JP2004215878A - Thigh bone re-cutting guide for artificial knee joint replacement technique - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a thigh bone re-cutting guide for an artificial knee joint replacement technique which enables re-cutting of the thigh bone without producing errors by a single unit guide. <P>SOLUTION: The thigh bone re-cutting guide comprises a main body 3 of the guide integrally formed by making contact with a femur distal bone cutting surface 1 of the thigh bone and a chamfer part bone cutting surface 2, a distal bone cutting slot 4, a chamfer part bone cutting slot 5, and a fixation pin inserting hole 7. <P>COPYRIGHT: (C)2004,JPO&NCIPI

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a guide for re-cutting a femur in knee replacement surgery. More specifically, the present invention relates to a femoral re-osteotomy guide in artificial knee joint replacement in which re-osteotomy can be performed with a single guide when performing re-osteotomy of the femur.
[0002]
[Prior art]
Conventionally, in a total knee arthroplasty, as a method of determining an installation angle of a femoral component, an intramedullary guide method in which a rod is inserted into a femoral shaft bone marrow, and a rod connected to a femoral osteotomy guide, There are two types of extramedullary guide systems, in which the bone is placed on the thigh skin, and an X-ray image or the like is used during the operation to determine the osteotomy angle using the femoral head as an index.
[0003]
In the extramedullary guide method, since the center of the femoral head is used as an index indirectly using an X-ray image or the like during the operation, it is difficult to accurately determine the center of the femoral head, and there is a problem that an error in the osteotomy angle easily occurs.
[0004]
In addition, since the intramedullary guide method uses the anatomical form of the femur as an index, the accuracy of the osteotomy angle is superior to the extramedullary guide method, but the rod insertion site and the insertion angle can be determined. In many cases, it depends on the feeling of the surgeon. In particular, there is a problem that an error is likely to occur when there is a deformation such as an osteophyte or the like in the intramedullary guide insertion site.
Further, the intramedullary guide method has a problem that it cannot be used in a case having a curved or deformed femur due to difficulty in inserting an intramedullary rod into the bone marrow of the femur.
[0005]
Therefore, there is a femoral extramedullary clamp guide device for artificial knee joint replacement shown in FIG. 14 as a guide device which can be expected to have a system equal to or higher than that of the intramedullary guide system even though the extramedullary guide system is used (for example, see Patent Document 1). .
[0006]
This guide device has a pair of holding pieces 101 and a first clamp 103 for holding a femoral distal metaphysis 102, and a pair of holding pieces 104 for a first clamp 103 of a femur metaphysis 105. A second clamp 106 that clamps a more proximal portion, a coupling mechanism 107 that couples the first clamp 103 and the second clamp 106 such that the first clamp 103 moves in parallel with the second clamp 106, Extramedullary rod 108 connected to connecting mechanism 107 so as to be located outside the bone on a straight line connecting the midpoint of the pair of holding pieces 101 of one clamp 103 and the midpoint of the pair of holding pieces 104 of second clamp 106. It is composed of
[0007]
Therefore, since the anatomical shape of the distal diaphysis of the femur is used as a reference, there is no error due to the insertion position and insertion angle of the rod, which depends on the operator's feeling when using the intramedullary rod. Obtaining equal or better accuracy can be reproduced without skill.
[0008]
[Patent Document 1]
JP-A-2000-28983 (FIG. 1)
[0009]
[Problems to be solved by the invention]
However, even if it is the above-mentioned femoral extramedullary clamp guide device for artificial knee joint replacement that obtains an accuracy equal to or higher than that of an intramedullary guide, it is impossible to completely eliminate errors, and It is the present situation that re-osteotomy of the femur is performed.
[0010]
The re-incision of the femur in this total knee arthroplasty requires that the distal femur and the chamfer be cut with separate guides. Therefore, there is a problem that the operation is complicated, and the post-incision shift and the anatomical shift occur.
[0011]
The present invention has been made in view of the above points, and provides a femoral re-osteotomy guide in total knee arthroplasty that enables re-osteotomy of a femur without error by a single guide. It is intended to do so.
