Rib contractor and tensioner

Abstract

To provide a rib contractor that enables firm joint of breast bones cut and separated to right and left such that the breast bones are not positionally deviated, and also enables suture of skin.SOLUTION: A rib contractor includes: a rope having a predetermined length, obtained by twisting a plurality of filaments to have a predetermined thickness, and having a semi-circular sharp hook provided in a distal end thereof; and a first crimp obtained by fixing a first crush member onto a thin rectangular plate, the first crush member being formed with a pipe line to which the rope is freely inserted. The rope is inserted into a body from one side end of a breast bone body by using the hook and drawn to the outside from the other side end, each end of the rope is inserted into the first crimp, the first crimp is arranged orthogonally to the breast bone body, and the first crush member is crushed.SELECTED DRAWING: Figure 9

Description

[Technical Field]

[0001] The present invention relates to a chest closure device that joins the sternum after opening the sternum for cardiac surgery or respiratory surgery and before suturing the skin, and a tensioner that is used to apply tension when joining the sternum with the chest closure device. [Background technology]

[0002] During cardiac or thoracic surgery, a surgical procedure called median sternotomy is sometimes used, in which the sternum is cut vertically down the center, separated into left and right halves, and then secured with a thoracotomy. When using this procedure, a thoracotomy is required to remove the thoracotomy after the surgery is completed and reconnect the separated sternum. A clip made of a shape-memory alloy with curved hooks on both ends and a flexible loop in the center has been proposed as a thoracotomy device (Patent Document 1). This clip grips the separated left and right sternum halves with the hooks. When the temperature of the loop reaches or exceeds its shape recovery temperature, the loop shape returns to its memorized shape, reducing the distance between the hooks and reconnecting the separated left and right sternum. Another proposed clip has a hook folded back midway to increase the contact area between the sternum and the clip (Patent Document 2). In addition, Patent Document 2 shows in Figure 20 a chest closing device made by Muranaka Medical Instruments Co., Ltd., which is equipped with a pair of clamping members A on the left and right sides that clamp the incised sternum that has been opened on both sides from the outside in the left and right direction, a rack and pinion mechanism B that adjusts the distance between the clamping members A, and a handle C that manually rotates the pinion gear of the rack and pinion mechanism B.

[0003] However, when the sternum is joined using the clips or chest closure devices shown in Patent Documents 1 to 3, the left and right sternums may shift up and down and / or forward and backward, which takes time to join and may cause the ribs to be unbalanced. Therefore, a chest closure device has been proposed that consists of a box containing an extension mechanism that engages the tips of curved engaging bodies with the sternum or ribs and expands or contracts the opposing distance between the engaging bodies when the operating part is rotated (see Patent Document 3). This chest closing device brings the incised sternum closer by shortening the distance between the engaging bodies while the bottom of the box is in contact with the incised sternum, thereby eliminating misalignment in the up-down and front-back directions. Also, to reduce the opposing distance between the engaging bodies, a through-path is provided on the bottom of the box so that the engaging bodies can move. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] U.S. Patent No. 6,969,391 [Patent Document 2] Patent No. 7178618 [Patent Document 3] Patent No. 7188719 Summary of the Invention [Problem to be solved by the invention]

[0005] The chest closure device described in Patent Document 3 can reconnect the separated left and right sternums without causing misalignment, but the box housing the extension mechanism requires a certain height, and a handle must be installed on the top surface of the box to adjust the distance between the engaging bodies, which makes the height quite high. Therefore, even if it can prevent misalignment of the sternum, it makes it difficult to suture the skin, and post-operative care is necessary. In view of the above circumstances, the object of the present invention is to provide a chest closing device that firmly joins the sternum, which has been separated into left and right parts by median sternotomy, so that it does not move up and down or left and right and cause displacement, that allows for skin suturing, that can be left in the body even after the sternum has healed, and that can be used to quickly deal with cases where the patient's condition suddenly changes after the chest has been closed and it becomes necessary to reopen the chest. [Means for solving the problem]

