WO2020203796A1 - 手術器具 - Google Patents
手術器具 Download PDFInfo
- Publication number
- WO2020203796A1 WO2020203796A1 PCT/JP2020/014098 JP2020014098W WO2020203796A1 WO 2020203796 A1 WO2020203796 A1 WO 2020203796A1 JP 2020014098 W JP2020014098 W JP 2020014098W WO 2020203796 A1 WO2020203796 A1 WO 2020203796A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- main body
- surgical instrument
- femur
- excision
- contact surface
- Prior art date
Links
- 0 CC[C@](C(C*1)[C@](*2)[C@]2C[C@](*)C2C3)C1[C@]2C3=C Chemical compound CC[C@](C(C*1)[C@](*2)[C@]2C[C@](*)C2C3)C1[C@]2C3=C 0.000 description 2
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Classifications
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2/461—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of knees
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/38—Joints for elbows or knees
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/38—Joints for elbows or knees
- A61F2/3859—Femoral components
Definitions
- the present disclosure relates to a surgical instrument that guides an osteotomy instrument for additional excision of the femur in total knee arthroplasty.
- the gap between the proximal tibia and the distal femur at the flexion position of the knee in the flexion position and the extension position respectively.
- the distance, that is, the extension gap and the flexion gap need to be the same.
- the operator first performs a horizontal osteotomy of the proximal tibia and an osteotomy of the distal femur. Then, it is known that after the femur is osteotomized in total knee arthroplasty, the femur is re-cut and the femur after the osteotomy is downsized.
- the guide body is attached by inserting the fixing pin into the locking hole while keeping the distal femur osteotomy and the chamfer osteotomy of the guide body in close contact with the distal femur and the anterior chamfer. Re-cut the femur.
- the fixing pin is removed, the guide body is turned upside down, and the osteotomy surface of the chamfer part is fixed in close contact with the posterior chamfer part of the femur by the fixing pin, and posterior with an osteotomy instrument. Re-cut the chamfer part.
- the present disclosure discloses a surgical instrument capable of additionally excising the bone after excision of the distal femur to easily adjust the gap between the extension position and the flexion position.
- the surgical instrument is a surgical instrument for guiding an osteotomy instrument for excising the femur, and is a first contact capable of contacting the distal end excision surface of the distal part of the femur.
- the main body includes a main body having a surface and a posterior condyle contact portion having a second contact surface capable of contacting the posterior condyle excision surface of the posterior condyle portion of the femur and connected to the main body portion.
- the portion has a first slit extending in a direction parallel to the second contact surface, and a second slit extending in a direction intersecting the first contact surface and the second contact surface. It is a surgical instrument characterized by being present.
- a surgical instrument capable of additionally excising the bone after excision of the distal femur to easily adjust the gap between the extension position and the flexion position.
- FIG. 3A is a view showing a state in which a position adjusting mechanism is not attached
- FIG. 3B is a state in which a position adjusting mechanism is attached. It is a figure shown by. It is a front view which shows the surgical instrument shown in FIG. 3A.
- FIG. 6A shows the state before attaching the surgical instrument to the distal part of the femur
- FIG. 6B is the distance from the femur.
- the state where the surgical instrument is attached to the position is shown.
- FIG. 7A shows the state which the distal part of the femur was additionally excised
- FIG. 7B is after the additional excision.
- the state where the surgical instrument is removed from the distal part of the femur is shown.
- FIG. 8A shows the case where the position adjustment mechanism is not attached
- FIG. 8B is the case where the position adjustment mechanism is attached. It is a figure which shows about.
- the direction indicated by the arrow described as front is referred to as front or front side
- the direction indicated by the arrow described as rear is referred to as rear or rear side.
- the direction indicated by the arrow described as right is referred to as the right
- the direction indicated by the arrow described as left is referred to as the left
- the direction indicated by the arrow described as above is referred to as the upper side
- the direction indicated by the lower side is referred to as downward.
- FIG. 1 is a diagram showing a surgical instrument 1 according to an embodiment, and is a perspective view showing a state in which the surgical instrument 1 is attached to the distal femur 101 in a flexed state.
- FIG. 2 is a side view showing a state in which the surgical instrument 1 shown in FIG. 1 is attached to the distal femur 101 in the flexed position.
