JP2006246910A - Surgical instrument and surgical instrument set - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical instrument capable of filling a bone defect site with a filler efficiently, and a surgical instrument set. <P>SOLUTION: An inserter (the surgical instrument) 4 is provided for filling a bone defect site with a filler. The inserter comprises a tube 41 having a penetrating hollow section and a pushing bar 43 which is inserted into the hollow section of the tube 41 for discharging the filler contained in the hollow section. The hollow section opens to an opening 413 on the side of the front end of the tube 41. The opening preferably has an almost oval shape, and the distance between the front end of the tube 41 and the front end of the opening is preferably 0.5-50 mm. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a surgical instrument and a surgical instrument set.

  As a treatment method for so-called vertebral body compression fractures where the vertebral body collapses due to trauma, osteoporosis, etc., a filling material (bone filling material) is transcutaneously (via the vertebral arch) into the collapsed vertebral body There are treatments to fill.

  In this treatment method, first, the collapsed vertebral body is returned to its original shape, that is, after a reduction operation is performed on the vertebral body, a bone is formed in the cavity (bone defect) formed in the vertebral body by this operation. Filling with a filling material is performed. Alternatively, the vertebral body is filled with a bone prosthetic material to push fragile cancellous bone and finally reinforce the interior of the vertebral body.

  Conventionally, in such a treatment method, using a filling device having a (cylindrical) cylinder having a lumen (hollow part) penetrating from the proximal end to the distal end, bone is directly formed from a hole opened in the vertebral body. The filling material was filled in the collapsed vertebral body (see, for example, Patent Document 1).

  However, with a conventional filling device, it may be difficult to fill a bone defect with a sufficient amount of bone filling material when the bone defect is relatively large or has a complicated shape. there were. In other words, when a conventional filling device is used, the bone filling material to be filled is likely to be unevenly distributed near the distal end of the cylindrical body (is likely to stay), and it is difficult to supply the bone filling material over the entire bone defect portion. There was a case.

JP 2003-169811 A

  An object of the present invention is to provide a surgical instrument and a surgical instrument set that can efficiently fill a bone defect with a filler.

Such an object is achieved by the present inventions (1) to (23) below.
(1) A surgical instrument used to fill a bone defect with a filler,
A cylinder having a hollow portion therethrough;
An extrusion rod inserted through the hollow portion of the cylindrical body and capable of discharging the filler loaded in the hollow portion;
The surgical instrument according to claim 1, wherein the hollow portion is opened at an opening provided on a side of the cylindrical body at a distal end side thereof.

  Thereby, a bone defect part can be efficiently filled with a filler. In particular, even when the bone defect portion is relatively large or has a complicated shape, the bone defect portion can be efficiently filled with the filler.

(2) The surgical instrument according to (1), wherein the opening is substantially elliptical.
Thereby, a bone defect part can be more efficiently filled with a filler.

  (3) The surgical instrument according to (1) or (2), wherein a distance from the distal end portion of the cylindrical body to the distal end portion of the opening is 0.5 to 50 mm.

  Thereby, it is possible to more efficiently fill the bone defect part with the filler, and in particular, when the bone defect part is relatively large or has a complicated shape, the filler is added to the bone defect part. Can be more efficiently filled. Moreover, a filler can be efficiently supplied also to a site | part comparatively far from the cylinder of a bone defect part.

  (4) The surgical instrument according to any one of (1) to (3), wherein the hollow portion is curved or bent near the tip thereof.

  Thereby, it is possible to more efficiently fill the bone defect part with the filler, and in particular, when the bone defect part is relatively large or has a complicated shape, the filler is added to the bone defect part. Can be more efficiently filled. Moreover, a filler can be efficiently supplied also to a site | part comparatively far from the cylinder of a bone defect part.

  (5) The surgical instrument according to any one of (1) to (4), wherein the cylindrical body is curved or bent near the tip thereof.

  Thereby, it is possible to more efficiently fill the bone defect part with the filler, and in particular, when the bone defect part is relatively large or has a complicated shape, the filler is added to the bone defect part. Can be more efficiently filled. Moreover, a filler can be efficiently supplied also to a site | part comparatively far from the cylinder of a bone defect part.

  (6) The angle formed by the axial direction on the proximal end side of the cylindrical body and the tangential direction of a curved or bent portion provided near the distal end is 5 to 30 °, as described in (5) above. Surgical instruments.

  Thereby, it is possible to more efficiently fill the bone defect part with the filler, and in particular, when the bone defect part is relatively large or has a complicated shape, the filler is added to the bone defect part. Can be more efficiently filled. Moreover, a filler can be efficiently supplied also to a site | part comparatively far from the cylinder of a bone defect part.

  (7) The surgical instrument according to (5) or (6), wherein a direction in which the cylindrical body is bent or bent is substantially the same as a direction in which the opening is provided.

  Thereby, it is possible to more efficiently fill the bone defect part with the filler, and in particular, when the bone defect part is relatively large or has a complicated shape, the filler is added to the bone defect part. Can be more efficiently filled. Moreover, a filler can be efficiently supplied also to a site | part comparatively far from the cylinder of a bone defect part.

  (8) The surgical instrument according to any one of (1) to (7), further including a marker indicating a direction in which the opening of the cylindrical body is provided.

  Thereby, the direction in which the opening is facing in the bone defect can be easily and reliably confirmed, and the filling of the bone defect with the filler can be performed more efficiently.

  (9) The surgical instrument according to any one of (1) to (8), wherein a scale indicating an insertion depth is formed along a longitudinal direction of the side surface of the cylindrical body.

  Thereby, the front-end | tip position of the cylinder or an extrusion stick | rod in a bone defect part can be confirmed easily and reliably.

  (10) The surgical instrument according to any one of (1) to (9), wherein a cylindrical gripping portion is fixed near a proximal end portion of the cylindrical body.

  Accordingly, the surgical instrument can be operated by gripping the cylindrical gripping portion, and the operability of the filling operation of the filling material into the bone defect portion is improved.

(11) The surgical instrument according to (10), wherein a concave portion is formed along a circumferential direction in the vicinity of a central portion in a longitudinal direction of the cylindrical gripping portion.
Thereby, the cylinder gripping part can be gripped more reliably.

(12) The surgical instrument according to (8) or (11), wherein a ring-shaped flange is formed in the vicinity of the proximal end portion of the cylindrical body gripping portion.
Thereby, the cylinder gripping part can be gripped more reliably.

  (13) The surgical instrument according to any one of (8) to (12), wherein an inner diameter of the cylindrical gripping portion gradually increases toward a proximal end side.

  Thereby, operation which loads a filler in the hollow part of a cylinder, and operation which inserts an extrusion stick in the hollow part of a cylinder can be performed more smoothly and reliably.

  (14) The surgical instrument according to any one of (1) to (13), wherein at least the vicinity of the tip of the push-out rod has flexibility.

  Thereby, the filler loaded in the hollow part of the cylinder can be more reliably supplied to the bone defect part. In particular, when a plurality of fillers are loaded in the hollow portion of the cylindrical body, the amount of filler supplied to the bone defect portion can be easily adjusted. In addition, an optimal amount of filler can be easily and reliably supplied to each part of the bone defect. Moreover, the filler loaded in the hollow part of the cylinder can be discharged from the hollow part of the cylinder without waste.

  (15) The surgical instrument according to any one of (1) to (14), wherein a tip of the push rod has a rounded shape.

  Thereby, when performing filling operation of a filler, it can prevent effectively damaging a biological tissue.

  (16) The surgical instrument according to any one of (1) to (15), wherein a vicinity of a tip of the push-out rod protrudes from the opening in a state where the push-out rod is inserted into the cylindrical body.

