JP5803013B2 - Jig system for artificial knee joint placement - Google Patents

Description

  The present invention relates to a jig and a jig system for installing an artificial knee joint, and more particularly, to a bending position balancer device for installing an artificial knee joint used when a knee is in a bent position, and a jig system including the same.

  Artificial knee joints are sometimes used to treat patients who have osteoarthritis or chronic rheumatism due to wear of the knee cartilage. FIG. 12 is a schematic side cross-sectional view showing the left leg femur and tibia with an artificial knee joint. As shown in FIG. 12, the artificial knee joint 100 includes a femur F so as to cover the tibial tray 102 and the surface liner 104 fixed to the proximal end Te of the tibia T and the distal end Fe of the femur F. And a femoral component 106 secured to the body. In some cases, a spacer (not shown) is inserted between the tibial tray 102 and the tibia T. The femur F and the tibia T are connected and pulled together mainly by ligaments (not shown) arranged on the left and right sides thereof, so that the femoral component 106 is pressed against the surface liner 104. ing. In the knee prosthesis 100, the femoral component 106 slides along the surface liner 104 when the knee is moved between a bent position (flexion position) and an extended position (extension position).

  FIG. 13 is a schematic side view showing the left leg tibia and femur partially excised for placement of the knee prosthesis. As shown in FIG. 13, the proximal end Te of the tibia T has an installation surface for removing the worn cartilage and fixing the tibial tray 102 to the tibia T, that is, the proximal end surface Tc. It has been excised (bone cut) to form. Similarly, the distal end Fe of the femur F is used to remove worn cartilage and to form five mounting surfaces Fc1-Fc5 for securing the femoral component 106 to the femur F. Has been excised (bone cut). The five installation surfaces include a distal end surface Fc1, a front installation surface Fc2 and a rear installation surface Fc3 perpendicular to the distal end surface Fc1, and a distal end surface Fc1, the front installation surface Fc2, and the rear installation surface Fc3. Two inclined installation surfaces Fc4 and Fc5.

  The proximal end surface Tc of the tibia T and the distal end surface Fc1 of the femur F are respectively connected to the proximal end of the tibia T and the distal end of the femur F so that the patient's height does not change after the artificial knee joint 100 is attached. They are formed at predetermined distances LT and LF from the end. Generally, the proximal end surface Tc of the tibia T is formed perpendicular to the axis of the tibia T. After forming the proximal end face Tc of the tibia T and the distal end face Fc1 of the femur F, the tension state of the ligament (the ligament tension and the left / right balance) when the knee is in the extended position is adjusted. Since the proximal end face Tc of the patient's tibia T and the distal end face Fc1 of the femur F before adjustment are not parallel due to the unbalance of the left and right ligaments, by releasing a part of the soft tissue of the ligament, The proximal end face Tc and the distal end face Fc1 are made parallel. Then, for example, a spacer having an appropriate thickness is inserted between the tibia T and the femur F. Next, in order to obtain a predetermined tension state of the ligament, the thickness of the spacer is increased or decreased, and the soft tissue is further released.

  Next, the knees are placed in a bent position, and the positions of the front placement surface Fc2 and the back placement surface Fc3 of the femur are determined. In recent years, when forming the front placement surface Fc2 and the rear placement surface Fc3 of the femur, the gap between the tibia T and the femur F is adjusted in order to confirm the tension state of the ligament when the knee is in the bending position. The balancer apparatus which can be used has come to be used (for example, refer patent document 1). In this case, after confirming the tension state of the ligament in the flexion position by the balancer device and adjusting if necessary, the size of the femoral component 106 is determined, and the positions of the front placement surface Fc2 and the rear placement surface Fc3 of the femur are determined. To decide.

  Further, as another method for determining the positions of the anterior placement surface Fc2 and the posterior placement surface Fc3 of the femur, the posterior condyle of the femur F (the medial posterior condyle Fp1 and the lateral posterior condyle Fp2, see FIGS. 1 and 5). ) Is used as a reference to determine the installation position of the osteotomy jig for forming the installation surfaces Fc2 to Fc5, and using the osteotomy jig, the rear installation surface Fc3 and the front installation surface Fc2 are formed. (For example, refer to Patent Document 2).

JP 2007-75517 A JP 2011-78529 A

  Japanese people often bend their knee joints deeper than their Western counterparts. Therefore, by making the tension state of the ligament when the knee is in the flexed position match the tension state of the ligament when the knee is in the extended position, it is possible to reduce discomfort and wear after installing the artificial knee joint Particularly desired. Further, it is known that when the knee moves between the extended position and the bent position, a rotational movement is generated between the femur and the tibia. Therefore, it is desirable to adjust the tension state in consideration of such a turning motion.

  In the balancer device described in Patent Document 1, the femur F is supported through a rod extending in the longitudinal direction therein, and can be rotated around the rod. For this reason, the rotation angle generated when the knee is changed from the extended position to the bent position during the artificial knee joint operation may deviate from the original rotation angle. In other words, when the knee is in the flexed position, when the original rotation angle is generated in the femur F, the knee is in the flexed position due to the tension of the ligament adjusted when the knee is in the extended position. Sometimes the tension of the ligaments can become unbalanced. Therefore, when the knee is in the flexion position, the tension state of the ligament when the knee is in the flexion position is adjusted by adjusting the tension state of the ligament under the original rotation angle. May be even closer.

  In the apparatus described in Patent Document 2, a line L1 obtained by projecting a line connecting the medial epicondyle Fs1 and the lateral epicondyle Fs2 of the femur F onto a plane including the distal end face Fc1 (see FIG. And the rotation axis of the femoral component 106 are preferably parallel, and the rotation angle of the femur relative to the tibia T when the knee is in the flexed position is adjustable. . However, even if the tension state of the ligament can be adjusted under the original rotation angle, the inner / outer epicondyle connection line may not be parallel to the rotation axis. Therefore, when the knee is in the flexion position, the tension state of the ligament when the knee is in the flexion position is adjusted by adjusting the tension state of the ligament under the original rotation angle. May be even closer.

  Therefore, the present invention makes the tension state of the ligament when the knee is in the bending position closer to the tension state of the ligament when the knee is in the extended position, that is, with high accuracy, the femoral component is An object of the present invention is to provide a flexion balancer device and a jig system for installing an artificial knee joint that can be attached to a knee joint.

  In order to achieve the above-mentioned object, a bending position balancer device according to the present invention used in a state where a knee is in a bending position in order to install an artificial knee joint includes a tibial attachment portion attached to a proximal end surface of a tibia, and a thigh A femoral attachment portion attached to the distal end of the bone; and a movement mechanism that moves the femoral attachment portion in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment portion. It has a locking mechanism that maintains a predetermined distance between the femoral attachment portion and the tibial attachment portion, and the femoral attachment portion supports the drilling guide portion attached to the moving mechanism and the posterior condylar bone of the femur A condyle support portion and a rotation mechanism for rotating the condyle support portion with respect to the drilling guide portion, the drilling guide portion being perpendicular to the proximal end surface of the tibia and having a knee An opposing surface facing the distal end surface of the femur when in a flexed position, and a bone A through guide hole provided on the opposing surface for forming a reference jig hole for the jig on the distal end surface of the femur, and the condyle support is perpendicular to the opposing surface and the knee is It has a condyle contact plane that contacts the posterior condyle of the femur when it is in the bent position, and it can rotate with respect to the drilling guide section around a rotation axis perpendicular to the facing surface. The mechanism is characterized in that it can be operated with a predetermined distance between the femoral attachment portion and the tibial attachment portion by a lock mechanism.

