JP2003339727A - Positioning instrument of guide pin - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a positioning instrument of a guide pin capable of simply grasping the insertion direction and position of the guide pin three-dimensionally before inserting the guide pin in a bone to shorten an operating time. <P>SOLUTION: A positioning device for a guide pin 12 preliminarily used for guiding an implant in a bone has a guide pin mounting part 1 mounted on the guide pin 12 temporarily fixed toward implant insertion direction and two index pin holding parts 2 and 3 for holding two index pins 13 and 14 parallel to the guide pin 12 so as to separate a predetermined angle interval centering around the guide pins 12. <P>COPYRIGHT: (C)2004,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a guide pin positioning device that is used in advance to guide insertion of an implant into bone.

[0002]

2. Description of the Related Art As a treatment method for fractures or cracks around the neck of the femur, surgery for fixing the space between the head of the femur and the neck with an implant such as a compression hip screw is generally used. Has been done. Prior to such an operation, a guide pin for guiding the insertion of the implant into the bone is inserted into the femoral bone from below the greater trochanter to the center of the head. Whether this guide pin is correctly inserted into the bone, depending on its insertion direction and position,
The fixing effect of the implant is influenced.

Conventionally, as shown in FIG. 7, a guide pin 12 is used.
Is inserted into the bone, a handle part 17 for applying the base 16 to the neck 33 of the femur 30 and a guide part provided at a predetermined angle for inserting the guide pin 12 between the base part 16 and the handle 17. This is done by using the temporary fixing member 15 having 18.
That is, the base portion 16 of the temporary fixing member 15 is brought into contact with the neck portion 33 of the femur 30 below the greater trochanter 31 and the handle portion 17 is operated to determine the direction of the guide portion 18 and the guide pin 12 to the guide portion 18. The guide pin 12 is inserted into the femur 30 to some extent, and the insertion direction is confirmed by the front and back images and side images of the X-ray fluoroscopic image, and the guide pin 12 is inserted when an appropriate direction is obtained. It was finally inserted.

[0004]

However, the guide pin 1 is attached to the femur 30 by the temporary fixing member 15 described above.
Although the 2 can be inserted, the provisional fixing member 15 is provided due to the distance between the insertion point and the target femoral head.
It was difficult to insert the guide pin 12 in an appropriate direction at once by using, and some experience and intuition were required. In addition, in order to insert the guide pin 12 in the proper direction in the X-ray fluoroscopic image, it is necessary to insert the guide pin 12 into the bone to some extent to determine whether the guide pin 12 is inserted in the proper direction. I needed some intuition.

Therefore, in the prior art, the guide pin 1
In order to determine the proper insertion direction of 2, the guide pin 1 should be checked while checking the anterior-posterior and lateral images of the X-ray fluoroscopic image.
Since it is necessary to reinsert 2 several times, there is a problem that not only the operation time becomes long, but also X-rays have to be irradiated many times. Therefore, according to the present invention, the insertion direction and position of the guide pin can be known before actually inserting the guide pin into the bone, and the operation time can be shortened and the radiation exposure dose can be reduced. It is an object of the present invention to provide a guide pin positioning device that can be used.

[0006]

SUMMARY OF THE INVENTION In order to solve the above problems, the present invention provides a guide pin positioning device which is used in advance to guide insertion of an implant into a bone and which has an implant insertion direction. A guide pin mounting portion to be mounted on the guide pin temporarily fixed toward and two index pin holding portions for holding two index pins parallel to the guide pin with a predetermined angular interval about the guide pin. The present invention provides a guide pin positioning device. According to the present invention, two index pins held in parallel with the guide pin are observed by X-ray fluoroscopy from two directions overlapping with the guide pin respectively, and from the insertion direction and the insertion position indicated by the image of the index pin overlapping with the guide pin, The insertion direction and position of the guide pin can be easily grasped three-dimensionally with the two index pins inserted into the desired length before inserting the guide pin into the bone. It is possible to shorten the radiation dose and reduce the radiation exposure dose.

