WO2020138114A1 - 手術器具及び手術器具システム - Google Patents
手術器具及び手術器具システム Download PDFInfo
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- WO2020138114A1 WO2020138114A1 PCT/JP2019/050699 JP2019050699W WO2020138114A1 WO 2020138114 A1 WO2020138114 A1 WO 2020138114A1 JP 2019050699 W JP2019050699 W JP 2019050699W WO 2020138114 A1 WO2020138114 A1 WO 2020138114A1
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- surgical instrument
- femur
- guide
- distal end
- spacer
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
- A61B17/154—Guides therefor for preparing bone for knee prosthesis
- A61B17/155—Cutting femur
Definitions
- the present disclosure relates to a surgical instrument and a surgical instrument system used in total knee arthroplasty, particularly in unicompartmental knee arthroplasty.
- the tibia and the posterior condyle of the femur in the flexed position of the knee joint are arranged so that the knee can be bent and stretched smoothly after the attachment of the artificial knee joint (hereinafter also referred to as an implant).
- the bone cutting is performed by adjusting the amount of cutting of the distal end of the femur in the extended position with reference to the gap.
- the extension position gap which is the distance between the tibia and the femur in the extended position with the implant attached, is It is adjusted to be the same as the dimension of the flexion gap, which is the distance from
- the procedure for osteotomy in unicompartmental knee arthroplasty guides a spacer part to be inserted between the proximal end of the tibia and the femur and the osteotomy instrument for osteotomy of the femur. Therefore, it is performed using a surgical instrument configured with a guide part attached to the spacer part. Specifically, the procedure is as follows.
- the operator cuts the proximal end of the tibia facing the affected condyle (usually the internal condyle) flat.
- the surgeon inserts the spacer part of the surgical instrument between the tibia and the femur, the proximal end of which has been excised.
- the spacer portion having the maximum thickness that can be inserted between the proximal end portion of the tibia and the distal end portion of the femur in each of the extended position and the flexed position is inserted.
- the thickness of the spacer portion is confirmed and compared in the extended position and the flexed position.
- the operator inserts the spacer part between the proximal end of the tibia and the distal end of the femur, and a slit for cutting the distal end of the femur is formed. Attach the guide part of 1 to the spacer part. Then, the distal end of the femur is cut with a bone cutting device guided by the slit of the first guide portion. The position at which the distal end of the femur is cut at this time is set so that the extension gap after attachment of the implant becomes the same as the dimension of the flexion gap before osteotomy.
- the operator removes the first guide part from the spacer part and puts the knee joint of the patient in the extended position into the flexed position. Then, after attaching a second guide portion having a slit for cutting and chamfering the posterior condyle of the femur to the spacer portion, the guide portion is fixed to the bone-cut distal end of the femur with a pin. To do.
- the surgeon After fixing the guide part, the surgeon removes the spacer part and cuts the posterior condyle of the femur by the bone cutting tool by the thickness of the implant. The surgeon then chamfers the distal end of the femur from which the posterior condyle of the femur has been excised, with a bone resection tool. Then, the implant is attached to the distal end of the femur boned by these procedures.
- the above procedure adjusts the cutting position of the distal end of the femur and cuts the bone to make the extension gap and flexion gap the same size, so that the knee joint can be bent and stretched smoothly after the implant is attached.
- the purpose is to
- the surgical instrument of the present disclosure is a surgical instrument for guiding a bone resecting instrument that excises one of the posterior condyles of the femur, and has a first surface that abuts one of the posterior condyles of the femur.
- a spacer portion having a thickness, a second surface that intersects with the first surface of the spacer portion and abuts on a distal end portion of the femur, and a guide portion connected to the spacer portion; and the first surface And a guide slit through which a bone resection instrument can be inserted, the guide slit penetrating along a direction parallel to the guide slit.
- the surgical instrument system of the present disclosure includes at least two surgical instruments for guiding a bone cutting instrument for cutting one of the posterior condyles of the femur.
- the surgical instrument has a first surface that abuts one of the posterior condyles of the femur, a spacer portion having a predetermined thickness, and a distal end portion of the femur that intersects the first surface of the spacer portion.