[0006] The first invention is a chest closure device for reconnecting a sternum separated by a median sternotomy, comprising: a rope of a predetermined length made by twisting together multiple wires made of ELI titanium alloy material to a predetermined thickness and having a sharp semicircular hook at the tip; and a first crimp having a first crushing member formed with a duct through which the rope can be freely inserted, fixed on a thin rectangular plate; the rope is inserted into the body from one side end of the sternal body using the hook, and the rope is pulled out from the body from the other side end via the back side of the sternal body, with each end of the rope passed through the first crushing member so that the first crimp is positioned perpendicular to the sternal body; one end of the rope is fixed and the other end is pulled, and after the sternum has been reconnected, the first crushing member is crushed. In this case, holes are made with the hook at symmetrical positions on the left and right sides of the separated manubrium, and the rope is inserted into the body through one hole, and the ends of the rope are pulled out of the body through the other hole, and the first crimp is inserted into the first crushing member, and the first crimp is positioned perpendicular to the manubrium, and the first crimp is also positioned perpendicular to each intercostal space of the sternal body, thereby crushing each of the first crushing members. It is preferable that the first crushing member has a height of less than 5 mm, that two conduits are formed, and that one end of the rope is inserted into one of the conduits and the other end is inserted into the other conduit. By using a chest closure device that has a rope of a specified diameter with a hook at the end, one or two canals through which the rope passes, and a first crimp consisting of a thin rectangular plate and a first crushing member that fixes the rope inside the canal by crushing it, the sternum separated into left and right sides by median sternotomy can be firmly joined together to prevent it from moving up and down or left and right and becoming displaced, and the skin can be sutured. Furthermore, if postoperative symptoms worsen and emergency surgery is required, the rope can be cut with a cutter to quickly reopen the chest.

[0007] The second invention is a chest closure device for performing a median sternotomy and rejoining the separated sternum, comprising: a rope of a predetermined length made of multiple wires made of ELI titanium alloy twisted together to a predetermined thickness and equipped with sharp hooks at the ends; and a second crimp fixed to the center of a first rectangular thin plate-like member, wherein second thin rectangular plate-like members perpendicular to the first plate-like member are connected to each end of the long sides of the first thin plate-like member, and a second crushing member having a duct through which the rope can be freely inserted is formed. The second crimp is positioned perpendicular to the sternal body, and the rope is inserted into the body from one side end using the hooks, and is pulled out from the body from the other side end via the back side of the sternal body. The second crushing member is then inserted into the body from the other side end, and the second crimp is positioned perpendicular to the sternal body. One end of the rope is fixed and the other end is pulled, and the sternum is joined together, and then the second crushing member is crushed. In this case, holes are made with the hook at symmetrical positions on the separated manubrium, and the rope is inserted into the body through one hole and pulled out from the body through the other hole. Each end of the rope is then inserted into the second crushing member to form the second crimp, which is then positioned perpendicular to the manubrium, and second crimps can also be positioned perpendicularly between the third and fourth ribs and between the fifth and sixth ribs on the body of the sternum to crush each of the second crushing members. It is preferable that the second crushing member has a height of less than 3 mm, has two conduits formed therein, and has one end of the rope inserted into one of the conduits and the other end inserted into the other conduit. In this way, by connecting second plate-like members perpendicular to each other near the long edge of the first plate-like member and providing a second crimp with a second crushing member fixed to the center of the first plate-like member through which a rope is passed, the area of ​​contact with the sternum is substantially larger than that of the first crimp of the first invention, preventing the sternum from moving up and down or left and right and shifting position, and firmly joining the sternum and allowing the skin to be sutured. Furthermore, if postoperative symptoms worsen and emergency surgery is required, the thoracotomy can be quickly reopened, just as in the first invention.

[0008] The tensioner of the third invention comprises a first pipe through which a rope of a predetermined diameter passes, a second pipe having a fixing means joined to its inner surface for fixing the first pipe inserted inside and the rope inserted into the first pipe and having a male thread formed on its outer surface, a cylindrical housing that covers a part of the second pipe, and a cylindrical portion having an opening that abuts the open end of the housing and having a female thread formed on its inner surface that screws onto the second pipe, wherein a handle is provided on the closed outer surface of the cylindrical portion, and when the handle is turned by hand, the first pipe fixed to the fixing means moves in and out of the housing, pulling the rope. An elastic member is provided in the internal space of the cylindrical portion that moves by being threadedly engaged with the second pipe, and the pulling force of the rope can be limited to 600 Newtons or less. With the use of a special tool for pulling the rope, the sternum can be quickly reattached using a chest closure. [Effects of the Invention]