- the illustration of the fixing pin 6b for attaching the surgical instrument 1 to the femur 100 is omitted.
- Surgical instrument 1 is an instrument used to guide an osteotomy instrument (not shown) when additionally excising the femur 100 in total knee arthroplasty.
- an excised surface is formed in the distal part of the femur with an instrument different from the surgical instrument 1.
- a plurality of excised surfaces are formed on the femur 100.
- a distal end excision surface 102 which is an excision surface perpendicular to the bone axis of the femur, is formed at the distal femur 101.
- the posterior condyle excision surface 104 is formed perpendicular to the distal end excision surface 102.
- at least a posterior chamfer excision surface 105 extending obliquely with respect to the distal end excision surface 102 and the posterior condyle excision surface 104 is formed.
- the distal end excision surface 102 is the excision surface at the distal femur 101 excised to install the femoral component (not shown) of the artificial knee joint, for example, with respect to the femoral axis L100. Formed as a vertical cut surface.
- the posterior condyle excision surface 104 is the excision surface of the posterior condyle portion 103 of the femur 100 formed perpendicular to the distal end excision surface 102.
- the distal end excision surface 102 may be formed as an excision surface substantially perpendicular to the bone axis L100 of the femur, depending on the purpose and the like.
- the distal end excision surface 102 may be formed so as to be inclined from a position perpendicular to the bone axis L100 of the femur due to an excision error of the osteotomy, correction of the joint surface, and the like.
- FIG. 3 is a side view showing the surgical instrument 1 shown in FIG. 2
- FIG. 3 (a) is a view showing a state in which the position adjusting mechanism 4 is not attached
- FIG. 3 (b) is a position. It is a figure which shows the state which the adjustment mechanism 4 is attached.
- FIG. 4 is a front view showing the surgical instrument 1 shown in FIG.
- FIG. 5 is a cross-sectional view of the surgical instrument 1 shown in FIG. 4 at the position seen along the line AA.
- the surgical instrument 1 guides the osteotomy instrument for excising the femur when the excision surface of the distal femur 101 formed by the osteotomy is additionally excised.
- the surgical instrument 1 has a main body portion 2, a posterior condyle contact portion 3, and a position adjusting mechanism 4.
- the main body 2 is formed in a substantially plate shape having a predetermined thickness in the anterior-posterior direction, and is in contact with the distal end excision surface 102 of the distal femur 101. Be placed.
- the main body 2 is fixed to the distal end excision surface 102 by a fixing pin 6b described later when performing additional excision of the excision surface of the distal femur 101.
- the shape of the main body 2 is symmetrical.
- the main body 2 includes a first contact surface 5, a fixing mechanism 6, a first slit 7 for guiding an osteotomy device for additional excision of the posterior condyle portion in a direction parallel to the posterior condyle excision surface 102, and posterior It has a second slit 8 for guiding an osteotomy instrument for additional excision of the posterior condyle portion in a direction parallel to the lateral chamfer excision surface 105, and a magnetic material 9.
- the first contact surface 5 is a flat surface formed on the rear side of the main body 2.
- the first contact surface 5 can contact the distal end excision surface 102 of the femur 100 formed perpendicular to the bone axis L100 of the femur in the main body 2.
- the first contact surface 5 is provided in a direction perpendicular to the posterior condyle excision surface 104.
- the fixing mechanism 6 is configured to hold the first contact surface 5 on the distal end excision surface 102.
- the fixing mechanism 6 in the present embodiment includes a pin hole 6a and a fixing pin 6b.
- the pin hole 6a is a hole through which the fixing pin 6b to be inserted into the femur is inserted, and is provided as a hole for holding the first contact surface 5 on the distal end excision surface 102.
- the pin hole 6a is provided as a through hole penetrating the main body 2.
- the fixing pin 6b is inserted into the femur 100 in a state of being inserted through the pin hole 6a.
- Two pin holes 6a are provided above the main body 2.
- the fixing pins 6b inserted into the pin holes 6a are inserted from the front side, respectively. The directions in which the two pin holes 6a penetrate the main body 2 are different from each other. Therefore, the fixing pins 6b inserted into the pin holes 6a are fixed to the distal femur 101 so as to face different directions from each other.
- the first slit 7 is a hole for guiding the osteotomy instrument when the posterior condyle excision surface 104 of the distal femur 101 is additionally excised.