[0012]
[Means for Solving the Problems]
In order to achieve the above object, a femoral re-osteotomy guide in a total knee arthroplasty according to the present invention is a femoral re-osteotomy guide in a total knee arthroplasty using a femoral osteotomy guide. A guide body integrally formed by contacting a distal bone cut surface and a chamfer bone cut surface, and a fixed thickness cut of a distal femur contacting a distal femur cut surface provided on the guide body. A slot for a distal osteotomy for making a bone, and a slot for a shanfer part osteotomy for making a constant thickness incision in a chamfer part in contact with a chamfer part bone cutting surface provided in the guide body.
[0013]
Here, the femoral re-osteotomy guide is provided with a guide body integrally contacting the distal femur incision surface and the chamfered bone incision surface formed after the total knee arthroplasty using the femoral osteotomy guide. By doing so, re-osteotomy with a single guide becomes possible.
[0014]
Further, the slot for the distal osteotomy and the slot for the chamfered osteotomy that are opened along the guide body are grooves for osteotomy of the femur distal contact surface and the chamfered part contact surface with a constant thickness, Re-osteotomy is performed by inserting a bone saw into these distal osteotomy slots and the chamfered osteotomy slots.
[0015]
In order to achieve the above object, a femoral resection bone guide in a total knee replacement surgery according to the present invention is a femoral resection bone guide in a total knee replacement surgery using a femoral bone resection guide. A guide body integrally formed by contacting the distal contact surface of the femur and the bone cut surface of the chamfer, and the distal portion of the femur contacting the distal cut surface of the femur provided on the guide body; A slot for distal incision for incision, a slot for incision for a chamfer part for incising the chamfer part having a constant thickness in contact with a chamfer part contact surface provided on the guide body, and a femur And a slot for incision in the rear chamfer section for incising the rear chamfer section to a constant thickness.
[0016]
Here, the femoral re-osteotomy guide is provided with a guide body integrally contacting the distal femur incision surface and the chamfered bone incision surface formed after the total knee arthroplasty using the femoral osteotomy guide. This allows for re-osteotomy of the distal femur, the chamfer and the posterior chamfer.
[0017]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings for understanding the present invention.
[0018]
FIG. 1 is a side view showing an example of a femoral re-excised bone guide in a total knee arthroplasty to which the present invention is applied, FIG. 2 is a front view in FIG. 1, and FIG. 3 is a plan view in FIG. The femoral re-osteotomy guide shown here comprises a guide body 3 integrally formed with the femur distal bone cut surface 1 and the chamfered bone cut surface 2 of the femur, the distal cut bone slot 4 and the shank. It is composed of a fur section osteotomy slot 5 and a fixing pin insertion hole 7.
[0019]
Here, the distal osteotomy slot 4 is adapted to engage the distal femur distal contact surface 1 in order to perform a re-osteotomy of the distal femur portion (not shown) that contacts the distal femoral contact surface 1. The guide body 3 is opened with a certain width below the upper surface on both sides so that the bone can be cut in parallel.
[0020]
In addition, the slot 5 for the cut-off bone for the chamfered portion is parallel to the contact surface 2 for the chamfered portion in order to perform re-cutting of the chamfered portion (not shown) in contact with the contacted surface 2 for the chamfered portion. The opening is provided with a certain width obliquely from both side surfaces of the guide body 3 so that the bone can be cut.
[0021]
Further, the distal incision slot 4 and the chamfered incision slot 5 have a groove width in which a bone saw (not shown) can be inserted and slide in the groove.
[0022]
Therefore, as shown in FIG. 4, when the femoral distal portion 11 of the femur 10 is osteotomically cut by 2 mm by a re-cutter, the slot position C for the shamfer section of the shamfer section 12 is set to the shamfer section contact position. In setting the position of this point C, the length of the point C from the point A must be considered, but the length of the points A and B can be arbitrarily set. Since BC can be set, if BC is X1, if X1 is obtained, the slot position C for the osteotomy of the chamfer can be calculated. In this case, the lengths of X1 and X2 are equal.