  Thereby, the filler loaded in the hollow part of the cylinder can be discharged from the hollow part of the cylinder without waste.

  (17) The surgical instrument according to any one of (1) to (16), wherein a push bar holding portion is fixed near a base end of the push bar.

  As a result, it is possible to operate the surgical instrument by gripping the push rod holding portion, and the operability of the filling operation of the filling material into the bone defect portion is improved.

  (18) The surgical instrument according to any one of (1) to (17), wherein the filler is a bone grafting material.

  (19) The surgical instrument according to (18), wherein the bone grafting material is a powder made of ceramics.

  Ceramics can exist stably in a living body for a long time, and is excellent as a biomaterial.

  (20) The surgical instrument according to (18), wherein the bone filling material is a powder of a calcium phosphate compound.

  Calcium phosphate compounds can be stably present in a living body for a long period of time, and are particularly excellent as a biomaterial.

(21) A surgical instrument set used for vertebral body compression fracture reduction,
The surgical instrument according to any one of (1) to (20) above;
A diameter expanding device for expanding a hole formed in at least the crushed vertebral body, a shape reducing device for reducing the upper part of the crushed vertebral body to a substantially normal position, and a vertebral body subjected to reduction A surgical instrument set comprising: at least one selected from the group consisting of push-in instruments for increasing the density of filled fillers.

  Thereby, a bone defect part can be efficiently filled with a filler. In particular, even when the bone defect portion is relatively large or has a complicated shape, the bone defect portion can be efficiently filled with the filler.

  (22) The surgical instrument set according to the above (21), wherein gripping portions of the surgical instruments constituting the surgical instrument set are different.

  Thereby, it can recognize more reliably that it is a different surgical instrument by the difference of each holding part.

  (23) The surgical instrument set according to (21) or (22), wherein each surgical instrument constituting the surgical instrument set can be specified by each of the grip portions.

  As a result, it is possible to easily identify (specify) which surgical instrument is used, and it is possible to more reliably prevent mistakes such as mistaken surgical instruments to be used.

  According to the present invention, there is provided a surgical instrument and a surgical instrument set that can efficiently fill a bone defect with a filler.

  In addition, according to the present invention, when performing an operation for filling a bone defect with a filler, the operation is highly safe and can be performed with minimal invasiveness, and the burden on the patient is reduced.

  DESCRIPTION OF EMBODIMENTS Hereinafter, preferred embodiments of a surgical instrument and a surgical instrument set according to the present invention will be described in detail with reference to the accompanying drawings.

  FIG. 1 is a perspective view showing the configuration of the surgical instrument (filling instrument) of the present invention, and FIG. 2 is an enlarged side view showing the region on the distal end side of the cylindrical body of the surgical instrument (filling instrument) shown in FIG. FIG. 3 is a perspective view showing a configuration of a surgical instrument (expansion instrument) constituting the surgical instrument set of the present invention, and FIGS. 4 and 5 are respectively a surgical instrument of the present invention. FIG. 6 is a perspective view showing a configuration of a surgical instrument (shape reduction instrument) constituting the set, and FIG. 6 is a perspective view showing a configuration of a surgical instrument (pushing instrument) constituting the surgical instrument set of the present invention. 7 to 12 are diagrams for explaining a method of using the surgical instrument set of the present invention, and FIG. 13 is a diagram schematically showing a vertebra subjected to vertebral body compression fracture reduction. It is. 7 to 12 show a view of the vertebra viewed obliquely from the lower side (shown by cutting out a part of the vertebral body), and a plan view of the vertebra on the lower side. 1 and 3 to 6, the left side is referred to as “tip”, the right side is referred to as “base end”, and the lower side in FIG. 2 is referred to as “tip” and the upper side is referred to as “base end”. In addition, hereinafter, in the upper diagrams of FIGS. 7 to 12 and FIG. 13, the upper side is “upper (head side)”, the lower side is “lower (leg side)”, the left side is “front (ventral side)”, and the right side. Is “back (back side)”.

  The surgical instrument and surgical instrument set according to the present invention are used for a surgery in which a filler for a bone defect portion is filled.

  Here, the bone defect refers to a bone cavity caused by a loss due to trauma, removal by removal surgery of a tumor or the like, a decrease in bone density due to osteoporosis or the like, or a combination of these factors.

  The surgical instrument and surgical instrument set of the present invention are at least one bone bone selected from the group consisting of vertebral body, iliac bone, scapula, humerus, ulna, radius, femur, tibia and radius. It is suitably used for surgery for filling a defect with a filler. These bones are relatively large size (dimension) bones, but in such bones, the bone defect portion to be filled with the filler is often relatively large or has a complicated shape, etc. By applying to such a bone, the effect of the present invention can be exhibited more remarkably. In other words, according to the present invention, the bone prosthetic material can be efficiently filled at a high filling rate even in the above-described bone defect portion.

  Below, the case where this invention is applied to the technique (vertebral body compression fracture reduction) which repairs this vertebral body when a vertebral body is crushed is demonstrated as a representative.

The surgical instrument set of the present embodiment is used, for example, for vertebral body compression fracture reduction, and includes an inserter (filling instrument) 4 and a guide rod (expansion instrument) 1 which are surgical instruments of the present invention. A vertical elevator (shape reduction device) 2, a horizontal elevator (shape reduction device) 3, and an impactor (pushing device) 5. Note that the vertical elevator 2 and the horizontal elevator 3 are both types of shape reduction devices, but can be selectively used according to the reduction position of the vertebral body 91. Hereinafter, each surgical instrument (component) will be sequentially described.
First, an inserter (filling instrument) 4 which is a surgical instrument of the present invention will be described.

<Inserter (surgical instrument of the present invention)>
An inserter (filling device) 4 shown in FIGS. 1, 2 and 11 is a surgical device used for filling a filling material 7 in a vertebral body 91 (in a bone defect), and will be described in detail later. The surgical instrument (particularly the vertical elevator 2 and the horizontal elevator 3) that constitutes the surgical instrument set of the present invention as described above is formed in the vertebral body 91 that has been reduced in shape (formed in the vertebral body 91 by reduction). This is a surgical instrument used to fill the cavity 911) with the filler 7.

  The inserter 4 includes a cylindrical body 41, a push rod 43 inserted through a hollow portion (inner cavity) 412 of the cylindrical body 41, a cylindrical gripping portion 42 provided at a proximal end portion of the cylindrical body 41, And a push bar holding portion 44 provided at the base end of the push bar 43.

  The cylinder 41 has a hollow portion 412 in which a filler 7 described later is loaded. And this hollow part 412 is open | released by the opening part 413 provided in the side in the front end side of the cylinder 41. FIG. As described above, the present invention is characterized in that the cylindrical body constituting the surgical instrument (filling instrument) includes a hollow portion communicating with the opening provided on the side near the tip.

By the way, even when the opening is provided at the distal end of the cylindrical body, that is, when the hollow portion penetrates from the proximal end to the distal end of the cylindrical body, the filler is supplied to the bone defect portion. It is possible to do. However, in such a case, there are the following problems.
When the opening is provided at the tip of the cylinder, the filler to be filled is likely to be unevenly distributed near the tip of the cylinder (it is easy to stay), and it becomes difficult to supply the bone grafting material over the entire bone defect. easy. Such a tendency becomes particularly prominent when the bone defect portion is relatively large or has a complicated shape. Further, even when the opening is provided at the tip of the cylinder, when filling the filler, the position of the cylinder at the tip of the cylinder within the bone defect is changed, so that the entire bone defect is covered. Although it is conceivable to supply a bone prosthetic material, in such a case, it is necessary to change the inclination of the cylinder and the burden on the patient may increase.