- the first slit 7 guides an osteotomy instrument for additional excision of the posterior condyle portion 103 in a direction parallel to the posterior condyle excision surface 104.
- the first slit 7 is formed so as to be parallel to the posterior condyle resection surface 104 when the surgical instrument 1 is installed in the distal femur 101.
- the first slits 7 are formed at two positions on the left and right below the main body 2.
- the first slit 7 formed on the right side of the main body 2 is formed so as to open in the front-rear direction and the right direction.
- the first slit 7 formed on the left side of the main body 2 is formed so as to open in the front-rear direction and the left direction.
- the second slit 8 is a hole for guiding the osteotomy instrument when the posterior chamfer excision surface 105 of the femur 100 is additionally excised.
- the second slit 8 guides an osteotomy instrument that additionally excises the posterior condyle portion 103 in a direction parallel to the posterior chamfer excision surface 105. That is, the second slit 8 is formed parallel to the rear chamfer cut surface 105.
- the second slit 8 is formed at two positions on the left and right of the main body 2.
- the second slit 8 is formed as a hole that obliquely penetrates the main body 2 in the front-rear direction.
- the second slit 8 is inclined downward from the front to the rear.
- the magnetic body 9 is provided so that the position adjusting mechanism 4 can be detachably attached to the first contact surface 5 of the main body 2.
- the magnetic body 9 is formed in a substantially cylindrical shape.
- Two magnetic bodies 9 are provided inside the main body 2, and are arranged substantially in the center in the left-right direction.
- the magnetic body 9 is a permanent magnet such as a rare earth magnet.
- the posterior condyle contact portion 3 is formed in a substantially plate shape having a predetermined thickness in the vertical direction.
- the posterior condyle contact portion 3 extends in a direction perpendicular to the main body portion 2.
- the posterior condyle contact portion 3 is provided integrally with the main body portion 2.
- the posterior condyle contact portion 3 extends posteriorly in a cantilever shape at the lower end portion of the main body portion 2.
- the posterior condyle contact portion 3 is arranged in the gap between the proximal tibia 111 and the distal femur 101 of the tibia 110.
- the posterior condyle contact portion 3 is in contact with the posterior condyle excision surface 104 between the proximal tibia 111 and the posterior condyle portion 103 of the femur 100 in the flexed position. Be placed.
- the posterior condyle contact portion 3 has a second contact surface 10 and a third slit 11.
- the second contact surface 10 can directly contact the posterior condyle excision surface 104 of the femur 100.
- the second contact surface 10 is a flat surface provided on the upper surface of the posterior condyle contact portion 3.
- the second contact surface 10 is configured as a surface perpendicular to the first contact surface 5 of the main body 2.
- the third slit 11 is a hole provided so that the osteotomy instrument that is guided by the second slit 8 and additionally excises the posterior chamfer excision surface 105 does not hit the posterior condyle contact portion 3.
- the third slit 11 is formed in the posterior condyle contact portion 3 and is arranged on an extension line of the second slit 8.
- the third slit 11 is formed parallel to the second slit 8 and the rear chamfer cut surface 105.
- the position adjusting mechanism 4 is a member for adjusting the excision position of the distal femur 101.
- the position adjusting mechanism 4 can displace the holding position of the first contact surface 5 with respect to the distal end cut surface 102.
- the position adjusting mechanism 4 in the present embodiment is configured as an additional spacer 4a.
- the additional spacer 4a is detachably attached to the first contact surface 5 of the main body 2.
- the additional spacer 4a attached to the first contact surface 5 is configured to abut the distal end excision surface 102 of the femur 100. That is, when the additional spacer 4a is attached to the first contact surface 5 of the main body 2, the distal end excision surface 102 of the femur 100 abuts on the additional spacer 4a and comes into contact with the first contact surface 5. Do not contact directly.
- the main body 2 is installed on the distal end cut surface 102 via the additional spacer 4a when the additional spacer 4a is attached.
- the additional spacer 4a is formed in a flat plate shape. At least the front and rear surfaces of the additional spacer 4a are formed parallel to each other.
- the additional spacer 4a is a material attracted by magnetic force, that is, a ferromagnet, and for example, iron, stainless steel, or the like is used.