- a guide portion connected to the spacer portion, and a guide slit that penetrates along a direction parallel to the first surface and into which a bone resection instrument can be inserted.
- At least two of the surgical instruments have different distances from the first surface to the guide slit.
- FIG. 4 is a side view showing the surgical instrument shown in FIG. 3.
- FIG. 4 is a front view showing the surgical instrument shown in FIG. 3.
- a plurality of parts are required for the operation, such as using a first guide part and a second guide part that are separate from the spacer part. is there.
- the amount of bone cut is adjusted in the extended position to cut off the distal end of the femur. No adjustment was made to remove the posterior condyle of the femur. Therefore, by cutting the posterior condyle of the femur in the flexed position so that the extension gap and the flexion gap have the same dimensions after the attachment of the implant, the gap can be easily adjusted by a simple operation. Realization of equipment is desired.
- FIG. 1 is a diagram showing a surgical instrument according to an embodiment of the present disclosure, and is a diagram showing a state in which the surgical instrument 1 is attached to a distal end 111 of a femur.
- FIG. 1 illustrates a state in which the surgical instrument 1 is attached to the inner condyle side of the left leg knee joint of the human body.
- FIG. 2 is a diagram showing a surgical instrument system 10 according to an embodiment of the present disclosure.
- FIG. 3 is a perspective view showing the surgical instrument 1 according to an embodiment of the present disclosure.
- FIG. 4 is a side view showing the surgical instrument 1 shown in FIG.
- FIG. 5 is a front view showing the surgical instrument 1 shown in FIG.
- a thin line is added to represent the outer shape.
- the directions shown in each figure are based on the human body when the surgical instrument is attached in a bent position. Specifically, in each drawing, the directions described as front, rear, top, bottom, left, and right correspond to the front, back, top, bottom, left, and right directions of the human body.
- the direction indicated by the arrow described above is referred to as the upper side or the upper side
- the direction indicated by the arrow described as the lower is referred to as the lower side or the lower side
- the direction indicated by the arrow described as the front is the front side or
- the direction indicated by the arrow, which is referred to as the front is referred to as the rear side or the rear
- the direction indicated by the arrow, which is indicated as the left is referred to as the left side or the left
- the direction which is indicated by the arrow, which is indicated as the right Is referred to as the right side or the right side.
- the left-right direction is also referred to as the width direction D.
- the surgical instrument 1 shown in the present embodiment is for guiding a long thin plate-shaped bone resecting instrument C for resecting one of the posterior condyles 112 of the femur 110 in the unicompartmental knee replacement surgery.
- a plurality of surgical instruments 1 are used as the surgical instrument system 10 in the unicompartmental knee replacement surgery in this embodiment. That is, the surgical instrument system 10 uses at least two surgical instruments 1a and 1b as shown in FIG. 2, for example, when excising the posterior condyle 112 of the femur.
- the surgical instruments 1a and 1b of the surgical instrument system 10 have different positions where guide slits 33, which will be described later, are provided.
- the surgical instrument 1 is used by being placed between the tibia 100 and the femur 110 in the artificial knee joint unicondylar replacement surgery. More specifically, the surgical instrument 1 is attached to the distal end portion 111 of the femur and one side of the posterior condyle 112 of the femur excised by the bone resecting instrument C such as a bone saw.
- the surgical instrument 1 includes a spacer portion 2 and a guide portion 3.
- the surgical instrument system 10 is used to cut the posterior femoral condyle 112 at a predetermined position, and includes a plurality of surgical instruments 1.
- the surgical instrument system 10 used in the unicompartmental knee replacement surgery includes two surgical instruments 1 which are a surgical instrument 1a and a surgical instrument 1b.
- the surgical instrument 1a and the surgical instrument 1b have different distances from the posterior condyle contact surface 20 (also referred to as the first surface) to the guide slit 33, which will be described later.
- the spacer portion 2 is arranged at a position facing the posterior condyle 112 of the femur 110.
- the spacer portion 2 is provided as a member having a predetermined thickness and extending in a flat plate shape.
