JP2008018141A - System for bone prosthetic material - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To surely and easily take out a guide body filled in a broken bone part together with a bone prosthetic material from the broken bone part to the outside. <P>SOLUTION: The bone prosthetic material 14 is composed of a helically wound coil spring 20, and a guide wire 16 composed of an elastic material is inserted to the inside of the coil spring 20 and integrally engaged. A connecting block 24 which can be connected with an impactor 38 is provided on the end part of the guide wire 16. Then, in the state of inserting the guide wire 16 to the coil spring 20 and connecting it to the impactor 38, the bone prosthetic material 14 is filled through the introduction tube 36 of a filling instrument 18 to the broken bone part 56 of a vertebral body 12. Also, after the bone prosthetic material 14 is filled in the broken bone part 56, by pulling out the impactor 38, the guide wire 16 connected to the impactor 38 is pulled out to the outside and detached. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to a bone filling material system including a bone filling material filled in a fractured part such as a vertebral body compression fracture caused by osteoporosis, a bone diseased part caused by various diseases, and the like, and a filling device for filling the bone filling material.

  In recent orthopedic osteoporosis treatments and fracture treatments, it is important to be minimally invasive in order to reduce the burden on patients. Percutaneous vertebroplasty (PVP) has been performed in response to vertebral fractures due to osteoporosis (see, for example, Patent Documents 1 and 2). In such percutaneous vertebroplasty, for example, fillers such as calcium phosphate bone cement and polymethylmethacrylate (PMMA) bone cement are fed into the fracture site and filled. There is a possibility of leakage from the fracture site to the outside of the vertebral body, and there are concerns about side effects and biocompatibility.

  Therefore, in recent years, vertebroplasty using a hydroxyapatite (HA) block has been developed and is becoming popular (see, for example, Patent Documents 3 and 4). Since this hydroxyapatite block is solid, side effects and biocompatibility due to leakage from the fracture site to the outside can be avoided, and there is an advantage that it is not necessary to worry about curing time. On the other hand, there is a problem that the operability is poor when the filling efficiency of the hydroxyapatite block is increased.

  On the other hand, instead of the hydroxyapatite block described above, a percutaneous vertebra is continuously filled with a semi-rigid wire, cable or the like as a filler to the fracture site and fed to the fracture site so as to fold the filler. Body plastic surgery is performed (see, for example, Patent Document 5).

JP-T-2002-522148 Japanese National Patent Publication No. 9-508292 JP 2005-168670 A International Publication No. 2005/055886 Pamphlet JP 2005-537098 A

  By the way, in the prior art which concerns on patent document 5, when it is going to be filled with the filler which consists of a semi-rigid body wire, a cable, etc., the sponge-like cancellous bone filled in the vertebral body becomes resistance and is filled. A large amount of force is required to perform the work. As a result, it is difficult to continuously fill the filler, and it is difficult to fill the filler at a desired position in the fracture site.

  The present invention has been made in consideration of the above problems, and enables the guide body filled with the bone prosthetic material to be reliably and easily taken out from the fractured part of the vertebral body and the like, and It is an object of the present invention to provide a bone grafting material system capable of safely and efficiently performing a bone filling material filling operation.

In order to achieve the above object, the present invention provides a bone prosthetic material comprising a coil body in which strands are spirally wound,
A guide body made of an elastic material and inserted into the bone filling material;
An introduction tube that is inserted into the bone and guides the bone filling material into the bone;
An extruding member that is inserted in a freely displaceable manner with respect to the introduction tube, and pushes out the bone prosthetic material to the inside of the bone;
Engagement means capable of integrally disengaging the pushing member and the guide body;
With
The guide body is detachably provided on the push-out member by the engaging means.

  According to the present invention, the helically wound coil body is used as a bone grafting material, and a guide body made of an elastic material is inserted into the bone grafting material, and the bone grafting material is inserted into the bone with respect to the guide body. The pushing member pushed out to the inner side is integrally engaged by the engaging means. Then, the bone filling material is inserted into the introduction tube in a state where the pushing member and the guide body are engaged, and the bone filling material is integrated with the guide body by extruding the bone filling material by the pushing member, thereby causing a vertebral body compression fracture due to osteoporosis. Such as a fractured part such as a fractured part due to various diseases (hereinafter referred to as a fractured part or a fractured part). In addition, a coil body means that the strand was wound spirally.

