JP2005323787A - Ligament reconstruction surgery tool - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a ligament reconstruction surgery tool capable of enhancing the durability of a ligament implanted by boring the bone constituting a joint in ligament reconstruction surgery. <P>SOLUTION: The ligament reconstruction surgery tool has a shank 22 having a columnar shape and cutting wing 24 having cutting edge 26, a cutting wing housing space 27 for housing the cutting wing 24 is formed near the distal end of the shank 22, the cutting wing 24 pivots a position 27a (a housed position) being housed in the cutting wing housing space 27 and a position 27b (a deploying position projecting from the cutting wing housing space) not being housed in the cutting wing housing space 27, a running away face 25 for cut bone pieces to move is formed in the cutting wing 24, the running away face 25 is formed in a curved face, and a fringe portion of the running away face 25 formed in the curved face constitutes the cutting edge 26. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a surgical instrument used in a ligament reconstruction operation in which a ligament is transplanted and reconstructed inside a knee joint or the like.

FIG. 6 is a front view showing the relationship between the knee ligament and the femur 2 and the tibia 3, and FIG. 7 is a perspective view showing the relationship between the femur 2 and the tibia 3.
In FIG. 6, an anterior cruciate ligament 7 and a posterior cruciate ligament 8 are accommodated between a femur 2 and a tibia 3 and an inner meniscus 14 and an outer meniscus 16 are accommodated. Further, the inner side collateral ligament 11 and the outer side collateral ligament 12 are provided so as to support the femur 2 and the tibia 3 from the side.

  FIG. 7 schematically shows the accommodation area S of the anterior cruciate ligament 7, the posterior cruciate ligament 8, the inner meniscus 14, and the outer meniscus 16 accommodated between the femur 2 and the tibia 3.

  In the operation for reconstructing the anterior cruciate ligament 7 and the posterior cruciate ligament 8 in the knee joint region S, as shown in FIG. 8, a position 3a in the vicinity of the knee joint side end portion of the tibia is drilled obliquely from the front to the A direction. Then, the tibia 3 is penetrated, and as shown in FIG. 9, the position 2a of the femur 2 is drilled from the diagonally forward direction to the B direction with a drill, and the artificial ligament or the site to be transplanted by the patient (the ligament is implanted) Site: A ligament of another site different from the knee) in the illustrated example is transplanted.

When a ligament is transplanted by such a ligament reconstruction operation, it has hitherto been a problem that the durability of the transplanted ligament is not good.
For example, when an artificial ligament is transplanted, it may be damaged before the transplanted artificial ligament is fixed, and the transplanted patient may be in an inappropriate state for returning to daily life. There were many.

  There are not a few cases in which an artificial ligament or a ligament from another living body (a ligament from a tissue that is not the same as a patient who has undergone transplantation) is damaged in about three months after transplantation.

  On the other hand, in many cases, the ligaments of one's own (own ligaments taken from a site other than the site requiring human body transplantation) are maintained without being damaged until the ligaments are fixed. However, when the ligament is fixed and exercised, the transplanted ligament is often damaged. Statistically, there are many cases where damage occurs 4 to 5 years after transplantation.

As described above, since the transplanted ligament is damaged, there are many cases in which re-operation is necessary in ligament reconstruction surgery.
However, especially if the ligament is removed and transplanted from another part of the patient's own body undergoing ligament reconstruction surgery, if the re-operation is repeated as a result of damage to the transplanted ligament, it can eventually be transplanted There is a risk that the ligament will no longer exist.

As another conventional technique, a device for fixing a cruciate ligament graft to a knee joint has been proposed (see, for example, Patent Document 1).
However, such conventional technology cannot improve the durability of the transplanted ligament.
JP 2000-229087 A

  The present invention has been proposed in view of the above-described problems of the prior art, and makes it possible to increase the durability of a ligament to be transplanted by drilling a bone constituting a joint during a ligament reconstruction operation. It aims to provide an instrument for ligament reconstruction surgery.

  As a result of various studies, the inventor drills bone with a drill in ligament reconstruction surgery, and bone burrs formed at the end of the drilled hole damage the implanted ligament. I found out that I was giving.