[0009] The chest closure device of the present invention can reconnect the sternum, which has been separated into left and right halves by median sternotomy, without causing misalignment. Furthermore, since the height is less than 5 mm, it is possible to suture the skin and leave it in place even after the sternum has healed. Furthermore, if it becomes necessary to reopen the chest after closure, the rope can be cut to quickly open the chest. [Brief explanation of the drawings]

[0010] [Figure 1] FIG. 1 is a diagram showing an example of a rope constituting the chest closing device of this embodiment. [Figure 2(a)] FIG. 2(a) is a plan view showing an example of a first crimp constituting the chest closure device of this embodiment. [Figure 2(b)] FIG. 2(b) is a front view showing an example of a first crimp constituting the chest closure device of this embodiment. [Figure 2(c)] FIG. 2(c) is a side view showing an example of a first crimp constituting the chest closure device of this embodiment. [Figure 3(a)]FIG. 3(a) is a plan view showing another example of the first crimp constituting the chest closure device of this embodiment. [Figure 3(b)] FIG. 3(b) is a front view showing another example of the first crimp constituting the chest closure device of the first invention. [Figure 3(c)] FIG. 3(c) is a side view showing another example of the first crimp constituting the chest closure device of the first invention. [Figure 4] FIG. 4 is a diagram showing the position where the rope of this embodiment is inserted at the side end of the sternum. [Figure 5] FIG. 5 shows an example of placing the chest closing device of this embodiment on the manubrium and body of the sternum and joining the separated sternum. [Figure 6] FIG. 6 is a diagram showing a method for pulling the rope of the chest closing device of this embodiment to join the sternum. [Figure 7(a)] FIG. 7(a) is a plan view showing an example of the second crimp of this embodiment. [Figure 7(b)] FIG. 7(b) is a front view showing an example of the second crimp of this embodiment. [Figure 8] FIG. 8 is a diagram showing the position where the rope of this embodiment is inserted at the side end of the sternum. [Figure 9] FIG. 9 shows an example of joining the separated sternum by placing the chest closing device of this embodiment on the manubrium and body of the sternum. [Figure 10] FIG. 10 is an external view showing the tensioner of this embodiment. [Figure 11] FIG. 11 is a cross-sectional view showing the tensioner of this embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0011] Hereinafter, embodiments of the chest closure devices of the first and second inventions, and an embodiment of the tensioner of the third invention will be described with reference to the drawings. [Embodiment of the First Invention] 1 to 3 are diagrams showing an embodiment of the chest closure device of the first invention, in which FIG. 1 is a diagram showing the rope that constitutes the chest closure device, and FIGS. 2 and 3 are diagrams showing the first crimp that constitutes the chest closure device. FIG. 1 is a diagram showing an example of a rope constituting the chest closing device of this embodiment. The rope 10 shown in Figure 1 is made of three or seven titanium alloy wires twisted together, has an outer diameter of 1.0 mm, and a total length of 500 mm. One end has a semicircular hook 11 with a sharp tip attached, which can be used to pull the rope 10 around the sternum. This wire is made of what is known as extra-low interstitial element (ELI) material, which has low oxygen, nitrogen, hydrogen, and iron content, and is a representative type of titanium for medical use. It has excellent low-temperature toughness, and the rope 10 of this embodiment can withstand a tension of 1,600 Newtons.

[0012] Fig. 2 is a diagram showing an example of a first crimp constituting the chest closure device of this embodiment, and Fig. 3 is a diagram showing another example. In Fig. 2 and Fig. 3, (a) is a plan view, (b) is a front view, and (c) is a side view. The first crimp 20 shown in Figures 2 and 3 has a first crushing member 23 made of titanium alloy, on which two pipe lines 22 with circular cross-sections are formed, fixed. The first crimp 20, an example of which is shown in Figure 2, has a plate 21 with a long side of 26 mm, a short side of 6 mm, and a thickness of 0.1 mm, on which a first crushing member 23 with a length of 25 mm and a rectangular cross section of 3.8 mm x 2 mm, in which two ducts 22 with an outer diameter of 2 mm are formed, is fixed, and the first crimping member 23 has a height of 2.1 mm. Another example of a first crimp 20 shown in Figure 3 has a rectangular cross section of 4.2 mm x 2.9 mm, with two ducts 22 each with an outer diameter of 2 mm formed on a plate 21 with a long side of 29 mm, a short side of 8.2 mm, and a thickness of 0.5 mm, a first crushing member 23 with a length of 25 mm fixed thereto, and a height of 3.39 mm. The values ​​shown here are merely examples and are not necessarily limited to these. However, if the height of the first crushing member 23 is set to less than 4 mm, the plate 21 that fixes the first crushing member 23 is also extremely thin, so the height of the chest closure device 1 placed on the sternum is less than 5 mm, making it possible to suture the skin immediately after placing the chest closure device 1. Furthermore, since the plate 21 of the latter first crimp 20 is larger and thicker than that of the former first crimp 20, it is easier to prevent shaking up and down and left and right and to eliminate positional displacement.