[0023]
Therefore, as shown in FIG. 5, the length of X2 is obtained by X2 = 2 mm × tan α. Therefore, since the α angle is 45 °, X2 is 2 × tan45 ° = 2 mm. By adding this length to point B, the position at point C is calculated.
[0024]
As described above, the distance between the points A and B is set by the α angle, and the length of X2 can be calculated by applying the formula to the above formula based on the re-bone thickness of the distal portion of the femur. Accordingly, the slot position C for the osteotomy of the chamfer can be determined.
From this, in the femoral re-osteotomy guide of the present invention, if the angle α that matches the angle between the distal contact surface of the femur cut by the incision guide device and the chamfered bone cut surface is set, Re-osteotomy can be performed regardless of the size.
[0025]
Next, as another example of the installation of the slot for the osteotomy section of the chamfer, as shown in FIG. 6, the slot 5 for the osteotomy section of the chamfer is formed with a valgus or varus angle according to the left and right legs. Things.
[0026]
As another installation example of the distal osteotomy slot 4, as shown in FIG. 7, the distal osteotomy slot 4 is formed with a valgus or varus angle according to the left and right legs. It is.
In this way, by setting the valgus or varus angle of the slot for the osteotomy or the slot for the distal osteotomy, the re-osteotomy according to the valgus or varus angle cut by the incision guide device Can be performed.
[0027]
In the femoral re-osteotomy guide to which the present invention is applied, first, as shown in FIG. 8, the femur D cut by the femoral osteotomy guide has a front surface 13, a distal portion 11 of the femur, and an anterior chamfer portion. The osteotomy 12a, the posterior chamfer 12b and the posterior condyle 14 are formed.
[0028]
Then, as shown in FIG. 9, the femur distal bone cut surface 1 and the chamfer bone cut surface 2 of the guide main body 3 are brought into close contact with the femur distal portion 11 and the anterior chamfer portion 12a of the femur D. The fixing pin 15 is inserted from the fixing pin insertion hole 7 into the locking hole 16 drilled in the femur D, and the guide body 3 is mounted.
[0029]
Next, a bone saw (not shown) for an incision is inserted into the distal incision slot 4 and the chamfered incision slot 5 provided in the guide body 3, and the femur distal portion 11 of the femur D is inserted. The distal femur 11 and the front chamfer 12a are re-cut by sliding them toward the front chamfer 12a.
[0030]
Next, as shown in FIG. 10, after re-cutting the distal portion 11 of the femur D and the anterior chamfer portion 12a, the fixing pin 15 is removed from the femur D, and the guide body 3 is moved up and down. On the contrary, the chamfered bone cut surface 2 is fixed again with the fixing pin 15 in a state where the cut surface 2 is in close contact with the posterior chamfered portion 12b of the femur D, and the bone saw (5) is cut into the chamfered cutout slot 5 for the cut bone. (Not shown), and slides toward the rear chamfer portion 12b to re-cut the rear chamfer portion 12b.
[0031]
FIG. 11 is a side view showing another example of a re-excised femoral bone guide in a knee replacement surgery to which the present invention is applied.
[0032]
The femoral re-osteotomy guide shown here comprises a guide body 3 integrally formed with the femur distal bone cut surface 1 and the chamfered bone cut surface 2 of the femur, the distal cut bone slot 4 and the shank. It is composed of a fur section osteotomy slot 5, a posterior chamfer section osteotomy slot 5A, a posterior condylar osteotomy slot 6, and a fixing pin insertion hole 7.
[0033]
Therefore, the femur distal contact surface 1 and the chamfered bone cut surface 2 formed on the guide body are shown as an example of a femoral re-osteotomy guide in the above-described total knee arthroplasty to which the present invention is applied. is there.
[0034]
Further, the slot 4 for the distal incision is also provided with a certain width below the upper surface on both sides of the guide body 3 so that the incision can be performed in parallel with the distal contact surface 1 of the femur.
