JP2002282263A - Operation instrument kit for excising ostegenetic vertebral arch - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an operation instrument kit for excising an ostegenetic vertebral arch having superior operability and safety as compared with the conventional one. SOLUTION: This operation instrument kit for excising ostegenetic vertebral arch enables laminectomy for vertebra and thoracic vertebra. As compared with the conventional laminectomy for the lumbar vertebra, the structure of a bone cutting wire is optimized, and this instrument is provided with right and left guide pipes, whereby a large improvement effect is obtained in respect of operability and safety as compared with the convention operation instrument kit for excising an ostegenetic vertebral arch.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical instrument for osteogenic laminectomy of a vertebra, which is used for spinal surgery such as spinal cord tumor and spinal canal stenosis.

[0002]

BACKGROUND OF THE INVENTION In orthopedic surgery, Leonard Gigli
However, various improvements have been made after osteotomy with a single steel wire whose surface was roughened (Gigli, Centralblatt
fur Chirurgie, 18, 409-411, 1894). These osteotomy wires are very convenient when performing normal bone cutting operations, but when cutting bones near nerves such as the spinal cord, that is, when performing a laminectomy operation, the dura or nerve roots are used. Likely to hurt.

[0003] Therefore, a method of passing an osteotomy wire through a Venula needle or the like to cover the cut surface of the osteotomy wire and then inserting the osteotomy wire into the epidural space of the spine is generally used (Tomita et al. 28, 1249-1257, 1993). However,
In the conventional method, the operability at the time of insertion into the epidural space of the spine is poor, and a skilled technique is required.

[0004]

SUMMARY OF THE INVENTION An object of the present invention is to provide a novel surgical instrument for osteogenic laminectomy which is superior in operability and safety as compared with the prior art. is there.

[0005]

Means for Solving the Problems In order to solve the above-mentioned problems, the present inventors have conducted intensive studies and developed a new surgical instrument for osteogenic laminectomy excellent in operability and safety. Reached.

First, in order to pass the osteotomy wire under the intervertebral foramen, ie, under the lamineus, a method of directly passing the wire through the intervertebral foramen is used.
(Direct approach) and a method of passing through the foramen via the facet joint (transfacet approach) are conceivable. The former applies to the lumbar vertebra and the latter applies to the cervical and thoracic vertebrae due to the anatomical features of the vertebrae. The latter transfacet approach is an unprecedented and novel approach that enables the cutting of the vertebral arch, which is difficult at the high level where the spinal cord is present, that is, at the cervical and thoracic levels.

[0007] The transcervical approach is used to cut the cervical and thoracic vertebral arches. The osteotomy wire set on the guide spatula can be safely and easily passed through the intervertebral foramen to reach the intervertebral foramen. For this purpose, the distal end of the guide spatula has a hole for setting a bone cutting wire and a saw-toothed structure provided on one side of the distal end for incising the joint capsule. As a result, the wire can be set through the hole at the tip of the guide spatula, and the osteotomy wire can be safely and easily guided from the side of the spinal canal to the intervertebral foramen through the facet joint.

Further, it is preferable that the distal end of the osteotomy wire used for the cervical vertebra and the thoracic vertebra be hardened by welding so that the osteotomy wire can be easily inserted into the hole of the guide spatula. .

[0009] The laminectomy of the lumbar spine is performed by a direct approach, and there are two methods. Insertion into the spinal canal from outside the foramen (lateral approach) and insertion from the spinal canal to the outside of the foramen (medial approach)
It is. When inserting the osteotomy wire into the intervertebral foramen, it is important for safety that the cut surface of the osteotomy wire is not exposed, and this is different from the transvertebral approach. Therefore, it is preferable to cover the cut surface by passing the osteotomy wire through the guide pipe. Furthermore, the length of the guide pipe is preferably long enough that the cut surface of the osteotomy wire cannot contact tissue around the affected part when inserting the osteotomy wire into the spinal epidural space.

[0010] The tip of the osteotomy wire used for the lumbar spine is
Exposed from the tip of the guide pipe increases the risk of damaging tissue, such as the dura, when inserting the osteotomy wire into the intervertebral foramen, especially with the lateral approach. On the other hand, dural injury is less likely with the medial approach,
The tip of the wire is buried in the soft tissue, and when the tip of the wire is picked up with a wire head gripper and pulled out, it is highly likely that the tip is difficult to confirm.