  In the flexion balancer device thus configured, the patient's knee is placed in the flexion position, the tibial attachment is attached to the proximal end surface of the tibia, and the posterior condyle of the femur is attached to the condylar support part of the femoral attachment. The femoral attachment is attached to the distal end of the femur by abutting on the condyle abutment plane. Using the moving mechanism, move the femoral attachment part in a direction perpendicular to the proximal end surface of the tibia with respect to the tibia attachment part (direction of the facing surface of the drilling guide part), and use the locking mechanism to attach the femur A predetermined distance is maintained between the limb and the tibial attachment, thereby providing a tension in the flexion position that is as large as the ligament tension adjusted in the extension position. If the rotation angle of the femur is not properly adjusted, the distal end surface of the femur and the facing surface of the drilling guide portion are not parallel. Supporting the tibia using a rotation mechanism while maintaining a predetermined distance between the femoral attachment part and the tibial attachment part using a locking mechanism, that is, with the same tension as the ligament tension adjusted in the extended position The pivoting angle of the femur is adjusted by rotating the body about a pivot axis perpendicular to the facing surface with respect to the drilling guide, and the distal end surface of the patient's femur and the facing surface of the drilling guide Make parallel. In that state, a drill or the like is inserted into a through guide hole provided on the opposing surface, and an installation reference hole for the osteotomy jig is formed on the distal end surface of the femur. As a result, the tension of the ligament when the knee is in the flexed position is made closer to the tension of the ligament when the knee is in the extended position, that is, with high precision, the femoral component is attached to the femur Enable.

  In order to achieve the above object, a jig system according to the present invention for installing an artificial knee joint has the above-described bending position balancer apparatus and an extension position balancer apparatus used when the knee is in an extended position. An extension position balancer device includes an extension position tibial attachment portion attached to the proximal end face of the tibia, an extension position femoral attachment portion attached to the distal end face of the femur, and an extension position femoral attachment portion. An extension position moving mechanism that moves in a direction perpendicular to the proximal end surface of the tibia with respect to the attachment portion, and the extension position movement mechanism has a predetermined distance between the extension position femoral attachment portion and the extension position tibial attachment portion. The extension position locking mechanism that maintains the distance is provided, and the extension position tibial attachment portion of the extension position balancer device and the tibial attachment portion of the bending position balancer device are positioned with respect to a common reference position of the proximal end surface of the tibia. Specially It is set to.

  In the jig system configured as described above, since the tibial attachment portion of the flexion balancer device and the tibial attachment portion of the extension balancer device are positioned with respect to a common reference position on the proximal end surface of the tibia, the extension balancer The tension achieved with the device and the tension achieved with the flexion balancer device can be compared on the same basis, and as a result, the tension of the ligament when the knee is in the flexed position and the knee in the extended position It allows the femoral component to be attached to the femur in a manner that is closer to the ligament tension at a given time, that is, with high accuracy.

  In an embodiment of the jig system according to the present invention, preferably further comprising a trial device, the trial device sliding a trial tibial attachment portion attached to the proximal end surface of the tibia and a femoral component attached to the femur. And a trial movement mechanism that moves the bearing part in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment part, and the trial movement mechanism is attached to the bearing part and the trial tibial attachment. A trial lock mechanism that maintains a predetermined distance between the parts is provided, and the trial tibial attachment part of the trial device and the tibial attachment part of the bending balancer device are positioned with respect to a common reference position.

  In the jig system configured as described above, after forming the femoral component mounting surface, the femoral component is attached to the femur and placed on the bearing portion positioned at the positioning portion on the proximal end surface of the tibia. The femoral component (including the femoral component trial having the same shape as the femoral component) is slid on the bearing portion by bending the knee between the extended position and the bent position. Since the tibial attachment part of the bending balancer device and the tibial attachment part of the extension balancer device are positioned with respect to a common reference position of the proximal end surface of the tibia, the tension state of the ligament in the extension position and the ligament in the bending position The tension state can be compared with the same criteria, and the tension state can be confirmed under the same conditions as the actual femoral component. As a result, the tension of the ligament when the knee is in the flexed position is made closer to the tension of the ligament when the knee is in the extended position, that is, with high precision, the femoral component is attached to the femur Enable.

  In the embodiment of the jig system according to the present invention, preferably, the tibial attachment portion of the flexion balancer device and the extension tibial attachment portion of the extension balancer device are constituted by a common tibial attachment portion, and the flexion balancer device The movement mechanism and the extension position movement mechanism of the extension position balancer device are configured by a common movement mechanism, and the femoral attachment portion of the bending position balancer device and the extension position femoral attachment portion of the extension position balancer device are common. Removably attached to the moving mechanism.

  In the jig system configured as described above, since the tibial attachment portion of the bending position balancer device and the tibial attachment portion of the extension position balancer device are configured by a common tibial attachment portion, the tension state achieved by the extension position balancer device , The tension achieved by the flexion balancer device can be compared under the same conditions. As a result, the tension of the ligament when the knee is in the flexed position can be compared with that of the ligament when the knee is in the extended position. It makes it possible to attach the femoral component to the femur in a manner that is closer to tension, i.e. with high accuracy.

  In an embodiment of a jig system according to the present invention having a trial device, preferably, the tibial attachment portion of the bending balancer device, the extension tibial attachment portion of the extension balancer device, and the trial tibial attachment portion of the trial device are common. The movement mechanism of the bending position balancer device, the extension position movement mechanism of the extension position balancer device, and the trial movement mechanism of the trial device are configured by a common movement mechanism, and are formed by the tibial attachment portion, and the femur of the bending position balancer device The attachment portion, the extension femoral attachment portion of the extension balancer device, and the bearing portion of the trial device are detachably attached to a common moving mechanism.

  In the jig system configured as described above, the tibial attachment portion of the bending balancer device, the tibial attachment portion of the extension balancer device, and the trial tibial attachment portion of the trial device are configured by a common tibial attachment portion. The tension state achieved by the position balancer device and the tension state achieved by the bending position balancer device can be compared under the same conditions. Furthermore, the trial device can be moved in substantially the same state as when the actual artificial knee joint is attached, and the tension state of the ligament can be confirmed in a state closer to the actual state. As a result, the tension of the ligament when the knee is in the flexed position is made closer to the tension of the ligament when the knee is in the extended position, that is, with high precision, the femoral component is attached to the femur Enable.

  In an embodiment of a jig system according to the present invention having a trial device, more preferably, the extension position femoral attachment portion of the extension position balancer device includes a common coupling portion that is removably attached to a common movement mechanism, and a femoral bone. A common attachment portion disposed between the tibia and the tibia, a common arm portion connecting the coupling portion and the attachment portion, and a spacer attached to the common attachment portion and abutting the distal end surface of the femur The trial device has a common coupling portion, a common attachment portion, a common arm portion, and a bearing element attached to the common attachment portion and supporting the femoral component.

  In the jig system configured as described above, the common part between the extension position balancer device and the trial device increases, so that when the trial device is used, the tension state achieved by the extension position balancer device and the bending position balancer device It is possible to confirm with high accuracy the tension state achieved by.