- the additional spacer 4a is detachably attached to the main body 2 provided with the magnet via magnetic force.
- One additional spacer 4a in the present embodiment is attached to the first contact surface 5 of the main body 2. Then, a plurality of additional spacers having different thicknesses may be provided, and they can be used by replacing them with other additional spacers 4a having different thicknesses according to the amount of osteotomy of the additional excision. This allows the surgeon to adjust the amount of osteotomy on the posterior chamfer excision surface.
- FIG. 6 is a diagram showing a step of additionally excising the distal femur 101
- FIG. 6A shows a state before attaching the surgical instrument 1 to the distal femur 101
- b) shows a state in which the surgical instrument 1 is attached to the distal femur 101
- FIG. 7 is a diagram showing a step of additional excision of the distal femur
- FIG. 7 (a) shows a state in which the distal femur is additionally excised
- FIG. 7 (b) is an additional excision.
- the state in which the surgical instrument is removed from the distal part of the femur is shown.
- the femur 100 is shown in the outer shape, and the surgical instrument 1 is shown in the cross section.
- the fixing pin 6b is not shown.
- the operator At the time of total knee arthroplasty, the operator first performs a horizontal osteotomy of the proximal tibia 111 and an osteotomy of the distal femur 101.
- the distal femur 101 where the osteotomy was performed, includes a plurality of posterior condyle resection surfaces 104, distal end resection surface 102, and posterior chamfer resection surface 105, as shown in FIG. 6 (a).
- the excised surface is formed.
- the operator abuts the second contact surface 10 of the posterior condyle contact portion 3 with the posterior condyle excision surface 104, and the first contact surface 5 is distal. It comes into contact with the edge cut surface 102.
- the surgeon fixes the surgical instrument 1 to the femur 100 in a state of being in contact with the distal femur 101 by the fixing pin 6b.
- the surgical instrument does not inadvertently swing when the operator performs additional excision. Therefore, the additional excision can be performed with the surgical instrument stably fixed to the femur.
- the posterior chamfer excision surface 105 of the distal femur 101 is additionally excised by the osteotomy instrument guided by the second slit 8 of the main body 2.
- the posterior chamfer excision surface 105a is formed on the excised surface after the posterior chamfer excision surface 105 is additionally excised.
- the posterior condyle resection surface 104 of the distal femur 101 is additionally resected by the osteotomy instrument guided by the first slit 7 of the main body 2.
- a posterior condyle resection surface 104a is formed on the resection surface after the posterior condyle resection surface 104 is additionally resected.
- the surgical instrument 1 is removed from the distal femur 101.
- the distal femur 101 from which the surgical instrument 1 has been removed has the shape shown in FIG. 7 (b). This additional excision increases the flexion gap and adjusts the difference between the extension gap and the flexion gap.
- the posterior chamfer excision surface 105 is additionally excised, so that the distal femur 101 is formed so that the femur component can be attached.
- FIG. 8 is a view showing a surgical instrument 1 for performing additional excision of the distal femur 101
- FIG. 8 (a) shows a case where the additional spacer 4a is not attached
- FIG. 8 (b) shows an additional It is a figure which shows the case where the spacer 4a is attached.
- the femur 100 is shown in the outer shape, and the surgical instrument 1 is shown in the cross section.
- the fixing pin 6b for attaching the surgical instrument 1 to the femur 100 is not shown.
- an instrument of appropriate size is first used to form an excised surface of the femur 100 that is sized for each individual patient.
- the surgical instrument 1 that performs additional excision after forming the excised surface the surgical instrument 1 having a size corresponding to the instrument used when the excised surface is formed is used.
- the posterior chamfer excised surface 105 is additionally excised with a large surgical instrument 1 that does not correspond to this, As shown in FIG. 8 (a), the posterior chamfer excision surface 105 is excised more than the required excision amount.
- the posterior chamfer excision surface 105 is additionally excised with a small size surgical instrument 1 that does not correspond to this, the posterior side The chamfer excision surface 105 is excised in a state where the excision amount is less than the required amount.