  Therefore, after the filling of the bone prosthetic material into the fracture portion or the like is completed, the guide member engaged with the push member is integrated from the fracture portion or the like through the introduction tube by taking out the push member from the introduction tube to the outside. Can be taken out. As a result, the guide body filled in the fracture part and the like together with the bone grafting material can be reliably taken out from the fractured part and the like by a simple operation of pulling out the pushing member from the introduction tube. The filling operation can be performed smoothly and efficiently.

  In addition, when removing the guide body from the fractured part, etc., it is not necessary to remove the introduction tube inserted into the fractured part, etc., so work efficiently when another bone prosthetic material is continuously filled. In addition, since the guide body and the pushing member are configured to be detachable by the engaging means, the guide body taken out from the fractured part or the like can be quickly and easily replaced with another guide body. is there.

  Furthermore, by detaching the guide body from the bone grafting material, the bone grafting material can be stably filled by the elastic force of the guide body, even when the bone grafting material is made of a material with low elasticity. . In addition, when a highly elastic guide wire is formed, the guide wire does not remain in the fractured portion, so that the range of material selection can be expanded.

Furthermore, the engaging means includes a first engaging portion provided at an end portion of the guide body,
It is good to provide the 2nd engaging part which is provided in the edge part of the said extrusion member which faces the said guide body, and is engaged with the said 1st engaging part. Thereby, the end of the guide body and the end of the pushing member can be engaged via the first engaging portion and the second engaging portion, so that the guide body and the pushing member can be integrated. The guide body can be reliably removed from the fractured part or the like.

  Still further, the second engagement portion includes a projecting portion protruding in the radial direction, and the first engagement portion is formed in a cylindrical shape into which the second engagement portion is inserted. It is good to provide the engaging groove with which a protrusion is engaged. As a result, the second engaging portion is inserted into the first engaging portion, and the protrusion of the second engaging portion is engaged with the engaging groove of the first engaging portion. It becomes possible to easily engage the first engaging portion and the second engaging portion. As a result, the guide body and the pushing member can be displaced integrally.

The engagement groove extends along the axial direction of the first engagement portion, and the engagement state of the first and second engagement portions is maintained by the engagement of the protrusions. A locking groove,
A guide groove that communicates with the lock groove and opens at an end of the one engaging portion;
With
When the second engaging portion is inserted into the first engaging portion, the protrusion may be guided to the lock groove through the guide groove.

  As a result, the second engagement portion is inserted into the first engagement portion, and the protrusion of the second engagement portion is guided from the guide groove to the lock groove, thereby engaging the protrusion with the lock groove. The first engagement portion and the second engagement portion can be easily engaged under the care.

  According to the present invention, the following effects can be obtained.

  That is, the pushing member that pushes the bone prosthetic material along the introduction tube to the inside of the bone and the guide body are detachably engaged by the engaging means. After filling, the guide member engaged with the push-out member can be easily and surely taken out from the fractured part to the outside by removing the push-out member from the introduction tube to the outside. Therefore, the filling operation of the bone grafting material can be performed smoothly and efficiently.

  Further, when the guide body is taken out from the fracture part or the like, it is not necessary to remove the introduction tube inserted into the fracture part or the like, so that the work can be efficiently performed when the bone filling material is continuously filled. At the same time, since the guide body and the pushing member are configured to be detachable by the engaging means, the guide body taken out from the fractured part or the like can be quickly and easily replaced with another guide body.

  A preferred embodiment of the bone prosthesis system according to the present invention will be described in detail below with reference to the accompanying drawings, taking a preferred embodiment as an example of application to a vertebral body compression fracture.

  As shown in FIG. 1, the bone grafting material system 10 includes a bone grafting material 14 filled in a patient's vertebral body 12 (see FIG. 9) and an elastic material inserted into the bone grafting material 14. A guide wire (guide body) 16 formed in a spiral shape and a filling device 18 for filling the vertebral body 12 with the bone filling material 14.

  As shown in FIGS. 1 and 2, the bone grafting material 14 includes a coil spring (coil body) 20 in which strands 20a having the same diameter are spirally wound along the axial direction. The coil spring 20 is made of a metal material such as Ti or a Ti alloy, for example, and has a predetermined length along the axial direction. The length of the coil spring 20 is selected or set in advance according to the internal volume of the patient's vertebral body 12 (see FIG. 9) filled with the bone prosthesis material 14 including the coil spring 20.