  On the other hand, according to the present invention, the filling material loaded in the hollow portion can be efficiently filled into the bone defect portion. In particular, even when the bone defect portion is relatively large or has a complicated shape, the bone defect portion can be efficiently filled with the filler. Further, in the present invention, since the opening is provided on the side of the cylinder, for example, the cylinder is rotated around the axis (without changing the inclination of the cylinder with respect to the axial direction). Thus, the filler can be more efficiently filled. Further, even if such rotation is not performed, for example, when the filler is filled, the filler can be filled so as to diffuse efficiently by directing the opening upward with respect to the direction of gravity.

  The shape of the opening 413 is not particularly limited, but is preferably substantially elliptical. Thereby, the filler 7 can be more efficiently (easy and reliably) filled into the vertebral body 9.

  As described above, the opening 413 is provided on the side of the cylinder 41, but the distance from the tip of the cylinder 41 to the tip of the opening 413 (length L0 in FIG. 2) is 0. 5 to 50 mm is preferable, and 0.5 to 20 mm is preferable. Thereby, the filler 7 can be more efficiently filled into the vertebral body 9. In addition, the filler 7 can be efficiently supplied to a portion of the vertebral body 9 that is relatively far from the cylindrical body 41. On the other hand, if the distance from the tip of the cylinder 41 to the tip of the opening 413 is less than the lower limit value, the effect of the present invention may not be sufficiently exerted depending on the size, shape, etc. of the filler 7. There is sex. In addition, when the distance from the distal end of the cylinder 41 to the distal end of the opening 413 exceeds the upper limit value, not only can the vertebral body be filled, but also there is a possibility that it will leak out from the pedicle.

  Further, as shown in FIG. 2, the hollow portion 412 is curved in the vicinity of its tip (near the tip of the cylinder 41). As a result, the vertebral body 9 can be filled with the filler 7 more efficiently. In particular, when the space (cavity 911) in the vertebral body 9 to be filled with the filler 7 is relatively large or a complicated shape is formed. Even when the vertebral body 9 is provided, the filler 7 can be more efficiently filled into the vertebral body 9. In addition, the filler 7 can be efficiently supplied to a portion of the vertebral body 9 that is relatively far from the cylindrical body 41. Such an effect is also obtained when the hollow portion 412 is bent as in the case where the hollow portion 412 is bent near the tip thereof, as shown in the figure.

  The cylindrical body 41 is set to have an outer diameter substantially equal to the inner diameter of the hole 93 formed in the vertebra 9. Thereby, during the operation of filling the filling material 7 into the vertebral body 91, the filling material 7 passes from the gap between the outer peripheral surface of the cylindrical body 41 and the inner peripheral surface of the hole 93 to the outside of the vertebra 9 (outside the bone defect portion). ) Can be effectively prevented.

  Moreover, the length of the cylinder 41 is not particularly limited, but is preferably about 9 to 17 cm, and more preferably about 11 to 15 cm. By making the length of the cylinder 41 within the above range, the inserter 4 can be handled more easily.

  In addition, a scale 411 indicating the insertion depth is formed in the cylindrical body 41 along the longitudinal direction of the outer surface thereof. Thereby, even when the distal end side of the inserter 4 is inserted into the hole 93 of the vertebra 9 and cannot be visually recognized, the distal end position of the cylinder 41 (or a push bar 43 described later) within the vertebral body 91 can be easily set. Can be confirmed.

  Examples of the constituent material of the cylindrical body 41 include various metal materials such as aluminum or aluminum alloy, stainless steel, titanium or titanium alloy, polycarbonate, polymethyl methacrylate, polyimide, polysulfone, polyferylene sulfide, polyether ether ketone, and polyacetal. , Fluorine resin such as liquid crystal polymer, polybutylene terephthalate, polytetrafluoroethylene, various resin materials such as silicone resin, various ceramic materials such as alumina and hydroxyapatite, among these, metal materials And stainless steel is particularly preferable. When it is made of stainless steel, it has high strength, is strong against impact, and has heat resistance, so that it can sufficiently withstand the heat when sterilizing the instrument. Moreover, by comprising stainless steel, the slidability between the inner peripheral surface of the cylinder 41 and the outer peripheral surface of the push rod 43 can be improved (low frictional force), and the movement operation of the push rod 43 can be further improved. It can be done easily.

  Moreover, the cylinder 41 may be formed into a pipe shape, for example, or may be formed into a coil shape. For example, when the cylinder 41 is formed in a pipe shape, the coating made of the resin material as described above may be coated near the inner surface of the cylinder 41. Thereby, the slidability of the inner peripheral surface of the cylinder 41 and the outer peripheral surface of the push rod 43 can be improved (low frictional force), and the push rod 43 can be moved more easily.

  The cylindrical body gripping portion 42 is fixed (fixed) to the base end portion of the cylindrical body 41 by, for example, a method such as screwing, screwing, press-fitting, caulking, welding, or bonding. The inserter 4 is operated by gripping the cylinder gripping portion 42.

  The cylinder gripping portion 42 is formed of a substantially cylindrical member. A concave portion 421 is formed along the circumferential direction in the center portion of the cylindrical gripping portion 42 in the longitudinal direction. A ring-shaped flange 422 is formed at the proximal end of the cylinder gripping portion 42. The concave portion 421 and the flange 422 each function as a slip prevention means, and by providing these in the cylindrical gripping portion 42, the cylindrical gripping portion 42 can be gripped more reliably. . Thereby, operation of the inserter 4 can be performed more reliably.

  Further, the cylinder gripping portion 42 has its inner diameter gradually increasing toward the proximal end. Thereby, for example, the operation of loading the filler 7 into the hollow portion 412 of the cylindrical body 41 and the operation of inserting the push rod 43 into the hollow portion 412 of the cylindrical body 41 can be performed more smoothly and reliably. it can.

  An extrusion rod 43 capable of discharging the filler 7 loaded in the hollow portion 412 is inserted into the hollow portion 412 of the cylindrical body 41. The push rod 43 has a substantially circular cross section, and the outer diameter thereof is set to be substantially equal to the inner diameter of the cylindrical body 41. Specifically, the outer diameter of the push rod 43, that is, the inner diameter of the cylinder 41 is not particularly limited, but is preferably about 3 to 6 mm.

  The push rod 43 has a rounded tip. Thus, by forming the tip of the push rod 43 to be rounded, it is possible to effectively prevent the living tissue from being inadvertently damaged when the filling material 7 is filled. it can.

  The push rod 43 is inserted into the cylindrical body 41, that is, in a state where the distal end of the push rod gripping portion 44 described later is in contact with the proximal end of the cylindrical gripping portion 42, and the distal end thereof is the cylindrical body. It is configured to protrude from the opening 413 of the 41. In other words, the length of the push rod 43 is such that the tip of the push rod 43 protrudes from the opening 413 of the cylindrical body 41 in the above state. By setting it as such a structure, the filler 7 can be discharged | emitted from the hollow part 412 of the cylinder 41 without waste.

  The push rod 43 can be configured by, for example, those exemplified as the constituent material of the cylinder 41 described above.

  Moreover, it is preferable that the extrusion rod 43 is flexible at least near the tip. Thereby, the filler 7 loaded in the hollow portion 412 of the cylindrical body 41 can be more reliably supplied into the vertebral body 9. In particular, when a plurality of fillers 7 are loaded in the hollow portion 412 of the cylindrical body 41, the amount of the filler 7 supplied into the vertebral body 9 can be easily adjusted. In addition, an optimal amount of filler 7 can be easily and reliably supplied to each part in the vertebral body 9. Further, the filler 7 loaded in the hollow portion 412 of the cylindrical body 41 can be discharged from the hollow portion 412 of the cylindrical body 41 without waste.