- the additional spacer 4a is a position adjusting mechanism, and by being attached to the first contact surface 5 of the main body 2, the relative position of the second slit 8 with respect to the rear chamfer cut surface 105 can be adjusted. For example, as shown in FIG. 8B, by attaching the additional spacer 4a, the position of the first contact surface 5 with respect to the distal end cut surface 102 is separated from the state where the additional spacer 4a is not attached. The excision position of the second slit 8 with respect to the posterior chamfer excision surface 105 can be moved to a position where the excision amount is smaller.
- the operator can remove the posterior chamfer excision surface 105 with an appropriate excision amount by attaching and detaching the additional spacer 4a. It will be possible to do. Therefore, it is possible to easily adjust the gap between the extension position gap and the bending position.
- the surgical instrument 1 has a main body portion 2 and a posterior condyle contact portion 3.
- the main body 2 has a first contact surface 5 capable of contacting the distal end excision surface 102 of the femur 100, and the posterior condyle contact portion 3 is on the posterior condyle excision surface 104 of the femur 100. It has a second contact surface 10 that can be contacted.
- the second slit 8 of the above is provided.
- the operator when the operator additionally resects the posterior condyle portion 103 of the femur 100 in total knee arthroplasty, the operator makes a second surgical instrument 1 on the posterior condyle excision surface 104 after osteotomy of the distal femur 101. After the contact surface 10 is brought into contact with the contact surface 10, additional excision can be performed. That is, when excising the posterior condyle excision surface 104 and the posterior chamfer excision surface 105 of the distal femur 101, the operator performs additional excision at the target position with reference to the second contact surface 10. be able to.
- the surgeon adjusts the position of the surgical instrument 1 with reference to the second contact surface 10 so that the extension position gap and the flexion position gap are the same, and the posterior condyle portion is sized to require excision.
- An additional excision of 103 can be performed.
- the bone after excision of the distal femur 101 can be additionally excised to easily adjust the gap between the extension position and the flexion position.
- the first contact surface 5 can be held on the distal end excision surface 102 by the fixing mechanism 6. Therefore, the main body 2 is fixed to the femur 100, and the surgical instrument 1 does not inadvertently swing when performing additional excision. As a result, the surgeon can perform the additional excision work in a state where the surgical instrument 1 is stably fixed to the femur 100.
- the fixing mechanism 6 includes a fixing pin 6b and a pin hole 6a through which the fixing pin 6b is inserted. Therefore, the first contact surface 5 is held by the distal end excision surface 102 by the fixing pin 6b that is inserted through the pin hole 6a and inserted into the femur 100. That is, the fixing mechanism 6 can be realized with a simple configuration, and the main body 2 can be firmly and stably fixed to the distal femur 101.
- the surgical instrument 1 is provided with a position adjusting mechanism 4 capable of adjusting the holding position of the first contact surface 5 with respect to the distal end excision surface 102. Therefore, the operator can adjust the position of the second slit 8 with respect to the distal femur 101 by the position adjusting mechanism 4. That is, the surgeon can adjust the amount of osteotomy without exchanging the surgical instrument 1.
- the additional spacer 4a can be attached to the first contact surface 5 of the main body 2, and the main body 2 is distal with the additional spacer 4a. It abuts on the edge cut surface 102.
- the first contact surface 5 of the main body 2 can be held at a distance of the additional spacer 4a from the distal femur 101, and the second slit 8 with respect to the distal femur 101 can be held.
- the position can be adjusted. That is, the surgeon can adjust the amount of osteotomy simply by attaching the additional spacer 4a to the main body 2 without exchanging the surgical instrument 1.
- At least one of the main body 2 and the additional spacer 4a of the surgical instrument 1 contains a magnetic material, and the additional spacer 4a is detachably attached to the main body 2. Be done. Therefore, the surgeon who uses the surgical instrument 1 can easily adjust the amount of osteotomy of the femur 100 by attaching and detaching the additional spacer 4a to and from the main body 2.
- the fixing mechanism 6 includes the pin hole 6a and the fixing pin 6b has been described as an example, but this may not be the case.
- the fixing mechanism 6 may be provided in the main body 2 as a locking portion that can be locked to the femur 100.
- the position adjusting mechanism 4 may include a sliding portion that slidably holds the first contact surface 5 of the main body portion 2 in the direction of the bone axis L100 of the femur.
- the additional spacer 4a may be made of a material having a magnetic material 9 and the main body 2 being attracted by a magnetic force.