[0013] FIG. 4 is a diagram showing the position where the rope of this embodiment is inserted at the side end of the sternum. As shown in Figure 4, the sternum 30 consists of a manubrium 31, a sternal body 32, and a xiphoid process 33, and seven ribs 34 are connected to it symmetrically on both sides. Six ropes 10 are inserted to connect the sternum 30 using the chest closing device 1 of this embodiment. Four holes 36 are opened symmetrically on both the upper and lower parts of the manubrium 31 using hooks (not shown) 11 at the ends of the ropes 10. Two ropes 10 are inserted into one of the symmetrical holes 36 opened in the manubrium 31 and pulled out from the other hole 26. After the ropes 10 are inserted, the hooks (not shown) 11 at the ends of the ropes 10 are cut off with a cutter (not shown). In the sternal body 32, four ropes 10 are inserted into the side ends 37 of each intercostal space 35 from the second rib 342 to the sixth rib 346 using hooks (not shown) 11 at the ends of the ropes 10, and the ropes 10 are pulled out from the opposite side ends 37 via the back side of the sternal body 32, and the four ropes 10 are passed through. After the rope hooks are passed through, they are cut with a cutter (not shown).

[0014] FIG. 5 shows an example of placing the chest closing device of this embodiment on the manubrium and body of the sternum and joining the separated sternum. As shown in Figure 5, the chest closure device 1 of this embodiment has two first crimps 20 on the manubrium 31 and four first crimps 20 arranged orthogonally between the intercostals 35 of the sternal body 32. A rope 10 is inserted through each of the ducts (not shown) 22 of the first crushing member 23 arranged on the manubrium 31, and the ends of the rope 10 are pulled with both hands to fix the position of the first crimp 20. Next, one end of the rope 10 is grasped with an instrument (not shown) and the other rope 10 is pulled with another instrument (not shown) to tighten the rope 10 until the left and right sternum 30 are joined. The ducts 22 of the first crushing member 23 are then crushed with the instrument, firmly fixing the ropes 10 inserted through the ducts 22. Any excess rope 10 protruding from the first crushing member 23 is cut with a cutter (not shown). Here, in this embodiment, two pipelines (not shown) 22 are formed in first crushing member 23, but it is not necessary to form two pipelines; it is also possible to form one pipeline and insert rope 10 from both sides to tighten it. However, if the rope 10 is inserted into each of the two pipelines and crushed, each of the ropes 10 inserted into each pipeline will be reliably pressed and therefore reliably fixed.

[0015] FIG. 6 is a diagram showing a method for pulling the rope of the chest closing device of this embodiment to join the sternum. As shown in Figure 6, the rope 10 is inserted into one of the two conduits (not shown) 22 formed in the first crushing member 23, and the rope 10 is gripped with a crimper 50 to secure the rope 10 so that it does not move. Next, the tip of the other rope 10 inserted into the other conduit (not shown) 22 is inserted into the first pipe 42 of the tensioner 40, and the rope 10 is secured to the internal second pipe 43 with the thumbscrew 45 of the tensioner 42. Then, the handle 41 is turned by hand to move the first pipe 42 and the second pipe 43, pulling the rope 10 and joining the separated sternum. The pulling force on the rope 10 is limited to a maximum of 600 N by an internal helical spring (not shown). Here, crimper 50 can be used as a tool for crushing each of the conduits (not shown in the figure) 22 of first crushing member 23 and fixing inserted rope 10 so as not to move, or as a tool for fixing gripped rope 10 so as not to move. If first crushing member 23 has two conduits 22, it is advisable to crush each of the conduits with crimper 50 from both sides of the opposing longitudinal direction of the two conduits 22. The tensioner 40 is a dedicated device for pulling the rope 10 constituting the chest closure device 1 with a predetermined force, and its structure etc. will be described later as a third invention.