  In addition, the constituent material of the coil spring 20 is not particularly limited, and it is preferable to use a synthetic resin material, a metal material, or the like that has no problem in terms of biological harm. Specifically, examples of the synthetic resin material include ketone resins such as polyether ketone, polyether ether ketone, and polyallyl ether ketone, and thermoplastic resins such as polyphenylene sulfide and polysulfone. On the other hand, examples of the metal material include Ti alloys such as Ti, Ti-4Al-6V, and Ni-Ti, and stainless steel. Pure Ti is suitably plastically deformed, and is preferably familiar with the surrounding bone. In addition, the superelastic alloy is relatively flexible and has resilience. Therefore, by configuring the coil spring 20 with a superelastic alloy, sufficient flexibility and bendability can be obtained, and the shape of the fractured portion 56 can be followed while avoiding obstacles inside the fractured vertebral body 12. And can be filled stably.

  Further, the surface of the coil spring 20 may be coated with PTFE (Teflon: registered trademark) or silicon oil may be applied, for example. Thereby, since the surface resistance of the bone grafting material 14 made of the coil spring 20 is reduced, the bone grafting material 14 can be moved more smoothly when filling the vertebral body 12.

  Furthermore, by treating the surface of the coil spring 20 with alkali, the affinity when the bone grafting material 14 is filled in the fractured portion 56 can be improved, and bone formation in the fractured portion 56 can be promoted.

  The guide wire 16 is made of a metal material having superelasticity such as a Ti alloy (for example, Ni-Ti) and is elongated along the axial direction, is pre-shaped into a predetermined shape such as a spiral, and can be bent freely. It is formed.

  The constituent material of the guide wire 16 is preferably an alloy (including superelasticity) exhibiting pseudoelasticity. More preferably, a superelastic alloy is optimal. This superelastic alloy is relatively flexible and has resilience. Therefore, by configuring the guide wire 16 with a superelastic alloy, sufficient flexibility and bendability can be obtained, and the shape of the fractured portion 56 can be followed while avoiding obstacles inside the fractured vertebral body 12. And can be filled stably.

  Preferred compositions of this superelastic alloy include Ni-Ti alloys such as 49-52 atomic% Ni-Ti alloys, 38.5-41.5 wt% Cu-Zn alloys, 1-10 wt% Cu-Zn-X alloy of X (X is at least 1 type in Be, Si, Sn, Al, Ga), Ni-Al alloy of 36-38 atomic% Al, etc. are mentioned. Of these, the Ni-Ti alloy described above is particularly preferable.

  The length of the guide wire 16 is set to be approximately equal to or slightly longer than the length along the axial direction of the coil spring 20. As described above, since the guide wire 16 has a predetermined elastic force, the coil spring 20 into which the guide wire 16 is inserted has a shape following the shape of the guide wire 16. The coil spring 20 may have a shape that follows the shape of the guide wire 16 in advance.

  Further, as shown in FIG. 2, a stopper portion 22 that is bent at a predetermined angle with respect to the axis of the guide wire 16 is formed at one end portion of the guide wire 16. One end of the coil spring 20 inserted through 16 is locked.

  On the other hand, as shown in FIGS. 2 and 3, a bottomed cylindrical connecting block (first engaging portion) 24 is connected to the other end of the guide wire 16, and the connecting block 24 will be described later. As described above, the end portion spaced from the guide wire 16 is opened by the insertion hole 26.

  The outer diameter of the connecting block 24 is set larger than the inner diameter of the coil spring 20, and is set to be substantially equal to or smaller than the outer diameter of the coil spring 20. That is, when the connection block 24 is filled into the fractured portion 56 through the filling device 18 together with the coil spring 20, one end of the connection block 24 may enter the coil spring 20 due to its outer diameter. Rather, it is suitably held against the end of the coil spring 20. On the other hand, since the connecting block 24 is set to be substantially equal to or smaller than the outer diameter of the coil spring 20, a guide wire including the connecting block 24 in an introduction pipe 36 (described later) of the filling device 18 through which the coil spring 20 is inserted. 16 can be inserted.

  Thus, when the guide wire 16 is inserted into the coil spring 20, the coil spring 20 is held between the stopper portion 22 of the guide wire 16 and the connecting block 24, and both ends of the guide wire 16 are It does not come off from the part. In other words, the stopper portion 22 and the connecting block 24 function as locking means that can integrally hold the coil spring 20 that is the bone grafting material 14 with respect to the guide wire 16.