- the magnetic body 9 is provided not only on the main body 2 but also on the additional spacer 4a, and the poles of the magnetic body 9 provided on the main body 2 and the additional spacer 4a are arranged so as to be opposite to each other. May be configured to attract each other.
- the additional spacer 4a is attached to and detached from the first contact surface 5 of the main body 2 by magnetic force has been described as an example, but this may not be the case.
- the additional spacer 4a may be mechanically removable, such as being fitted by a slide into the first contact surface 5 of the main body 2.
- the surgical instrument 1 is a surgical instrument 1 for guiding an osteotomy instrument for excising the femur 100, which is an excision surface in the distal femur 101 and is the femur.
- the main body 2 provided with the first contact surface 5 capable of contacting the distal end cut surface 102, which is the cut surface perpendicular to the bone axis of 100, and the first contact surface 5 provided perpendicular to the first contact surface 5.
- a second contact surface 10 capable of contacting the posterior condyle excision surface 104, which is the excision surface of the posterior condyle portion 103 of the femur 100, and the posterior condyle contact portion 3 provided integrally with the main body portion 2.
- the main body 2 has a first slit 7 that guides an osteotomy instrument for additional excision of the posterior condyle portion 103 in a direction parallel to the posterior condyle excision surface 104, and a distal end excision surface 102 in the femur 100. Guides an osteotomy device for additional excision of the posterior condyle portion 103 in a direction parallel to the posterior chamfer excision surface 105 formed so as to extend obliquely to the posterior condyle excision surface 104.
- a second slit 8 is provided.
- the surgical instrument 1 has a main body portion 2 and a posterior condyle contact portion 3.
- the main body 2 has a first contact surface 5 capable of contacting the distal end excision surface 102 of the femur 100, and the posterior condyle contact portion 3 is on the posterior condyle excision surface 104 of the femur 100. It has a second contact surface 10 that can be contacted.
- the operator when the operator additionally resects the posterior condyle portion 103 of the femur 100 in total knee arthroplasty, the operator makes a second surgical instrument 1 on the posterior condyle excision surface 104 after osteotomy of the distal femur 101. After the contact surface 10 is brought into contact with the contact surface 10, additional excision can be performed. That is, when excising the posterior condyle excision surface 104 and the posterior chamfer excision surface 105 of the distal femur 101, the operator performs additional excision at the target position with reference to the second contact surface 10. be able to.
- the surgeon adjusts the position of the surgical instrument 1 with reference to the second contact surface 10 so that the extension position gap and the flexion position gap are the same, and the posterior condyle portion is sized to require excision.
- An additional excision of 103 can be performed.
- the bone after excision of the distal femur 101 can be additionally excised to easily adjust the gap between the extension position and the flexion position.
- the surgical instrument 1 further includes a fixing mechanism 6 for holding the first contact surface 5 on the distal end excision surface 102.
- the fixing mechanism 6 can hold the first contact surface 5 on the distal end excision surface 102. Therefore, the main body 2 is fixed to the femur 100, and the surgical instrument 1 does not inadvertently swing when performing additional excision. As a result, the surgeon can perform the additional excision work in a state where the surgical instrument 1 is stably fixed to the femur 100.
- the fixing mechanism 6 includes a fixing pin 6b inserted into the femur 100 and a pin hole 6a provided as a through hole penetrating the main body 2 through which the fixing pin 6b is inserted.
- the pin 6b is inserted into the femur 100 in a state of being inserted into the pin hole 6a, so that the first contact surface 5 is held by the distal end excision surface 102.
- the fixing mechanism 6 includes a fixing pin 6b and a pin hole 6a through which the fixing pin 6b is inserted. Therefore, the first contact surface 5 is held by the distal end excision surface 102 by the fixing pin 6b that is inserted through the pin hole 6a and inserted into the femur 100. That is, the fixing mechanism 6 can be realized with a simple configuration, and the main body 2 can be firmly and stably fixed to the distal femur 101.
- the surgical instrument 1 includes a plurality of the pin holes 6a, and the directions in which the pin holes penetrate the main body 2 are different from each other.
- the main body 2 can be better fixed to the femur 100.
- the surgical instrument 1 is further provided with a position adjusting mechanism 4 that can displace the holding position of the first contact surface 5 with respect to the distal end excision surface 102.