  In the embodiment of the jig system according to the present invention, preferably, the moving mechanism has an auxiliary support part that contacts the tibia below the tibial attachment part.

  In the jig system configured as described above, the moving mechanism can be stably attached to the tibia, and the tension state of the ligament can be stably adjusted and confirmed.

  In an embodiment of the jig system according to the present invention, preferably, the tibial attachment has a positioning part positioned at a reference position of the proximal end surface of the tibia and a support arm extending from the positioning part toward the moving mechanism. The arm is arranged to be shifted to the left or right of the tibia when the positioning portion is positioned on the proximal end surface of the tibia.

  In the artificial knee joint installation jig configured as described above, since the support arm is shifted to the left or right from the center of the tibia, the support arm does not interfere with the patella ligament, and the first measurement and the first measurement are performed. Two measurements can be made.

  In an embodiment of the jig system according to the invention, it preferably further comprises a tibial template with a guide hole for forming a reference hole for positioning the tibial tray of the knee prosthesis on the proximal end surface of the tibia.

  According to the bending position balancer device and the jig system according to the present invention for installing an artificial knee joint, the tension state of the ligament when the knee is in the bending position is made closer to the tension state of the ligament when the knee is in the extension position. Thus, the femoral component can be attached to the femur with high accuracy.

1 is a perspective view showing a tibial template of a jig system according to the present invention. FIG. It is a perspective view which shows the extension position balancer apparatus of the jig system by this invention. It is a side view which shows the extension position balancer apparatus of FIG. It is a perspective view which shows the bending position balancer apparatus by this invention. It is a front view which shows the bending position balancer apparatus of FIG. 1 is an exploded perspective view of a jig system according to the present invention. It is a perspective view which shows the common part of the jig system of FIG. It is a partial exploded perspective view of the femoral attachment part of a bending position balancer device. FIG. 9 is a partial rear view of the femoral attachment portion of FIG. 8. It is a perspective view which shows the trial apparatus of the jig system by this invention in extension position. It is a perspective view which shows the trial apparatus of the jig system by this invention in a bending position. It is a schematic side sectional view showing a femur and a tibia in which an artificial knee joint is installed. FIG. 6 is a schematic side view showing a tibia and a femur partially excised for placement of an artificial knee joint.

  Hereinafter, with reference to the drawings, an embodiment of a jig system and a bending balancer device for installing an artificial knee joint according to the present invention will be described. The jig system and the flexion balancer device according to the present invention are used with the tibia as a reference. Hereinafter, the direction in which the tibia extends is referred to as the up-down direction, and the patient's front-rear direction and left-right direction in the tibia are referred to as the front-rear direction A and the left-right direction B, respectively (see FIG. 1). The terms “distal” and “proximal” are also used for the patient's torso. Moreover, in embodiment described below, a left leg is illustrated. Thus, the terms “inside” and “outside” correspond to the right and left sides of the left leg, respectively.

  A preferred embodiment of the jig system 1 for placing an artificial knee joint according to the present invention includes a tibial template 2 (see FIG. 1), an extended position balancer device 4 (see FIGS. 2 and 3), and a bent position balancer device 6 (see FIGS. 4 and 4). 5) and a trial device 60 (FIGS. 10 and 11).

  First, the tibial template 2 will be described. As shown in FIG. 1, the tibial template 2 is for determining the size of the tibial tray 102 of the artificial knee joint 100 and the installation position of the tibial tray 102 on the proximal end surface Tc of the tibia T. A plurality of templates according to the size are prepared. In the present embodiment, the tibial template 2 is provided at the connecting arm 2a, the relatively large first template 2b provided at one end of the connecting arm 2a, and the other end of the connecting arm 2a. The second template 2c having a relatively small size is provided. The tibial template 2 may further include a template of another size, or may be made separately for each template.

  The tibial template 2 determines the positions of the tibial tray 102 in the front-rear direction A and the left-right direction B with respect to the proximal end surface Tc of the tibia T. Specifically, each template 2b, 2c includes a guide hole 2d for forming a reference hole (reference position) R for positioning the tibial tray 102 of the artificial knee joint 100 on the proximal end surface Tc of the tibia T. ing. The reference hole R is also preferably a hole for positioning and fixing the tibial tray 102 of the artificial knee joint 100. The reference hole R is usually two, and is formed by a drill having a diameter that fits into the guide hole 2d. In the present embodiment, each of the first and second templates 2b and 2c has four guide holes 2d, two of which are spare guide holes.

  Next, the extension position balancer device 4 will be described. As will be described in detail later, in the present embodiment, the extension position balancer device 4 and the bending position balancer device 6 are different from the common portion (tibial attachment portion 8, moving mechanism 12) and the different portion (femoral attachment portions 10, 30). The extension position balancer device 4 and the bent position balancer device 6 are configured to be assembled by exchanging different portions with respect to the common portion (see FIG. 6).

  The extension position balancer device 4 is used when the knee is in the extension position, as shown in FIGS. As shown in FIGS. 3 and 6, the stretched balancer device 4 includes a tibial attachment portion 8 attached to the proximal end surface Tc of the tibia T, and a femoral attachment portion 10 attached to the distal end surface Fc1 of the femur F. And a moving mechanism 12 that moves the femoral attachment part 10 in a direction perpendicular to the proximal end surface Tc of the tibia T with respect to the tibial attachment part 8. The moving mechanism 12 has a fixed portion 14 to which the tibial attachment portion 8 is fixed and a movable portion 16 to which the femur attachment portion 10 is attached.

  As shown in FIGS. 6 and 7, the tibial attachment portion 8 includes a positioning portion 8a that is positioned in a reference hole R (reference position) of the proximal end surface Tc of the tibia T, and a support that extends forward from the positioning portion 8a. An arm 8b and a coupling portion 8c for attaching the support arm 8b to the fixed portion 14 are provided. The positioning portion 8a is plate-shaped and has a hole 8d aligned with the reference hole R. The hole 8d is preferably a counterbore hole, and a pin 8e (see FIG. 7) having a head is inserted into the reference hole R and the counterbore hole 8d, so that the tibial attachment portion 8 is a proximal end face Tc of the tibia T. Is positioned. It is preferable that the pin 8e does not protrude above the positioning portion 8a. As described above, the reference hole R is preferably a hole into which a pin for positioning and fixing the tibial tray 102 of the artificial knee joint 100 is inserted, and can reproduce the relative position of the tibial attachment portion 8 with respect to the tibial tray 102. Is preferred. The support arm 8b is preferably arranged to be shifted leftward or rightward from the center of the tibia T when the tibial attachment 8 is positioned on the proximal end surface Tc of the tibia T. The coupling portion 8c is fixed to the fixing portion 14 by a bolt 8f (see FIG. 6).

  The fixed portion 14 of the moving mechanism 12 includes a main body portion 18 and a rotating body 20 rotatably supported by a front-rear direction hole 18a provided at an upper portion of the main body portion 18 so as to extend in the front-rear direction A. The main body portion 18 has a vertical hole 18b that receives a slide rack portion 16a of the movable portion 16 described later so as to be movable in the vertical direction C. The rotating body 20 has a pinion 20a that is operatively engaged with the slide rack portion 16a. In order to engage the slide rack portion 16a and the pinion 20a, the front-rear direction hole 18a and the vertical direction hole 18b communicate with each other. The tip of the rotating body 20 has a convex portion 20b or a concave portion into which a tool (for example, a torque wrench) for rotating the rotating body 20 is fitted. By rotating the pinion 20 a of the rotating body 20, the slide rack portion 16 a of the movable portion 16 is moved in the vertical direction C with respect to the fixed portion 14, that is, the femoral attachment portion 10 is moved vertically with respect to the tibial attachment portion 8. Allows movement in direction C.