  An insertion hole 26 that opens outwardly extends along the axial direction inside the connection block 24, and communicates with the insertion hole 26 on the outer peripheral surface of the connection block 24. An engagement portion (engagement groove) 28 with which an impactor (extrusion member) 38 of the filling device 18 is engaged is formed. That is, the connection block 24 has one end 24a side connected to the other end of the guide wire 16, and the other end 24b side of the connection block 24 is opened by an insertion hole 26 formed therein.

  The engaging portion 28 includes a first groove (lock groove) 30 extending in a predetermined length along the axial direction of the connection block 24, and a circumferential direction of the connection block 24 from a substantially central portion of the first groove 30 ( A second groove (guide groove) 32 extending along the directions of the arrows A1 and A2) and substantially parallel to the first groove 30 from the end of the second groove 32 to the other end 24b of the connecting block 24 opened. And a third groove (guide groove) 34 extending along the axial direction of the connecting block 24. The first groove 30 and the third groove 34 are formed with a substantially constant width dimension W1 (see FIG. 3) substantially orthogonal to the extending direction.

  The second groove 32 is a wide groove that is connected so as to be substantially orthogonal to the first groove 30 and communicates so as to be substantially orthogonal to the third groove 34. That is, the first groove 30 and the third groove 34 are formed substantially parallel to each other, communicate with each other via the second groove 32, and the first to third grooves 30, 32, 34 are connected to the connection block 24. It is formed in a substantially crank shape with respect to the outer peripheral surface.

  The first groove 30 extends from the one end portion 24a and the other end portion 24b side of the connection block 24 with a predetermined length spaced from each other.

  As shown in FIGS. 1 and 10 to 12, the filling device 18 includes a cylindrical introduction tube 36 that guides the bone grafting material 14 into the vertebral body 12, and an impactor 38 that is inserted into the introduction tube 36. Including.

  The introduction tube 36 is formed of a metal material such as stainless steel, for example, and has a long main tube portion 40 and a short diameter-expanded portion 42 that is larger in diameter than the main tube portion 40. The portion 40 and the enlarged diameter portion 42 are smoothly connected in a tapered shape. A passage 44 through which the bone grafting material 14 is inserted is formed inside the main cylindrical portion 40 and the enlarged diameter portion 42, and the inner peripheral diameter of the passage 44 is slightly larger than the diameter of the bone grafting material 14. It is formed (see FIGS. 10 to 11).

  As will be described later, the introduction tube 36 is set to such a length that it can be remotely operated from a position where the surgeon is not exposed to the X-rays irradiated to the affected area and does not impair the operability. Good.

  The impactor 38 includes a shaft portion 46 that is inserted into the introduction tube 36 and pushes out the bone grafting material 14, a grip portion 48 that is provided at one end portion of the shaft portion 46 and is gripped by an operator, and the other end of the shaft portion 46. And a connecting portion (second engaging portion) 50 that can be engaged with the connecting block 24 of the guide wire 16. The shaft portion 46 is provided with a stopper 52 whose diameter is increased radially outward at a portion on the gripping portion 48 side. When the impactor 38 is inserted into the introduction pipe 36, the stopper 52 is increased in diameter. The displacement of the impactor 38 toward the introduction pipe 36 is restricted.

  The shaft portion 46 is formed to be longer than the longitudinal dimension of the introduction tube 36 and has flexibility and is hard in the compression direction. The shaft portion 46 is inserted into the passage 44 of the introduction tube 36 by pushing a grip portion 48 provided at one end. The other end is pushed out. The diameter of the shaft portion 46 is set to be smaller than the inner peripheral diameter of the passage 44 in the introduction pipe 36.

  As shown in FIG. 4, the connecting portion 50 is reduced in diameter in the radial direction with respect to the shaft portion 46, and protrudes from the other end portion of the shaft portion 46 with a predetermined length along the axial direction. It is formed. The diameter of the connecting portion 50 is set to be approximately equal to or slightly larger than the inner peripheral diameter of the insertion hole 26 of the connecting block 24 in the guide wire 16. That is, the connecting portion 50 is set to a size that can be inserted into the connecting block 24.

  On the end portion side of the outer peripheral surface of the connecting portion 50, a protruding portion 54 that protrudes at a predetermined height in the radially outward direction and is formed in a substantially rectangular cross section along the axial direction of the connecting portion 50 is provided. As can be easily understood from FIG. 4, the protruding portion 54 is provided at a position on the shaft portion 46 side that is slightly separated from the end portion of the connecting portion 50.