Therefore, it is preferable to improve the structure of the distal end of the osteotomy wire to enhance the operability when inserting the osteotomy wire into the intervertebral foramen and to enhance safety. The present inventors have noticed that the cervical, thoracic, and lumbar vertebrae of the spine differ in the form of the facet joints and the shape and size of the space of the spinal epidural space. It was concluded that optimization for cervical / thoracic surgery and for lumbar surgery is preferred. In the lumbar spine, these tip structures also serve as stoppers to prevent the osteotomy wire passed through the guide pipe from falling out of the guide pipe. For the cervical and thoracic vertebrae, it is preferable to harden the distal end by welding so that the bone cutting wire can easily pass through the hole of the guide spatula.

Also, if the rear end of the lumbar vertebral osteotomy wire is exposed from the rear end of the guide pipe, the operator may be injured during the operation. Therefore, the guide handle for enhancing the operability when inserting the osteotomy wire into the intervertebral foramen is a structure that is convenient for the operator to hold, and has a hollow structure at the center and a rear end of the guide pipe. It is preferable to have a structure capable of storing the osteotomy wire exposed from the side.

[0013]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Embodiments of the present invention will be described based on examples with reference to the drawings.

The wire material for the osteotomy wire has a strength enough to cut vertebrae and a twisted twisted stainless steel filament so that the surface roughness does not slip on the bone surface during cutting. It has a thread shape. There is no particular limitation on the outer diameter, but 0.5 mm or less is suitable.

The guide spatula is a guide spatula used for passing an osteotomy wire through an intervertebral foramen of the cervical and thoracic vertebrae. In order to facilitate the passage of the osteotomy wire through the facet joint, it is preferable that the distal end of the guide spatula has a thin plate shape and is bent into a gentle curve. In addition, a hole for passing a bone cutting wire is formed at the tip of the guide spatula.
At the time of use, the osteotomy wire is fixed through the two holes at the distal end so that the wire does not easily come off when passing through the facet joint. Between the two holes at the tip of the guide spatula, one groove is formed on the back surface of the tip along the length of the guide spatula. This is a device for eliminating looseness of the set osteotomy wire and keeping the wire in close contact with the back surface of the spatula so that the wire can smoothly pass through a narrow space. In order to incise the joint capsule, a saw-toothed structure is provided on one side of the distal end, and can be used as a saw. Further, for the right side and the left side, the saw-tooth structure on the side of the tip portion is provided on the opposite side. As a result of these ingenuities, when the wire is passed through the two holes at the tip of the guide spatula and passed through the narrow facet joint from the spinal canal to the intervertebral foramen, the osteotomy wire is guided safely and with good operability. Can be. An example of a guide spatula is shown in FIG.

Regarding the metal fitting for the lumbar vertebra (for direct approach) osteotomy wire of the present invention, in the lateral approach, a spatula-shaped shape is used to make the distal end easily visible even when buried in soft tissue outside the intervertebral foramen. It is preferable that the material bend in accordance with the shape of the guide pipe. In order to prevent the distal end from being pulled into the guide pipe when the bone cutting wire is passed through the guide pipe, the maximum width of the distal end fitting needs to be larger than the outer diameter of the guide pipe. Outer diameter 0.36
FIG. 2 shows an example in which a spatula-type tip fitting is crimped to the tip of a SUS304 stainless steel cable having a diameter of 1.0 mm.

In the lumbar spine (for direct approach),
Regarding the metal fitting of the osteotomy wire used for the medial approach, a spherical structure is optimal in consideration of the shape of the spinal epidural space of the lumbar spine. In order to prevent the distal end portion from being drawn into the guide pipe when the bone cutting wire is passed through the guide pipe, the maximum diameter of the distal end fitting needs to be larger than the outer diameter of the guide pipe. However, if the diameter is too large, the surrounding tissue may be compressed when the lumbar vertebra is inserted into the epidural space, so the maximum diameter of the spherical tip metal fitting is naturally limited. SUS3 with outer diameter 0.36mm
FIG. 3 shows an example in which a spherical end fitting is caulked to the end of a 04 stainless steel cable.

