JP7758337B2 - Bone Fixation System - Google Patents

Description

The present invention relates to a bone fixation system.

Various bone fixation systems have been used in the past to fix a fracture by introducing multiple bone fixation devices toward the femoral head. For example, in the following Patent Document 1, multiple (three) sliding screws held by a plate fixed on the bone surface of the lateral part of the proximal femur are introduced toward the femoral head to fix the femoral head.

Meanwhile, a known CHS (compression hip screw) system with a plate fixed to the bone surface of the lateral portion of the proximal femur, as described in Patent Document 2, includes a tube 13 in which a cylindrical body 17 is integrated with the plate 15, a tube plate 5 configured to fit onto the plate 15, and a lag screw 25 inserted into the cylindrical body 17, with a detachable structure for the tube 13 and tube plate 5. In this case, as shown in Figure 6 of Patent Document 2, the tube plate 5 may be provided with an extension 51 with a hole 53, and a cortical screw (fixation screw) 55 may be screwed through the hole 53 toward the femoral head.

Japanese Patent Application Laid-Open No. 2018-015432 Japanese Patent Application Laid-Open No. 2003-038508

As mentioned above, in a bone fixation system in which multiple bone fixators held by a plate fixed on the bone surface of the lateral part of the proximal femur are introduced toward the femoral head, the bone shape and size of the proximal femur, the extent of the fracture, and the bone strength vary from patient to patient, so it may be necessary to set various positions for the bone fixator passage within the cross section of the femoral neck and the position within the femoral head that the tip of the bone fixator (screw portion) reaches. For this reason, it is necessary to select a plate in advance to suit the patient's condition, or to replace it with a plate of a different shape during surgery, thereby adjusting the position of the bone fixator to suit the patient's situation.

Furthermore, because the shape of the bone surface on the lateral side of the proximal femur varies from patient to patient, during actual surgery, depending on the positioning of the plate on the lateral side, the plate shape may not match the shape of the bone surface, which may compromise the stability of the plate on the bone surface on the lateral side. In particular, because the greater trochanter is located proximal to the lateral side where the plate is to be placed, the bone surface on the lateral side curves more significantly toward the proximal side. As a result, the curvature of the bone surface does not match the shape of the plate, making it impossible to place the plate in a stable state. This makes it difficult to ensure the support strength of the bone fixation device inserted into the femoral head, resulting in insufficient retention strength at the fracture site. Furthermore, because the shape of the bone surface on the lateral side interferes with the shape of the plate, the angle of plate placement may change, making it impossible to properly orient the bone fixation device toward the femoral head.

The present invention solves the above problems, and its objective is to optimize fracture fixation methods and improve the stability and retention strength of bone fixation by configuring bone fixation devices or plates so that their placement can be changed depending on the patient's condition.

In order to solve the above problems, the bone fixing system according to the present invention includes a first bone fastener and a second bone fastener, each of which is introduced from the lateral side toward the femoral head, a first holder that holds the first bone fastener at a first holding position, and a second holder that is configured to be engageable with the first holder and that holds the second bone fastener at a second holding position. In this bone fixing system, the first holder and the second holder are configured to be relatively movable in a movement direction in which the interval between the first holding position and the second holding position changes. The first holder and the second holder are configured to be positionable in a plurality of mutually different relative positional relationships along the movement direction , i.e., at a plurality of positions corresponding to a plurality of mutually different intervals . At this time, the multiple relative positional relationships , i.e., the multiple positions corresponding to the multiple intervals , are configured to be able to be maintained in a state in which the first bone fixation device introduced from the outer portion is held by the first holder at the first holding position, and the second bone fixation device introduced from the outer portion is held by the second holder at the second holding position.

In the present invention, it is preferable to further include a positioning means configured to be able to position the first holding body and the second holding body in a state where they are held so as not to move relative to each other in the movement direction at each of the plurality of relative positional relationships, i.e., at each of a plurality of positions corresponding to the plurality of intervals. This positioning means desirably has a first engaging portion provided on the first holding body, a second engaging portion provided on the second holding body, and engaging members that are respectively detachably engaged with the first engaging portion and the second engaging portion. This engaging member may be a screw that threads into at least one of the first engaging portion and the second engaging portion, and in particular may be a bone screw that is screwed into a bone, or a positioning engaging screw that is not screwed into a bone.

In these cases, it is desirable that the first engagement portion and the second engagement portion each be an engagement hole that can engage with the head of the engagement member, and that the other engagement hole include multiple hole portions arranged along the movement direction. Here, as will be described later, the multiple hole portions are not limited to being formed integrally within a single opening, but may instead be configured as an array of separate holes. Furthermore, it is even more desirable that the head of the engagement member includes a male thread, and that the engagement hole of one of the first engagement portion and the second engagement portion be a female-threaded screw hole that screws into the male thread of the head.

It is also desirable that the first engagement portion and the second engagement portion are each engagement holes that can engage with the head of the engagement member, and that the other engagement hole is an elongated hole aligned with the movement direction. In this case, it is even more desirable that the head of the engagement member includes a male thread, and that the engagement hole of one of the first engagement portion and the second engagement portion is an internally threaded screw hole that screws into the male thread of the head. In this case, it is even more desirable that the head of the engagement member includes a portion that can be fastened to the periphery of the elongated hole. In other words, it is desirable that the other engagement hole be an elongated hole aligned with the movement direction and have a periphery that can be fastened by the head of the engagement member.

The engaging member may be a positioning engaging screw that is engaged with both the first engaging portion and the second engaging portion and is not inserted into the bone. Alternatively, the engaging member may be a bone screw that is inserted into the bone with both the first engaging portion and the second engaging portion inserted, thereby fixing the first retaining body and the second retaining body to the bone in addition to its positioning function.

In the present invention, it is preferable that the first retainer comprises a first structural part disposed on the bone surface at the outer side facing away from the femoral head, and that the second retainer comprises a second structural part disposed on the bone surface and engaging with the first structural part on the bone surface in a manner that allows relative movement in the movement direction. It is preferable that the first structural part and the second structural part engage with each other in an overlapping manner on the bone surface. In this case, it is preferable that the first structural part and the second structural part comprise a guide structure that guides the second retainer along the movement direction relative to the first retainer. It is further preferable that the guide structure include a groove structure formed along the movement direction and a groove fitting part that fits into the groove structure and is configured to slide along the movement direction. It is preferable that both the first structural part and the second structural part are configured in a plate shape. It is also preferable that the first retainer (the first structural part) and the second retainer (the second structural part) are configured to be detachable.

In the present invention, the first holder preferably has a barrel portion that guides the first bone fixation device so that it can be inserted and removed, and a flange portion that is integral with the barrel portion and can engage with the second holder. In this case, the flange portion corresponds to the first structural part that is placed on the outer bone surface facing away from the femoral head.

In the present invention, the second holder preferably includes a retaining hole for retaining the head of the second bone fixation device. Here, the retaining hole is preferably a female-threaded screw hole that screws into the head of the second bone fixation device, and the head of the second bone fixation device preferably includes a male thread that screws into the female thread.