  When the connecting portion 50 is inserted into the insertion hole 26 of the connecting block 24, the first to third grooves 30, 32, 34 of the connecting block 24 are formed as shown in FIGS. 5, 7, and 8. The protrusion 54 is inserted. The protrusion 54 has a width dimension W2 (see FIG. 4) substantially orthogonal to the axis of the connecting portion 50, which is substantially the same as the width dimension W1 (see FIG. 3) of the first groove 30 and the third groove 34 in the connecting block 24. Or it is set slightly smaller.

  On the other hand, the longitudinal dimension L of the protrusion 54 is set to be approximately equal to or slightly smaller than the width dimension W3 of the second groove 32 (see FIGS. 3 and 4).

  The bone prosthetic material system 10 according to the embodiment of the present invention is basically configured as described above. Next, the operation and effect of the system will be described.

  First, the guide wire 16 is inserted into the coil spring 20 constituting the bone prosthesis 14 to be integrally engaged, and the impactor 38 of the filling device 18 is preliminarily attached to the connecting block 24 of the guide wire 16. Keep connected.

  Here, the case where the guide wire 16 and the impactor 38 are connected will be schematically described with reference to FIGS.

  First, the protruding portion 54 of the connecting portion 50 is aligned with the third groove 34 of the connecting block 24, and the connecting portion 50 is inserted into the connecting block 24 so that the protruding portion 54 is inserted into the third groove 34. Inserting into the hole 26 (see FIG. 7), the protrusion 54 reaches the end of the second groove 32.

  Next, the impactor 38 including the connecting portion 50 is rotated by about 90 ° so that the protrusion 54 is displaced along the second groove 32 toward the first groove 30 side (arrow A1 direction). As a result, as shown in FIG. 8, the protrusion 54 moves along the circulating second groove 32 and comes into contact with the joining portion with the first groove 30 (see FIG. 6). Then, by displacing the connecting portion 50 again toward the guide wire 16 (in the direction of arrow B), the protrusion 54 is displaced along the first groove 30, and the protrusion 54 is at the tip of the first groove 30. It reaches the engaged state (see FIG. 5).

  Thereby, the protrusion 54 is locked with respect to the engaging portion 28 of the connection block 24, and the guide wire 16 including the connection block 24 and the impactor 38 having the protrusion 54 are connected. That is, the connecting block 24 and the connecting portion 50 can connect the guide wire 16 and the impactor 38 by engaging the protruding portion 54 with the engaging portion 28, while the protruding portion 54 of the connecting portion 50 is By moving the first groove 30, the second groove 32, and the third groove 34 and performing an operation opposite to that at the time of insertion, the protrusion 54 can be detached from the engagement portion 28. That is, the protrusion 54 functions as an engaging means that connects the connecting block 24 and the connecting portion 50 to each other and can release the connection. In other words, the guide wire 16 including the connecting block 24 and the impactor 38 having the connecting portion 50 are configured to be detachable.

  Next, a method of filling the fracture material 56 with the bone grafting material 14 as a percutaneous vertebroplasty using the filling instrument 18 including the connected guide wire 16 and the impactor 38 will be described. Hereinafter, the case where the bone grafting material 14 is filled into the fractured part 56 in the vertebral body 12 which is an affected part of an osteoporotic patient will be described as an example.

  First, as an initial treatment, the patient is anesthetized and the position of the affected vertebral body 12 is confirmed using an X-ray CT monitor or the like, and the introduction tube 36 and the metal puncture needle 58 are combined from the back as shown in FIG. In use, the insertion opening 60 is opened in the vertebral body 12. The vertebral body 12 includes a fracture portion 56, and the insertion port 60 communicates with the fracture portion 56. When the puncture needle 58 is pulled out, the introduction tube 36 is placed in the vertebral body 12.

  Next, as shown in FIG. 10, the filling device 18 is inserted into the fractured portion 56 from the insertion port 60, and a part of the introduction tube 36 is inserted into the fractured portion 56 to protrude. At this time, an X-ray apparatus (not shown) is operated to irradiate the affected part of the patient with X-rays, and the operator observes the image obtained on the basis of the X-rays detected by the detection unit of the X-ray apparatus while performing the procedure It can be performed.