  The fixing portion 14 of the moving mechanism 12 further locks the rotating body 20 to prevent the femoral attachment portion 10 from descending with respect to the tibial attachment portion 8, and the femoral attachment portion 10 and the tibial attachment portion. 8 has a lock mechanism 22 that maintains a predetermined distance between 8. Specifically, the lock mechanism 22 includes a claw lever 22a that can be engaged with a number of hooks 20c provided around the rotating body 20, and a shaft 22b that pivotally supports the claw lever 22a. And a spring 22c for urging the claw lever 22a toward the catching portion 20c so as to prevent the movable portion 16 from descending (that is, to maintain the movable portion 16 in a lifted state). ing.

  It is preferable that the fixing portion 14 of the moving mechanism 12 further includes an auxiliary support portion 24 that comes into contact with the tibia T below the tibial attachment portion 8. Specifically, the main body portion 18 has a bottom surface 18c inclined obliquely downward toward the tibia T, and the auxiliary support portion 24 has an extension element 24a extending from the bottom surface 18c toward the tibia T. The extension element 22a is movable along the bottom surface 18c, and is fixed to the bottom surface 18c by a knob 24b in contact with the tibia T.

  The movable portion 16 of the moving mechanism 12 includes a slide rack portion 16a that is received in the vertical hole 18b of the main body portion 18, a circular cross-sectional longitudinal through-hole 16b provided in the upper portion of the slide rack portion 16a, and a slide rack portion 16a. The scale plate 16c is attached to the main body. The scale plate 18c has a vertical scale 16d provided at the lower part thereof and an angular direction scale 16e provided at the upper part thereof. The vertical scale 16d is for representing the vertical position of the movable part 16 with respect to the fixed part 14, that is, the vertical position of the femoral attachment part 10 with respect to the tibial attachment part 8. The vertical scale 18d is exposed by a window 18d provided in the main body portion 18, and is indicated by an instruction line 18e (see FIG. 7) provided at the edge of the window 18d. The angular scale 16e is for representing the angular position of the femoral attachment part 10 with respect to the movable part 16. The angle direction scale 16e is located above the fixing portion 14, and is an indicator 10e attached to the tip of the coupling shaft portion 10c of the femoral attachment portion 10 inserted in the front-rear direction through hole 16b of the slide rack portion 16a. (See FIG. 6). When the lower surface 8g (see FIG. 6) of the positioning portion 8a of the tibial attachment 8 is parallel to the upper surface 26a of the spacer 26 described later, that is, the proximal end surface Tc of the tibia T and the distal end surface Fc1 of the femur F are When parallel, the indicator 10e indicates zero.

  As shown in FIG. 6, the femoral attachment portion 10 includes a coupling shaft portion 10 a that is detachably attached to the movable portion 16 of the moving mechanism 12, and an attachment portion 10 b that is disposed between the femur F and the tibia T. The arm portion 10c connects the coupling shaft portion 10a and the attachment portion 10b, and the spacer 26 is attached to the attachment portion 10b and contacts the distal end face Fc1 of the femur F. The coupling shaft portion 10a has a circular cross section and fits in the front-rear direction through hole 16b of the slide rack portion 16a of the movable portion 16, so that the femoral attachment portion 10 is centered on the coupling shaft portion 10a. It can be rotated. The arm portion 10c is preferably arranged to be shifted to the left or right of the tibia T when the femoral attachment portion 10 is attached to the movable portion 16. It is preferable that the shifted direction is the same as the direction in which the support arm 8b of the tibial attachment 8 is shifted. The attachment portion 10b is plate-shaped and has a protrusion 10d for positioning the spacer 26. The spacer 26 has an upper surface 26a that contacts the distal end surface Fc1 of the femur F.

  Next, the bending position balancer device 6 will be described.

  As shown in FIGS. 4 to 5, the bending position balancer device 6 according to the embodiment of the present invention is used in a state where the knee is in the bending position. The bending position balancer device 6 includes a tibial attachment portion 8 attached to the proximal end face Tc of the tibia T, a femoral attachment portion 30 attached to the distal end portion Fe of the femur F, and the thighbone attachment portion 10 attached to the tibial bone. And a moving mechanism 12 that moves the portion 8 in a direction perpendicular to the proximal end surface Tc of the tibia T. Since the tibial attachment part 8 and the moving mechanism 12 are components common to the extension position balancer device 4, description thereof is omitted.

  As shown in FIGS. 4 and 6, the femur attachment unit 30 includes a drilling guide unit 30 a and a condyle support unit 30 b. The drilling guide unit 30a includes a coupling part 32 that is detachably attached to the movable part 16 of the moving mechanism 12, a drilling guide part 34 that is coupled to the coupling part 32, and a stylus part 36, and includes a condylar bone. The support unit 30b rotates the condyle support part 38 that supports the posterior condyles Fp1 and Fp2 (see FIGS. 1 and 5) of the femur F, and the perforation guide part 34 with respect to the drilling guide part 34. And a rotation mechanism 40. Moreover, the condyle support part 38 and the rotation mechanism 40 constitute a support unit.

  The coupling portion 32 includes a coupling shaft portion 32a that fits in the front-rear direction through hole 16b of the slide rack portion 16a of the movable portion 16, and a mounting shaft portion 32b that extends in the front-rear direction A on the opposite side of the coupling shaft portion 32a. Have. The coupling shaft portion 32a has a circular cross section so that the femoral attachment 30 is rotatable about the coupling shaft portion 32a. The mounting shaft portion 32 b has a non-circular cross section and fits into a first mounting hole 34 a provided in the drilling guide part 34, so that the drilling guide part 34 is relative to the coupling part 32. Although it can move in the front-rear direction A, it does not rotate. An indicator 10e that indicates the angular scale 16e of the movable portion 16 is attached to the tip of the coupling shaft portion 32a.

  As shown in FIG. 8, the drilling guide part 34 has a cross shape when viewed from the front, and has a main body part 34b extending in the vertical direction C and an arm part 34c extending in the horizontal direction from the vertical part 34b. . The main body portion 34b has the above-described first mounting hole 34a and a second mounting hole 34d that fits into a protruding portion 40a of the rotation mechanism 40 described later. The second mounting hole 34 d has a non-circular cross section, and the protruding portion 40 a of the rotation mechanism 40 does not rotate with respect to the drilling guide portion 34. Further, the drilling guide portion 34 has a facing surface 34e that is perpendicular to the proximal end surface Tc of the tibia T and faces the distal end surface Fc1 of the femur F when the knee is in a bent position. .

  The arm portion 34c of the drilling guide portion 34 is provided on the opposing surface 34e in order to form an installation reference hole H (see FIG. 5) of the osteotomy jig (not shown) in the distal end face Fc1 of the femur F. This osteotomy jig has a penetration guide hole 34f, and is a jig for osteotomy of the installation surfaces Fc2 to F5 for attaching the femoral component 106 (see FIG. 12) to the femur F. . There are usually two installation reference holes H opened by the guide hole 34f, and a pin (not shown) is inserted into the reference hole H, and this pin is used for positioning a bone cutting jig (not shown). The through guide hole 34f is preferably a circular hole for guiding the drill. It is preferable that a plurality of through guide holes 34f are provided including a spare.