- the surgical instrument 1 is provided with a position adjusting mechanism 4 capable of adjusting the holding position of the first contact surface 5 with respect to the distal end excision surface 102. Therefore, the operator can adjust the position of the second slit 8 with respect to the distal femur 101 by the position adjusting mechanism 4. That is, the surgeon can adjust the amount of osteotomy without exchanging the surgical instrument 1.
- the position adjusting mechanism 4 is detachably attached to the main body 2 on the first contact surface 5, and is configured to come into contact with the distal end cut surface 102 while being attached to the main body 2.
- the additional spacer 4a is detachably attached to the main body 2 on the first contact surface 5, and is configured to come into contact with the distal end cut surface 102 while being attached to the main body 2.
- the additional spacer 4a can be attached to the first contact surface 5 of the main body 2, and the main body 2 abuts on the distal end cut surface 102 with the additional spacer 4a.
- the first contact surface 5 of the main body 2 can be held at a distance of the additional spacer 4a from the distal femur 101, and the second slit 8 with respect to the distal femur 101 can be held.
- the position can be adjusted. That is, the surgeon can adjust the amount of osteotomy simply by attaching the additional spacer 4a to the main body 2 without exchanging the surgical instrument 1.
- At least one of the main body 2 and the additional spacer 4a includes a magnetic material 9, and the additional spacer 4a is detachably attached to the main body 2 via magnetic force.
- At least one of the main body 2 and the additional spacer 4a of the surgical instrument 1 contains the magnetic material 9, and the additional spacer 4a is detachably attached to the main body 2. Therefore, the surgeon who uses the surgical instrument 1 can easily adjust the amount of osteotomy of the femur 100 by attaching and detaching the additional spacer 4a to and from the main body 2.
- the main body 2 is provided with a magnet
- the additional spacer 4a is provided with a ferromagnet and is detachably attached to the main body 2 via magnetic force.
- an additional spacer 4a containing a ferromagnetic material such as iron or stainless steel can be reliably attached to the main body 2. Therefore, the production of the additional spacer 4a becomes easy.
- the surgical instrument 1 is provided with a plurality of the additional spacers having different thicknesses.
- Surgical instrument 1 can be used for re-cutting to install the femoral side component in total knee arthroplasty.
- the present disclosure can be widely applied to surgical instruments that guide osteotomy instruments for additional excision of the femur in total knee arthroplasty.
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Abstract
Description
図6は、大腿骨遠位部101を追加切除する工程を示す図であって、図6(a)は、大腿骨遠位部101に手術器具1を取付ける前の状態を示し、図6(b)は、大腿骨遠位部101に手術器具1を取付けた状態を示す。図7は、大腿骨遠位部を追加切除する工程について示す図であって、図7(a)は、大腿骨遠位部を追加切除した状態を示し、図7(b)は、追加切除した後において、大腿骨遠位部から手術器具を取り外した状態を示す。なお、図6及び図7においては、大腿骨100を外形で示し、手術器具1を断面で示している。また、図6及び図7においては、固定用ピン6bの図示を省略している。