[0016] [Embodiment of the Second Invention] The chest closure device of the second invention is composed of a rope and a second crimp, but since the structure of the rope is the same as that described in the embodiment of the first invention, drawings and explanations will be omitted, and the chest closure device of this embodiment will be described in terms of the second crimp. FIG. 7 shows an example of the second crimp of this embodiment, where (a) is a plan view and (b) is a side view. An example of second crimp 25 shown in Figure 7 is made up of a thin, rectangular first plate-like member 26 made of a titanium alloy, and second plate-like members 27 perpendicular to first plate-like member 26 are joined to each end of the long side of the first plate-like member 26, and a second crushing member 28 having two circular pipes 22 formed therein for inserting rope 10 is fixed to the center of first plate-like member 26. Here, the first plate-like member 26 is a rectangular plate with long sides of 30 mm, a width of 4.5 mm, and a thickness of 0.1 mm, and the second plate-like member 27 is a rectangular plate with long sides of 15 mm, a width of 5 mm, and a thickness of 0.1 mm, both with rounded corners. The second crushable member 28 is 6 mm long, 4.5 mm wide, and 2.2 mm high, and the diameter of the two ducts 22 is 2 mm, but this is not necessarily limited to these dimensions. However, if the height of the second crushable member 28 is set to less than 3 mm, the first plate-like member 26 that secures the second crushable member 28 is extremely thin, so the height of the chest closure device 2 placed on the sternum 30 will be 3 mm or less, and the skin can be sutured immediately after closing the chest with the chest closure device 2. Furthermore, the area of ​​the second crimp 25 that comes into contact with the sternum is larger than that of the first crimp 20 of the first invention, so that up-down and left-right movement is further suppressed, and the number of chest closure devices 2 that need to be attached to the sternum can be reduced.

[0017] FIG. 8 is a diagram showing the position where the rope of this embodiment is inserted at the side end of the sternum. As shown in Figure 8, the sternum 30 consists of a manubrium 31, a sternal body 32, and a xiphoid process 33, and seven ribs 34 are connected to each sternum 30 symmetrically. To join the sternum 30 with the chest closure device 2 of this embodiment, four ropes 10 are inserted through the sternal manubrium 31. Two holes 36 are opened symmetrically in the manubrium 31 using the hooks of the ropes 10. Then, one rope 10 is installed by inserting it into one of the holes 36 drilled in the manubrium 31 and pulling it out from the other hole 36. The hook at the end of the rope 10 is cut off with a cutter. The rope 11 is inserted into the side end 37 of the sternal body 32 at the hooks of the rope 10 at two locations, between the third rib 343 and the fourth rib 344, and between the fifth rib 345 and the sixth rib 346, and the rope 10 is pulled out from the opposite side end 37 via the back side of the sternal body 32, and the two ropes 10 are inserted. Then, the hooks at the ends of the ropes 10 are cut off with a cutter. Here, a rope is also inserted between the second rib 342 and the third rib 343, but this rope 10 is not necessarily required. When there is a risk that the sternum cannot be sufficiently joined by simply placing the chest closure devices 2 of this embodiment in three places, the rope is inserted to ensure the joining.