  Moreover, the extrusion rod 43 may be formed into a rod shape or a pipe shape, or may be formed into a coil shape, for example. For example, when the extrusion rod 43 is formed in a pipe shape, a coating made of the resin material as described above may be coated near the outer surface of the extrusion rod 43. Thereby, the slidability of the inner peripheral surface of the cylinder 41 and the outer peripheral surface of the push rod 43 can be improved (low frictional force), and the push rod 43 can be moved more easily. Moreover, by making the extrusion rod 43 into the shape of a coil, the extrusion rod 43 can have moderate flexibility relatively easily.

  The push rod 43 is not limited to a solid one, and may be a hollow one. The hollow rod-shaped body may be either one in which at least one end is closed or one in which both ends are open. In the latter case, for example, a sheath (tubular body), a catheter tube and the like can be mentioned.

  Further, a push bar holding portion 44 is fixed (fixed) to the base end portion of the push bar 43 by a method such as screwing, screwing, press-fitting, caulking, welding, adhesion, or the like. The inserter 4 is operated by holding the push bar holding portion 44.

  Concave portions 441 and 441 are formed in the push rod grip 44 along the longitudinal direction thereof. The two concave portions 441 function as slip prevention means, and are disposed to face each other via the shaft of the push rod holding portion 44. By forming such recesses 441, 441, the push rod grip 44 can be gripped more reliably.

  As the filler 7 in the present invention, any material may be used, but powder of a material used as a bone filling material (biomaterial) is preferable. In addition, the powder as used herein refers to powder particles, granules, block bodies (for example, a substantially prismatic shape, a substantially cylindrical shape, and a part thereof (particularly, an angle inclined by a predetermined angle with respect to the bottom surface and the top surface). It is a broad concept including a minute slice or a needle-like body, and the shape, form, manufacturing method and the like are not particularly limited.

  As such powders, for example, powders of various ceramics such as alumina, zirconia, calcium phosphate compounds, etc. can be suitably used. Ceramics can exist stably in a living body for a long time, and is excellent as a biomaterial. Among the ceramics as described above, powders made of calcium phosphate compounds are particularly preferable. Calcium phosphate compounds can be stably present in a living body for a long period of time, and are particularly excellent as a biomaterial.

Examples of calcium phosphate compounds include hydroxyapatite (Ca ₁₀ (PO ₄ ) ₆ (OH) ₂ ), TCP (Ca ₃ (PO ₄ ) ₂ ), Ca ₂ P ₂ O ₇ , Ca (PO ₃ ) ₂ , and Ca. ₁₀ (PO ₄ ) ₆ F ₂ , Ca ₁₀ (PO ₄ ) ₆ Cl ₂ , DCPD (CaHPO ₄ .2H ₂ O), Ca ₄ O (PO ₄ ) _2, etc., one or two of these The above can be mixed and used.

  The average particle size of the powder is not particularly limited, but is usually preferably about 0.1 to 6.0 mm, and more preferably about 1.0 to 5.0 mm. In addition, when the powder is not substantially spherical (for example, a block body as described above), the average length of the powder in three orthogonal directions (X-axis direction, Y-axis direction, Z-axis direction) Is preferably a value within the above range.

  The inserter 4 also has a marker (index) 423 that indicates the direction in which the opening 413 is provided. The marker 423 is formed, for example, by coloring or the like at a position corresponding to the opening 413 on the outer periphery of the cylinder gripping portion 42 (the front side in FIG. 1). Thereby, even if the cylinder 41 is inserted into the hole 93 of the vertebra 9 and the opening 413 cannot be visually recognized, the direction in which the opening 413 faces in the vertebral body 91 can be easily confirmed. .

  In the present embodiment, the marker 423 is formed on the cylinder gripping portion 42. Instead, for example, a region other than the cylinder gripping portion 42 such as a region on the proximal end side of the cylinder 41 is used. You may form in the part.

<Guide bar>
The guide rod 1 shown in FIGS. 3 and 8 is a surgical instrument used to enlarge the diameter of the hole 93 formed in the vertebra 9 having the crushed vertebral body 91. Two holes 93 are usually formed so as to reach the vertebral body 91 from the vertebral arch 92 on both sides.

  The guide rod 1 includes a rod-like body 11 having a substantially circular cross section, and a grip portion 12 provided at a base end portion of the rod-like body 11.

  The guide rod 1 is used so that the tip end side of the rod-shaped body 11 is inserted into the hole 93. Thereby, the diameter of the hole 93 can be expanded.

  The inner diameter of the hole 93 (the inner diameter after performing the diameter-expansion operation) has individual differences (individual differences), but is usually preferably about 4.5 to 6.5 mm. By setting the inner diameter of the hole 93 within the above range, the vertebra 92 (particularly, the pedicle) can be easily used when performing operations using the above-described inserter (filling instrument) 4 and each surgical instrument described later. These operations can be performed efficiently while being prevented from being destroyed.

  Moreover, it is preferable that the diameter of the hole 93 is gradually increased. By gradually expanding the diameter of the hole 93, the hole 93 is made to have a desired inner diameter without causing destruction of the vertebral arch 92 even when the bone is fragile, particularly in an osteoporotic patient. Can do.

  From this point of view, it is preferable to prepare a plurality of types of guide rods 1 having different outer diameters of the rod-shaped body 11.

  Although the length of this rod-shaped body 11 is not specifically limited, It is preferable that it is about 13-21 cm, and it is more preferable that it is about 15-19 cm. By setting the length of the rod-shaped body 11 within the above range, the guide rod 1 can be handled more easily.

  The rod-shaped body 11 has a rounded tip. In this way, by forming the tip of the rod-like body 11 to be rounded, it is possible to effectively prevent the living tissue from being inadvertently damaged when the diameter of the hole 93 is increased. it can.

  Further, the bar 11 is formed with a scale 111 indicating the insertion depth along the longitudinal direction of the outer surface thereof. Thereby, even if the distal end side of the rod-shaped body 11 is inserted into the hole 93 of the vertebra 9 and cannot be visually recognized, the distal end position of the rod-shaped body 11 in the vertebral body 91 can be easily confirmed.

  Examples of the constituent material of the rod-shaped body 11 include various metal materials such as aluminum or aluminum alloy, stainless steel, titanium or titanium alloy, polycarbonate, polymethyl methacrylate, polyimide, polysulfone, polyferylene sulfide, and polyether ether. Examples include various resin materials such as ketone, polyacetal, liquid crystal polymer, and polybutylene terephthalate, and various ceramic materials such as alumina and hydroxyapatite. Among these, metal materials are preferable, and stainless steel is particularly preferable. When these are made of stainless steel, they have high strength, resistance to impacts, and heat resistance, so that they can sufficiently withstand the heat when sterilizing the instrument.

  The grip portion 12 is fixed (fixed) to the base end portion of the rod-like body 11 by, for example, a method such as screwing, screwing, press-fitting, caulking, welding, or bonding. The guide rod 1 is operated by holding the grip portion 12.

  Concave portions 121 and 121 are formed in the grip portion 12 along the longitudinal direction thereof. The two recesses 121 function as anti-slip means, and are arranged to face each other with the axis of the grip portion 12 interposed therebetween. By forming such recesses 121, 121, the grip portion 12 can be gripped more reliably.

<Vertical elevator>
The vertical elevator 2 shown in FIG. 4 and FIG. 9 is a surgical instrument used to reduce the upper part of the vertebral body 91, particularly the upper front part, to a substantially normal position.

  The vertical elevator 2 has a rod-shaped main body 21, a pressing portion 22 provided at the distal end portion of the main body 21, and a gripping portion 23 provided at the proximal end portion of the main body 21.