The primary purpose of the guide pipe is to prevent damage to surrounding tissues by covering the cut surface of the osteotomy wire when inserting the osteotomy wire into the lumbar intervertebral foramen. Therefore, it is necessary that the length of the guide pipe be longer than the length of the portion that comes into contact with the surrounding tissue at the time of insertion. Further, the guide pipe must be able to secure an inner diameter enough to allow the bone cutting wire to be smoothly inserted and removed when the bone cutting wire is passed through the guide pipe and when the guide pipe is withdrawn after inserting the intervertebral foramen. Further, in order to adapt to the shape of the intervertebral foramen, it is preferable that the distal end region of the guide pipe is not linear, but a shape that is easily adapted to the shape of the intervertebral foramen, for example, an arc shape.
Also, the outer diameter of the guide pipe needs to be small enough to allow the lumbar intervertebral foramen to pass smoothly. Further, in order to prevent damage caused when contacting the tissue, it is desirable that the outer surface of the guide pipe be smooth by a mirror finish or the like.

There are two cases, depending on the surgical site, where the osteotomy wire is inserted into the right intervertebral foramen and when the insertion is made into the left intervertebral foramen. To cope with such a situation, it is necessary that the arc-shaped portion and the straight portion at the tip of the guide pipe are not on the same plane but have an appropriate angle. When manufacturing such a guide pipe, it can be manufactured by processing the arc-shaped portion at the tip of the guide pipe and then bending the linear portion to the right or left of the arc-shaped portion. The bending angle at this time is not particularly limited, and is preferably set to an optimum angle according to the application.

A pipe made of SUS304 having an outer diameter of 2.0 mm and an inner diameter of 1.0 mm (an outer surface is mirror-finished) was used.
FIG. 4 shows an example of the guide pipe for the left side. In this example, the angle between the arc-shaped portion and the linear portion at the tip is 45.
°. In consideration of safety, the tip of the guide pipe is pressed about 3 mm, and the tip is rounded.

The handle portion 4 of the guide handle (FIG. 5)
Is not particularly limited as long as it is appropriate in thickness and length to be grasped by an operator. At the center of the guide handle, a hollow structure is provided in the length direction for inserting an osteotomy wire (indicated by a broken line in FIG. 5). The diameter of the hollow portion is not particularly limited as long as the bone cutting wire can be inserted smoothly. At the tip, a tip holder 6 and a tip fitting 3 for fixing a guide pipe are provided.
Is provided. At the rear end, there is a lock block 7 and a clamp fitting 5, which are used to lock the osteotomy wire. The pins 8 and 9 are used when the lock block 7 is moved to fix the osteotomy wire passed through the hollow portion.

Surgical instruments for osteogenic laminectomy include cervical spine
For thoracic spine, it consists of osteotomy wire and guide spatula, and for lumbar spine, it consists of osteotomy wire, guide pipe and guide handle. In addition, during surgery on the cervical spine and thoracic spine, a headless wire is passed through the two holes of the guide spatula. On the other hand, during surgery on the lumbar vertebrae, insert the rear end of the osteotomy wire from the distal end of the guide pipe, pull out the osteotomy wire from the rear end of the guide pipe, and connect the metal fitting of the osteotomy wire to the distal end of the guide pipe. Set correctly. In particular, when a tip spatula-shaped osteotomy wire is set, it is necessary to confirm that the direction of the tip fitting is correct. Next, the rear end of the osteotomy wire is inserted into the hollow portion through the opening at the tip of the guide handle, and the osteotomy wire is pulled out from the rear end of the guide handle. After inserting the rear end of the guide handle into the front end opening of the guide handle and fixing it, pulling the osteotomy wire and confirming that there is no slack, pulling the lock block (7 in FIG. 5) backwards. The cutting wire is fixed and ready for use.

In the case of the cervical spine and thoracic vertebral osteogenic laminectomy, a surgical instrument for osteogenic laminectomy in which a headless wire is set on a guide spatula is used. In the case of the lumbar spine osteogenic laminectomy, a surgical instrument for osteogenic laminectomy in which a spherical or spatula-shaped wire is set according to the intended use is used.

In addition, depending on the left and right sides of the lamine to be cut, a surgical instrument for osteogenic laminectomy for the right side in the case of a right side lamine,
In the case of the left lamine, a surgical instrument for osteogenic laminectomy for the left side is used.