  The stylus portion 36 is used to determine the size of the femoral component. The stylus portion 36 includes a sliding member 36a that is slidably fitted in the vertical hole 34g of the drilling guide portion 34, and a rotating member 36c that is received by the sliding member 36a and is rotatable about the vertical axis 36b. And a stylus 36e slidably fitted in the groove 36d at the top of the rotating member 36c. The stylus 36e has an elongated plate shape, extends from the top of the rotating member 36c to the proximal side A2 along the femur F, and is bent downward so as to contact the front face Fa (see FIG. 4) of the femur F. It has a tip 36f. Thus, the stylus 36d is movable in the vertical direction C with respect to the drilling guide portion 34, is rotatable about the vertical axis 36b, and is anteroposterior in the longitudinal direction A (the femur in the bent position) along the groove 36d. Slidable in the proximal and distal direction of F). The vertical position of the stylus 36e with respect to the drilling guide portion 34 is determined by the pin 36g attached to the sliding member 36a so as to extend into the vertical slot 34h provided in the drilling guide portion 34 and the vertical slot 34h. The scale 34i is provided along the scale 34i. The position of the tip portion 36f of the stylus 36e is indicated by a scale 36h provided on the stylus 36e and an indication portion 36i provided on the groove 36d. The size of the femoral component 106 is determined from the scales 34i and 36h.

  The condyle support portion 38 includes an inner plate 38a that abuts against the medial condyle posterior portion Fp1 (see FIGS. 1 and 5) of the femur F in a bent position, and an outer posterior condyle Fp2 (see FIG. 1 and FIG. 5) and a plate-like bridge 38c that connects the inner plate 38a and the outer plate 38b. The upper surface of the inner plate 38a and the upper surface of the outer plate 38b allow one condylar contact to contact the posterior condyles Fp1 and Fp2 of the femur F when it is perpendicular to the opposing surface 34e and the knee is in a bent position. A plane 38d is formed. Further, the condylar bone support portion 38, and thus the condyle contact plane 38d, can rotate with respect to the drilling guide portion 34 about a rotation axis 44 perpendicular to the facing surface 34e. The rotation axis 44 is preferably located at a location where the medial condyle posterior portion Fp1 of the femur F and the condyle contact plane 38d of the medial plate 38a abut. The condyle support 38 has a hole 38e where the rotation axis 44 is located.

  In this embodiment, the rotation mechanism 40 includes a protruding portion 40a that fits in the second mounting hole 34d of the drilling guide portion 34 in the front-rear direction A, and a plate portion 40b that is connected to the protruding portion 40a. ing. The shape of the second mounting hole 34d and the protruding portion 40a is such that the protruding portion 36a and the plate portion 40b can move in the front-rear direction A with respect to the drilling guide portion 34, but other relative movements and relative rotational movements are possible. It is determined not to. The plate portion 40b has a hole 40c at a position located on the rotation axis 44. Therefore, the hole 40c is aligned with the hole 38e. The pin 40d is inserted into the hole 40c and the hole 38e, so that the condyle support portion 38 is pivotally attached to the drilling guide portion 34 via the pin 40d.

  The rotation mechanism 40 further includes a handle shaft 46 attached to the bridge 38 c in parallel with the rotation axis 44, a handle 48 attached to the handle shaft 46 so as to be rotatable about the handle shaft 46, and the handle shaft 46. It has an eccentric cam 50 having a circular contour that is eccentrically fixed to the handle 48, and a link arm 52 that has a ring 52a fitted to the eccentric cam 50 and extends outwardly therefrom. The link arm 52 has a plate shape and is disposed between the condyle support portion 38 and the plate portion 40b.

  The link arm 52 has a pin 52b extending toward both the bridge 38c and the plate portion 40b of the condyle support 38. The bridge 38c of the condyle support 38 has an elongated groove 38f that slidably receives the pin 52b, and the plate portion 40b has an elongated groove 40e that slidably receives the pin 52b. The elongated grooves 38f and 40e change the rotation angle of the condyle support portion 38 with respect to the drilling guide portion 34 when the handle 48 is rotated, that is, the rotation angle of the femur F changes. Determined. In this embodiment, the elongate groove 38f of the bridge 38c extends substantially parallel to the condyle contact plane 38d, and the elongate groove 40e of the plate portion 40b extends obliquely upward from the outside toward the inside. The handle 48 preferably has a scale 48a that indicates the rotation angle of the condyle contact plane 38d with respect to the proximal end surface Tc of the tibia T, and the bridge 38c has an indicator (in this embodiment, an instruction for indicating the scale 48a). Line). The rotation angle can vary from 3 degrees to 9 degrees, for example. The distal end portion of the link arm 52 is fitted into a groove portion 38g provided in the outer portion 16b of the bridge 34, whereby the link arm 52 can swing along the bridge 38c. The rotation mechanism 40 can be operated with the locking mechanism 22 maintaining a predetermined distance between the femoral attachment portion 30 and the tibial attachment portion 8.

  For example, as shown in FIG. 9A, when the scale 48a of the handle 48 is adjusted to 3 degrees, the eccentric cam 50 is positioned outside (to the left in FIG. 9) with respect to the handle shaft 46, and the link arm The pin 52b of 52 is located on the outermost side of the groove 38f of the bridge 38c and the groove 40e of the plate portion 40b. As a result, the rotation angle of the condyle support portion 38 with respect to the drilling guide portion 34 is 3 degrees. As shown in FIG. 9B, when the scale 48a of the handle 48 is rotated up to 6 degrees, the eccentric cam 50 is positioned on the upper side (upper side in FIG. 9) with respect to the handle shaft 46, and the link arm The pin 52b of 52 is located approximately in the middle of the groove 34f of the bridge 38c and the groove 40e of the plate portion 40b. Thereby, the condyle support part 38 rotates around the rotation axis 44 with respect to the drilling guide part 34, and the rotation angle of the condyle support part 38 with respect to the drilling guide part 34 becomes 6 degrees. Further, as shown in FIG. 9C, when the scale 48a of the handle 48 is rotated up to 9 degrees, the eccentric cam 50 is positioned inside (to the right in FIG. 9) with respect to the handle shaft 46, and the link The pin 52b of the arm 52 is located on the innermost side of the groove 34f of the bridge 38c and the groove 40e of the plate portion 40b. As a result, the hole guide part 34 is rotated about the rotation axis 44 with respect to the body part 4, and the rotation angle of the condyle support part 38 with respect to the hole guide part 34 is 9 degrees.

  Next, the trial apparatus will be described.

  As shown in FIGS. 6, 10, and 11, the artificial knee joint installation jig 1 is further detachably attached to the movable portion 16 and slides on a femoral component trial 106 ′ attached to the femur F. It is preferable to have a trial device 60 that supports it. The trial device 60 includes a tibial attachment portion 8 attached to the proximal end surface Tc of the tibia T, a trial support portion 62 that slidably supports a femoral component trial 106 ′ attached to the femur F, and a trial support portion. And a moving mechanism 12 that moves 62 in a direction perpendicular to the proximal end surface Tc of the tibia T with respect to the tibial attachment portion 8. Since the tibial attachment part 8 and the moving mechanism 12 are components common to the extension position balancer device 4, description thereof is omitted. The femoral component trial 106 ′ is a test femoral component having the same shape as the femoral component 106.