[0018] FIG. 9 shows an example of joining the separated sternum by placing the chest closing device of this embodiment on the manubrium and body of the sternum. As shown in FIG. 9, the chest closure device 2 of this embodiment is placed between the manubrium 31, the third rib 343 and the fourth rib 344, and the fifth rib 345 and the sixth rib 346. Depending on the situation, the chest closing device 1 described as an embodiment of the first invention is placed between the second rib 342 and the third rib 343. For the second crimp 25 of the chest closure device 2, one end of the rope 10 is inserted into one of the two ducts (not shown in the figure) 22 of the second crushing member 28, and the other end of the rope 10 is inserted from the opposite side into the other duct (not shown in the figure) 22. Then, the ropes 10 inserted into the two ducts (not shown in the figure) 22 are pulled with both hands, and the second crimp 25 is fixed in a predetermined position on the manubrium 31 or body 32 of the sternum. As with the second crushing member 28, the first crimp 20 of the chest closure device 1 is made by inserting a rope 10 into each of the two ducts 22 of the first crushing member 23 and pulling each end of the rope 10 with both hands to secure the first crimp 20 in place between the second rib 342 and the third rib 343. 6, one end of the rope 10 is gripped with a crimper 50 (not shown) to fix it so that it does not move, and the other end of the rope 10 is inserted into the first pipe 42 of a tensioner 40 (not shown), and the rope 10 is fixed to the internal second pipe 43 with a thumbscrew 45 of the tensioner 40. Then, the handle 41 is turned by hand to move the first pipe 42 and the second pipe 43, pulling the rope 10 and joining the separated sternum 30. The pulling force on the rope 10 is limited to a maximum of 600N. Then, the pipes (not shown) 22 of the second crushing member 28 and the first crushing member 23 are crushed with clippers 50 (not shown), and the ropes 10 inserted into the pipes are firmly fixed so that they do not move. Any ropes 10 that protrude from the first crushing member 23 and the second crushing member 28 are cut off with a cutter (not shown). Here, two pipelines (not shown) 22 are formed in the first crushing member 23 and the second crushing member 28, but it is not necessary to form two pipelines; it is also possible to form one pipeline and insert the rope 10 from both sides and tighten it. However, if the rope 10 is inserted into each of the two pipelines and each pipeline is crushed, the rope 10 will be securely fixed in each pipeline. In addition, in this case, in addition to the chest closing device 2 of the second embodiment of the present invention, the chest closing device 1 of the first embodiment of the present invention is used in combination to join the sternum more reliably and safely, but it may be used in combination depending on the joining situation using the chest closing device 2, and is not necessarily required.

[0019] [Third embodiment of the invention] 10 and 11 are diagrams showing an embodiment of a tensioner according to the third invention, with FIG. 10 being an external view of the tensioner of this embodiment and FIG. 11 being a cross-sectional view of the tensioner of this embodiment. The tensioner 40 shown in Figures 10 and 11 is a device for inserting a rope 10 into each of the first crushing member 23 and the second crushing member 28, as described in Figures 6 and 9, and for pulling one end of the rope 10 fixed with a clipper 50. The tensioner 40 of this embodiment comprises a first pipe 42 into which the tip of the rope 10 is inserted, a second pipe 43 having a bolt (corresponding to the fixing means of the present invention) 44 joined to its inner surface for fixing the first pipe fitted inside and the rope inserted into the first pipe, a cylindrical housing 46 that covers part of the second pipe 43, and a cylindrical portion 47 that has an opening that abuts the open end 46a of the housing 46 and has a female thread 47a formed on its inner surface that screws into the second pipe 43. Further, a male thread 43a that screws into a female thread 47a of the cylindrical portion 47 is formed on the outer peripheral surface of the second pipe 43, and a manual handle 41 is provided on the outside of the closed surface of the cylindrical portion 47. A thumbscrew 45 screws into the bolt 44, and by turning the thumbscrew 45, the rope 10 inserted into the first pipe 42 can be fixed to the second pipe 43. Furthermore, by turning the handle 41 by hand, the second pipe 43 moves inside the housing 46, and the first pipe 42 fixed by the bolt 44 also moves in and out of the housing 46, so that the rope 10 inserted into and fixed to the first pipe 42 can be pulled. In addition, a helical spring 48 that regulates the pressing force is installed in the internal space of the cylindrical portion 47 that screws onto the second pipe 43, and the force with which the second pipe 43 moves and pulls the rope 10 is limited to 600 Newtons or less. When the handle 41 is turned to the left, the first pipe 42 and the second pipe 43 move away from the handle 41, weakening the pressing force of the helical spring 48. When the handle is turned to the right, the first pipe 42 moves inward into the housing 46, strengthening the pressing force of the helical spring 48, but when the pressing force reaches 600 N, the handle 41 will no longer turn. [Explanation of symbols]