Similarly, the slot 5 for the incised bone of the chamfer portion is also parallel to the contact surface 2 of the chamfer portion in order to perform re-cutting of the front chamfer portion 12a of the femur D in contact with the contact surface 2 of the chamfer portion. The guide body 3 is opened with a certain width diagonally from both side surfaces of the guide main body 3 so that an incision can be made.
[0035]
In addition, the slot 5A for the posterior chamfered osteotomy is provided with a certain width obliquely downward from both side surfaces of the guide body 3 so as to open the posterior shamfered portion 12b of the femur D in order to perform re-osteotomy. is there.
[0036]
Next, as another installation example of the slot for the cut bone for the chamfer section and the slot for the cut section for the rear chamfer, as shown in FIG. It is formed with a valgus or varus angle according to the left and right legs.
[0037]
In addition, as shown in FIG. 13, as another installation example of the distal osteotomy slot 4, the distal osteotomy slot 4 is formed to have a valgus or varus angle according to the left and right legs. It is.
In this way, by setting the valgus or varus angle of the slot for the osteotomy or the slot for the distal osteotomy, the re-osteotomy according to the valgus or varus angle cut by the incision guide device Can be performed.
[0038]
In another example of the femoral re-osteotomy guide to which the present invention is applied, the femur distal contact surface 1 and the chamfer portion contact surface 2 of the guide body 3 are connected to the femoral distal portion 11 of the femur D and the anterior shanks. The guide body 3 is mounted by inserting the fixing pin 15 into the locking hole 16 formed in the femur D from the fixing pin insertion hole 7 in a state of being in close contact with the fur portion 12a.
[0039]
Then, a bone saw (not shown) for incision is inserted into the distal incision slot 4 and the chamfered incision slot 5 provided in the guide body 3, and the femur distal portion 11 of the femur D and The distal femur 11 and the front chamfer 12a are re-cut by sliding them toward the front chamfer 12a.
[0040]
Next, a bone saw (not shown) is inserted into the slot 5A for incision in the posterior chamfer section, and the femoral bone D is slid toward the posterior chamfer section 12b to re-cut the posterior chamfer section 12b. is there.
[0041]
Further, a bone saw (not shown) for an incision is inserted into the slot 6 for the posterior condylar incision, and is slid toward the posterior condyle 14 of the femur D, thereby performing re-osteotomy of the posterior condyle 14.
[0042]
In this way, it is possible to perform re-osteotomy of the distal portion of the femur, the anterior chamfer, the posterior chamfer, and the posterior condyle without removing the guide body from the femur.
[0043]
In addition, the guide body must be used for each size by adding an osteotomy slot for the posterior chamfer and the posterior condyle. When the size is reduced in addition to the resection of the posterior part, the distal part of the femur is re-cut as before, then replaced with a guide device of a smaller size, and the front and rear shuffling parts, Although the re-osteotomy of the posterior condyle had to be performed, the femoral re-osteotomy guide of the present invention can perform the re-osteotomy with one guide, that is, so-called downsizing.
[0044]
【The invention's effect】
As described above, according to the present invention, the resection of the bone can be performed by a single guide body, so that the complexity of the operation is simplified and no displacement occurs after the cut. Further, it can be easily performed without being affected by the experience of the surgeon.
[0045]
In addition, a single guide body enables accurate knee arthroplasty with an incised bone, which contributes to improvement of the patient's QOL.
[Brief description of the drawings]
FIG. 1 is a side view showing an example of a femoral re-osteotomy guide in a knee replacement surgery to which the present invention is applied.
FIG. 2 is an explanatory front view of FIG.
FIG. 3 is an explanatory plan view of FIG. 1;
FIG. 4 is an explanatory view showing the setting of the position of the slot for the osteotomy in the femur in the femoral re-osteotomy guide in the total knee arthroplasty to which the present invention is applied.
FIG. 5 is an enlarged explanatory view of a main part in FIG. 4;
FIG. 6 is an explanatory view showing another example of setting a slot for a stomach osteotomy in a femoral resection bone guide in a total knee arthroplasty to which the present invention is applied.