  The main body 21 has a substantially circular cross section, and the outer diameter thereof is set smaller than the inner diameter of the hole 93 formed in the vertebra 9.

  The main body 21 has a scale 211 indicating the insertion depth along the longitudinal direction of the outer surface thereof. Thereby, even if the distal end side of the vertical elevator 2 is inserted into the hole 93 of the vertebra 9 and cannot be visually recognized, the distal end position of the pressing portion 22 described later in the vertebral body 91 can be easily confirmed.

  A pressing portion 22 having a flat plate shape is formed integrally with the main body 21 at the distal end portion of the main body 21.

  The pressing part 22 is a part that presses the upper part of the vertebral body 91 upward, and is inclined with respect to the main body 21.

  The vertical elevator 2 having such a configuration is such that, for example, the proximal end side of the main body 21 is pushed down with the distal end portion inserted into the vertebral body 91 (the state shown in FIG. 9), and the distal end surface of the pressing portion 22 The 221 can be used in such a manner that the 221 is brought into contact with the upper inner surface of the vertebral body 91 and the front upper portion of the vertebral body 91 is pressed by the pressing portion 22. Thereby, the front upper part of the vertebral body 91 can be lifted upward.

  That is, in the vertical elevator 2, the distal end surface 221 of the pressing portion 22 is a contact surface that contacts the upper inner surface of the vertebral body 91.

  Although the angle (angle (theta) 1 in FIG. 4) which the press part 22 and the main body 21 make is not specifically limited, Usually, it is preferable that it is about 5-30 degrees, and it is more preferable that it is about 5-15 degrees. By setting the angle θ1 within the above range, the reduction operation of the vertebral body 91 can be performed more easily and reliably without damaging the pedicle.

  In addition, irregularities are formed on the tip surface 221. As a result, the sliding of the distal end surface 221 with respect to the upper inner surface of the vertebral body 91 can be prevented or suppressed, and this operation can be performed more reliably when the vertebral body 91 is reduced by the vertical elevator 2. .

  The shape of the unevenness is not particularly limited, but preferably has a convex portion with a sharp top. Thereby, the slip with respect to the upper part inner surface of the vertebral body 91 of the front end surface 221 can be prevented or suppressed more reliably.

In addition, each convex part may be either, for example, one regularly arranged in a lattice shape or one irregularly (randomly) arranged.
Further, the tip surface 221 may have a very small unevenness, that is, a rough surface.

  As the constituent materials of the pressing portion 22 and the main body 21, the same materials as those mentioned for the rod-shaped body 11 of the guide rod 1 can be used.

  Further, the overall length of the pressing portion 22 and the main body 21 (length L1 in FIG. 4) is not particularly limited, but is preferably about 13 to 21 cm, and more preferably about 15 to 19 cm. . Thereby, handling of the vertical elevator 2 becomes easier.

  The pressing portion 22 is not limited to being integrally formed with the main body 21 and may be fixed to the main body 21 by, for example, a method such as screwing or fitting. .

  In addition, the gripping portion 23 is fixed (fixed) to the base end portion of the main body 21 by a method such as screwing, screwing, press-fitting, caulking, welding, adhesion, or the like. The vertical elevator 2 is operated by holding the grip portion 23.

  Concave portions 231 and 231 are formed in the grip portion 23 along the longitudinal direction thereof. The two recesses 231 function as anti-slip means and are arranged to face each other with the shaft of the gripping part 23 interposed therebetween. By forming such concave portions 231 and 231, the grip portion 23 can be gripped more reliably.

  Further, the vertical elevator 2 has a marker 232 that indicates the inclination direction of the pressing portion 22, that is, the direction in which the pressing portion 22 faces. The marker 232 is formed at a position (upper side in FIG. 4) corresponding to the distal end surface 221 on the outer periphery of the grip portion 23 by coloring or the like, for example. Thereby, even when the distal end side of the vertical elevator 2 is inserted into the hole 93 of the vertebra 9 and cannot be visually recognized, the direction in which the pressing portion 22, particularly the distal end surface 221 faces, is easily confirmed in the vertebral body 91. can do.

  In the present embodiment, the marker 232 is formed on the grip portion 23, but instead of this, for example, the marker 232 may be formed on a portion other than the grip portion 33 such as the base end portion of the main body 21. .

<Horizontal elevator>
The horizontal elevator 3 shown in FIGS. 5 and 10 is a surgical instrument used to reduce the upper part of the vertebral body 91, in particular, the central upper part thereof to a substantially normal position.

  The horizontal elevator 3 includes a rod-shaped main body 31, a pressing portion 32 provided at the distal end portion of the main body 31, and a gripping portion 33 provided at the proximal end portion of the main body 31.

  The main body 31 has a substantially circular cross section, and the outer diameter is set smaller than the inner diameter of the hole 93 formed in the vertebra 9.

  The main body 31 has a scale 311 indicating the insertion depth along the longitudinal direction of the outer surface thereof. Thereby, even if the distal end side of the horizontal elevator 3 is inserted into the hole 93 of the vertebra 9 and cannot be visually recognized, the distal end position of the pressing portion 32 described later in the vertebral body 91 can be easily confirmed.

A pressing portion 32 having a flat plate shape is formed integrally with the main body 31 at the distal end portion of the main body 31.
The pressing portion 32 is a portion that presses the upper portion of the vertebral body 91 upward.

  The horizontal elevator 3 having such a configuration is configured such that, for example, the proximal end side of the main body 31 is pushed downward with the distal end portion inserted into the vertebral body 91 (the state shown in FIG. 10). One of the side surfaces 321 can be brought into contact with the upper inner surface of the vertebral body 91 and the central upper portion of the vertebral body 91 can be pressed by the pressing portion 32. Thereby, the center upper part of the vertebral body 91 can be used by lifting upward.

  In the present embodiment, a pair of side surfaces 321 and 321 (the front surface and the back surface in FIG. 5) of the pressing portion 32 that are opposed to each other are the contact surfaces. In the horizontal elevator 3, at least a part of the peripheral surface of the pressing portion 32 may be a contact surface that contacts the upper inner surface of the vertebral body 91.

  In addition, the side surfaces 321 and 321 are each provided with unevenness. Thereby, since it is possible to prevent or suppress the slip of each side surface 321 with respect to the upper inner surface of the vertebral body 91, this operation can be performed more reliably when the vertebral body 91 is reduced by the horizontal elevator 3. .

  The shape of the unevenness is not particularly limited, but preferably has a convex portion with a sharp top. Thereby, the slip with respect to the upper inner surface of the vertebral body 91 of each side surface 321 can be prevented or suppressed more reliably.

  In addition, each convex part may be either, for example, one regularly arranged in a lattice shape or one irregularly (randomly) arranged.

  Further, each side surface 321 may have a very small unevenness, that is, a rough surface.

  Such a pressing portion 32 is provided to be inclined with respect to the main body 31. Thereby, reduction operation of the vertebral body 91 can be performed in a wide range by using the pressing portion 32 by rotating it around the axis of the main body 31 (see the lower diagram in FIG. 10).

  Although the angle (angle (theta) 2 in FIG. 5) which the press part 32 and the main body 31 make is not specifically limited, Usually, about 5-30 degrees is preferable and it is more preferable that it is about 5-15 degrees. By setting the angle θ2 within the above range, the reduction operation of the vertebral body 91 can be performed in a wider range.

  As the constituent materials of the pressing portion 32 and the main body 31, the same materials as those mentioned for the rod-like body 11 of the guide rod 1 can be used.