In the present invention, the second bone fixation device preferably has a sleeve portion held by the second holder, and a bone fixation shaft that is inserted retractably into the sleeve portion and has a bone engagement portion at its tip that engages with bone. Here, the sleeve portion preferably has a head portion of the second bone fixation device that is held in a holding hole in the second holder. It is also desirable to have a bone engagement structure on the outer circumferential surface of the sleeve portion that engages with bone. Examples of this bone engagement structure include a screw structure and a group of multiple protrusions.

In the present invention, it is preferable that one first bone fastener and one first holding portion are provided, and two second bone fasteners and two second holding portions are provided.

In the present invention, it is preferable that the femoral head is provided in the proximal femur, and that the first and second bone fasteners pass through locations adjacent to the inside of each vertex of the inverted triangular cross section of the femoral neck as they approach the femoral head. That is, it is preferable that the first and second bone fasteners pass through a location adjacent to the inside of the distal vertex of the three vertices of the inverted triangular cross section of the femoral neck and a location adjacent to the inside of at least one of the two proximal vertices as they approach the femoral head. In this case, it is further preferable that the second holder protrudes proximally from the first holder and has a proximal region including the second holding position and a distal region configured to be movable relative to the first holder along the movement direction, and that the proximal region have a back surface shape that gradually curves outward from the distal region along the movement direction.

According to the present invention, by configuring the placement of plates and bone fixation devices to be changeable depending on the patient's condition, it is possible to optimize the fracture fixation method and improve the stability and strength of bone fixation.

1A is a front perspective view showing a first treatment mode for an affected area to which the first embodiment of the bone fixing system according to the present invention is applied, as seen from the front side; FIG. 1B is a side assembly view showing a state of an implant assembly as seen from the side; FIG. 1A is an axial assembly view showing the state of the implant assembly in a first treatment state of the first embodiment as viewed along the axial direction, and FIG. 1B is a rear perspective view as viewed from the diagonally inner side, and FIG. 1C is an explanatory view showing the relationship between the cross-sectional shape of the femoral neck and the introduction position of the bone fixation device. 1A is a front view of a first holder equipped with a bone fixation device of the first embodiment; FIG. 1B is an axial view of the first holder; FIG. 1C is a cross-sectional view of a portion where a reference hole is provided; FIG. 1D is a plan view of a second holder; and FIG. 1E is an explanatory perspective view showing how a flange portion formed on the first holder is engaged with the second holder. 1A is a front perspective view showing a second treatment mode of the first embodiment as seen from the front side, and FIG. 1B is a side assembly view showing the state of the implant assembly as seen from the side. 1A is an axial assembly view showing a state of the implant assembly in a second treatment state of the first embodiment as viewed along the axial direction, and FIG. 1B is a rear perspective view as viewed from the diagonally inner side. 10A is a plan view showing a second holder of the second embodiment, and FIG. 10B is a cross-sectional view of a positioning hole corresponding to a reference hole and a fixing bone screw. 1A to 1C are explanatory diagrams showing the procedure of a surgical procedure using each embodiment. 1A and 1B are explanatory diagrams showing the procedure of a surgical procedure, and FIG. 1C is a perspective view of an angle guide used in the surgical procedure.

(First embodiment)
Next, embodiments of the present invention will be described in detail with reference to the accompanying drawings. First, the overall configuration of a first embodiment of a bone fixing system according to the present invention will be described with reference to Figs. 1 to 5. As shown in Fig. 1, the bone fixing system 100 of the first embodiment includes a first holder 110, a second holder 120, a first bone fixation device 130, and a second bone fixation device 140. Here, the first bone fixation device 130 is held by the first holder 110. Furthermore, the second bone fixation device 140 is held by the second holder 120.

As shown in Figures 3(a)-(c), the first holder 110 has a barrel portion 111 that retractably houses the first bone fixation device 130, and a flange portion 112 that is integral with the barrel portion 111. The barrel portion 111 is the portion that is inserted into the bone and is preferably cylindrical. The flange portion 112 is configured as a plate that extends in a direction intersecting the axis of the barrel portion 111 and includes an opening 112a that communicates with the interior of the barrel portion 111 and a reference hole 113 for receiving a bone screw 150 or a positioning engagement screw. The angle φ between the axis of the barrel portion 111 and the plate surface of the flange portion 112 is set to match the patient's neck-shaft angle (typically 120-135 degrees). The side edge 112b of the flange portion 112 is configured to be able to fit into the side groove 122b of the fitting portion 122a, which will be described later. A female thread 113a is formed on the inner surface of the reference hole 113, and this female thread 113a is configured to be able to threadably engage with a male thread 152a formed on the outer surface of the head 152 of the bone screw 150, which is a locking screw.

In the illustrated example, the first bone fixation device 130 is a bone screw having a bone engagement portion 131 with a screw thread at its tip, and a shaft portion 132 that is inserted into the barrel portion 111 so that it can freely protrude. However, the first bone fixation device 130 is not limited to a bone screw, and may be any device that has a bone engagement portion. For example, it may be configured as a locking pin with an expandable bone engagement portion at its tip, or a hook pin with a hook portion at its tip that can protrude in a hook shape as a bone engagement portion.

In the illustrated example, the first bone anchor 130 is introduced toward the femoral head T3 of the proximal femur. In this embodiment, both the first bone anchor 130 and the second bone anchor 140 are introduced toward the femoral head T3, but the first bone anchor 130 is introduced distally of the femoral head T3. The second bone anchor 140 is introduced proximally of the femoral head T3.

1, the second bone fixation device 140 comprises a sleeve 140A held by the second holder 120, and a bone fixation shaft 140B that is retractably inserted into the sleeve 140A and has a bone engagement portion 141 at its tip that engages with the bone, and a shaft portion 142 at its base end that can be inserted into the sleeve portion 140A. The sleeve 140A is provided with a head portion 143 that corresponds to the retaining hole 124 of the second holder 120. The head portion 143 is formed with a male thread 143a that threadably engages with the female thread 124a of the retaining hole 124. A bone engagement structure 144 is formed on the outer peripheral surface of the sleeve 140A distal to the head portion 143. In the illustrated example, the bone engagement structure 144 is a helical thread formed on the outer peripheral surface of the sleeve 140. When the second bone fastener 140 is introduced into the bone, the bone engagement structure 144 engages with the cortical bone of the outer part T1 during the process of locking the head 143 of the second bone fastener 140 into the retaining hole 124 of the second retainer 120, firmly fixing the second retainer 120 to the outer part T1 via the sleeve 140A.

As shown in Figures 3(d) and (e), the second holding body 120 is configured in a plate-like shape overall, and has a surface 121 facing away from the bone and a back surface 122 facing the bone. The surface 121 and back surface 122 are provided with an opening 123, which is a through-hole, a holding hole 124, and a positioning hole 125. The back surface 122 is provided with a recess 122a into which the flange portion 112 of the first holding body 110 fits, and on both widthwise sides of this recess 122a, side grooves (groove structure portions) 122b into which the side edges (groove fitting portions) 112b of the flange portion 112 fit. The second holding body 120 is assembled so that it overlaps with the flange portion 112 by fitting the recess 122a from the distal side and sliding it toward the proximal side. The second retainer 120 (surface 121 and back surface 122) has a substantially flat plate shape along the longitudinal axis XL in the distal region, which includes the range from the opening 123 to the positioning hole 125. Meanwhile, in the proximal region, which is closer to the opening 123, the second retainer 120 gradually curves outward toward the proximal end, forming a plate shape that extends in a direction at an angle δ with respect to the longitudinal axis XL. This angle δ is set so that the second bone fastener 140 retained in the retaining hole 124 formed in the proximal region is aligned with the neck-shaft angle.