  For example, in the case of a ligament reconstruction operation in a knee joint, when a bone (a tibia in FIG. 8 and a femur in FIG. 9) is drilled with a drill, as shown in FIGS. A “burr” (3b) is formed on the end surface (3s), and a “burr” (2b) is formed on the tibial side end surface (2s) of the femur 2.

  In a conventional ligament reconstruction operation, a ligament is transplanted while leaving the burr (3b, 2b) formed on the end face (3s, 2s) of the bone drilled with a drill intact. It was found that it was damaged (frayed) by (3b, 2b) and was cut.

  The present invention was created based on such knowledge, and the transplanted ligament is cut by the burr (3b, 2b) of the bone existing on the end face (3s, 2s) of the drilled hole (D3, D2). Is configured to prevent.

  That is, the ligament reconstruction surgical instrument of the present invention includes a columnar (for example, columnar) shank (22) and a cutting blade (24) having a cutting edge (26), and is near the tip of the shank (22). Is formed with a cutting blade accommodating space (27) for accommodating the cutting blade (24), and the cutting blade (24) has a position (accommodating position) (27a) accommodated in the cutting blade accommodating space (27). A position not accommodated in the cutting blade accommodation space (27) (deployed position protruding from the cutting blade accommodation space) (27b) is pivotally supported, and the cutting blade (24) has a cut bone fragment. Is formed by a curved surface, and the edge of the flank (25) formed by the curved surface forms a cutting edge (26). (Claim 1).

For example, when the ligament reconstruction surgical instrument of the present invention is applied to knee ligament reconstruction surgery, the bone formed on the knee joint side end (3s) of the through hole (D3) drilled in the tibia (3) When the burr (3b) is cut, the flank (25) is curved so as to be recessed toward the side where the cutting blade accommodating space (27) is formed, and the cutting edge (26) is It is preferable to be formed so as to face the side opposite to the side where the blade accommodating space (27) is formed (Claim 2).
The ligament reconstruction surgical instrument of the present invention is inserted into the through-hole drilled in the tibia, and the cutting blade is pressed against the knee joint side end of the through-hole by applying a force to pull the ligament reconstruction surgical instrument. This is in order to surely remove the burr of the bone formed at the end (the knee joint side end of the through hole) by the edge.

On the other hand, when the bone burr (2b) formed on the knee joint side end (2s) of the hole (D2) drilled in the femur (2) is excised, the flank (25) is used as the cutting blade. It is curved so as to be recessed toward the side opposite to the side where the receiving space (27) is formed, and the cutting edge (26) is formed so as to face the side where the cutting blade receiving space (27) is formed. (Claim 3).
This is because the cutting blade is pressed against the hole drilled in the femur, and the cutting edge is brought into contact with the burr of the bone formed at the knee joint side end of the hole to reliably remove it.

  In the practice of the present invention, the shank is preferably connectable to an existing electric rotating device.

  In carrying out the present invention, a hollow cylindrical sheath having an inner diameter (41i) larger than the outer diameter of the shank (22) but smaller than the inner diameter of the hole drilled in the bone, It is preferable to provide a sheath (41) having a notch (42) having a curved shape at the tip (claim 4).

  The ligament reconstruction surgery performed using the ligament reconstruction surgical instrument of the present invention includes a step of inserting a shank (22) into a hole (D3) drilled in a bone (for example, the tibia 3) and a cutting blade (24). The cutting blade deployment step of rotating the shank (22) and deploying the cutting blade (24) in a state in which the portion near the tip of the shank reached the joint, and the joint side of the hole (D3) drilled in the bone (3) The process of contacting the cutting edge side of the cutting blade (24) with the end face (3s), and rotating the shank (22) and the cutting blade (24) in the same direction as rotated in the cutting blade unfolding process, The cutting process of excising the burr (3b) of the bone (3) formed in 3s), and the shank (22) being rotated in the cutting blade deployment process after excising the burr (3b) of the bone (3) Rotate in the opposite direction to cut the cutting blade (24) near the tip of the shank. A housing step for housing in the blade housing space (27) and a hole (D3) in which the shank (22) is drilled in the bone (3) in a state where the cutting blade (24) is housed in the cutting blade housing space (27). ) From