Further, according to the present invention, the predetermined angular interval is approximately 9
The guide pin positioning device according to claim 1, wherein the guide pin positioning device is at 0 ° intervals. According to the present invention, since the two index pins are held at 90 ° intervals with the guide pin as the center, the three-dimensional insertion direction and position of the index pin shown overlapping with the guide pin from two directions orthogonal to each other. It can be grasped accurately.

Further, according to the present invention, the guide pin mounting portion or the index pin holding portion has a fitting hole into which the guide pin or the index pin can be detachably fitted.
Alternatively, the guide pin positioning device according to item 2 is provided. According to the present invention, the guide pin or the index pin can be easily attached to and detached from the fitting hole for use.

Further, according to the present invention, the index pin holding portion is
The guide pin positioning device according to any one of claims 1 to 3, wherein a plurality of guide pin positioning devices are provided in a radial direction around the guide pin. According to the present invention, it is possible to hold the index pin and use it by selecting the index pin holding portion at an appropriate position and distance from the guide pin according to the body shape of the patient.

The present invention also provides a guide pin positioning device according to any one of claims 1 to 4, wherein a connecting portion for connecting the index pin holding portion and the guide pin mounting portion is provided so as to be expandable and contractible. It is a thing. According to the present invention, the index pin can be set and held at an appropriate position by expanding and contracting the connecting part that connects the index pin holding part and the guide pin mounting part according to the body shape of the patient.

The present invention also provides a guide pin positioning device according to any one of claims 1 to 5, wherein the guide pin mounting portion is rotatably provided around the guide pin. . According to the present invention, the guide pin mounting portion can be rotated about the guide pin to adjust the overlapping position of the index pin held by the index pin holding portion. The index pin can be aligned with the guide pin in the X-ray fluoroscopic image without moving the X-ray fluoroscope when adjusting the fluoroscopic position for superimposing in the fluoroscopic direction.

Further, according to the present invention, the guide pin mounting portion is provided with a temporary fixing member for temporarily fixing the guide pin at a predetermined insertion angle. The equipment is provided. According to the present invention, since the insertion angle of the guide pin mounted on the guide pin mounting portion can be fixed by the temporary fixing member and temporarily fixed, the insertion angle of the guide pin can be easily corrected by the temporary fixing member to quickly The insertion direction can be determined.

Further, according to the present invention, any one of claims 1 to 7 wherein the guide pin holding portion and the guide pin mounting portion are connected to each other by retracting from a surface position where the guide pin and the index pin are connected so as to overlap each other. The present invention provides a guide pin positioning device as described above. According to the present invention, since the connecting portion between the index pin holding portion and the guide pin mounting portion is retracted from the position connecting the guide pin and the index pin, the connecting portion and the temporary fixing member interfere with each other in the retracted portion. Therefore, the index pin can be provided in the direction of the temporary fixing member,
It is possible to determine the left-right direction when viewed from the insertion direction of the guide pin.

Further, the present invention provides a guide pin positioning device according to any one of claims 1 to 8, wherein the guide pin mounting portion is integrally provided with the temporary fixing member. According to the present invention, the structure can be simplified by providing the guide pin mounting portion integrally with the temporary fixing member.

Further, the present invention is used for positioning a guide pin for guiding insertion of an implant for fixing between the greater trochanter and lesser trochanter of the femur into the bone. The present invention provides a guide pin positioning device as described in 1. ADVANTAGE OF THE INVENTION According to this invention, even if it is difficult to determine the insertion direction, such as a guide pin that guides insertion of the implant that fixes between the greater trochanter and lesser trochanter of the femur, the guide pin can be easily guided. The insertion direction of the pin can be determined.

In the present invention, the guide pin temporarily fixed in the implant insertion direction for mounting the guide pin mounting portion is composed of a guide pin member different from the guide pin actually inserted into the bone. Can
For example, one guide pin member consists of a shaft member that can be attached to and detached from the guide portion of the temporary fixing member, and is replaced with the guide pin to be actually inserted into the bone when the positioning with the index pin is completed. It is also possible to use it as a member used only for positioning, and for example, the other guide pin member is constituted by a hollow shaft member integrally provided in the guide portion of the temporary fixing member, It is also possible to configure a guide pin that is actually inserted into the bone to be inserted into the bone by guiding the guide pin into the hollow when the insertion positioning with the pin is completed.