[0020] 1, 2 Chest closure device 10 Rope 11 Hook 20 First Crimp 21 Plate 22 Conduit 23 First crushing member 25 Second Crimp 26 First plate-shaped member 27 Second plate-shaped member 28 Second crushing member 30 Sternum 31 Manubrium 32 Sternal body 33 Xiphoid process 34 Ribs 342 Second rib 343 Third rib 344 Fourth rib 345 Fifth rib 346 Sixth rib 35 intercostals 36 holes 37 side edge 40 Tensioner 41 Handle 42 First Pipe 43 Second Pipe 43a male thread 44 volts 45 Thumb screws 46 Case 46a End face 47 Cylindrical part 47a female thread 48 String spring 50 Clipper

Claims

1. A chest closure device for joining the sternum separated by median sternotomy, A rope of a specified length made of multiple strands of titanium alloy ELI material twisted together to a specified thickness, with a semicircular sharp hook at the end, A first crimp is provided, the first crushing member having a duct through which the rope can be freely inserted, fixed on a thin rectangular plate; The first crimp is arranged perpendicular to the sternum body, and one end of the rope is fixed and the other end is pulled to the outside of the body by inserting the rope into the body from one side end of the sternum body using the hook, and the rope is pulled out from the other side end of the sternum body to the outside of the body, and the first crimp is arranged perpendicular to the sternum body, and the first crimp is disposed perpendicular to the sternum body, and the first crimp is crushed after fixing one end of the rope and pulling the other end of the rope to join the sternum.

2. A chest closing device as described in claim 1, characterized in that holes are made with the hook at symmetrical positions on the left and right sides of the separated manubrium, the rope is inserted into the body through one hole, and the ends of the rope are pulled out from the body through the other hole, and each end is inserted into the first crushing member, so that the first crimp is positioned perpendicular to the manubrium, and the first crimp is also positioned perpendicular to each intercostal space of the sternal body to crush each of the first crushing members.

3. 2. The chest closing device according to claim 1, wherein the first crushing member has a height of less than 5 mm, two ducts are formed, one end of the rope is inserted into one of the ducts, and the other end of the rope is inserted into the other duct.

4. A chest closure device for performing a median sternotomy and joining the separated sternum, A rope of a specified length made of multiple strands of titanium alloy ELI material twisted together to a specified thickness, with a sharp hook at the end. a second crimp that fixes a second crushing member having a duct through which the rope can be freely inserted to a central portion of the first plate-like member, the second crushing member being formed by connecting a rectangular thin second plate-like member to each end of a long side of the first plate-like member, the second crimp being fixed to the central portion of the first plate-like member, The second crimp is arranged perpendicular to the sternum body, and one end of the rope is fixed and the other end is pulled to the outside of the body by inserting the rope into the body from one side end of the sternum body using the hook and passing the rope through the second crushing member. The second crimp is characterized in that the rope is inserted into the body from one side end of the sternum body using the hook and passing the rope through the other side end of the rope to the outside of the body from the back side of the sternum body and passing the rope through the second crushing member, and the second crimp is arranged perpendicular to the sternum body, and one end of the rope is fixed and the other end is pulled to join the sternum and then the second crushing member is crushed.

5. A chest closing device as described in claim 4, characterized in that holes are made with the hook at symmetrical positions on the separated manubrium, and the second crimp, in which the ends of the rope are inserted into the body through one hole and pulled out from the other hole and passed through the second crushing member, is positioned perpendicular to the manubrium, and second crimps are also positioned perpendicularly between the third and fourth ribs and between the fifth and sixth ribs of the sternal body to crush each of the second crushing members.

6. 5. The chest closing device according to claim 4, characterized in that the second crushing member has a height of less than 3 mm, two ducts are formed, one end of the rope is inserted into one of the ducts and the other end of the rope is inserted into the other duct.

7. A tensioner comprising: a first pipe through which a rope of a predetermined thickness passes; a second pipe having a fixing means joined to its inner surface for fixing the first pipe inserted inside and the rope inserted into the first pipe and having a male thread formed on its outer surface; a cylindrical housing covering a part of the second pipe; and a cylindrical portion having an opening that abuts the open end of the housing and having a female thread formed on its inner surface to screw into the second pipe, wherein a handle is provided on the closed outer surface of the cylindrical portion, and when the handle is turned by hand, the first pipe fixed to the fixing means moves in and out of the housing to pull the rope.

8. An elastic member is provided in an internal space of the cylindrical portion which moves by being screwed into the second pipe, 8. The tensioner of claim 7, wherein the pulling force of the rope is limited to 600 Newtons or less.

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