  For example, in the case of knee ligament reconstruction surgery, when the burr (3b) of the bone (3) formed at the knee joint end of the through hole (D3) drilled in the tibia (3) is excised The flank (25) is curved so as to be recessed toward the side where the cutting blade accommodating space (27) is formed, and the cutting edge (26) is formed as the cutting blade accommodating space (27). A ligament reconstruction surgical instrument (Claim 2) formed so as to face the opposite side of the ligament reconstruction side, and the ligament reconstruction surgical instrument (Claim 2) on the front side of the practitioner during the cutting step It is preferable to carry out while pulling.

  On the other hand, in the case of knee ligament reconstruction surgery, when excising the burr (2b) of the bone (2) formed at the knee joint side end of the hole (D2) drilled in the femur (2) The flank (25) is curved so as to be recessed to the side opposite to the side where the cutting blade accommodating space (27) is formed, and the cutting edge (26) is curved to the cutting blade accommodating space (27). Using a ligament reconstruction surgical instrument (Claim 3) formed so as to face the side where the ligament is formed, the ligament reconstruction surgical instrument (Claim 2) is pressed against the distal end side during the cutting process. However, it is preferable to carry out.

In the housing step, if the cutting blade (24) is not housed in the cutting blade housing space (27) even if the shank (22) is rotated, the inner diameter is larger than the outer diameter of the shank (22). A hollow cylindrical sheath (41) whose outer diameter is smaller than the inner diameter of a hole (D3) drilled in a bone (for example, the tibia 3), and having a notch (42) having a curved shape at the tip The sheath (41) (Claim 4) is inserted over the shank (22), the sheath (41) is brought into contact with the cutting blade (24), and the sheath (41) has a curved notch (42). The cutting blade (24) is preferably slid along and stored in the sheath (41).
In this way, it is possible to cope with the case where the cutting blade (24) is not stored in the shank (22) and cannot be taken out from the knee joint.

  For example, when transplanting a ligament to a knee joint, after drilling the tibia and femur, using the ligament reconstruction surgical instrument of the present invention described above, at the time of drilling (location where the ligament is transplanted: for example, knee joint) Remove burrs formed on the end face.

  That is, when the entire shank of the ligament reconstruction surgical instrument of the present invention inserted from the drilled hole is rotated, for example, in the clockwise direction, centrifugal force acts on the cutting blade due to the mass of the cutting blade having the cutting edge. Expands from Shank. If the cutting edge of the developed cutting blade is brought into contact with the femoral side end surface of the tibia of the drilled hole or the tibial side end surface of the femur and the shank is rotated, the “burr” of the bone existing on the end surface is It is cut and removed by the cutting edge.

  Here, the femoral side perforation end face of the through hole of the tibia is shaved while pulling the ligament reconstruction surgical instrument of the present invention (Claim 2) forward.

  Moreover, the burr | flash of the perforation end surface of a femur is shaved, pushing the ligament reconstruction surgery instrument (Claim 3) of this invention ahead.

In this way, bone “burrs” formed on the perforated end surfaces of the femur and tibia are removed during ligament reconstruction surgery (for example, at the knee joint) by applying “backing” processing in machining.
As a result of the removal of burrs by the cutting edge, ligaments transplanted into the knee joint, for example, using the drilled holes are not damaged (by the burrs), and the durability of the transplanted ligaments is greatly improved. To do.

  After removing the burrs, when removing the ligament reconstruction surgical instrument of the present invention, if the entire ligament reconstruction surgical instrument is rotated, for example, counterclockwise to accommodate the deployed cutting blade, the mass of the cutting blade Centrifugal force acts and the cutting blade is stored in the shank.

In the conventional medical technique, the burr is removed only by chamfering when the artificial joint is mounted. In other words, no burrs are removed from the drilled end face of the drilled bone.
Also, during surgery, if the incision surface is large, the patient will be damaged, so the incision surface should be kept only at the hole when piercing the bone, so that the incision surface is not widened or increased, It was difficult to remove bone burrs.