[0017]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described based on illustrated examples. 1 to 3, reference numeral 10 denotes an instrument main body of a guide pin positioning instrument according to the present invention, and the instrument main body 10 is mounted on a guide pin 12 temporarily fixed in the implant insertion direction. Two index pin holding parts 2, 3 provided to hold the mounting part 1 and two index pins 13 and 14 in parallel with the guide pin 12 with a predetermined angular interval about the guide pin 12.
Consists of.

As shown in FIGS. 4 to 7, the guide pin 12 inserts a compression hip screw 19 which is an implant for fixing between the greater trochanter 31 and the lesser trochanter 32 of the femur 30 into the bone. To guide you.
In the embodiment of the present invention, as shown in FIG. 2 or FIG.
The guide pin 12 is inserted into the guide portion 18 of the temporary fixing member 15 so that the tip thereof does not enter the bone, and temporarily fixed to the neck portion 33 by the handle portion 17 so that the instrument body 10 according to the present invention is used. Is configured.

In the embodiment, the guide pin mounting portion 1 is
There is a fitting hole 4 into which the guide pin 12 can be removably fitted, and by mounting the guide pin mounting portion 1 on the guide pin 12 through the fitting hole 4, the instrument body 10 is temporarily fixed. It is configured so that it can be rotatably attached to the unit 15. In addition, the guide pin mounting portion 1 rotates about the guide pin 12 and adjusts the rotation so that the index pins 13 and 14 overlap with the guide pin 12 at the time of shooting, and the guide pin mounting unit 1 has a predetermined angular interval such as 90 °. It is configured so that the position can be easily adjusted in the X-ray fluoroscopic direction set and set.

In the embodiment of FIG. 1, the index pin holding portions 2 and 3 have fitting holes 5 and 6 into which the index pins 13 and 14 can be detachably fitted, respectively, and the guide pin 1
The guide pins 13 and 14 are connected to the guide pin mounting portion 1 by connecting portions 7 and 8 so that the index pins 13 and 14 can be held at intervals of about 90 ° around the center 2. In the case of the embodiment, the index pin holding portion 2 has different distances along the radial direction with the guide pin 12 as the center so that the index pin 13 can be held at an appropriate position according to the body shape of the patient. In addition, the index pin holding portion 3 having the plurality of fitting holes 5 and holding the index pin 14 expands and contracts the index pin holding portion 3 having the fitting hole 6 in the radial direction around the guide pin 12. It is provided so that expansion and contraction can be adjusted so that the position can be adjusted.

That is, in the index pin holding portion 3, a connecting portion 8 for connecting the index pin holding portion 3 and the guide pin mounting portion 1,
9 is a shaft member that is telescopically fitted in a telescopic manner,
The scale graduation 11 allows the distance of the index pin holding portion 3 to be adjusted to an appropriate position. In addition,
It is also possible to provide the connecting portion 8 so as to be rotationally adjustable about the axis of the connecting portion 9 so that the parallel relationship between the guide pin 12 and the index pins 13 and 14 can be adjusted.

As a practical matter, the difference in body size between individual patients is not so large, and the fitting holes 4, 5, 6
The perfect parallelism of the guide pin does not cause any misalignment or loosening in the positioning device of the guide pin, so that it can be operated by one operator with one hand during use, and the surgical instrument can be used before and after use. Considering that it is completely sterilized and has a structure that is easy to wash and keep clean, the positioning device for the guide pin according to the present invention is as simple as possible, and it is a solid unit with robustness that does not twist. Different structures are preferred. From this point of view, only one fitting hole 5 is required. Further, when considering a structure that can be adapted to the body shape of an individual, a structure having a plurality of fitting holes 5 in parallel is preferable to a structure in which the connecting portions 8 and 9 expand and contract.