  The total length of the pressing portion 32 and the main body 31 (length L2 in FIG. 5) is not particularly limited, but is preferably about 13 to 21 cm, and more preferably about 15 to 19 cm. . Thereby, handling of the horizontal elevator 3 becomes easier.

  The pressing portion 32 is not limited to being formed integrally with the main body 31, and may be fixed to the main body 31 by, for example, a method such as screwing or fitting. .

  In addition, the gripping portion 33 is fixed (fixed) to the base end portion of the main body 31 by a method such as screwing, screwing, press-fitting, caulking, welding, or bonding. The horizontal elevator 3 is operated by holding the grip 33.

  Concave portions 331 and 331 are formed in the grip portion 33 along the longitudinal direction thereof. The two recesses 331 function as slip prevention means, and are arranged to face each other via the axis of the gripping portion 33. By forming such concave portions 331 and 331, the grip portion 33 can be gripped more reliably.

  Further, the horizontal elevator 3 has a marker 332 that indicates the inclination direction of the pressing portion 32, that is, the direction in which the pressing portion 32 faces. The marker 332 is formed at a position that is substantially 90 ° with the side surfaces 321 and 321 on the outer periphery (lower side in FIG. 5) of the grip portion 33 by, for example, coloring. Thereby, even if the front end side of the horizontal elevator 3 is inserted into the hole 93 of the vertebra 9 and cannot be visually recognized, the direction in which the pressing portion 32 faces in the vertebral body 91 can be easily confirmed. Further, in this case, it can be seen that the side surfaces 321 and 321 are oriented in a direction that is substantially 90 ° with the marker 332.

  In the present embodiment, the marker 332 is formed on the grip portion 33, but instead of this, for example, the marker 332 may be formed on a portion other than the grip portion 33 such as a base end portion of the main body 31.

<Impactor>
The impactor (pushing instrument) 5 shown in FIGS. 6 and 12 is a surgical instrument used to increase the density of the filling material 7 filled in the reduced vertebral body 91. As described above, according to the surgical instrument (filling instrument) of the present invention, the bone defect can be efficiently filled with the filler, but an impactor (pushing instrument) as described in detail below is used. Thus, it is possible to make the filling rate of the filler in the bone defect portion particularly high while preventing the burden on the patient from increasing.

  The impactor 5 has a rod-shaped main body 51, a pressing portion 52 provided at the distal end portion of the main body 51, and a gripping portion 53 provided at the proximal end portion of the main body 51.

  The main body 51 has a substantially circular cross section, and its outer diameter is set smaller than the inner diameter of the hole 93 formed in the vertebra 9.

  The main body 51 has a scale 511 indicating the insertion depth along the longitudinal direction of the outer surface thereof. Thereby, even if the distal end side of the impactor 5 is inserted into the hole 93 of the vertebra 9 and cannot be visually recognized, the distal end position of the pressing portion 52 described later can be easily confirmed.

  A pressing portion 52 having a substantially columnar shape is integrally formed with the main body 51 at the distal end portion of the main body 51.

  The pressing part 52 is a part that presses the filler 7. As shown in FIG. 12, the impactor 5 having such a configuration is used so as to move forward (upper middle left direction in FIG. 12) and press the filler 7 on the tip surface 521. Can do. Thus, the density (filling density) can be increased by pressing and solidifying the filler 7.

  In addition, irregularities are formed on the tip surface 521. Thereby, since the front end surface 521 can hold the filler 7 (particularly the powdery filler 7), when performing the operation of increasing the density of the filler 7 by the impactor 5 (densification), This densification operation can be performed more reliably.

  The shape of the unevenness is not particularly limited, but preferably has a convex portion with a sharp top. Thereby, the front end surface 521 can hold the filler 7 more reliably.

In addition, each convex part may be either, for example, one regularly arranged in a lattice shape or one irregularly (randomly) arranged.
Further, the tip surface 521 may have a very small unevenness, that is, a rough surface.

  Further, the outer diameter of the pressing portion 52 gradually increases toward the tip. Thereby, the contact area of the press part 52 and the filler 7 can be increased, and the densification operation of the filler 7 can be performed more efficiently.

  Note that the outer diameter of the distal end of the pressing portion 52 is set substantially equal to the inner diameter of the hole 93 formed in the vertebra 9.

  As the constituent materials of the pressing portion 52 and the main body 51, the same materials as those mentioned for the rod-like body 11 of the guide rod 1 can be used.

  Further, the overall length of the pressing portion 52 and the main body 51 (length L3 in FIG. 6) is not particularly limited, but is preferably about 13 to 21 cm, and more preferably about 15 to 19 cm. . Thereby, handling of the impactor 5 becomes easier.

  The pressing portion 52 is not limited to being formed integrally with the main body 51, and may be fixed to the main body 31 by a method such as screwing or fitting.

  In addition, the gripping portion 53 is fixed (fixed) to the base end portion of the main body 51 by, for example, a method such as screwing, screwing, press-fitting, caulking, welding, or bonding. The impactor 5 is operated by gripping the grip portion 53.

  Concave portions 531 and 531 are formed in the grip portion 53 along the longitudinal direction thereof. The two concave portions 531 function as slip prevention means, and are arranged to face each other with the shaft of the grip portion 53 interposed therebetween. By forming such concave portions 531, 531, the grip portion 53 can be gripped more reliably.

  As mentioned above, although the five surgical instruments 1-5 were demonstrated, in these surgical instruments 1-5, it is preferable that each holding part 12,23,33,44,53 is different, respectively. Thereby, it can recognize more reliably that it is a different surgical instrument by the difference of each holding part.

  In this case, each gripping part differs depending on at least one of, for example, a method of changing the shape, size, material, touch, color, etc., a method of attaching a marker such as a character (number), a symbol, or a figure. Can be.

  In the illustrated configuration, for example, a portion indicated by A1 of the gripping portion 12, a portion indicated by A2 of the gripping portion 23, a portion indicated by A3 of the gripping portion 33, a portion indicated by A4 of the gripping portion (holding portion for push rod) 44, The portions indicated by A5 of the grip portion 53 can be made into different colors, or different numbers can be given to the portions A1 to A5, respectively.

  Thereby, it is possible to easily identify (specify) which surgical instrument it is by simply looking at each gripping part 12, 23, 33, 44, 53, and mistakenly use the surgical instrument to be used. Such mistakes can be prevented more reliably.

  Moreover, when attaching a different number to each part A1-A5, you may make it attach a number according to the order used when performing a vertebral body compression fracture. In this case, it is convenient to sequentially select the surgical instrument to be used while looking at the numbers.

Moreover, in each surgical instrument 1-5, each holding | grip part 12,23,33,44,53 and the part of each front end side may be detachable. In this case, each of the surgical instruments 1 to 5 can have a configuration in which their gripping portions are common to each other and the tip side is replaced and used.
Next, an example of how to use the surgical instrument set will be described.

  [1] First, under X-ray fluoroscopy, as shown in FIG. 7, a probe (treatment tool) is punctured from the vertebral arch 92, 92 of the vertebra 9 subjected to vertebral body compression fracture reduction toward the vertebral body 91. . As a result, small-diameter holes 93 and 93 are formed on the left and right sides of the vertebra 9 from the vertebral arch 92 to the vertebral body 91.

  [2] Next, the grip portion 11 of the guide rod 1 is gripped, and the tip end side is inserted into one hole 93 as shown in FIG. Thereby, the diameter of one hole 93 is expanded.

In addition, as for the guide rod 1, the thing from which the outer diameter of the rod-shaped body 11 differs (for example, three types of (phi): 4mm, 5mm, 6mm) is prepared. The holes 93 can be gradually expanded in diameter by using these in order from a small diameter.
Such a diameter expansion operation of the hole 93 is performed on the left and right holes 93.