- the spacer portion 2 extends in the anteroposterior direction with a certain width between the tibia proximal end portion 101 and the femoral posterior condyle 112 when the knee joint is in the flexed position.
- the spacer portion 2 is provided along the posterior condyle 112 of the femur 110.
- the spacer portion 2 has a posterior condyle contact surface 20 (also referred to as a first surface) and a tibia facing surface 21.
- the posterior condyle contact surface 20 is formed flat as a surface of the spacer portion 2 facing the posterior condyle 112 of the femur 110 with reference to FIGS. 1 to 4.
- the posterior condyle contact surface 20 contacts one of the posterior condyles 112 of the femur 110 when the knee joint of the patient is in the flexed position. More specifically, the posterior condyle contact surface 20 of the spacer portion 2 abuts on the most protruding portion of the posterior condyle 112 of the femur 110.
- the tibia facing surface 21 is formed flat as a surface of the spacer portion 2 facing the tibia 100.
- the guide part 3 is arranged at a position facing the distal end 113 of the femur 110.
- the guide portion 3 has a predetermined thickness and is provided as a portion arranged along the distal end 113 of the femur 110.
- the guide portion 3 extends forward from the lower end of the spacer portion 2. That is, it extends in the front-rear direction, which is the direction perpendicular to the spacer portion 2.
- the guide portion 3 has a distal end contact surface 30 (also referred to as a second surface), an outer surface 31, a pin hole 32, a guide slit 33, and a recess 34.
- the distal end abutment surface 30 is formed flat as a surface of the guide portion 3 on the side facing the distal end 113 of the femur 110.
- the distal end contact surface 30 is provided so as to intersect the posterior condyle contact surface 20 of the spacer portion 2, and more specifically, extends perpendicularly to the posterior condyle contact surface 20.
- the distal end contact surface 30 also abuts the distal end 113 of the femur 110. More specifically, the distal end abutment surface 30 of the guide portion 3 abuts the surface of the excised femoral distal end 113.
- the distal end contact surface 30 contacts the most protruding portion of the distal end 113 of the femur 110.
- the outer surface 31 is formed as a surface into which a pin (not shown) is inserted.
- the pin hole 32 is provided as a through hole that penetrates the guide portion 3.
- a pin for fixing the surgical instrument 1 to the femur 110 is inserted through the pin hole 32.
- the pin hole 32 holds the distal end contact surface 30 at the distal end 113 of the femur 110 by inserting a pin inserted into the femur 110.
- At least two pin holes 32 are provided in the guide portion 3.
- at least two pin holes 32 provided in the guide portion 3 have different directions in which they penetrate the guide portion 3, respectively.
- two pin holes 32 according to the present embodiment are provided in the guide portion 3, and the pin holes 32a are provided in the guide portion 3 in the vertical direction, that is, shown in FIG. It is provided so as to penetrate in the direction parallel to the axis L110 of the femur 110.
- the pin hole 32b is provided so as to be closer to the pin hole 32a in the guide portion 3 from the outer surface 31 toward the distal end contact surface 30. Accordingly, the surgical instrument 1 can be more firmly fixed by the plurality of pins so as not to move with respect to the femur, and the bone cutting operation can be performed more easily in a stable state.
- the surgical instrument 1 when compared with a surgical instrument having a plurality of pin holes penetrating in the same direction, the surgical instrument 1 can be easily attached to a bone while ensuring that the surgical instrument 1 can be inserted in the direction in which the pin is inserted. It is possible to prevent the detachment from occurring easily.
- the guide slit 33 is provided for inserting the bone resection tool C and cutting the posterior condyle 112 of the femur at a predetermined position.
- the guide slit 33 is provided so as to penetrate along the direction parallel to the posterior condyle abutment surface 20 at a position apart from the posterior condyle abutment surface 20 by a predetermined distance from the posterior condyle abutment surface 20.
- the bone resection instrument C is inserted into the guide slit 33 from the outer surface 31 side.
- the bone resecting instrument C inserted into the guide slit 33 forms a resection surface parallel to the posterior condyle contact surface 20 at a position separated from the posterior condyle contact surface 20 by a predetermined distance from the posterior femoral bone.