In the illustrated embodiment, the connecting portion 7 is
The intermediate portion is provided so as to be retracted from the surface position where the guide pin 12 and the index pin 13 are connected so as to overlap each other.
In FIG. 2, when the guide pin 12 and the index pin 13 are adjusted so as to overlap with each other when viewed from the X-ray fluoroscopic direction, the intermediate portion of the connecting portion 7 and the handle portion 17 of the temporary fixing member 15 are adjusted.
It is configured to prevent overlapping and interference and difficult adjustment. As a result, the handle portion 17 of the temporary fixing member 15 and the connecting portion 7 do not interfere with each other, the index pin 13 can be oriented in the lateral direction with respect to the femur 30, and a side view of the X-ray fluoroscopic image shown in FIG. Thus, the direction and position of the guide pin 12 can be confirmed by the index pin 13. In this case, the intermediate portion of the connecting portion 7 is configured so that the index pin 13 overlaps the guide pin 12 with respect to the femur 30 in a stable state in which the connecting portion 7 is brought into contact with the handle portion 17 of the temporary fixing member 15. It is preferable.

The guide pin mounting portion 1 is not limited to the detachable mounting of the guide pin mounting portion 1 on the guide pin 12 as in the embodiment shown in FIGS.
2 or 7, for example, a pipe shaft-shaped extension is provided on the side opposite to the bone, and the guide pin mounting portion 1 is rotatably provided around the pipe axially, and the device body 10 of the present invention and the temporary fixing member are provided. 1
5 and 5 can be detachably attached or integrally provided. It is also possible to integrally provide the guide pin 18 with the index pin holding portions 2 and 3 via the connecting portions 7, 8 and 9 without rotating. Incidentally, it is of course possible to provide the connecting portions 8 and 9 so as not to expand and contract, or to provide the intermediate portion thereof withdrawal similarly to the connecting portion 7. In addition, the guide pin mounting portion 1,
The index pin holding portions 2 and 3 may be of a sandwiching type capable of sandwiching the pin from the side like a clothespin, instead of the fitting holes 4, 5 and 6.

Next, the operation of the guide pin positioning device according to the present invention will be described. As shown in FIG. 2 or 3, the base portion 16 of the temporary fixing member 15 is applied to the bone neck portion 33 of the femur 30 below the greater trochanter 30 and the guide pin 12 is inserted into the guide portion 18 of the temporary fixing member 15. Then, the guide pin 12 is temporarily fixed by setting the insertion angle into the bone. By fitting the fitting hole 4 of the guide pin mounting portion 1 into the guide pin 12, the positioning tool body 10 of the guide pin is mounted on the guide pin 12, and the guide pin mounting portion 1 is rotationally adjusted about the guide pin 12. Then, the angle of the instrument main body 10 is adjusted and fixed so that the guide pin 12 and one of the index pins 13 are overlapped with each other when seen from the see-through direction of the X-ray, which is set to a photographing angle of a predetermined angle.

In this fixed state, the other index pin 14 is set so as to overlap with the guide pin 12 from the X-ray fluoroscopic direction in the other direction, and photography is possible. At this time, the index pin 13 is held in the fitting hole 5 of the index pin holding portion 2 at an appropriate position and also held in the fitting hole 6 of the index pin holding portion 3 according to the body shape of the patient. 14, the length of the connecting members 8 and 9 can be adjusted according to the body shape of the patient. As shown in FIG. 2 or FIG. 3, it is needless to say that the index pins 13 and 14 are mounted together with the lesser trochanter 32 of the femur 30 so that they can be seen in a radiographic image.

After that, the front and rear images and side images of the X-ray fluoroscopic image are confirmed, and adjustment is performed by the temporary fixing member 15 so that the inserting direction and position of the guide pin 12 are appropriate. When the inserting direction and the position of the guide pin 12 are proper, the inserting direction of the guide pin 12 is fixed by the temporary fixing member 15, and the guide pin positioning tool main body 10 is removed from the guide pin 12 if necessary and temporarily fixed. Member 1
The guide pin 12 can be inserted into the bone for a required length while being guided by the guide portion 18 of the fifth embodiment.