  The trial support portion 62 connects the coupling shaft portion 10a detachably attached to the movable portion 16, the attachment portion 10b disposed between the femur F and the tibia T, and the coupling shaft portion 10a attachment portion 10b. Arm portion 10c and bearing element 64 attached to attachment portion 10b and supporting femoral component trial 106 '. Since the coupling shaft portion 10a, the attachment portion 10b, and the arm portion 10c are components common to the femoral attachment portion 10 of the extension balancer device 4, description thereof is omitted.

  The bearing element 64 is positioned on the attachment portion 10b by the projection 10d of the attachment portion 10b. The bearing element 64 has an upper surface 64 a that abuts the femoral component 106, and the upper surface 64 a has the same shape as the upper surface of the surface liner 104 (see FIG. 12) that rests on the tibial tray 102.

  Each component of the jig system 1 may be made of a material that allows sterilization by a sterilizer (autoclave). Such a material is, for example, a stainless steel material.

  Next, the operation of the bending position balancer device and the jig system according to the present invention will be described.

  A template 2b, 2c matching the size of the tibia T, for example, the first template 2b is selected. The first template 2b is placed on the proximal end face Tc of the tibia T, a drill is passed through the guide hole 2d, and a reference hole R is made in the proximal end face Tc. Based on the reference hole R, the tibial tray 102 is positioned and installed. The tibial tray 102 is preferably fixed to the tibia T using the reference hole R. Further, by inserting the pin 8e into the reference hole R, the extended position balancer device 4, the bent position balancer device 6, and the trial device 60 are attached. Therefore, the relative relationship among the attachment positions of the tibial tray 102, the extension balancer device 4, the flexion balancer device 6, and the trial device 60 to the tibia T can be reproduced. Further, by appropriately determining the dimensions of the extension position balancer device 4, the bending position balancer device 6, and the trial device 60, the extension position balancer device 4, the bending position balancer device 6, and the trial device 60 are provided with an actual artificial knee joint. The tension state of the ligament can be reproduced.

  Moreover, the tibial attachment part 8 and the moving mechanism 12 of the extension position balancer device 4 are assembled. Specifically, the tibial attachment portion 8 is fixed to the fixing portion 14 of the moving mechanism 12 with a bolt 8f. In the moving mechanism 12, the main body portion 18 of the fixed portion 14, the rotating body 20, the lock mechanism 22, and the auxiliary support portion 24 are assembled. Further, the slide rack portion 16a of the movable portion 16 is moved together with the scale plate 16c in a state in which the claw lever 22a of the lock mechanism 22 is separated from the catch portion 20c of the rotating body 20 against the urging force of the spring 22c. The body portion 18 is inserted into the vertical hole 18b.

  Further, the femur attachment part 10 is attached to the movable part 16. Specifically, after the coupling shaft portion 10a of the femoral attachment portion 10 is inserted into the front-rear direction through hole 16b of the slide rack portion 16a of the movable portion 16, the support body 10e is attached to the distal end of the coupling shaft portion 10a. . Further, a spacer 26 having an appropriate thickness is attached to the attachment portion 10b. Thereby, the extension position balancer apparatus 4 is assembled.

  Next, with the patient's knee in the extended position, the extended position balancer device 4 is placed between the tibia T and the femur F. Specifically, the hole 8d of the tibial attachment portion 8 is aligned with the reference hole R, the pin 8e is inserted into the hole 8d and the reference hole R, and the tibial attachment portion 8 is attached to the proximal end surface Tc of the tibia T. Further, in a state where the positioning portion 8 a of the tibial attachment portion 8 is pressed against the proximal end surface Tc of the tibia T, the extension element 24 a of the auxiliary support portion 24 is brought into contact with the tibia T, and the extension element 24 a is brought into contact with the bottom surface of the main body portion 18. It is fixed to 18c with a knob 24b. Thereby, the positioning portion 8a of the tibial attachment portion 8 is separated from the proximal end surface Tc of the tibia T due to the weight of the moving mechanism 12 or the like, and the extension balancer device 4 is prevented from being inclined and attached. Since the support arm 8b of the tibial attachment portion 8 and the arm portion 10c of the femur attachment portion 10 are arranged to be shifted to the left or right of the tibia T, they can be operated without interfering with the patella ligament. If it is difficult to perform the placement work, the femoral attachment part 10 may be once removed from the movable part 16 or the knee may be bent.

  A pinion 20a is rotated by engaging and rotating a torque driver or the like with the convex portion 20b of the rotating body 20, the coupling shaft portion 32a is lifted via the slide rack portion 16a, and the femoral attachment portion 10 is moved to the femur. The F distal end face Fc1 is brought into contact with and further lifted. By the lock mechanism 22, the rotating body 22 is prevented from rotating in a direction in which the femoral attachment portion 10 is lowered, and the femoral attachment portion 10 is maintained in a lifted state. When the femoral attachment 10 is lifted with a predetermined torque, the ligament is adjusted so that the gap between the femur F and the tibia T and the tension state (tension and left / right balance) of the ligament have predetermined values. The clearance between the femur F and the tibia T is referred to the vertical scale 16, the tension of the ligament is determined by a torque driver or the like, and the left-right balance of the ligament is referred to the angular scale 16 e.

  When the adjustment of the ligament in the extended position is completed, the extended position balancer device 4 is removed, and the bending position balancer device 6 to be used next is prepared. First, the femoral attachment part 30 of the bending position balancer device 6 is assembled. Next, the femoral attachment part 10 is removed from the stretched balancer apparatus 4, and instead, the femoral attachment part 30 of the flexion balancer apparatus 6 is attached. Specifically, after the coupling shaft portion 32a of the coupling portion 32 is inserted into the front-rear direction through hole 16b of the slide rack portion 16a of the movable portion 16, the support 10e is attached to the tip of the coupling shaft portion 32a.

  Next, the patient's knee is placed in the bending position, and the bending position balancer device 6 is placed between the tibia T and the femur F. Specifically, similarly to the arrangement of the extension balancer device 4, the tibial attachment portion 8 is attached to the proximal end surface Tc of the tibia T, the extension element 24a of the auxiliary support portion 24 is brought into contact with the tibia T, and the extension element 24a is It is fixed to the bottom surface 18c of the main body portion 18 by a knob 24b. As a modification, after adjustment of the ligament in the extended position, the femoral mounting portion 10 of the extended position balancer device 4 is removed while the tibial mounting portion 8 and the moving mechanism are attached to the patient. Six femoral attachment portions 30 may be attached. If it is difficult to perform the placement operation, the coupling portion 32, the drilling guide portion 34, the stylus portion 36, and the condyle support unit 30b may be once removed from each other. When the bending balancer device 6 is disposed between the tibia T and the femur F, the facing surface 34e of the drilling guide portion 34 faces the distal end surface Fc1 of the femur F, and the posterior condyles Fp1, Fp2 rests on the condyle contact plane 38d of the inner plate 38a and the outer plate 38b of the condyle support 38.