  However, according to the present invention having the above-described configuration, the burr on the knee joint side end surface of the through-hole drilled in the tibia and the femur via the holes drilled in the tibia and femur for ligament transplantation It is possible to reliably remove burrs on the knee joint side end face of the hole perforated.

If the cutting blade is not stored in the shank and cannot be removed from the knee joint, the above-described sheath may be used.
If the sheath is pushed in while rotating to the right, the cutting edge comes into contact with the curved notch of the sheath and the cutting edge slides along the notch, so that the cutting blade rotates and is stored in the sheath.
If the cutting blade is stored in the sheath, the ligament reconstruction surgical instrument of the present invention can be taken out from the knee joint for each sheath through the hole drilled in the bone.

Hereinafter, an embodiment of the instrument for ligament reconstruction surgery of the present invention will be described with reference to the drawings.
1 to 3 show an instrument for ligament reconstruction surgery according to the present invention.
FIG. 1 shows a ligament reconstruction surgical instrument 21 for cutting and removing tibia burrs, and FIG. 2 is an X sectional view of FIG.

  The ligament reconstruction surgical instrument 21 is integrally formed by a cylindrical shank 22, a cutting blade 24 provided in the vicinity of one end 23 of the shank 22, and a holding part 30 provided at the other end of the shank 22. It has been configured.

  The shank 22 is formed by cutting a cutting blade housing space 27 having a deformed fan-shaped cross section between the straight parallel surfaces 32 and 33 in the vicinity of the end portion 23, and the cutting blade 24 is inserted into the cutting blade housing space 27 with a pin 29. It is comprised so that it may be pivotally supported by. The diameter of the shank is determined by the size of the ligament to be transplanted, and for example, a diameter of about 6 mm to 7 mm is used.

  The wall portion 22a corresponding to the deformed fan-shaped short radius of the cutting blade housing space 27 is a clockwise rotation limit position in FIG. 2 of the cutting blade 24 described later, and the wall portion 22b corresponding to the long radius is rotated counterclockwise. It is configured to be a limit position.

The cutting blade 24 is formed in a plate shape having a boss portion 24b, and the flank 25 formed of a curved surface in the plate portion is curved so as to be recessed toward the side where the cutting blade housing space 27 is formed. ing.
An edge portion of the flank 25 constituted by the curved surface constitutes a cutting edge 26, and the cutting edge 26 is formed to face the side opposite to the side where the cutting blade accommodating space 27 is formed. .
In other words, the cutting edge 26 is formed so as to face downward in FIG. 1, and is configured to be curved so as to be recessed from the lower side toward the upper side.

  In other words, the flank 25 is constituted by a curved surface such that the radial distance from the pin 29 of the flank 25 becomes shorter from the end 23, and the edge of the flank 25 defines the cutting edge 26. It is composed.

  Although the radius of curvature R of the flank 25 is about 3 mm in this example, it is preferable to make it larger as long as the cutting blade 24 can protrude from the shank 22.

  The inner diameter of the boss portion 24 b is formed to have a fitting dimension that allows the cutting blade 24 to rotate around the pin 29 by a centrifugal force that rotates the shank 22.

  The position of the cutting blade 24 in FIG. 2 is at a position 27 b where the bone can be cut by the rotation of the shank 22, and the position 27 a of the cutting blade 24 indicated by a two-dot chain line is housed in the cutting blade housing space 27. Indicates the state.

  The pin 29 passes through the boss portion 24b of the cutting blade 24 in the cutting blade housing space 27 and is fixed to the shank 22 at a position of a deformed fan shape eccentric from the shaft center.

The cutting blade 24 is attached to the shank 22 by forming insertion holes in the shank 22 and the boss portion 24b of the cutting blade 24, aligning the respective holes, and inserting the pins 29. Then, the top of the inserted pin 29 is fixed by caulking or welding.
Although not shown, instead of forming the boss portion 24 b on the cutting blade 24, a shaft-like protrusion may be integrally formed, and a recess that engages with the protrusion may be formed in the shank 22.