Thereafter, the temporary fixing member 15 is attached to the guide pin 12
As shown in FIG. 4, using a drilling tool such as a drill or a reamer, a hole is formed in the bone along the guide pin 12, and the lag screw 20 having a hole for inserting the guide pin 12 is screwed into the tool. It is inserted into the bone from the side of the greater trochanter 31 toward the side of the lesser trochanter 32 while being screwed along the guide pin 12 by 21. Further, as shown in FIG. 5 or 6, the side plate 22 is attached to the rear end portion of the lag screw 20 by the connecting screw 24,
By fixing the to the femur 30 with the bolt 23,
The lag screw 20 can be reinforced and fixed. Reference numeral 19 is a compression hip screw including a side plate 22 and a lag screw 20. In the above embodiment, the femoral bone is described as the guide pin insertion and positioning device, but as is clear from the description, the guide pin is similarly inserted into other bones and other objects. Needless to say, it can be implemented as an insertion positioning device when performing.

[0029]

As described above, the guide pin positioning device according to the present invention is a guide pin positioning device that is used in advance to guide the insertion of an implant into a bone. And a guide pin mounting portion that is mounted on a guide pin that is temporarily fixed in the direction, and two index pin holding portions that hold two index pins parallel to the guide pin with a predetermined angular interval about the guide pin. By having two index pins held parallel to the guide pin,
From the insertion direction and the insertion position indicated by the image of the index pin that overlaps with the guide pin when observed by X-ray fluoroscopy from the direction, the insertion direction and the position of the guide pin are set to two index pins before inserting the guide pin into the bone. Since it can be easily grasped in three dimensions with the bone inserted into the bone at an appropriate length, it is possible to shorten the operation time and reduce the radiation exposure dose without trial and error as in the past. There is an effect that can be.

Further, in the present invention, the predetermined angular interval is approximately 9
Due to having the configuration according to claim 1, which has an interval of 0 °, the two index pins are approximately 90 ° about the guide pin.
Since they are held at intervals, the three-dimensional insertion direction and position of the index pin, which overlaps with the guide pin, can be accurately grasped from two directions orthogonal to each other.

Further, according to the present invention, the guide pin mounting portion or the index pin holding portion has a fitting hole into which the guide pin or the index pin can be detachably fitted. There is an effect that the can be easily attached to and detached from the fitting hole for use.

Further, according to the present invention, the index pin holding portion is
The index pin located at an appropriate position and distance from the guide pin according to the body shape of the patient and the like by having a plurality of structures provided in the radial direction around the guide pin as a center. There is an effect that the holding portion can be selected and used by holding the index pin.

Further, according to the present invention, by having the constitution according to any one of claims 1 to 4 in which a connecting member for connecting the index pin holding portion and the guide pin mounting portion is provided to be expandable and contractable, There is an effect that the index pin can be set at an appropriate position by expanding and contracting the connecting member that connects the index pin holding part and the guide pin mounting part according to the body shape.

Further, according to the present invention, the guide pin mounting portion is provided so as to be rotatable around the guide pin, and thus the guide pin mounting portion is provided. The guide pin can be rotated about the guide pin to adjust the overlapping position of the index pin held by the index pin holding portion. Therefore, when adjusting the fluoroscopic position for superimposing the index pin on the guide pin in the X-ray fluoroscopic direction, the X-ray is adjusted. There is an effect that the index pin can be aligned with the guide pin in the X-ray fluoroscopic image without moving the fluoroscope.

Further, the present invention has a structure according to any one of claims 1 to 6, wherein the guide pin mounting portion is provided with a temporary fixing member for temporarily fixing the guide pin at a fixed insertion angle. By this, since the insertion angle of the guide pin mounted on the guide pin mounting portion can be determined and temporarily fixed by the temporary fixing member, the insertion angle of the guide pin can be easily corrected by the temporary fixing member to quickly change the insertion direction. There is an effect that can be decided.