- the condyle 112 can be excised.
- the portion of the guide portion 3 where the guide slit 33 is provided is configured to have a larger dimension in the width direction D than the portion of the guide portion 3 where the guide slit 33 is not provided.
- the guide slit 33 has a width larger than that of the guide portion 3.
- the guide slit 33 is formed such that the distal end contact surface 30 side of the guide portion 3 is open outward on both side surfaces of the guide portion 3 in the left-right direction. For this reason, the bone resection instrument C inserted into the guide slit 33 can be operated to shake the tip side of the blade largely in the width direction of the surgical instrument 1, that is, in the left-right direction, and the surgery can be performed while ensuring a movable range.
- the entire instrument can be made compact.
- the concave portion 34 is formed on the outer surface 31 side of the guide portion 3 as shown in FIGS. 1, 2, and 4.
- the pin hole 32b is arranged in the recess 34 so that the pin inserted into the pin hole 32b does not interfere with the bone saw inserted into the guide slit 33.
- the distance from the posterior condyle contact surface 20 of the spacer portion 2 to the guide slit 33 in the anteroposterior direction is equal.
- Each is configured differently. Specifically, during surgery, as shown in FIG. 2, two surgical instruments 1 provided with guide slits 33 at different positions for cutting the posterior condyle 112 of the femur are prepared, and the osteotomy of the posterior condyle 112 of the femur is cut. It is replaced according to the thickness to be used.
- the osteotomy procedure of this embodiment is performed by using the surgical instrument 1 described above.
- the procedure of osteotomy performed using the surgical instrument 1 will be described.
- the osteophytes of the distal end 111 of the femur are removed.
- a portion of the proximal end 101 of the tibia facing the one side of the posterior condyle 112 of the femur is flatly cut using a dedicated instrument (not shown).
- the surgical instrument 1 in which the spacer portion 2 and the guide portion 3 are integrally configured is inserted into the femur so that the spacer portion 2 is inserted between the tibia 100 and the femur 110 whose proximal ends are cut off. It is installed at 110.
- the distal end 111 of the femur may be cut in a flat shape in advance.
- the posterior condyle abutment surface 20 of the spacer portion 2 abuts on the posterior femoral condyle 112, and the distal end abutment surface 30 of the guide portion 3 on the distal femur distal end 113. In the abutted state, it is fixed to the distal end 111 of the femur with a pin.
- the posterior condyle 112 of the femur is excised by the bone resecting instrument C guided by the guide slit 33.
- the surgical instrument 1 is removed from the femur distal end portion 111, and the femur distal end portion 111 is excised by the thickness of the implant. Further, the implant is attached after chamfering the distal end 111 of the femur. Due to the unicompartmental knee replacement surgery performed according to the above procedure, the flexion gap and the extension gap after the implant is attached have the same size, so that the patient can smoothly bend and extend the knee joint. ..
- the surgical instrument 1 and the surgical instrument 1 of the surgical instrument system 10 include a spacer portion 2 and a guide portion 3 extending in a direction perpendicular to the spacer portion 2. Therefore, the operator can arrange the surgical instrument 1 so that the spacer portion 2 is arranged along the posterior condyle 112 of the femur and the guide portion 3 is arranged along the distal end portion 111 of the femur. .. Further, the spacer portion 2 has a posterior condyle contact surface 20 that abuts one of the posterior condyles 112 of the femur in the bent position, and the guide portion 3 extends perpendicularly to the posterior condyle contact surface 20.
- a distal end abutment surface 30 that abuts the bone distal end 111, a pin hole 32 for holding the distal end abutment surface 30 on the femoral distal end 111, and a bone resection instrument C are provided. It has a guide slit 33 to be inserted. Therefore, the operator uses the surgical instrument 1 having a simple structure as described above in the artificial knee joint unicondylar replacement operation to perform the bone resection in which the posterior condyle 112 of the femur in the flexed position is guided by the guide slit 33. The bone can be cut by the instrument C.
- the extension position is adjusted so that the flexion gap and the extension gap have the same dimensions after the implant is attached.
- the distal end 111 of the femur had been excised.