  A pinion 20a is rotated by engaging and rotating a torque driver or the like with the convex portion 20b of the rotating body 20, the coupling portion 32 is lifted via the slide rack portion 16a, and the femoral attachment portion 30 is lifted. The locking mechanism 22 prevents the rotating body 22 from rotating in the direction in which the femoral attachment portion 10 is lowered, and maintains the femoral attachment portion 30 in a lifted state. If the rotation angle of the femur F resting on the condyle contact plane 38d is not a desired rotation angle, the distal end surface Fc1 of the femur F and the facing surface 34e of the drilling guide portion 34 will not be parallel. In this case, as described above, the same tension as the ligament tension adjusted in the extended position is applied in a state where the femoral attachment portion 30 and the tibial attachment portion 8 are maintained at a predetermined distance by the lock mechanism 22. In this state, the rotation angle of the femur is changed by the rotation mechanism 40. Specifically, the rotation mechanism 40 rotates the tibial support 38 with respect to the drilling guide 34 around a rotation axis 44 perpendicular to the facing surface 34e. A state in which the distal end face Fc1 of the femur F and the facing surface 34e of the drilling guide part 34 are parallel to each other is a desirable rotation angle of the femur. When the rotation angle indicated by the scale 48 is different from the normal range, the tension of the ligament and the rotation angle may be changed repeatedly, and the tension state of the ligament in the extended position may be changed. You may adjust it again. By changing the rotation angle of the femur F, the tension state of the ligament when the knee is in the bent position can be made closer to the tension state of the ligament when the knee is in the extended position.

  Next, a drill or the like is inserted into a through guide hole 34f provided in the facing surface 34e, and an installation reference hole H for an osteotomy jig (not shown) is formed in the distal end surface Fc1 of the femur F. The installation reference hole H is a hole common to the femoral components 106 of different sizes, that is, the osteotomy jigs therefor. Thus, the tension of the ligament when the knee is in the flexed position is made closer to the tension of the ligament when the knee is in the extended position, i.e., attaching the femoral component to the femur with high accuracy. to enable.

  Also, the size of the femoral component 106 is determined using the stylus portion 36. When the confirmation of the ligament in the bent position is completed, the bent balancer device 6 is removed, and an osteotomy jig (not shown) is attached to the distal end face Fc1 of the femur F using the installation reference hole H. Installation surfaces Fc2 to Fc5 are formed on the distal end portion Fe. Thereby, it is possible to attach the roughly bone component 106 to the distal end Fe of the femur F.

  Further, in order to prepare the trial device 60 to be used next, the femoral attachment portion 30 is removed from the flexion balancer device 6 and, instead, the bearing portion 62 of the trial device 60 is attached. Specifically, after the coupling shaft portion 10a is inserted into the front-rear direction through hole 16b of the slide rack portion 16a of the movable portion 16, the support body 10e is attached to the tip of the coupling shaft portion 10a.

  A pin driver 20a is rotated by engaging and rotating a torque driver or the like with the convex portion 20b of the rotating body 20, the coupling shaft portion 10a is lifted via the slide rack portion 16a, and the bearing portion 62 is lifted. By the lock mechanism 22, the rotating body 22 is prevented from rotating in the direction in which the femoral attachment portion 10 is lowered, and the bearing portion 62 is maintained in a lifted state. The knee is moved between the extended position and the bent position, and the tension state of the ligament is confirmed. Since the bearing element 64 has the same shape as the bearing surface of the tibial tray 102 of the actual knee prosthesis 100, the tension state (gap) of the ligament can be reduced under the same conditions as when the actual knee prosthesis is installed. Can be confirmed.

  Since the bearing portion (tibial tray) of the conventional balancer device has a planar shape, the femoral component 106 is attached to the distal end Fe of the femur F and placed on the bearing portion as in the present invention. When the knee is moved between the extended position and the bent position, the femoral component 106 slides on the bearing portion in the front-rear direction A, and the ligament is in a tension state under the same conditions as when an actual artificial knee joint is installed. It was impossible to confirm.

  Although the embodiments of the present invention have been described above, the present invention is not limited to the above-described embodiments, and various modifications are possible within the scope of the invention described in the claims. Needless to say, these are also included within the scope of the present invention.

  In the above embodiment, the jig system 1 has the tibial template 2, the extended position balancer apparatus 4, the bent position balancer apparatus 6, and the trial apparatus 60. If the femoral component can be attached to the femur so that the tension of the ligament when it is in the knee is closer to the tension of the ligament when the knee is in the extended position, the tibial template 2 and the trial device 60 are selective. Is an element.

  In the above embodiment, in the extension position balancer device 4, the bending position balancer device 6, and the trial device 60, the tibial attachment portion 8 and the moving member 12 are common parts, but they are configured by different parts, and the jig system 1 However, they may have separate extension position balancer device 4, bending position balancer device 6, and trial device 60.

  In the above embodiment, the coupling shaft portion 10a, the attachment portion 10b, and the arm portion 10c are common components in the femoral attachment portion 10 of the extension position balancer device 4 and the trial support portion 62 of the trial device 60. May be configured by different parts, and the femoral attachment portion 10 and the trial support portion 62 may be configured as separate units.

  In the above embodiment, the reference hole R opened in the proximal end surface Tc of the tibia T is set as the reference position. However, a pin may be inserted into the reference hole R and the pin may be set as the reference position. Further, the reference hole R may not be a hole for fixing the tibial tray 102 as long as the tibial tray 102 of the artificial knee joint 100 can be positioned.

DESCRIPTION OF SYMBOLS 1 Jig system for artificial knee joint installation 2 Tibial template 4 Stretching balancer device 6 Bending balancer device 8 Tibial attachment part 8a Positioning part 8b Support arm 10 Femur attachment part 10a Coupling shaft part (coupling part)
10b Attachment portion 10c Arm portion 12 Movement mechanism 22 Lock mechanism 24 Auxiliary support portion 26 Spacer 30 Femur attachment portion (extension femoral attachment portion)
34 Drilling guide part 34e Opposing surface 34f Through guide hole 38 Condyle support part 38d Condyle contact plane 40 Rotating mechanism 44 Rotating axis 48a Scale 60 Trial device 62 Bearing part 64 Bearing element 100 Artificial knee joint 106 Femoral component 106 'femoral component trial F femur Fc1 distal end face Fe distal end Fp1, Fp2 posterior condyle R reference hole (reference position)
T Tibial Tc Proximal end face

Claims (7)