Further, according to the present invention, the index pin holding portion and the guide pin mounting portion are connected to each other by retracting from a surface position connecting the guide pin and the index pin. Since the connecting portion between the index pin holding portion and the guide pin mounting portion is retracted from the surface position connecting the guide pin and the index pin, the connecting portion and the temporary fixing member are provided at the retracted portion. Does not interfere with each other, the index pin can be rotated and set in the direction of the temporary fixing member, and the insertion direction of the guide pin can be easily determined.

According to the present invention, the guide pin mounting portion is provided integrally with the temporary fixing member, so that the guide pin mounting portion is temporarily fixed. The effect of being able to simplify the structure is that it is provided integrally with.

Further, the present invention is used for positioning a guide pin for guiding insertion of an implant for fixing between the greater trochanter and the lesser trochanter of the femur into the bone. By having the configuration described in, even if it is difficult to determine the insertion direction, such as a guide pin that guides the insertion of the implant that fixes between the greater trochanter and lesser trochanter of the femur into the bone, There is an effect that the insertion direction of the guide pin can be easily determined.

[Brief description of drawings]

FIG. 1 is a schematic perspective view of an embodiment of the device of the present invention.

FIG. 2 is a schematic explanatory view showing one usage mode thereof.

FIG. 3 is a schematic explanatory view showing another usage mode.

FIG. 4 is a schematic explanatory view illustrating a conventional treatment method after using the device of the present invention.

FIG. 5 is a schematic explanatory view illustrating a conventional treatment method for the device of the present invention.

FIG. 6 is a schematic explanatory view illustrating a conventional treatment method for the device of the present invention.

FIG. 7 is a schematic explanatory view illustrating a conventional treatment method for the device of the present invention.

[Explanation of symbols]

1 Guide pin mounting part 2, 3 Index pin holder 4, 5, 6 fitting holes 7,8,9 Connection 10 Instrument body 11 scale scale 12 guide pins 13,14 Indicator pin 15 Temporary fixing member 16 base 17 Handle 18 Guide 19 compression hip screws 20 lag screw 21 Screw-in tool 22 Side plate 23 Volts 30 femur 31 Great trochanter 32 Little trochanter 33 neck

Claims (10)

[Claims] 1. A guide pin positioning device used in advance for guiding insertion of an implant into a bone, the guide pin mounting portion being mounted on a guide pin temporarily fixed in the implant insertion direction. A guide pin positioning device having two index pin holding portions for holding two index pins parallel to the guide pin with a predetermined angular interval about the guide pin. 2. The guide pin positioning device according to claim 1, wherein the predetermined angular intervals are approximately 90 °. 3. The positioning of the guide pin according to claim 1, wherein the guide pin mounting portion or the index pin holding portion has a fitting hole into which the guide pin or the index pin can be detachably fitted. Equipment. 4. The guide pin positioning device according to claim 1, wherein a plurality of the index pin holding portions are provided in a radial direction around the guide pin. 5. The guide pin positioning device according to claim 1, wherein a connecting portion that connects the index pin holding portion and the guide pin mounting portion is provided to be expandable and contractable. 6. The guide pin positioning device according to claim 1, wherein the guide pin mounting portion is provided rotatably around the guide pin. 7. The guide pin positioning device according to claim 1, wherein the guide pin mounting portion is provided with a temporary fixing member for temporarily fixing the guide pin at a predetermined insertion angle. 8. The method according to claim 1, wherein the guide pin holding section and the guide pin mounting section are connected to each other by retracting from a surface position where the guide pin and the index pin are connected so as to overlap each other. Guide pin positioning device. 9. The guide pin positioning device according to claim 1, wherein the guide pin mounting portion is provided integrally with the temporary fixing member. 10. The guide according to claim 1, which is used for positioning a guide pin for guiding insertion of an implant for fixing between the greater trochanter and lesser trochanter of the femur into the bone. Pin positioning device.