- the surgical instrument 1 and the surgical instrument 1 of the surgical instrument system 10 it is possible to adjust the bone cutting amount of the posterior condyle 112 of the femur in the flexed position to perform the bone cutting.
- the flexion gap after the implant attachment is the same as the dimension of the extension gap before the osteotomy.
- the surgical instrument 1 of the surgical instrument system 10 has the guide slit 33 which is provided so as to penetrate along the direction parallel to the posterior condyle contact surface 20 and in which the bone resection instrument C is inserted. It has the guide part 3 which has.
- the surgical instrument 1 of the surgical instrument system 10 is at least two in number, and the distances from the posterior condyle contact surface 20 to the guide slit 33 are different from each other. Therefore, the bone cutting amount can be easily adjusted by replacing the surgical instrument 1 when excising the femoral posterior condyle 112 in the flexed position.
- the guide portion 3 is provided with at least two pin holes 32 as through holes. Then, a pin for fixing the surgical instrument 1 to the femur 110 is inserted through the at least two pin holes 32. As a result, the surgical instrument 1 is more firmly fixed by the plurality of pins so as not to move with respect to the femur.
- the surgical instrument 1 at least two pin holes 32 provided in the guide portion 3 penetrate in different directions. Therefore, as compared with the guide portion 3 provided with a plurality of pin holes 32 penetrating in the same direction, the surgical instrument 1 is easily detached in the pin piercing direction while ensuring the ease of attachment. Can be suppressed.
- the surgical instrument 1 as shown in FIG. 5, the dimension in the width direction D of the portion of the guide portion 3 where the guide slit 33 is provided is formed larger than that of the portion where the guide slit 33 is not provided. ing. Thereby, the surgical instrument as a whole can be made compact while ensuring the movable range of the bone resection instrument for excising bone while being inserted into the guide slit.
- the surgical instrument 1 in which the spacer portion 2 and the guide portion 3 are integrally configured has been described as an example, but this need not be the case.
- the spacer portion 2 and the guide portion 3 may be configured separately, and may be used in combination during surgery.
- the present disclosure can be widely applied as a surgical instrument and a surgical instrument system used in unicompartmental knee replacement surgery.
- Surgical instrument 10 Surgical instrument system 2
- Spacer 20 Posterior condyle contact surface (first surface) 3
- Guide part 30 distal end contact surface (2nd surface) 32 pin hole 33
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Abstract
Description
本実施形態における、手術器具1、及び手術器具システム10の手術器具1は、スペーサ部2と、スペーサ部2に対して垂直な方向に延びるガイド部3と、を備えている。このため、術者は、手術器具1を、スペーサ部2が大腿骨後顆112に対して沿うように配置するとともにガイド部3を大腿骨遠位端部111に沿うように配置することができる。また、スペーサ部2は、屈曲位の状態において大腿骨後顆112の一方に当接する後顆当接面20を有し、ガイド部3は、後顆当接面20に対して垂直に延び大腿骨遠位端部111に当接する遠位端部当接面30と、遠位端部当接面30を大腿骨遠位端部111に保持するためのピン孔32と、骨切除器具Cが挿入されるガイドスリット33とを有している。このため、術者は、人工膝関節単顆置換術において、上記のような簡素な構造の手術器具1を使用して、屈曲位における大腿骨後顆112をガイドスリット33によって案内された骨切除器具Cによって骨切りすることができる。