本実施の形態における、手術器具1は、本体部2と、後顆当接部3と、を有する。そして、本体部2は、大腿骨100の遠位端切除面102に当接可能な第1当接面5を有し、後顆当接部3は、大腿骨100の後顆切除面104に当接可能な第2当接面10を有している。また、本体部2において、後顆部分103を後顆切除面104と平行な方向に切除するための第1スリット7と、後顆部分103を後方側チャンファー切除面105に平行に切除するための第2スリット8と、を有している。このため、術者は、人工膝関節置換術において大腿骨100の後顆部分103を追加切除するに際して、大腿骨遠位部101の骨切り後の後顆切除面104に手術器具1の第2当接面10を当接させた上で、追加切除を行うことができる。即ち、術者は、大腿骨遠位部101の後顆切除面104及び後方側チャンファー切除面105を切除する際、第2当接面10を基準にして、狙った位置で追加切除を行うことができる。これにより、術者は、伸展位ギャップと屈曲位ギャップとが同じになるように、第2当接面10を基準に手術器具1の位置を調節して、切除が必要な寸法で後顆部分103の追加切除を行うことができる。
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。
(1)本開示のある局面に係る手術器具1は、大腿骨100を切除する骨切除器具を案内するための手術器具1であって、大腿骨遠位部101における切除面であって大腿骨100の骨軸に垂直な切除面である遠位端切除面102に当接可能な第1当接面5が設けられている本体部2と、第1当接面5に対して垂直に設けられるとともに大腿骨100の後顆部分103の切除面である後顆切除面104に当接可能な第2当接面10を有し、本体部2と一体に設けられる後顆当接部3と、本体部2には、後顆切除面104と平行な方向に後顆部分103を追加切除するための骨切除器具を案内する第1スリット7と、大腿骨100において遠位端切除面102と後顆切除面104との間でそれらに対して斜めに延びるように形成された後方側チャンファー切除面105に対して平行な方向に後顆部分103を追加切除するための骨切除器具を案内する第2スリット8と、が設けられている。
2 本体部
3 後顆当接部
4 位置調節機構
4a 追加スペーサ
5 第1当接面
6 固定機構
6a ピン孔
6b 固定用ピン
7 第1スリット
8 第2スリット
10 第2当接面
100 大腿骨
101 大腿骨遠位部
102 遠位端切除面
103 後顆部分
104 後顆切除面
105 後方側チャンファー切除面
L100 大腿骨の骨軸
Claims (10)
- 大腿骨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、
大腿骨遠位部の遠位端切除面に当接可能な第1当接面を有する本体部と、
前記大腿骨の後顆部分の後顆切除面に当接可能な第2当接面を有し前記本体部に接続した後顆当接部と、
を備え、
前記本体部には、
前記第2当接面と平行な方向に延びた第1スリットと、
前記第1当接面および前記第2当接面に交わる方向に延びた第2スリットと、を有していることを特徴とする、手術器具。 - 前記第1当接面を前記遠位端切除面に保持するための固定機構を更に備える、請求項1に記載の手術器具。
- 前記固定機構は、前記大腿骨に挿入される固定用ピンと、前記本体部を貫通する貫通孔として設けられて前記固定用ピンが挿通されるピン孔とを含み、
前記固定用ピンが前記ピン孔に挿通された状態で前記大腿骨に挿入されることで、前記第1当接面を前記遠位端切除面に保持するように構成されていることを特徴とする、請求項2に記載の手術器具。 - 前記ピン孔を複数備え、各前記ピン孔が前記本体部を貫通する方向が互いに異なる、
請求項3に記載の手術器具。 - 前記遠位端切除面に対して前記第1当接面の保持位置を変位可能な位置調節機構を更に備えることを特徴とする、請求項1から請求項4のいずれか1項に記載の手術器具。
- 前記位置調節機構は、前記本体部に対して前記第1当接面において着脱自在に取付けられ、前記本体部に取付けられた状態で前記遠位端切除面に当接するように構成された追加スペーサである、請求項5に記載の手術器具。
- 前記本体部及び前記追加スペーサの少なくともいずれかは磁性体を含み、
前記追加スペーサは、前記本体部に対して磁力を介して着脱自在に取付けられることを特徴とする、請求項6に記載の手術器具。 - 前記本体部は磁石を備え、
前記追加スペーサは強磁性体を備え、前記本体部に対して磁力を介して着脱自在に取付けられることを特徴とする、請求項6または7に記載の手術器具。 - 厚さの異なる複数の前記追加スペーサを備える、請求項6から請求項8のいずれか1項に記載の手術器具。
- 人工膝関節置換術において大腿骨側コンポーネントを設置するための再切骨に用いられる、請求項1から請求項9のいずれか1項に記載の手術器具。
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US17/598,194 US20220183700A1 (en) | 2019-03-29 | 2020-03-27 | Surgical instrument |
EP20781872.5A EP3949910A4 (en) | 2019-03-29 | 2020-03-27 | SURGICAL INSTRUMENT |
AU2020255806A AU2020255806A1 (en) | 2019-03-29 | 2020-03-27 | Surgical instrument |
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2019
- 2019-03-29 JP JP2019067856A patent/JP7353059B2/ja active Active
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2020
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- 2020-03-27 US US17/598,194 patent/US20220183700A1/en active Pending
- 2020-03-27 AU AU2020255806A patent/AU2020255806A1/en not_active Abandoned
- 2020-03-27 EP EP20781872.5A patent/EP3949910A4/en not_active Withdrawn
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