A flexion balancer device used in a state in which the knee flexion in order to install the artificial knee joint,
An extended balancer device used when the knee is in the extended position;
A trial device,
The bent position balancer device is:
A tibial attachment attached to the proximal end surface of the tibia;
A femoral attachment attached to the distal end of the femur;
A movement mechanism that moves the femoral attachment portion in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment portion, and the movement mechanism is between the femoral attachment portion and the tibial attachment portion. Having a locking mechanism for maintaining the distance at a predetermined distance,
The femoral attachment part includes a drilling guide part attached to the moving mechanism, a condyle support part that supports the posterior condyle of the femur, and the condyle support part that rotates with respect to the drilling guide part. A rotating mechanism for moving,
The perforating guide portion includes a facing surface that is perpendicular to the proximal end surface of the tibia and faces the distal end surface of the femur when the knee is in a flexed position, and an installation reference hole for the osteotomy jig. A penetrating guide hole provided in the opposing surface for forming on the distal end surface of
The condyle support portion has a condyle contact plane that is perpendicular to the facing surface and abuts against the posterior condyle of the femur when the knee is in a flexed position. It is rotatable with respect to the drilling guide portion around a moving axis,
The rotation mechanism, Ri operably der while maintaining between said tibial attachment part and the femoral attachment portion to a predetermined distance by said locking mechanism,
The extension position balancer includes an extension position tibial attachment portion attached to a proximal end surface of the tibia, an extension position femoral attachment portion attached to a distal end surface of the femur, and the extension position of the extension position femoral attachment portion. An extension position movement mechanism that moves in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment section, the extension position movement mechanism between the extension position femoral attachment section and the extension position tibial attachment section. Has an extended position locking mechanism that maintains a predetermined distance,
The trial device includes a trial tibial attachment portion attached to a proximal end surface of the tibia, a bearing portion that slidably supports a femoral component attached to the femur, and the bearing portion with respect to the tibial attachment portion. A trial movement mechanism that moves in a direction perpendicular to the proximal end surface of the tibia, and the trial movement mechanism has a trial lock mechanism that maintains a predetermined distance between the bearing portion and the trial tibial attachment portion,
The extension position tibial attachment portion of the extension position balancer device, the tibial attachment portion of the bending position balancer device, and the trial tibial attachment portion of the trial device are positioned with respect to a common reference position of the proximal end surface of the tibia. This is a jig system for artificial knee joint installation . A flexion balancer device used in a state in which the knee flexion in order to install the artificial knee joint,
An extension position balancer device used when the knee is in the extension position;
The bent position balancer device is:
A tibial attachment attached to the proximal end surface of the tibia;
A femoral attachment attached to the distal end of the femur;
A movement mechanism that moves the femoral attachment portion in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment portion, and the movement mechanism is between the femoral attachment portion and the tibial attachment portion. Having a locking mechanism for maintaining the distance at a predetermined distance,
The femoral attachment part includes a drilling guide part attached to the moving mechanism, a condyle support part that supports the posterior condyle of the femur, and the condyle support part that rotates with respect to the drilling guide part. A rotating mechanism for moving,
The perforating guide portion includes a facing surface that is perpendicular to the proximal end surface of the tibia and faces the distal end surface of the femur when the knee is in a flexed position, and an installation reference hole for the osteotomy jig. A penetrating guide hole provided in the opposing surface for forming on the distal end surface of
The condyle support portion has a condyle contact plane that is perpendicular to the facing surface and abuts against the posterior condyle of the femur when the knee is in a flexed position. It is rotatable with respect to the drilling guide portion around a moving axis,
The rotation mechanism, Ri operably der while maintaining between said tibial attachment part and the femoral attachment portion to a predetermined distance by said locking mechanism,
The extension position balancer includes an extension position tibial attachment portion attached to a proximal end surface of the tibia, an extension position femoral attachment portion attached to a distal end surface of the femur, and the extension position of the extension position femoral attachment portion. An extension position movement mechanism that moves in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment section, the extension position movement mechanism between the extension position femoral attachment section and the extension position tibial attachment section. Has an extended position locking mechanism that maintains a predetermined distance,
The extension position tibial attachment portion of the extension position balancer device and the tibial attachment portion of the bending position balancer device are positioned with respect to a common reference position of the proximal end surface of the tibia,
The moving mechanism is a jig system for knee joint installation, characterized in Rukoto to have a supplementary support portion abutting the tibia in lower than the tibial mounting portion. A flexion balancer device used in a state in which the knee flexion in order to install the artificial knee joint,
An extension position balancer device used when the knee is in the extension position;
The bent position balancer device is:
A tibial attachment attached to the proximal end surface of the tibia;
A femoral attachment attached to the distal end of the femur;
A movement mechanism that moves the femoral attachment portion in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment portion, and the movement mechanism is between the femoral attachment portion and the tibial attachment portion. Having a locking mechanism for maintaining the distance at a predetermined distance,
The femoral attachment part includes a drilling guide part attached to the moving mechanism, a condyle support part that supports the posterior condyle of the femur, and the condyle support part that rotates with respect to the drilling guide part. A rotating mechanism for moving,
The perforating guide portion includes a facing surface that is perpendicular to the proximal end surface of the tibia and faces the distal end surface of the femur when the knee is in a flexed position, and an installation reference hole for the osteotomy jig. A penetrating guide hole provided in the opposing surface for forming on the distal end surface of
The condyle support portion has a condyle contact plane that is perpendicular to the facing surface and abuts against the posterior condyle of the femur when the knee is in a flexed position. It is rotatable with respect to the drilling guide portion around a moving axis,
The rotation mechanism, Ri operably der while maintaining between said tibial attachment part and the femoral attachment portion to a predetermined distance by said locking mechanism,
The extension position balancer includes an extension position tibial attachment portion attached to a proximal end surface of the tibia, an extension position femoral attachment portion attached to a distal end surface of the femur, and the extension position of the extension position femoral attachment portion. An extension position movement mechanism that moves in a direction perpendicular to the proximal end surface of the tibia with respect to the tibial attachment section, the extension position movement mechanism between the extension position femoral attachment section and the extension position tibial attachment section. Has an extended position locking mechanism that maintains a predetermined distance,
The extension position tibial attachment portion of the extension position balancer device and the tibial attachment portion of the bending position balancer device are positioned with respect to a common reference position of the proximal end surface of the tibia,
Further, jig system for knee joint installation, characterized in Rukoto which have a tibial template having a guide hole for forming a reference hole for positioning a tibial tray of the knee prosthesis in a proximal end surface of the tibia . The tibial attachment portion of the bending position balancer device and the extension position tibial attachment portion of the extension position balancer device are configured by a common tibial attachment portion,
The movement mechanism of the bending position balancer device and the extension position movement mechanism of the extension position balancer device are configured by a common movement mechanism,
Femur attachment part of the flexion balancer device and extended position femur attachment part of the extended position balancer apparatus, any of claims 1 to 3, characterized in that it is removably attached to said common moving mechanism The jig system according to claim 1 . The tibial attachment portion of the bending position balancer device, the extension tibial attachment portion of the extension position balancer device, and the trial tibial attachment portion of the trial device are configured by a common tibial attachment portion,
The movement mechanism of the bending position balancer device, the extension position movement mechanism of the extension position balancer device, and the trial movement mechanism of the trial device are configured by a common movement mechanism, and the femoral attachment portion of the bending position balancer device, jig system of claim 1 wherein the extended position femur attachment part of the extended position balancer device and the bearing portion of the trial device, characterized in that it is removably attached to said common moving mechanism. The extension position femoral attachment portion of the extension position balancer device includes a common coupling portion that is detachably attached to the common movement mechanism, a common attachment portion that is disposed between the femur and the tibia, and the cup. A common arm portion connecting the ring portion and the attachment portion; and a spacer attached to the common attachment portion and abutting against a distal end surface of the femur;
The trial device includes the common coupling portion, the common attachment portion, the common arm portion, and a bearing element attached to the common attachment portion and supporting a femoral component. The jig system according to claim 5, wherein the jig system is characterized in that: The tibial attachment portion includes a positioning portion that is positioned at a reference position of a proximal end surface of the tibia, and a support arm that extends from the positioning portion toward the moving mechanism,
Said support arm, said positioning portion when positioned at the proximal end face of the tibia, in any one of claims 1 to 6, characterized in that it is arranged offset to the left or right side of the tibia The jig system described.

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