  Then, in a state where the guide wire 16 is inserted in advance into the coil spring 20 and connected to the impactor 38 via the connecting block 24, the bone prosthetic material 14 is integrated with the guide wire 16 into the introduction tube 36. It inserts in the enlarged diameter part 42 (refer FIG. 10). Specifically, the bone grafting material 14 is inserted into the introduction tube 36 from the stopper portion 22 side of the guide wire 16. In addition, the guide wire 16 is restricted in relative displacement in the axial direction with respect to the coil spring 20 by the stopper portion 22 provided on one end side thereof and the connecting block 24 provided on the other end side. The guide wire 16 is inserted into the introduction tube 36 integrally with the bone grafting material 14 without being pulled out of the coil spring 20.

  Further, as already described, since the bone grafting material 14 is formed in a spiral shape having a resilient force with a predetermined radius by the guide wire 16, the surgeon moves the curved bone grafting material 14 to the elastic bone. It is inserted into the passage 44 of the introduction pipe 36 while being deformed so as to be in a straight line against the generating force, and gradually with the impactor 38 so that the connecting block 24 of the guide wire 16 is in the passage 44. Push in.

  Next, the operator grasps the grasping portion 48 of the impactor 38 and displaces the shaft portion 46 along the passage 44 of the introduction tube 36 toward the vertebral body 12 (in the direction of arrow B in FIG. 10). Since the connecting portion 50 formed at the end of the shaft portion 46 and the guide wire 16 are connected, the bone prosthetic material 14 is pressed toward the vertebral body 12 together with the guide wire 16. At this time, the protrusion 54 of the connecting portion 50 is locked to the connecting block 24 in the first groove 30 of the connecting block 24. Therefore, the connection state between the impactor 38 and the guide wire 16 is preferably maintained.

  In other words, since the protrusion 54 does not move to the second groove 32 extending along the circumferential direction of the connecting block 24, the protrusion 54 passes through the second groove 32 to the third groove 34. The protrusion 54 is not guided and the connected state is not released. Further, since the connecting block 24 is formed larger than the inner peripheral diameter of the coil spring 20, the connecting block 24 does not enter the inside of the coil spring 20 under the pressing action by the impactor 38, It is suitably held against the end of the coil spring 20. Therefore, the guide wire 16 and the bone grafting material 14 are reliably pressed by the impactor 38.

  Then, as shown in FIG. 11, the bone grafting material 14 and the guide wire 16 made of the coil spring 20 are filled into the fracture portion 56 of the vertebral body 12 through the main tube portion 40 of the introduction tube 36. At this time, the bone grafting material 14 returns from the state of being linearly deformed in the introduction tube 36 so as to be deformed again into a spiral shape by the elastic force of the guide wire 16 and is bent into the fracture portion 56. While filling.

  As described above, the inside of the vertebral body 12 has the cancellous bone 62 having a sponge-like structure. For this reason, the bone filling material 14 gradually advances so as to be filled into the space generated in the cancellous bone 62 due to osteoporosis or the like, and the space generated in the cancellous bone 62 is suitably filled with the bone filling material 14 ( (See FIG. 12).

  Next, after confirming that the bone prosthetic material 14 has been filled in the fractured part 56 while viewing the image on the monitor, the surgeon moves the impactor 38 from the insertion opening 60 of the vertebral body 12 as shown in FIG. Extract in the direction of separation (arrow C direction). At this time, since the guide wire 16 is integrally connected to the connecting portion 50 of the impactor 38 via the connecting block 24, the impactor 38 is detached from the vertebral body 12, so The guide wire 16 integrally moves along the inside of the coil spring 20 and is extracted from the insertion port 60 to the outside through the passage 44 of the introduction pipe 36. In this case, the guide wire 16 is removed from the vertebral body 12 with the introduction tube 36 inserted into the insertion port 60 of the vertebral body 12.

  That is, the fracture portion 56 of the vertebral body 12 is filled with only the coil spring 20 that is the bone grafting material 14 (see FIG. 14). At this time, the projecting portion 54 of the impactor 38 is pulled in a direction (arrow C direction) in which the impactor 38 is separated from the bone grafting material 14, so that the impactor 38 side (in the first groove 30 of the connecting block 24 ( It is engaged with the end in the direction of arrow C). Therefore, the connection state between the impactor 38 and the guide wire 16 is preferably maintained. In other words, since the protrusion 54 does not move to the second groove 32 extending along the circumferential direction (arrow A2 direction) of the connecting block 24, the third groove is interposed via the second groove 32. The projecting portion 54 is not guided to 34 and the connected state is not released.

