar portion bent downward and extended from one end of the first crossbar portion. The bottom surface of the first crossbar portion is provided with two protrusions arranged at intervals, and the clamping groove is formed between the two protrusions.
6. The contactless pressure rod adjusting device for femoral intramedullary nail according to claim 1, characterized in that: The second adjusting member includes a second side rod portion, a second cross rod portion and a third side rod portion, the second side rod portion and the third side rod portion are respectively arranged in the up and down directions, the second cross rod portion is arranged in the horizontal direction, and one end of the second cross rod portion is connected to the lower end of the second side rod portion, and the other end of the second cross rod portion is connected to the lower end of the third side rod portion.
7. The contactless pressure rod adjusting device for femoral intramedullary nail according to claim 1, characterized in that: It also includes a first sleeve and a second sleeve, the first sleeve and the second sleeve are arranged in an upper and lower manner and are sleeved on the pressure rod, and the upper end of the first sleeve abuts against the pressure rod support module, the lower end of the first sleeve is threadedly connected to the upper end of the second sleeve, and the lower end of the second sleeve is used to abut against the surface of the femur.
8. The contactless pressure rod adjusting device for femoral intramedullary nail according to claim 7, characterized in that: The outer surface of the lower end of the first sleeve is provided with an external thread, the inner wall of the upper end of the second sleeve is provided with an internal thread, and the lower end of the first sleeve is inserted into the upper end of the second sleeve and threadedly connected together.
9. The contactless pressure rod adjusting device for femoral intramedullary nail according to claim 7, characterized in that: The second sleeve is provided with a plurality of reference holes at intervals along the up-and-down direction thereof, and a length reference structure is formed between the reference holes.
10. The contactless pressure rod adjusting device for femoral intramedullary nail according to claim 9, characterized in that: The reference holes are distributed at the lower end of the second sleeve.