The second retaining body 120 has an opening 123 near the center along the longitudinal axis XL, through which the base of the shaft 132 of the first bone fixation device 130 can pass. This opening 123 has an elliptical or oblong shape that extends along the longitudinal direction of the second retaining body 120 (the vertical direction in the figure, i.e., the movement direction XL) to ensure unhindered relative movement between the first retaining body 110 and the second retaining body 120, as described below. Two retaining holes 124 are formed proximal to the opening 123. In the illustrated example, these retaining holes 124 have female threads 124a on their inner surfaces, which are configured to be threadably engaged with male threads 143a formed on the outer periphery of the head 143 of the second bone fixation device 140, as described below.

As shown in FIG. 3(e), the flange portion 112 of the first holding body 110 fits into a recess 122a provided on the back surface 122 of the second holding body 120. More specifically, the flange portion 112 is held in a fitted state with its widthwise side edges 112b engaging with side grooves 122 provided on both widthwise sides of the recess 122a. The flange portion 112 and the recess 122 can be moved between a separated state and a fitted state by sliding them along the longitudinal direction of the first holding body 110 and the second holding body 120. In the illustrated example, the flange portion 112 and the second holding body 120 are assembled such that the flange portion 112 and the second holding body 120 can move relative to each other in the longitudinal direction due to the side edges 112b and the side grooves 122b fitting together, but cannot move relative to each other in the thickness direction. However, in the present invention, it is sufficient that the first holding body 110 (flange portion 112) and the second holding body 120 can be positioned in an overlapping state, and they may be configured to be relatively movable in the thickness direction and detachable.

The second holder 120 is provided with a positioning hole 125, which is a third opening. The positioning hole 125 has a first position A and a second position B, which correspond to the reference hole 113 of the flange portion 112 when the flange portion 112 is fitted into the recess 122a. That is, the positioning hole 125 has two hole portions, positions A and B, where the bone screw 150 or positioning engagement screw 150' to be attached to the reference hole 113 is positioned. Note that multiple hole portions may be provided, and three or more hole portions may also be provided. Furthermore, the multiple hole portions may not be interconnected within a single opening as in the illustrated example, but may be composed of multiple separately provided holes. Here, the distance between the first position A and the second position B is the positioning range ΔS, which is the distance between the set positions along the longitudinal axis XL. Bone screws 150 or positioning engagement screws 150', which serve as engagement members, are inserted into the reference holes 113 and positioning holes 125, and the male threads 152a formed on the outer peripheral surfaces of their heads 152 threadably engage with the female threads 113a and 125a, 125b, thereby positioning the flange portion 112 and second holder 120 in the longitudinal and thickness directions. While not shown, one example of the positioning engagement screw 150' is a bone screw 150 with the bone engagement portion 151 removed, i.e., one with only the head 152. The male threads 152a, which can be threadably engaged with the female threads 113a, 125a, 125b, are formed on the outer peripheral surface of the head 152.

At this time, by fitting slidably in the longitudinal direction into the guide structure (side edge 112b and side groove 122b) formed between the flange portion 112 and the second retainer 120, the bone screw 150 or positioning engagement screw 150', which is an engagement member that threads into the reference hole 113, can be positioned and fixed so that it is located at either the first position A or the second position B. Note that while the bone screw 150 and positioning engagement screw 150' are both screw members with male threads 152a on the head 152, the engagement member may be composed of something other than a screw member as long as it has the function of positioning and fixing relative to the first position A and the second position B. When the engagement member is a bone screw 150, in addition to the function of positioning the first retainer 110 (flange portion 112) and the second retainer 120 relative to each other, it also has the function of fixing the first retainer 110 and the second retainer 120 to the bone surface. In addition, as in this embodiment, by threading the engaging member into both the first engaging portion and the second engaging portion, the accuracy and strength of the positioning function can be improved.

1 and 2 show the reference hole 113 of the flange portion 112 positioned at a position corresponding to the first position A of the positioning hole 125 of the second holder 120 via an engaging member such as a bone screw 150 or a positioning engaging screw 150'. In this state, as shown in FIG. 2, the distance between the axis X1 of the first bone fastener 130, whose shaft portion 132 is held within the opening 123 of the second holder 120 via the barrel portion 111 of the first holder 110, and the axes X2 and X3 of the second bone fastener 140, whose head portion 143 is held in the holding hole 124 of the second holder 120 that holds it, is the bone fastener spacing LS1. Here, there are two second bone fixation devices 140, with their axes X2 and X3. In the illustrated example, the distance LS1 is based on the intersection of the longitudinal axis XL passing through axis X1 with the line connecting axes X2 and X3, and indicates the distance between this intersection and axis X1. However, the parameter indicating the distance between axis X1 and axes X2 and X3 need only correlate with the above-mentioned relative positional relationship in the movement direction XL, and is not limited to the distance LS1. In this embodiment, axes X1, X2, and X3 are parallel to each other.

As shown in Figure 1(a), the first bone fixation device 130 and the second bone fixation device 140 are both introduced from the lateral portion T1 through the neck T2 toward the femoral head T3, so the relative positions of the axes X1, X2, and X3 are extremely important. As shown in Figure 2(a), the distance between the distal axis X1 and the proximal anterior axis X3 is L1, the distance between the axis X1 and the proximal posterior axis X2 is L2, and when the longitudinal axis XL passing through axis X1 is used as the reference, the angle of the line extending from axis X1 to axis X3 is θ1, and the angle of the line extending from axis X1 to axis X2 is θ2. The fracture stability of the proximal femur T is determined by these distances L1 and L2 and the angles θ1 and θ2. When one second bone fixation device 140 is used, the fracture stability of the proximal femur T is determined by the distance L1 between axes X1 and X2 and the angle θ1 between the longitudinal axis XL of the line extending from axis X1 to X2. Whether one or two second bone fixation devices 140 are used, the distances L1 and L2 determine the position at which the shanks 132 and 142 pass inside the neck T2 (the distance from the cortical bone on the side of the neck T2) and also determine the positions of the bone engagement portions 131 and 141 inside the femoral head T3 (the distance from the cortical bone at the tip of the femoral head T3). Therefore, the reduction and retention force for the fracture of the proximal femur T and the rotational stability that prevents rotation of the femoral head T3 are determined.