In addition to these osteogenic laminectomy surgical instruments, bone screws, drill guides, drills, wire head grippers, driver guides, bone screw drivers, etc., are necessary for osteogenic laminectomy. If a set of instruments is arranged in a storage case, efficient surgery can be performed.
The storage case is not particularly limited as long as it can withstand high-pressure steam sterilization, but an aluminum storage case is optimal from the viewpoint of weight reduction. The member for fixing the position of each device installed in the storage case is not particularly limited as long as it is a material that can withstand high-pressure steam sterilization, but silicon rubber is optimal.

The drill guide is designed so that the tip of the drill guide can accurately indicate the piercing point so that the drill can accurately pierce the very thin vertebral arch, and that the piercing point is stable. The drill insertion hole has a serrated shape and is firmly fixed to the vertebra (FIG. 6).

The set of osteogenic laminectomy surgical instruments and the set of osteogenic laminectomy surgical instruments of the present invention require intra-spinal canal operations such as spinal cord tumors and spinal canal stenosis in spinal surgery. It is useful in the case of surgery.

Using the surgical instrument for osteogenic laminectomy of the present invention, in the lumbar region, an arc portion of the guide pipe is inserted into the intervertebral hole of the patient, and the distal end bracket of the osteotomy wire is exposed on the opposite side. Let it. Release the lock block at the rear end of the guide handle, pull out the tip fitting to an appropriate position, extract the arc of the inserted guide pipe to the outside of the spinal epidural space, and finally remove only the osteotomy wire. Leave in the foramen.

In the cervical and thoracic vertebrae, a guide spatula inserted through the headless wire is inserted into the intervertebral foramen of the patient so as to cut off the joint capsule inside the facet joint from inside the spinal canal, and the facet joint cavity is opened. Then, the joint capsule outside the facet joint is cut off, the guide spatula is extracted outside the foramen foramen, the guide spatula is extracted, and finally only the osteotomy wire is left in the foramen foramen.

After holding the appropriate portions on both sides of the inserted osteotomy wire with the left and right hands, and matching the cut site of the bone, the osteotomy wire is alternately pulled left and right to cut. By this method, it is possible to cut the necessary portion of the vertebral lamine and expand the affected area in the spinal canal to perform the operation without damaging the dura or nerve root.

The bone screw, drill guide, drill, wire head gripper, driver guide and bone screw driver included in the set of surgical instruments for osteogenic laminectomy are as follows:
It is used to return the cut bone fragment to its original position and fix it.
The drill guide should be hooked and hooked into the hole of the outlet so that it can accurately drill inside the thin vertebral bone fragment, so that the drilling piercing part and the outlet part can be properly grasped. The piercing portion has a serrated shape so that the bone can be held firmly. Using this drill guide, a screw hole is made to pass a bone screw for fixing the cut bone fragment in its original position. A commercially available bone screw can be used. For example, a cortical bone screw of Nakashima Propeller Co., Ltd. (medical device approval number: 201)
00BZZ01423000) has an advantage that the bone fragments can be fixed with a bone screw driver without having to cut the tap in advance, since the tip of the titanium screw is cut.

[0032]

EXAMPLES In order to demonstrate the usefulness of the surgical instrument for osteogenic laminectomy of the present invention, an example of operation using the surgical instrument for osteogenic laminectomy of the present invention will be described below. Although shown, the invention is not limited to only these examples.

[0033]

Example 1 For laminectomy of a patient with cervical spinal cord tumor,
A transfacet approach was used. The guide spatula was inserted into the two holes at the tip of the right-side guide spatula through a headless wire, and then inserted from the spinal canal side of the patient's cervical vertebra. After inserting the joint capsule inside the facet joint from inside the spinal canal, cut out the joint capsule outside the facet joint through the facet joint space and put out the guide spatula outside the foramen foramen, I took out the guide spatula. Finally, only the osteotomy wire was left in the intervertebral foramen, and the right vertebral arch was cut with the wire. By this method, the lamine could be safely cut without damaging the surrounding tissue. Similarly, laminectomy can be performed by cutting the left lamine with a left-sided guide spatula, the dura in the spinal canal can be sufficiently deployed, and surgery on the tumor can be performed.