  In the illustrated example, the holding unit 30 is formed in a cylindrical shape and is configured to be chucked by an electric motor (not shown).

  FIG. 3 shows a ligament reconstruction surgical instrument 21A that cuts and removes burrs from the femur.

  The ligament reconstruction surgical instrument 21 </ b> A is integrally formed by a cylindrical shank 22, a cutting blade 24 </ b> A provided in the vicinity of one end 23 of the shank 22, and a holding part 30 provided at the other end of the shank 22. It is comprised, and only the cutting blade is comprised differently with respect to the instrument 21 for ligament reconstruction surgery for the said tibial surgery.

  The cutting blade 24A is formed in a plate shape having a boss portion 24b, and a flank 25A formed of a curved surface in the plate-like portion is recessed to the side opposite to the side where the cutting blade housing space 27 is formed. Is curved.

An edge portion of the flank 25 </ b> A configured by the curved surface forms a cutting edge 26 </ b> A, and the cutting edge 26 </ b> A is formed to face the side where the cutting blade accommodating space 27 is formed.
In other words, the flank 25A is constituted by a curved surface such that the radial distance from the pin 29 of the flank 25A increases with distance from the end 23, and the edge of the flank 25A defines the cutting edge 26A. It is composed.

  That is, the cutting edge 26A is formed so as to face upward in FIG. 3, and is configured to be curved so as to be recessed downward from the upper side in FIG.

  All except the cutting blade 24A is the same as the ligament reconstruction surgical instrument 21, and as described later, the operation method is the same except for the direction of cutting the burr.

4 and 5 show the sheath 41 of the countermeasure tool when the cutting blade 24 or 24A does not return to the cutting accommodating space 27 after the operation for some reason.
The sheath 41 is formed in a hollow cylindrical shape with an outer diameter 41o smaller than the holes D2 and D3 drilled for surgery and an inner diameter 41i larger than the outer diameter d of the ligament reconstruction surgical instruments 21 and 21A. The curved cutout portion 42 is provided at the end. The usage will be described later.

The action of the ligament reconstruction surgical instruments 21, 21A and the sheath 41 will be described below with reference to FIG.
A pilot hole is drilled with a small diameter wire in advance, and the shank 22 of the ligament reconstruction surgical instrument 21 is inserted into the target tibia 3 that has been drilled with a predetermined treatment hole D3 (insertion step of inserting the shank).

  Next, in a state in which the portion near the tip end of the shank accommodated in the cutting blade accommodating space 27 reaches the joint, the shank 22 is rotated to deploy the cutting blade 24 to the deployment position 27b, and the side surface of the cutting blade in FIG. 24c is moved to a position in contact with the wall surface 22a (cutting blade expanding step).

  Next, as shown in FIG. 13, the cutting edge 26 side of the cutting blade 24 is brought into contact with the joint side end surface 3s of the hole D3 drilled in the tibia 3 (step of contacting the cutting edge 26 side).

  Subsequently, the burr 3b of the bone 3 formed on the end face 3s is excised by rotating the shank 22 and the cutting blade 24 in the same direction as that rotated in the cutting blade expanding step (burr cutting step). The burr is excised until a predetermined contact shoulder radius is obtained even if the ligament contacts the curved surface of the open end of the hole D3.

  After the burr 3b of the tibia 3 is excised, the shank 22 is rotated in the direction opposite to that rotated in the cutting blade deployment step, and the cutting blade 24 is received in the cutting blade accommodation space 27 near the tip of the shank. Is moved to a position where the side surface 24d of the cutting blade contacts the wall surface 22b (cutting blade accommodation step).

  Next, the shank 22 is pulled out from the hole D3 drilled in the tibia 3 in a state where the cutting blade 24 is housed in the cutting blade housing space 27 (shank pulling process).

  The normal deburring procedure is completed as described above. However, in the case of an abnormal situation where the cutting blade 24 does not return from the deployed state to the stowed state, the holding portion 30 of the ligament reconstruction surgical instrument 21 is released from the driving device, and the shank is removed. 22, the sheath 41 of FIG. 4 is covered and inserted into the hole D3.