以上、本開示の実施形態について説明したが、本開示は上述の実施の形態に限られるものではなく、特許請求の範囲に記載した限りにおいて様々に変更して実施することができるものである。例えば、次のような変形例が実施されてもよい。
10 手術器具システム
2 スペーサ部
20 後顆当接面(第1面)
3 ガイド部
30 遠位端部当接面(第2面)
32 ピン孔
33 ガイドスリット
100 脛骨
110 大腿骨
111 大腿骨遠位端部
112 大腿骨後顆
C 骨切除器具
D 幅方向
Claims (5)
- 大腿骨の後顆の一方を切除する骨切除器具を案内するための手術器具であって、
大腿骨の後顆の一方に当接する第1面を有し、所定の厚みを有するスペーサ部と、
前記スペーサ部の前記第1面に交わるとともに前記大腿骨の遠位端部に当接する第2面を有し、前記スペーサ部に接続したガイド部と、
前記第1面と平行な方向に沿って貫通した、骨切除器具が挿入可能なガイドスリットと、
を備えている手術器具。 - 請求項1に記載の手術器具であって、
前記ガイド部は、前記大腿骨に挿入されるピンを挿通可能なピン孔を更に有しており、
前記ピン孔は、前記ガイド部を貫通する貫通孔として設けられ、前記ガイド部に少なくとも2つ設けられていることを特徴とする、手術器具。 - 請求項2に記載の手術器具であって、
前記ガイド部に少なくとも2つ設けられた前記ピン孔は、前記ガイド部をそれぞれ貫通する方向が異なっていることを特徴とする、手術器具。 - 請求項1~3のいずれか1項に記載の手術器具であって、
前記ガイド部における前記ガイドスリットが設けられている部分が、前記ガイド部における前記ガイドスリットが設けられていない部分よりも幅方向の寸法が大きいことを特徴とする、手術器具。 - 手術器具システムであって、
大腿骨後顆の一方を切除する骨切除器具を案内するための手術器具を少なくとも2つ含み、
前記手術器具は、大腿骨の後顆の一方に当接する第1面を有し、所定の厚みを有するスペーサ部と、
前記スペーサ部の前記第1面に交わるとともに前記大腿骨の遠位端部に当接する第2面を有し、前記スペーサ部に接続したガイド部と、
前記第1面と平行な方向に沿って貫通した、骨切除器具が挿入可能なガイドスリットと、を有し、
少なくとも2つの前記手術器具は、前記第1面から前記ガイドスリットまでの距離がそれぞれ異なることを特徴とする、手術器具システム。
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US17/413,864 US20220054145A1 (en) | 2018-12-25 | 2019-12-24 | Surgical instrument and surgical instrument system |
AU2019414175A AU2019414175A1 (en) | 2018-12-25 | 2019-12-24 | Surgical instrument and surgical instrument system |
EP19902152.8A EP3903697A4 (en) | 2018-12-25 | 2019-12-24 | SURGICAL INSTRUMENT AND SURGICAL INSTRUMENT SYSTEM |
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JP2018240743A JP7189758B2 (ja) | 2018-12-25 | 2018-12-25 | 手術器具及び手術器具システム |
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US11540928B2 (en) * | 2017-03-03 | 2023-01-03 | Engage Uni Llc | Unicompartmental knee arthroplasty |
CN115005986B (zh) * | 2022-05-31 | 2023-04-07 | 北京长木谷医疗科技有限公司 | 单髁置换手术个性化智能导航定位装置及截骨器 |
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US20040153087A1 (en) * | 2003-02-04 | 2004-08-05 | Sanford Adam H. | Provisional orthopedic implant with removable guide |
US20050192588A1 (en) * | 2004-02-27 | 2005-09-01 | Garcia Daniel X. | Instrumentation and method for prosthetic knee |
US7601154B2 (en) * | 2005-04-18 | 2009-10-13 | Uni-Knee, Llc | Unicondylar knee instrument system |
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2018
- 2018-12-25 JP JP2018240743A patent/JP7189758B2/ja active Active
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2019
- 2019-12-24 US US17/413,864 patent/US20220054145A1/en active Pending
- 2019-12-24 WO PCT/JP2019/050699 patent/WO2020138114A1/ja unknown
- 2019-12-24 AU AU2019414175A patent/AU2019414175A1/en active Pending
- 2019-12-24 EP EP19902152.8A patent/EP3903697A4/en active Pending
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Also Published As
Publication number | Publication date |
---|---|
US20220054145A1 (en) | 2022-02-24 |
EP3903697A1 (en) | 2021-11-03 |
JP2020099568A (ja) | 2020-07-02 |
EP3903697A4 (en) | 2022-09-28 |
JP7189758B2 (ja) | 2022-12-14 |
AU2019414175A1 (en) | 2021-08-12 |
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