The shapes and sizes of the lateral portion T1, neck T2, and femoral head T3 vary not only among individuals, but also among races and genders. Differences also occur in fracture type and bone quality, such as osteoporosis. To maintain appropriate fracture reduction based on these shapes, sizes, and bone quality, the following conditions must be met for the introduction positions of the first and second bone fixation devices 130 and 140, which both pass through the neck T2 and into the femoral head T3. Typically, the introduction position of the first bone fixation device 130 is set at a position inside the cancellous bone CA that is in contact with or adjacent to the inside of the calcar CL, a part of the cortical bone CR located distal to the neck T2 and having an inverted triangular cross-sectional structure perpendicular to the neck axis, as shown in Figure 2(c). In this case, the first bone fixation device 130 primarily serves to support the patient's weight. This is because the cortical bone CR of the calcar CL is generally thick, which is expected to provide stable support. Furthermore, when a pair of second bone fixation devices 140 are used, they are preferably placed in positions within the cancellous bone CA that are in contact with or adjacent to the inside of the cortical bone CR that correspond to the two vertices, anterior (left side in the illustration) and posterior (right side in the illustration), on the proximal side of the inverted triangular cross section of the neck T2. In this case, because the cortical bone CR that corresponds to the posterior vertex is thicker, greater support stability can be expected from the second bone fixation device 140 that passes near this area.

The reason for using the second bone fixation device 140 in addition to the first bone fixation device 130 is to prevent the femoral head T3 from rotating around the first bone fixation device 130. Therefore, the insertion position of the second bone fixation device 140 into the femoral head T3 is preferably a position that can prevent rotation of the femoral head T3 around the first bone fixation device 130. In other words, it is most desirable that the second bone fixation device 140, having axes X2 and X3, abuts against the cortical bone of the femoral head T3 when rotation attempts to occur, preventing the rotation. In preferred embodiments, L1 ≥ L2, particularly L1 > L2, and θ1 ≥ θ2, particularly θ1 > θ2. The insertion angles of the first bone fixation device 130 and the second bone fixation device 140 are firmly maintained by the barrel 111 of the first holder 110 and the locking of the retaining hole 124 of the second holder 120. This prevents the "chopstick phenomenon" from occurring, in which multiple bone fixation devices overlap in an X-shape and fail, and prevents rotation of the femoral head T3.

When only one second bone anchor 140 is used, the second bone anchor 140 is introduced into the cancellous bone CA that is in contact with or adjacent to the inside of the cortical bone CR on the proximal side of the neck T2, but it is particularly preferable for the second bone anchor 140 to pass through a position in the cancellous bone CA that is in contact with or adjacent to the inside of the cortical bone CR at either the anterior or posterior corner (preferably the posterior corner when viewed from the thickness of the cortical bone CR) on the proximal side of the inverted triangular cross section.

In this embodiment, as shown in FIG. 4, the first retaining body 110 (flange portion 112) and the second retaining body 120 are configured to be relatively movable along the longitudinal axis XL (movement direction) while engaged with each other, allowing the bone screw 150 or positioning engagement screw 150' to be positioned and fixed at second position B (see FIG. 3(c)). This allows the distance between axes X1 and X3 to be set to LS2, which is smaller than LS1, as shown in FIG. 5. In this way, the distances L3 and L4 between axis X1 and axis X2 and X3 can be made smaller than L1 and L2, respectively.

In this embodiment, by placing the bone screw 150 or the positioning engagement screw 150' at the first position A, for example, the distance LS1 between the axes X1 and X3 is set large. In this case, the distance between the first bone anchor 130 and the second bone anchor 140 is large. Therefore, if the neck T2 is thin, the second bone anchor 140 may interfere with the cortical bone proximal to the neck T2, preventing the second bone anchor 140 from being inserted. As shown in FIG. 2(c), the anterior corner is generally positioned more proximally and the posterior corner is positioned more distally. However, because the vertical difference between the anterior and posterior corners varies from patient to patient, it is impossible to determine the position of the bone anchor to be inserted adjacent to the cortical bone CR of the posterior corner without knowing how distal the posterior corner is positioned. However, in the frontal X-ray image, the bone fixation device that passes near the inside of the anterior corner on the proximal side of the inverted triangle and the bone fixation device that passes near the inside of the posterior corner overlap front to back, making it difficult to visually identify the passage position of the posterior bone fixation device. In addition, the posterior corner itself is difficult to identify because it overlaps with the image of the anterior bone tissue, making it difficult to recognize the position of the posterior corner before surgery.

For this reason, in the past, multiple types of plates equivalent to the second holder 120 were prepared during surgery to correspond to different neck widths, and if the first plate did not fit, it was removed and replaced with a plate of a different size. This resulted in increased costs due to the need to prepare multiple plates, and unnecessary work was required, which lengthened the surgery time.

In this embodiment, after the actual surgery has begun and the guide pin, first holder 110, and second holder 120 are placed on the lateral portion T1, the position of the holding hole 124 of the second holder 120 relative to the first holder 110 (flange portion 112) is configured to be movable relative to the movement direction along the longitudinal axis XL. This allows the position of the second bone fixation device 140 to be appropriately adjusted relative to the neck T2, and makes it easy to set the position of the second bone fixation device 140, particularly when it is placed in correspondence with a posterior corner whose position is difficult to determine.

Furthermore, if the bone surface on the proximal side of the lateral portion T1 protrudes significantly due to the prominence of the greater trochanter, the proximal end of the second retaining portion 120 may interfere with the bone surface of the lateral portion T1, making it impossible to stably fix the second retaining portion 120 to the bone surface of the lateral portion T1. Furthermore, because the degree of prominence of the greater trochanter varies greatly among patients, it is difficult to perfectly match the back surface 122 (plate shape) of the second retaining body 120 to the bone surface of the lateral portion T1. However, while the curvature of the bone surface generally increases toward the proximal greater trochanter, the bone surface of the distal lateral portion T1 is generally configured to be approximately parallel and flat along the diaphyseal axis. Therefore, even if the problem of the second retaining body 120 not matching the bone surface of the lateral portion T1 arises, it can often be resolved by moving the second retaining body 120 distally. In particular, when the shape of the back surface 122 in the proximal region of the second holder 120 is curved outward, as is clear from a comparison of Fig. 1(a) with Fig. 4(a), interference between the back surface 122 and the bone surface on the proximal side of the lateral portion T1 can be avoided by simply moving the second holder 120 slightly distally. In the example of Fig. 4, a "gap" exists between the proximal region of the second holder 120 and the proximal surface of the lateral portion T1. In this way, the back surface 122 of the second holder 120, together with the flange portion 112, can be firmly fixed to the surface of the lateral portion T1, and the first bone fixation device 130 and the second bone fixation device 140 can be firmly fixed. This increases the holding strength of the fractured portion, thereby reliably withstanding loads such as body weight and preventing serious defects such as rotation of the femoral head T3 after surgery. In the second embodiment described below, it is possible to eliminate this "gap" and bring the entire back surface 122 of the second holding body 120 into close contact with the outer portion T1.

However, if multiple plates to match the bone shape and size as described above are not available, and a flange member corresponding to the first holder 110 is introduced and a plate is attached, and the shape of the raised portion of the greater trochanter on the bone surface of the lateral portion T1 does not match the plate, for example, if the flange member corresponds to a cervical angle of 125 degrees, it is replaced with a new flange member corresponding to a cervical angle of 135 degrees, shifted slightly distally, and then reinstalled, and a plate corresponding to this flange member is then attached. However, this not only requires a great deal of effort during surgery, but also requires multiple perforations to be formed in the lateral portion T1 to attach flange members of different shapes, which weakens the bone and makes it more susceptible to problems such as secondary fractures.