[0034]

Example 2 In the case of the medial approach of the lumbar spine, after setting a spatula-shaped wire to the guide pipe and the guide handle, the distal end of the guide pipe was inserted from inside the spinal canal to the outside of the intervertebral foramen. The spatula-shaped part of the wire was pinched with a wire head gripper, and the wire was pulled out to an appropriate length. Next, the guide pipe and the guide handle were removed to make only the wire, and then the target vertebra was cut with the wire.

[0035]

Embodiment 3 In the case of the lumbar spine outer approach, a spherical wire was set on the guide pipe and the guide handle, and then the distal end of the guide pipe was inserted into the spinal canal from outside the foramen. The spherical portion of the wire was pinched with a wire head gripper, and the wire was pulled out to an appropriate length.
Next, the guide pipe and the guide handle were removed to make only the wire, and then the target vertebra was cut with the wire.

[0036]

According to the surgical instrument for osteogenic laminectomy of the present invention, an osteogenic laminectomy, which has not been conventionally possible in the cervical and thoracic vertebrae, has been made possible. Conventional osteogenic lamine, characterized by the optimized structure of the osteotomy wire for the laminectomy with the lateral approach and the medial approach, respectively, and with the right and left guide pipes Compared to surgical instruments for resection,
A great improvement is obtained in terms of operability and safety. In addition, by performing this operation, it is not necessary to insert an expensive and powerful spinal instrument into the body, and a great effect can be obtained in terms of treatment and medical expenses.

[Brief description of the drawings]

FIG. 1 is a view showing the structure of a guide spatula, wherein the right side is a front view and the left side is a side view.

FIG. 2 is a diagram showing a partial structure of a distal end portion of the spatula wire, wherein the upper side is a front view, and the lower side is a two-side view showing a side view.

FIG. 3 is a diagram showing a partial structure of a distal end portion of the spherical wire, wherein the upper side is a front view and the lower side is a two-sided view of a side view.

FIG. 4 is a view showing the structure of the left guide pipe, in which the upper side is a side view and the lower side is a front view.

FIG. 5 is a view showing a structure of a guide handle.

FIG. 6 is a view showing the structure of the drill guide, wherein the right side is a front view, and the left side is a side view of the two views.

FIG. 7 shows a complete surgical instrument for osteogenic laminectomy.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Hole for passing a headless wire 2 ... Serrated part for incision of joint capsule 3 ... Tip fitting 4 ... Handle 5 ... Clamp fitting 6 ... Tip holder 7 ... Lock block 8 ... Pin 1 9 ... Pin 2

Claims (9)

[Claims] 1. An osteogenic laminectomy surgical instrument comprising a cervical and thoracic osteogenic laminectomy surgical instrument and a lumbar spine osteogenic laminectomy surgical instrument. 2. The surgical instrument for osteogenic laminectomy according to claim 1, wherein the surgical instrument for osteogenic laminectomy for the cervical and thoracic vertebrae comprises an osteotomy wire and a guide spatula. 3. The surgical instrument for osteogenic laminectomy according to claim 1, wherein a serrated portion for incising the joint capsule is provided on one side of the tip of the guide spatula. 4. The surgical instrument for osteogenic laminectomy according to claim 1, wherein the surgical instrument for osteogenic laminectomy for the lumbar spine comprises an osteotomy wire, a guide pipe and a guide handle. 5. The osteogenic laminectomy according to claim 1, wherein the osteotomy wire for the cervical and thoracic osteoplasty laminectomy surgical instrument is a headless wire. Surgical instruments. 6. The method according to claim 1, wherein the osteotomy wire of the surgical instrument for osteoplasty laminectomy for the lumbar spine is a spatula wire for an outer approach or a spherical wire for an inner approach. Item 6. The surgical instrument for osteogenic laminectomy according to Item 4. 7. The surgical instrument for osteogenic laminectomy according to claim 1, wherein the surgical instrument for osteogenic laminectomy has a right and a left. 8. A complete surgical instrument for osteogenic laminectomy, comprising the surgical instrument for osteogenic laminectomy according to claim 1 and a drill guide. 9. The surgical instrument for osteogenic laminectomy according to claim 1, a drill guide, a drill, a bone screw, a wire head gripper, a screwdriver guide, a bone screw driver, a universal hex driver, a spanner, and the like. Complete surgical instrument for osteogenic laminectomy consisting of a storage case.