FIG. 7 is an explanatory view showing another installation example of a distal osteotomy slot in a femoral re-osteotomy guide in artificial knee joint replacement to which the present invention is applied.
FIG. 8 is an explanatory view showing a cut portion of a femur cut by a femoral cut guide;
FIG. 9 is an explanatory view showing a state in which the guide body of the present invention is mounted on an incised portion of a femur.
FIG. 10 is an explanatory view showing a state in which a guide body is fixed upside down to a femur in order to perform re-osteotomy of a rear chamfer portion.
FIG. 11 is a side view showing another example of a femoral re-osteotomy guide in a total knee arthroplasty to which the present invention is applied.
FIG. 12 is an explanatory view showing another example of installation of the slot for the sciatic osteotomy in the femoral re-osteotomy guide of another example in the knee replacement surgery to which the present invention is applied.
FIG. 13 is an explanatory view showing another installation example of a distal osteotomy slot in a femoral re-osteotomy guide of another example in knee replacement surgery to which the present invention is applied.
FIG. 14 is an explanatory view showing an example of a conventional femoral extramedullary clamp guide device for artificial knee joint replacement.
[Explanation of symbols]
REFERENCE SIGNS LIST 1 distal contact surface of femur 2 contact surface of chamfer 3 guide body 4 slot for distal incision 5 slot for incision 5A for rear incision 6 slot for rear incision 6 slot for posterior condylar incision 7 for fixing Pin insertion hole 15 Fixing pin

Claims (9)

In the femoral re-osteotomy guide in total knee arthroplasty with femoral osteotomy guide,
A guide body integrally formed by contacting the femur distal bone cut surface and the chamfer part bone cut surface,
A distal osteotomy slot for incising the distal part of the femur in contact with the distal surface of the distal femur provided in the guide body to a constant thickness;
A femoral re-osteotomy guide in a total knee arthroplasty comprising: a chamfer section incision slot for incising the chamfer section at a constant thickness in contact with a chamfer section bone cut surface provided in the guide body. The position of the slot for the chamfer osteotomy is the angle between the distal contact surface of the femur and the chamfer osteotomy with reference to the thickness of the re-incision of the distal femur in contact with the distal femur incision. Is set while maintaining the
A femoral re-osteotomy guide for a total knee arthroplasty according to claim 1. The femoral re-osteotomy guide in a total knee arthroplasty according to claim 1 or 2, wherein the distal osteotomy slot is formed with a varus or varus angle. The femoral re-osteotomy guide in a total knee arthroplasty according to claim 1, 2 or 3, wherein the slot for osteotomy of the chamfer is formed with a varus or varus angle. In the femoral re-osteotomy guide in total knee arthroplasty with femoral osteotomy guide,
A guide body integrally formed by contacting the femur distal contact surface and the chamfered bone cut surface,
A distal osteotomy slot for incising the distal portion of the femur in contact with the distal surface of the distal femur provided in the guide body to a constant thickness;
A slot for a chamfer section cut bone for cutting a champa section in contact with a chamfer section contact surface provided on the guide body to a predetermined thickness,
A femoral re-osteotomy guide in total knee arthroplasty, comprising a posterior chamfer osteotomy slot for incising the posterior chamfer of the femur to a constant thickness. The slot position for the osteotomy slot and the slot position for the posterior osteotomy slot are determined by the re-cutting thickness of the distal portion of the femur in contact with the distal contact surface of the femur. It is set while maintaining the angle between the and the chamfer bone cut surface,
A femoral re-osteotomy guide for a total knee arthroplasty according to claim 5. The femoral re-osteotomy guide in a total knee arthroplasty according to claim 5 or 6, wherein the distal osteotomy slot is formed with a varus or varus angle. 8. The re-osteotomy of a femur in total knee arthroplasty according to claim 5, 6 or 7, wherein the slot for the osteotomy of the chamfer and the slot for the posterior osteotomy are formed with a valgus or varus angle. guide. The femoral re-osteotomy guide in a total knee arthroplasty according to claim 5, wherein a posterior condylar osteotomy slot is provided in the guide body.

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