In addition, in this embodiment, the guide structure that allows the second holding body 120 to slide relative to the first holding body 110 in the movement direction XL is formed by the side edge 112b of the flange portion 112 and the side groove 122b of the recess 122a. This makes it easy to slide the second holding body 120 without changing the position of the axis X1 of the first bone fixation device 130, even during surgery, simplifying the movement work during positioning. In particular, because the above guide structure allows movement only in the movement direction XL and guides so as to prevent movement in the thickness direction, the relative positional relationship after positioning is maintained more reliably and with higher rigidity.

In this embodiment, the relative positional relationship between the first holder 110 (flange portion 112) and the second holder 120 along the movement direction XL is configured to be changeable. Different relative positional relationships can be set at two locations, corresponding to a first position A and a second position B, and these relationships can be maintained. Therefore, the distances L1 and L2 between the axis X1 and the axes X2 and X3 can be increased or decreased to distances L3 and L4 corresponding to the larger and smaller gaps LS1 and LS2, respectively. In the illustrated example, the distance between the axes X2 and X3 remains constant, so that a change in the distances L1 and L2 (decreasing to L3 and L4) also changes the angles θ1 and θ2 (increasing to θ3 and θ4). The number of different positionable positions A and B is not limited to two, as in the illustrated example, but may be three or more. In this way, by configuring the first holder 110 and the second holder 120 to be positionable in multiple discontinuous positions, adjustment work is made easier and hesitation during surgery can be avoided.

The positioning range ΔS = LS1 - LS2, which is the amount of change in the intervals LS1 and LS2, is not particularly limited, but is preferably set taking into consideration the distance distribution function F(L ₁ ) corresponding to the distance L1 between the corners of the inverted triangle shape of the patient's neck T2, the distance distribution function F(L ₂ ) corresponding to the distance L2, the angle distribution function F(θ ₁ ) corresponding to the angle θ1, and the angle distribution function F(θ ₂ ) corresponding to the angle θ2. Here, it is preferable to determine each distribution function for each case by setting a patient group. Specifically, it is preferable to set the positioning range ΔS so that it can accommodate all patients between the value (M - σ) obtained by adding the standard deviation σ to the average value M of each distribution function and the value (M + σ) obtained by subtracting the standard deviation σ from the average value M of each distribution function. It is particularly preferable to set the positioning range ΔS so that it can accommodate all patients between (M - 2σ) and (M + 2σ).

For example, in the illustrated example, LS1 corresponding to first position A is 14.4 mm, and LS2 corresponding to second position B is 11.5 mm. At this time, L1 is 16.3 mm, L2 is 14.5 mm, θ1 is 23 degrees, θ2 is 19 degrees, L3 is 13.8 mm, L4 is 11.9 mm, θ3 is 27 degrees, θ4 is 23 degrees, and ΔS is 2.9 mm. The range of L1 and L3 is preferably within the range of 12.0-18.0 mm, and preferably within the range of 13.0-17.0 mm. The range of L2 and L4 is preferably within the range of 11.0-16.0 mm, and preferably within the range of 12.0-15.0 mm. Furthermore, the range of θ1 and θ3 is preferably within the range of 21.0-29.0 degrees, and preferably within the range of 22.0-28.0 degrees. Furthermore, the ranges of θ2 and θ4 are preferably within the range of 17.0-25.0 mm, and preferably within the range of 18.0-24.0 mm. The range of ΔS is preferably within the range of 1.0 mm-5.0 mm, and preferably within the range of 2.0-4.0 mm. These points also apply to the second embodiment described below.

Second Embodiment
Next, a bone fixing system 100' according to a second embodiment will be described with reference to Fig. 6. In this second embodiment, only the structures of the second holder 120' and the bone screw 160 or the positioning engagement screw 160' are different from those of the first embodiment, and therefore only the different parts will be described, and a description of the same parts as in the first embodiment will be omitted.

In this embodiment, as shown in FIG. 6(a), a second holding body 120' is used instead of the second holding body 120 of the first embodiment. This second holding body 120' has a positioning hole 125' with a different structure instead of the positioning hole 125 of the first embodiment, but the structure other than the positioning hole 125' can be configured in the same way as the second holding body 120 of the first embodiment.

As shown, the positioning hole 125' has an elongated hole shape extending in the direction of the longitudinal axis XL. No internal thread is formed on the inner surface 125a' of the positioning hole 125'. The positioning hole 125' and the reference hole 113 overlapping the positioning hole 125' are used with the bone screw 160 shown in FIG. 6(b) or a positioning engagement screw 160' (not shown), which has a structure in which the bone engagement portion 161 has been removed from the bone screw 160. The internal thread 113a formed on the inner surface of the reference hole 113 is configured to be threadably engaged with the external thread 162b of the head 162 of the bone screw 160 or the positioning engagement screw 160'. The head 162 has an upper head region H1 that engages with the inner surface 125a' of the positioning hole 125' of the second retainer 120', and a lower head region H2 in which the internal thread 162b is formed. As a result, the bone screw 160 or positioning engagement screw 160' is locked to the first retaining body 110 (flange portion 112) by the engagement of the male thread 162b and the female thread 113a, and also functions to fasten and fix the second retaining body 120' to the first retaining body 110 (flange portion 112) by the engagement of the fastening surface 162a of the upper head region H1 with the inner surface 125a'.

In this embodiment, the positioning structure consisting of the positioning hole 125', reference hole 113, and bone screw 160 or positioning engagement screw 160' is movable relative to the first holder 110 (flange portion 112) and the second holder 120' along the longitudinal axis XL, allowing the bone screw 160 or positioning engagement screw 160' to be positioned and fixed at any position within the positioning range ΔS from the first position A to the second position B. Furthermore, even if the bone screw 160 or positioning engagement screw 160' remains positioned within the positioning hole 125' and reference hole 113, it can be moved to any position within the positioning range ΔS as long as the upper temporal region H1 is in a threaded state that does not tighten the second holder 120', which further simplifies repositioning during surgery. In other words, the engaging member threads into one of the engaging holes and tightens around the periphery of the other engaging hole, which is an elongated hole. This allows for positioning at any location within the structural range of the elongated hole, thereby increasing the degree of freedom in positioning.

(Usage - Surgical procedure)
Finally, an example of how to use the bone fixing systems 100, 100' of the respective embodiments will be described with reference to Figures 7 and 8. First, as shown in Figure 7(a), the base 10B of the plate-type angle guide 10 inserted through an incision is abutted against the outer part T1, and the guide pins 13, 14 are inserted through the guide sleeves 11, 12 of the angle guide 10 and inserted into the femoral head T3 through the neck T2. Here, the angle guide 10 is shown enlarged in Figure 8(c).

The angle guide 10 includes a plate-shaped base 10B that abuts against the outer portion T1 and a handle 10H for the surgeon to grasp. Guide sleeves 11 and 12 are attached to the base 10B, and are attached to the base 10B in a predetermined position and orientation that corresponds to the axis of the opening 123 and the retaining hole 124 of the second retainer 120, 120'. It is preferable that the base 10B have the same outer shape as the second retainer 120, 120', and in particular, that the back surface shape be the same as the shape of the back surface 122 of the assembly of the flange portion 112 of the first retainer 110 and the second retainer 120, 120'. This allows for a trial procedure to be performed in parallel with the bone fixation system 100, 100' to confirm its position relative to the fracture site using X-ray images or other methods prior to actual use. The mounting positions of the guide sleeves 11 and 12 are set to a preset position (i.e., the pre-change position, e.g., the standard position) within the positioning range ΔS. In the illustrated example of the first embodiment, they are set to the standard position corresponding to the first position A.