  The sheath 41 is inserted to a position where it comes into contact with the cutting blade 24, and then the cutting blade 24 is fitted into the cutout portion 42 of the sheath 41.

  Next, the sheath 41 is turned, and the cutting blade 24 is moved from the deployment position 27b to the accommodation position 27a along the notch portion 42.

  Next, the ligament reconstruction surgical instrument 21 is pulled out with the sheath 41 covering the shank 22.

  After completing the above procedures, the ligament is transplanted to complete the transplant operation.

  Further, an implant (graft: a bone fragment generated at the time of drilling) is inserted into the through hole D3 of the tibia 3 away from the femur 2. That is, the bone pieces generated at the time of drilling (bones generated as chips at the time of drilling) are covered.

  The above is an explanation of the excision of the burr 3b of the tibia 3 by applying a pulling force by the ligament reconstruction surgical instrument 21, but for the femur 2 as shown in FIG. 14, a ligament reconstruction surgical instrument 21A is used. The burr 2b can be excised in the same manner by applying a pressing force.

It should be noted that the illustrated embodiment is merely an example, and is not intended to limit the technical scope of the present invention.
For example, the ligament reconstruction operation using the instrument of the present invention can be applied not only to the knee but also to other ligament reconstruction sites, that is, the ligament reconstruction operation in the shoulder, elbow, hand, and ankle joint.

It is a side view which shows the structure for femurs of the instrument for ligament reconstruction surgery of this invention. It is X sectional drawing of FIG. FIG. 2 is a side view showing the tibial configuration of FIG. 1. It is a side view of a sheath. It is a front view same as the above. It is a front view which shows a knee ligament and a joint. It is a perspective view which shows the relationship between a femur and a tibia. It is a perspective view which shows the drill drilling position of a tibia. It is a perspective view which shows the drill drilling position of a femur. It is sectional drawing which shows the burr | flash production | generation by the drill drilling of a tibia. It is sectional drawing which shows the burr | flash production | generation by the drill drilling of the femur. It is sectional drawing which shows the state which excises the burr | flash of a tibia. It is sectional drawing which shows the state which excises the burr | flash of a femur.

Explanation of symbols

A Tibial perforation direction B Femur perforation direction S Region between tibia and femur 2 Femur 3 Tibial 7 Anterior cruciate ligament 8 Back cruciate ligament 11 Inner collateral ligament 12 Outer collateral ligament 14 Inner meniscus 16 Outer meniscus 21 Ligament reconstruction Surgical instrument 22 Shank 24 Cutting blade 24b Boss portion 25 Flank face 26 Cutting edge 27 Cutting blade accommodation space 30 Holding portion 41 Sheath

Claims (4)

  A columnar shank and a cutting blade having a cutting edge are provided, and a cutting blade accommodating space for accommodating the cutting blade is formed in the vicinity of the tip of the shank. The cutting blade is accommodated in the cutting blade accommodating space. The cutting blade is pivotally supported between a position and a position not accommodated in the cutting blade accommodating space, and a flank for moving the cut bone fragment is formed on the cutting wing, and the flank is curved. An instrument for ligament reconstruction surgery, characterized in that an edge of a flank configured by a surface and configured by a curved surface constitutes a cutting edge.   The flank is curved so as to be recessed toward the side where the cutting blade accommodation space is formed, and the cutting edge is formed to face the side opposite to the side where the cutting blade accommodation space is formed. The ligament reconstruction surgical instrument according to claim 1.   The flank is curved so as to be recessed toward the side opposite to the side where the cutting blade accommodation space is formed, and the cutting edge is formed so as to face the side where the cutting blade accommodation space is formed. The ligament reconstruction surgical instrument according to claim 1.   A hollow cylindrical sheath whose inner diameter is larger than the outer diameter of the shank but whose outer diameter is smaller than the inner diameter of the hole drilled in the bone, wherein the sheath has a curved notch at the tip The ligament reconstruction surgery instrument according to any one of claims 1 to 4, further comprising:

Images