  [3] Next, the grasping portion 23 of the vertical elevator 2 is grasped, and as shown in FIG. 9, the distal end side (the distal end side of the pressing portion 22 and the main body 21) is connected to the vertebral body through one hole 93. It inserts in 91 and the press part 22 is located in a front part. At this time, the front end surface 221 of the pressing portion 22 is set upward.

  Then, the base end side of the main body 21 is pushed down. Thereby, the pressing part 22 can press the front upper part of the vertebral body 91 and lift it upward while the front end surface 221 contacts the front upper inner surface of the vertebral body 91.

  Next, the distal end side of the vertical elevator 2 is pulled out from the vertebra 9 and inserted again into the vertebral body 91 through the other hole 93, and the same operation as described above is performed.

  [4] Next, the grasping portion 33 of the horizontal elevator 3 is grasped, and as shown in FIG. 10, the distal end side (the distal end side of the pressing portion 32 and the main body 31) is connected to the vertebral body through one hole 93. It inserts in 91 and the press part 32 is located in a center part. In addition, at this time, one side surface 321 of the pressing portion 32 is kept facing upward.

  Then, the base end side of the main body 31 is pushed down. Thereby, the pressing part 32 can press the central upper part of the vertebral body 91 and lift it upward while the side surface 321 contacts the front upper inner surface of the vertebral body 91.

  Further, the pressing portion 32 is rotated by a predetermined angle around the axis of the main body 31, and the same operation as described above is performed. Thereby, reduction operation can be performed with respect to the wider range of the center upper part of the vertebral body 91.

  Next, the distal end side of the horizontal elevator 3 is pulled out from the vertebra 9 and inserted again into the vertebral body 91 through the other hole 93, and the same operation as described above is performed.

  Such reduction operations [3] and [4] of the vertebral body 91 are repeatedly performed a plurality of times so that the vertebral body 91 is reduced to an almost original shape.

  At this time, by reducing the vertebral body 91, a cavity 911 is formed therein.

  [5] Next, the cylinder gripping portion 42 of the cylinder 41 is gripped with one hand, and the distal end side is inserted into the vertebral body 91 through one hole 93 as shown in FIG. And the opening part 413 of the cylinder 41 is located in the desired location of the cavity 911. FIG.

  While maintaining this state, the filler 7 is loaded into the hollow portion 412 of the cylindrical body 41 from the proximal end of the cylindrical gripping portion 42.

  Next, the push rod holding portion 44 of the push rod 43 is held with the other hand, and the push rod 43 is inserted into the hollow portion 412 of the tubular body 41 from the proximal end of the tubular body grasping portion 42, in the distal direction. Moving. Thereby, the filler 7 in the hollow portion 412 of the cylindrical body 41 is pressed by the distal end portion of the push rod 43 and is transferred in the distal end direction through the cylindrical body 41.

  Further, when the push rod 43 is advanced in the distal direction, the vicinity of the distal end protrudes from the opening 413 of the cylindrical body 41, and the filler 7 is supplied to the cavity 911 and filled.

  When performing such an operation, the cylindrical body 41 may be rotated around its axis as necessary.

  When performing such a filling operation of the filler 7, the maximum protruding length of the push rod 43 from the tip of the cylinder 41 is caused by the contact of the push rod grip 44 with the cylinder grip 42. Since it is regulated, it is possible to prevent unnecessary portions of the vertebral body 91 from being pressed, and the safety is high.

  [6] Next, the grasping portion 53 of the impactor 5 is grasped, and the distal end side (the distal end side of the pressing portion 52 and the main body 51) is connected to the vertebral body through one hole 93 as shown in FIG. Insert into 91.

  Then, the filler 7 filled in the cavity 911 in the operation [5] is pressed by the pressing portion 52. Thereby, the density (filling density) of the filler 7 can be increased.

  The filling operation [5] of the filling material 7 and the densification operation [6] of the filling material 7 are repeatedly performed a plurality of times through the left and right holes 93, respectively. While filling the cavity 911 with the filler 7, the density is increased.

  Further, further reduction of the vertebral body 91 can be expected by performing such operations [5] and [6].

  [7] Next, the left and right holes 93 are respectively sealed with plugs 8 made of a biomaterial such as hydroxyapatite, as shown in FIG. Thereby, it is possible to prevent (block) the filler 7 from flowing out of the vertebral body 91 (cavity 911) through each hole 93. For this reason, it can prevent more reliably that the vertebral body 91 is crushed again.

  Each hole 93 may be sealed with, for example, bone cement instead of the plug 8.

  When the vertebral body compression fracture reduction for the vertebral body 91 is completed as described above, the surgical site (incision) is sutured, ligated, etc., and the operation is terminated.

  Since each surgical instrument is provided with a scale, when performing the operations [2] to [6], each operation is performed by performing these operations while viewing the scale. It is possible to prevent the distal end of the device from being inserted into the vertebral body 91 more than necessary, and to press unnecessary portions of the vertebral body 91, which is highly safe.

  Next, another embodiment of the surgical instrument (filling instrument) of the present invention will be described. In the following description, these embodiments will be described with a focus on differences from the above-described embodiments, and descriptions of similar matters will be omitted.

  14 and 15 are perspective views showing a configuration of a surgical instrument (filling instrument) according to another embodiment of the present invention.

  In the inserter (filling device) 4A shown in FIG. 14, the cylinder 41A is curved in the vicinity of the tip thereof. Further, in the inserter (filling device) 4B shown in FIG. 15, the cylindrical body 41B is bent in the vicinity of the tip thereof. Thus, in the present invention, the cylinder may be curved or bent near the tip thereof. As a result, the bone defect part (inside the vertebral body 91) can be more efficiently filled with the filler, particularly when the bone defect part (cavity 911) is relatively large or has a complicated shape. In this case, the bone defect part can be more efficiently filled with the filler. Moreover, a filler can be efficiently supplied also to a site | part comparatively far from the cylinder of a bone defect part.

  As described above, when the cylinders (cylinders 41A and 41B) are curved or bent near the distal ends, the axial direction on the proximal end side of the cylinders (cylinders 41A and 41B) and the vicinity of the distal ends are provided. The angle formed with the tangential direction of the curved or bent portion (angle θ3 in FIGS. 14 and 15) is preferably 5 to 30 °, and more preferably 5 to 15 °. By setting the angle θ3 to a value within the above range, the effect obtained by having the tubular body (cylindrical bodies 41A and 41B) having the curved or bent portions as described above is more remarkably exhibited.

  Further, when the cylinder (cylinders 41A and 41B) is curved or bent near the tip, the cylinder (cylinders 41A and 41B) is bent or bent as shown in FIGS. It is preferable that the direction in which the opening is provided and the direction in which the opening is provided are substantially the same. Thereby, the effect by having the site | part which the cylinder (cylinders 41A and 41B) has curved or bent as mentioned above is exhibited more notably.

  Further, when the cylindrical body (cylindrical bodies 41A and 41B) has a curved or bent portion as described above, for example, a surgical instrument (inside with the cylindrical body (cylindrical bodies 41A and 41B)). The sorters 4A, 4B) can be suitably used for the process of moving cancellous bone, scar tissue, etc. as a pretreatment for the filling operation for filling the filler, and the shape reduction instrument (vertical elevator 2, horizontal elevator as described above) The shape reduction operation (operation to reduce the vertebral body 91 to a substantially normal position) can be suitably performed without using the elevator 3) or the like.

  And the surgical instrument set of this invention may be equipped with the surgical instrument (inserter 4A, 4B) as shown, for example in FIG. 14, FIG.

  The preferred embodiments of the surgical instrument and surgical instrument set of the present invention have been described above, but the present invention is not limited to these.