However, the guide sleeves 11, 12 of the angle guide 10 may be configured to be adjustable so that they can be set to multiple positions within at least the positioning range ΔS. For example, in each of the above embodiments, the guide sleeve 12 may be configured to be movable by at least ΔS in the direction along the longitudinal axis XL. In this way, even in procedures using the angle guide 10, the guide pin 14 can be inserted so that it aligns with the changed position that is previously adapted to the patient's affected area. This eliminates the need to reinsert the guide pin 14, as described below.

Next, as shown in Figure 7(b), using the guide pin 13 as a reference, a drilling tool 30 (step reamer) is used via a sleeve tool 20 (reamer sleeve) to drill holes for the first holder 110 and first bone fixation tool 130. Then, as shown in Figure 7(c), using the guide pin 13 as a reference, the first holder 110 and first bone fixation tool 130 are assembled, and the flange portion 112 is attached to the second holders 120, 120' and introduced into the body. Then, using a rotary tool 40 (screwdriver), the first bone fixation tool 130 is screwed into the femoral head T3.

Next, as shown in Figure 8(a), using the guide pin 14 as a reference, a drilling tool 50 (screw-type reamer sleeve) is used to drill a hole through the retaining hole 124 of the second retainer 120. Then, as shown in Figure 8(b), the second bone fixation tool 140 is inserted and introduced to a predetermined position within the femoral head T3 using a rotary tool 60 (barrel T wrench).

The above surgical procedure is an example of application (surgical procedure) of the bone fixation system 100, 100' in the standard position initially set by the guide pins 13, 14. However, as previously mentioned, in practice, it is conceivable that the position between the first retainer 110 (flange 112) and the second retainer 120, 120' may be changed within the positioning range ΔS. In this case, for example, in the above-mentioned embodiments, after introducing the first bone fixation device 130 shown in FIG. 7(c), it is necessary to change the introduction position (e.g., the standard position) of the guide pin 14, preferably with the second retainer 120, 120' positioned on the lateral portion T1. Therefore, after changing the position of the second retainer 120, 120', the second retainer 120, 120' is fixed using the bone screws 150, 160 or the positioning engagement screws 150', 160', and the guide pin 14 is reinserted through a separate guide sleeve (not shown) attached to the retainer hole 124. When two retaining holes 124 or two second bone fixation devices 140 are used, it is desirable to maintain the reduction of the fracture by leaving one of the two guide pins 14 inserted, removing and reinserting the other, and then reinserting the first.

In this case, it is preferable to set the opening diameter of the retaining hole 124 large so that the guide pin 14 inserted in the original standard position can pass through the retaining hole 124 of the second retainer 120, 120'. That is, when correcting the guide pin 14 from the pre-change position (standard position) to the post-change position as described above, it is preferable that the opening radius of the retaining hole 124 be larger than the positioning range ΔS. In this way, when changing the insertion position of the guide pin 14 from the pre-change position to the post-change position by the positioning range ΔS, after introducing the second retainer 120, 120' in the step of Figure 7(c) so that the guide pin 14 in the pre-change position (e.g., the standard position) passes through the opening range of the retaining hole 124, it is possible to confirm that the second retainer 120, 120' can be set to the post-change position, and then reinserting the guide pin 14 into the appropriate post-change position. In practice, by setting the second holding bodies 120, 120' to their post-change positions, it is possible to confirm that the guide pin 14, which is set to pass through the center of the holding hole 124, can be inserted in the correct position, and then the guide pin 14 can be reinserted.

The positioning engagement screws 150', 160' can be pre-installed in the positioning holes 125, 125' and the reference hole 113. After the first holder 110, first bone fixation device 130, and second holder 120 are installed as shown in Figure 7(c), the second holder 120 can be moved and the positioning engagement screws 150', 160' can be tightened to secure the second holder 120 while observing the fitting status on the lateral portion T1. In this case, if it is ultimately necessary to use bone screws 150, 160, the positioning engagement screws 150', 160' can be removed after the second bone fixation device 140 is installed, and the bone screws 150, 160 can be installed. Note that the above-described usage is merely an example, and each embodiment can be used in a variety of usage situations. For example, the first retaining body 110 and the second retaining body 120, 120' may be positioned or fixed in advance using positioning engagement screws 150', 160' or the like according to the patient's condition, and then introduced into the body. If bone screws 150, 160 are not used, such as when positioning engagement screws 150', 160' are ultimately used, it is preferable that the flange portion 112 engages with the second retaining body 120 in the direction of axis X1 (thickness), and that the second retaining body 120 engages with the outer portion T1 in the directions of axes X2 and X3 by other means, such as a bone engagement structure 144.

An advantage of the positioning engagement screws 150', 160' is that, unlike the bone screws 150, 160, they can position the first and second holders 110, 120 without requiring access to the bone. In particular, as shown in Figure 2(c), the axis of the femoral neck T2 is offset anteriorly by ΔX relative to the diaphyseal axis XT, and therefore the axis X1 of the first bone fixation device 130, which is attached by the first holder 110, is similarly offset. Therefore, when using bone screws 150, 160, these bone screws 150, 160 are also inserted at a position offset from the diaphyseal axis XT. This can lead to problems such as bone cracking due to eccentric insertion of the bone screws, or the bone screws 150, 160 themselves being unusable depending on the bone quality. This problem can be avoided by using the positioning engagement screws 150', 160'. The eccentric insertion of the bone screws 150, 160 due to the forward offset ΔX of the diameter portion T2 can also be avoided by orienting the reference hole 113 and positioning holes 125, 125' diagonally backward, thereby introducing the bone screws 150, 160 toward the diaphyseal axis XT. However, this method requires separate left and right implants, which increases inventory and other costs.

(Action and effect)
According to the bone fixing systems 100, 100' of the above-described embodiments, the first holding body 110 and the second holding body 120 are configured to be relatively movable in the movement direction XL in which the distance between the first holding position X1 and the second holding positions X2, X3 changes, and are configured to be respectively positionable in a plurality of mutually different relative positional relationships (within a range of A, B, or A-B) along the movement direction XL, and these plurality of relative positional relationships are configured to be maintainable in a state in which the first bone fixation device 130 introduced from the lateral part T1 is held by the first holding body 110 at the first holding position X1, and the second bone fixation device 140 introduced from the lateral part T1 is held by the second holding body 120 at the second holding positions X2, X3. In this way, by configuring the arrangement of the plates and bone fixation devices to be changeable according to the patient's condition, it is possible to optimize fracture fixation and improve the stability and strength of bone fixation.

In each of the above embodiments, the first retainer 110 is fixed to the outer portion T1, and the second retainer 120 is fixed to the outer portion T1. As a result, the multiple relative positional relationships are maintained via the outer portion T1 (cortical bone). In particular, the barrel portion 111 is integrally formed with the flange portion 112 disposed on the outer portion T1, and is laterally secured by bone screws 150, 160 inserted into the bone through 125, 125' of the flange portion 112, thereby fixing the first retainer 110 to the outer portion T1. Furthermore, the sleeve portion 140A is locked into the retaining hole 124, and the bone engagement structure 144 engages with the cortical bone of the outer portion T1, thereby fixing the second retainer 120 to the outer portion T1. Therefore, because the first retainer 110 and the second retainer 120 are fixed via the cortical bone of the outer portion T1, the multiple relative positional relationships are maintained.

The fixation action of the bone screws 150, 160 to the lateral portion T1 in the direction of axis X1, or the fixation action of the bone engagement structure 144 and locking members 124, 143 to the lateral portion T1 in the directions of axes X2 and X3, as long as either one of them is present, maintains the fixation state of the first retainer 110 and the second retainer 120 on the lateral portion T1 even if shortening of the fracture occurs, and as a result, does not indirectly affect the relative positional relationship in the direction of movement XL. Furthermore, the axial locking action of the first bone fixation device 130 by the barrel portion 111 and the axial locking action of the second bone fixation device 140 by the threaded engagement of the retaining hole 124 with the head 143 of the sleeve portion 140A and the engagement of the bone engagement structure 144 with the cortical bone suppress tilting of the axes X1, X2, and X3, thereby providing the same effect in maintaining the reduction state of the femoral head T3 as maintaining the relative positional relationship in the direction of movement XL, which intersects these axes.

In addition, each embodiment further includes positioning means 125, 125', 113 that are configured to be able to position the first holding body 110 and the second holding body 120 in the movement direction XL in the multiple relative positional relationships described above. This makes it possible to (structurally) maintain the position of the second holding body 120 relative to the first holding body 110 in the movement direction XL within the bone fixing system 100, 100', thereby enabling the relative positional relationships between the first holding body 110 and the second holding body 120 to be set reliably and accurately and facilitating surgery.

Furthermore, in each embodiment, the positioning means includes a first engaging portion 113 provided on the first holding body 110, second engaging portions 125, 125' provided on the second holding body 120, and engaging members 150, 160, 150', 160' that releasably engage with the first engaging portion and the second engaging portion, respectively. This enables reliable positioning with a simple structure. Since the engaging members 150, 160, 150', 160' are screws that thread into at least one of the first engaging portion 113 and the second engaging portions 125, 125', reliable positioning is possible with a simple operation. In particular, since the engaging members are bone screws 150, 160 that are screwed into the bone, the first holding body 110 and the second holding body 120 can be reliably and stably fixed to the bone.

Specifically, the first engagement portion 113 and the second engagement portion 125, 125' are engagement holes that can engage with the head 152 of the engagement member 150, 150', respectively, and the other engagement hole 125 includes multiple hole portions 125a, 125b arranged along the movement direction. This allows for easy positioning after movement in the movement direction, simply by selecting one of the engagement holes 113 and one of the multiple hole portions 125a, 125b and using the engagement member 150, 150'. In this case, the head 152 of the engagement member has a male thread 152a, and one of the engagement holes 113 of the first engagement portion and the second engagement portion is a female-threaded screw hole that threads with the male thread 152a of the head, enabling more reliable and accurate positioning based on the engagement action caused by the threaded engagement.

Furthermore, the first engagement portion 113 and the second engagement portion 125' are engagement holes that can engage with the heads 162 of the engagement members 160, 160', respectively, and the other engagement hole 125' is an elongated hole aligned with the movement direction XL. This allows the engagement members 160, 160' inserted through the engagement holes 113 to be positioned at any position within the range of the extension of the movement direction XL of the engagement hole 125', thereby increasing the degree of freedom in positioning. In this case, the heads 162 of the engagement members have male threads 162b, and the engagement holes 113 of one of the first and second engagement portions are female-threaded holes that threadably engage with the male threads 162b of the heads, enabling more reliable and accurate positioning based on the engagement action caused by the threaded engagement.

Next, the first holder 110 has a first structural portion 112 that is placed on the bone surface of the lateral portion T1 facing away from the femoral head T3, and the second holder 120 has a second structural portion 122a that is placed on the bone surface and engages with the first structural portion on the bone surface in a manner that allows relative movement in the movement direction XL, with the first structural portion 112 and the second structural portion 122a engaging in an overlapping manner on the bone surface. As a result, the first structural portion 112 and the second structural portion 122a overlap each other on the bone surface, and the first holder 110 and the second holder 120 are fixed firmly to each other on the bone surface, thereby enabling the fracture site to be firmly held.

Here, the first structural portion 112 and the second structural portion 122a are provided with a guide structure that guides the second holding body 120 relative to the first holding body 110 along the movement direction XL. This guide structure stabilizes the relative movement between the first holding body 110 and the second holding body 120, facilitating movement operations and improving positioning accuracy. In particular, the guide structure includes a groove structure 122b formed along the movement direction XL and a groove fitting portion 112b that fits into the groove structure 122b and is configured to be slidable along the movement direction XL, allowing the first holding body 110 and the second holding body 120 to fit together and be firmly fixed to each other on the bone surface.

In each embodiment, the femoral head T3 is provided in the proximal femur, and the first bone anchor 130 and the second bone anchor 140 pass through a point adjacent to the inside of the distal apex of the three vertices of the inverted triangular cross section of the neck T2, as well as a point adjacent to the inside of at least one of the two proximal apexes, toward the femoral head T3, thereby enabling stable and strong support of the fractured portion of the proximal femur.

In this case, the second holder 120 has a proximal region that extends proximally beyond the first holder 110 and includes the second holding positions X2 and X3, and a distal region that is configured to be movable relative to the first holder 110 along the movement direction XL. The proximal region has a back surface that gradually curves outward from the distal region along the movement direction XL, allowing the second holder 110 to be stably and firmly positioned on the bone surface from the lateral portion T1 toward the greater trochanter. In particular, this makes it easy to position the proximal region of the second holder 120 in accordance with the curved shape of the bone surface toward the greater trochanter, and ensures a wide positioning range ΔS for moving the second holder 120 relative to the first holder 110 along the movement direction XL while ensuring stability of the second holder 120 on the bone surface.

Regarding the usage modes and surgical procedures of each embodiment, the above-mentioned distances LS1 and LS2 can be advantageously adjusted during surgery, as described above. However, they can also be positioned before surgery to match the patient's condition, which is known in advance. In this case, surgery time can be shortened, and product costs can be reduced because there is no need to prepare a large number of parts with different dimensions. For example, in the past, many parts were required to be prepared to match the patient's bone shape and size, such as the neck-shaft angle and anteversion angle. However, by enabling relative movement of the second holder 120 with respect to the first holder 110 along the movement direction XL, it is possible to accommodate differences in bone shape and size to a certain extent, and it is expected that the number of parts required to match the bone shape and size will be reduced.

The bone fixation system of the present invention is not limited to the illustrated examples described above, and various modifications can be made without departing from the spirit and scope of the present invention. For example, the above embodiments describe the case where one first bone fixation device 130 and two second bone fixation devices 140 are introduced from the lateral portion T1, through the neck portion T2, and toward the femoral head portion T3. However, even when only one second bone fixation device 140 is used in addition to the first bone fixation device 130, the same effects as those described above can basically be achieved.