  Moreover, each part of each surgical instrument (including the surgical instrument of the present invention) constituting the surgical instrument of the present invention can be replaced with any component that can exhibit the same function.

  In addition, the surgical instrument of the present invention may be configured such that, for example, the vicinity of the tip having an opening is detachable from the cylindrical body. In other words, in the surgical instrument of the present invention, the cylinder may include a cylinder body and a distal end side member that can be attached to and detached from the distal end side of the cylinder body. Furthermore, the surgical instrument (surgical instrument set) of the present invention may include a plurality of members having different conditions such as the size and shape of the opening and the aforementioned θ3 as the distal end side member. . With the configuration as described above, the distal end side member is appropriately selected according to the patient's case and the like, and the present invention can be more suitably applied in surgery (procedure) such as vertebral body compression fracture reduction. . In such a case, the cylindrical body and the tip side member can be made detachable by providing the threaded portion on the cylindrical body and the tip side member.

  Moreover, the surgical instrument set of this invention should just have the surgical instrument (filling instrument) of this invention at least, The combination is not limited to the thing of the said embodiment. For example, in the surgical instrument set of the present invention, any one or more of the diameter expanding instrument, the shape reducing instrument, and the pushing instrument may be omitted, and any surgical instrument may be added. Also good. Moreover, when the surgical instrument (filling instrument) of the present invention has a curved or bent distal end as shown in FIGS. 14 and 15, the filling instrument is preferably used for shape reduction operation. The shape reduction device as described above can be omitted. Further, according to the surgical instrument (filling instrument) of the present invention, the bone defect part can be efficiently filled with the filler, so that the pushing instrument as described above may be omitted.

  In the above embodiment, the surgical instrument and surgical instrument set of the present invention are described as being used for vertebral body compression fracture reduction. However, the surgical instrument and surgical instrument set of the present invention are vertebral body compression fractures. It may be used for procedures (surgery) other than reduction.

It is a perspective view which shows the structure of the surgical instrument (filling instrument) of this invention. It is an enlarged side view which shows the area | region of the front end side of the cylinder of the surgical instrument (filling instrument) shown in FIG. It is a perspective view which shows the structure of the surgical instrument (diameter expansion instrument) which comprises the surgical instrument set of this invention. It is a perspective view which shows the structure of the surgical instrument (shape reduction instrument) which comprises the surgical instrument set of this invention. It is a perspective view which shows the structure of the surgical instrument (shape reduction instrument) which comprises the surgical instrument set of this invention. It is a perspective view which shows the structure of the surgical instrument (pushing instrument) which comprises the surgical instrument set of this invention. It is a figure for demonstrating the usage method of the surgical instrument set of this invention. It is a figure for demonstrating the usage method of the surgical instrument set of this invention. It is a figure for demonstrating the usage method of the surgical instrument set of this invention. It is a figure for demonstrating the usage method of the surgical instrument set of this invention. It is a figure for demonstrating the usage method of the surgical instrument set of this invention. It is a figure for demonstrating the usage method of the surgical instrument set of this invention. It is a figure which shows typically the vertebra which the vertebral body compression fracture reduction was performed. It is a perspective view which shows the structure of the surgical instrument (filling instrument) of other embodiment of this invention. It is a perspective view which shows the structure of the surgical instrument (filling instrument) of other embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Guide rod 11 Bar-shaped body 111 Scale 12 Grasp part 121 Recessed part 2 Vertical elevator 21 Main body 211 Scale 22 Press part 221 Tip surface 23 Gripping part 231 Concave 232 Marker 3 Horizontal elevator 31 Main body 311 Scale 32 Press part 321 Side part 33 Concave part 33 332 marker 4, 4A, 4B inserter 41, 41A, 41B cylinder 411 scale 412 hollow part (lumen)
413 Opening 42 Cylinder gripping part 421 Recessed part 422 Flange 423 Marker (index)
43 Extrusion bar 44 Extrusion bar gripping part 441 Concave part 5 Impactor 51 Main body 511 Scale 52 Pressing part 521 Tip surface 53 Grasping part 531 Concave part 6 Probe 7 Filling material 8 Plug body 9 Vertebral body 91 Vertebral body 911 Cavity 92 Vertebral arch 93 Hole

Claims (23)

A surgical instrument used to fill a bone defect with a filler,
A cylinder having a hollow portion therethrough;
An extrusion rod inserted through the hollow portion of the cylindrical body and capable of discharging the filler loaded in the hollow portion;
The surgical instrument according to claim 1, wherein the hollow portion is opened at an opening provided on a side of the cylindrical body at a distal end side thereof.   The surgical instrument according to claim 1, wherein the opening is substantially elliptical.   The surgical instrument according to claim 1 or 2, wherein a distance from a distal end portion of the cylindrical body to a distal end portion of the opening is 0.5 to 50 mm.   The surgical instrument according to any one of claims 1 to 3, wherein the hollow portion is curved or bent near the tip thereof.   The surgical instrument according to any one of claims 1 to 4, wherein the cylindrical body is curved or bent near the tip thereof.   The surgical instrument according to claim 5, wherein an angle formed between an axial direction on the proximal end side of the cylindrical body and a tangential direction of a curved or bent portion provided near the distal end is 5 to 30 degrees.   The surgical instrument according to claim 5 or 6, wherein a direction in which the cylindrical body is bent or bent is substantially the same as a direction in which the opening is provided.   The surgical instrument according to any one of claims 1 to 7, further comprising a marker indicating a direction in which the opening of the cylindrical body is provided.   The surgical instrument according to any one of claims 1 to 8, wherein a scale indicating an insertion depth is formed along a longitudinal direction of a side surface of the cylindrical body.   The surgical instrument according to any one of claims 1 to 9, wherein a cylindrical gripping portion is fixed near a proximal end portion of the cylindrical body.   The surgical instrument according to claim 10, wherein a concave portion is formed along a circumferential direction in the vicinity of a central portion in a longitudinal direction of the cylindrical gripping portion.   The surgical instrument according to claim 8 or 11, wherein a ring-shaped flange is formed in the vicinity of a proximal end portion of the cylindrical body gripping portion.   The surgical instrument according to any one of claims 8 to 12, wherein an inner diameter of the cylindrical gripping portion gradually increases toward a proximal end side.   The surgical instrument according to any one of claims 1 to 13, wherein the push rod has flexibility at least near the tip.   The surgical instrument according to any one of claims 1 to 14, wherein a tip end of the push rod has a rounded shape.   The surgical instrument according to any one of claims 1 to 15, wherein the push rod protrudes from the opening in a state where the push rod is inserted into the cylindrical body.   The surgical instrument according to any one of claims 1 to 16, wherein a push bar holding portion is fixed near a base end portion of the push bar.   The surgical instrument according to any one of claims 1 to 17, wherein the filler is a bone grafting material.   The surgical instrument according to claim 18, wherein the bone prosthetic material is a ceramic powder.   The surgical instrument according to claim 18, wherein the bone prosthetic material is a powder of a calcium phosphate compound. A surgical instrument set used for vertebral body compression fracture reduction,
The surgical instrument according to any one of claims 1 to 20,
A diameter expanding device for expanding a hole formed in at least the crushed vertebral body, a shape reducing device for reducing the upper part of the crushed vertebral body to a substantially normal position, and a vertebral body subjected to reduction A surgical instrument set comprising: at least one selected from the group consisting of push-in instruments for increasing the density of filled fillers.   The surgical instrument set according to claim 21, wherein grips of the surgical instruments constituting the surgical instrument set are different. The surgical instrument set according to claim 21 or 22, wherein each surgical instrument constituting the surgical instrument set can be specified by each of the grip portions.

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