100...bone fixation system, 110...first retainer, 111...barrel portion, 112...flange portion, 112a...opening, 112b...side edge, 113...reference hole, 113a...female thread, 120...second retainer, 121...surface, 122...back surface, 122a...engaging portion, 122b...side groove, 123...opening, 124...retaining hole, 124a...female thread, 125...positioning hole, 125a...female thread formed at first position, 125b...female thread formed at second position, A...first position, B...second position, 130...first bone fixation device, 131...bone engagement portion, 132...shaft portion, 140...second Bone fixation device, 141...bone engagement portion, 142...shank portion, 143...head portion, 143a...male thread, 144...bone engagement structure, 150...bone screw, 151...bone engagement portion, 152...head portion, 152a...male thread, 160...bone screw, 161...bone engagement portion, H1...upper head region, H2...lower head region, 162...head portion, 162a...fastening surface, 162b...male thread, 150', 160'...positioning engagement screw, L1-L4...distance, LS1, LS2...spacing, ΔS...positioning range, θ1-θ4...angle, 10...angle guide, 10B...base, 11, 12...guide sleeve, 10H...handle

Claims (9)

A bone fixing system comprising: a first bone fastener and a second bone fastener, each of which is introduced from an outer side toward a femoral head; a first holder that holds the first bone fastener at a first holding position; and a second holder that is configured to be engageable with the first holder and holds the second bone fastener at a second holding position,
the first holding body and the second holding body are configured to be relatively movable in a movement direction in which an interval between the first holding position and the second holding position changes , and are configured to be respectively positionable at a plurality of positions corresponding to a plurality of mutually different intervals ,
a plurality of positions corresponding to the plurality of intervals are configured to be able to be maintained in a state in which the first bone fastener introduced from the outer portion is held by the first holder at the first holding position, and the second bone fastener introduced from the outer portion is held by the second holder at the second holding position ,
a positioning means configured to be able to position the first holder and the second holder in a state in which the first holder and the second holder are held so as not to move relative to each other in the movement direction at each of a plurality of positions corresponding to the plurality of intervals,
the positioning means has a first engaging portion provided on the first holding body, a second engaging portion provided on the second holding body, and engaging members that are respectively detachably engaged with the first engaging portion and the second engaging portion;
the engaging member is a screw that is screwed into at least one of the first engaging portion and the second engaging portion,
the engaging member is a bone screw that is screwed into the bone;
Bone fixation system. A bone fixing system comprising: a first bone fastener and a second bone fastener, each of which is introduced from an outer side toward a femoral head; a first holder that holds the first bone fastener at a first holding position; and a second holder that is configured to be engageable with the first holder and holds the second bone fastener at a second holding position,
the first holding body and the second holding body are configured to be relatively movable in a movement direction in which an interval between the first holding position and the second holding position changes , and are configured to be respectively positionable at a plurality of positions corresponding to a plurality of mutually different intervals ,
a plurality of positions corresponding to the plurality of intervals are configured to be able to be maintained in a state in which the first bone fastener introduced from the outer portion is held by the first holder at the first holding position, and the second bone fastener introduced from the outer portion is held by the second holder at the second holding position ,
a positioning means configured to be able to position the first holder and the second holder in a state in which the first holder and the second holder are held so as not to move relative to each other in the movement direction at each of a plurality of positions corresponding to the plurality of intervals,
the positioning means has a first engaging portion provided on the first holding body, a second engaging portion provided on the second holding body, and engaging members that are respectively detachably engaged with the first engaging portion and the second engaging portion;
the first engaging portion and the second engaging portion are engaging holes into which the heads of the engaging members can engage,
One of the engagement holes includes a plurality of hole portions arranged along the movement direction.
Bone fixation system. A bone fixing system comprising: a first bone fastener and a second bone fastener, each of which is introduced from an outer side toward a femoral head; a first holder that holds the first bone fastener at a first holding position; and a second holder that is configured to be engageable with the first holder and holds the second bone fastener at a second holding position,
the first holding body and the second holding body are configured to be relatively movable in a movement direction in which an interval between the first holding position and the second holding position changes , and are configured to be respectively positionable at a plurality of positions corresponding to a plurality of intervals different from each other,
a plurality of positions corresponding to the plurality of intervals are configured to be able to be maintained in a state in which the first bone fastener introduced from the outer portion is held by the first holder at the first holding position, and the second bone fastener introduced from the outer portion is held by the second holder at the second holding position ,
a positioning means configured to be able to position the first holder and the second holder in a state in which the first holder and the second holder are held so as not to move relative to each other in the movement direction at each of a plurality of positions corresponding to the plurality of intervals,
the positioning means has a first engaging portion provided on the first holding body, a second engaging portion provided on the second holding body, and engaging members that are respectively detachably engaged with the first engaging portion and the second engaging portion;
the first engaging portion and the second engaging portion are engaging holes into which the heads of the engaging members can engage,
One of the engagement holes is an elongated hole along the movement direction and has a periphery that can be fastened by the head of the engagement member.
Bone fixation system. the engaging member is a screw that is screwed into at least one of the first engaging portion and the second engaging portion;
The bone fixing system according to claim 2 or 3 . the engaging member is a bone screw that is screwed into the bone;
The bone fixing system of claim 4 . A bone fixing system comprising: a first bone fastener and a second bone fastener, each of which is introduced from an outer side toward a femoral head; a first holder that holds the first bone fastener at a first holding position; and a second holder that is configured to be engageable with the first holder and holds the second bone fastener at a second holding position,
the first holding body and the second holding body are configured to be relatively movable in a movement direction in which an interval between the first holding position and the second holding position changes , and are configured to be respectively positionable at a plurality of positions corresponding to a plurality of mutually different intervals ,
a plurality of positions corresponding to the plurality of intervals are configured to be able to be maintained in a state in which the first bone fastener introduced from the outer portion is held by the first holder at the first holding position, and the second bone fastener introduced from the outer portion is held by the second holder at the second holding position ,
The femoral head is provided in the proximal femur,
the first bone fastener and the second bone fastener pass through a point adjacent to the inside of the distal apex of the three apexes of the inverted triangular cross section of the femoral neck and a point adjacent to the inside of at least one of the two apexes of the proximal side toward the femoral head;
the second holding body has a proximal region that protrudes proximally from the first holding body and includes the second holding position, and a distal region that is configured to be relatively movable with respect to the first holding body along the movement direction,
The proximal region has a back surface shape that is gradually curved outward from the distal region along the movement direction.
Bone fixation system. The method further includes a positioning means configured to be able to position the first holder and the second holder in a state where the first holder and the second holder are held so as not to move relative to each other in the movement direction at each of a plurality of positions corresponding to the plurality of intervals.
The bone fixing system of claim 6 . the positioning means has a first engaging portion provided on the first holding body, a second engaging portion provided on the second holding body, and engaging members that are releasably engaged with the first engaging portion and the second engaging portion, respectively;
The bone fixing system of claim 7 . the engaging member is a screw that is screwed into at least one of the first engaging portion and the second engaging portion;
The bone fixing system of claim 8.