  Then, the surgeon confirms the filling state of the bone grafting material 14 into the fractured part 56 while looking at the X-ray image of the monitor, and if the filling is insufficient, another bone grafting material 14 is continuously used. To fill.

  In this case, the guide wire 16 extracted from the vertebral body 12 and connected to the connecting portion 50 of the impactor 38 is removed, and a new guide wire 16 is connected to the connecting portion 50.

  First, the connecting portion 50 is displaced in the axial direction (in the directions of arrows B and C) from the state in which the protruding portion 54 of the connecting portion 50 shown in FIG. 5 is engaged with the first groove 30, and the protruding portion 54 is moved. After moving to the position facing the second groove 32, the connecting portion 50 is rotated in the circumferential direction (arrow A2 direction) of the connecting block 24 via the impactor 38 (see FIG. 8). And after moving the protrusion 54 from the 1st groove | channel 30 to the 2nd groove | channel 32 and moving the protrusion 54 to the edge part of the said 2nd groove | channel 32 which faces the 3rd groove | channel 34, the connection part 50 is connected to a connection block. By displacing in a direction away from 24 (direction of arrow C), the protrusion 54 moves along the third groove 34 and separates from the other end 24b of the connecting block 24 (see FIG. 7). As a result, the connection state between the connecting portion 50 of the impactor 38 and the connecting block 24 of the guide wire 16 is released.

  Then, another guide wire 16 combined with the next bone filling material 14 is connected to the connecting portion 50 of the impactor 38. The next bone filling material 14 is inserted together with the guide wire 16 from the enlarged diameter portion 42 of the introduction tube 36 that is still inserted into the insertion port 60. Then, by pressing the bone grafting material 14 toward the vertebral body 12 side (in the direction of arrow B in FIGS. 11 and 12) with the impactor 38, the next bone grafting material 14 together with the guide wire 16 through the shaft portion 46 is obtained. Is filled into the fracture 56 of the vertebral body 12.

  The next bone grafting material 14 is supplied to another space in the cancellous bone 62 in the fractured portion 56 in the same manner as the bone filling material 14 previously filled. Also in this case, after the filling operation is completed, the guide wire 16 is integrally extracted from the vertebral body 12 by pulling out the impactor 38 from the vertebral body 12.

  The operator confirms by a monitor that the bone filling material 14 is sufficiently filled in the fractured portion 56, and the filling operation of the bone filling material 14 is completed.

  Finally, the introduction tube 36 of the filling device 18 is extracted from the insertion port 60, and a procedure such as closing the opened insertion port 60 with a predetermined plug 64 is performed (see FIG. 14). Then, a predetermined post-treatment such as suturing of the affected part is performed, and the percutaneous vertebroplasty is completed.

  As described above, in the present embodiment, the bone prosthetic material 14 is configured from the coil spring 20 spirally wound along the axial direction, and the guide wire 16 made of an elastic material is inserted into the coil spring 20. At the same time, it can be connected to an impactor 38 that presses the bone prosthetic material 14 toward the vertebral body 12 (in the direction of arrow B) via a connecting block 24 connected to the end of the guide wire 16.

  The guide wire 16 is engaged with the inside of the bone grafting material 14, and the bone is subjected to the pressing action by the impactor 38 in a state where the connection block 24 of the guide wire 16 and the connection portion 50 of the impactor 38 are connected. The filling material 14 and the guide wire 16 are integrally filled into the fractured portion 56 of the vertebral body 12 along the introduction tube 36. After the filling of the bone prosthesis material 14 is completed, the guide wire 16 can be integrally extracted from the inside of the vertebral body 12 by pulling out the impactor 38 from the vertebral body 12.

  As a result, when the guide wire 16 is taken out from the vertebral body 12, a complicated operation of grasping and pulling out the end portion of the guide wire 16 becomes unnecessary, and the force for pulling out the impactor 38 can be used simply and reliably. In addition, the guide wire 16 can be removed from the vertebral body 12. As a result, the fracture portion 56 of the vertebral body 12 can be filled with only the bone grafting material 14 made of the coil spring 20 and the bone filling material 14 can be filled smoothly and efficiently.

  In addition, when the fracture material 56 in the vertebral body 12 is filled with the bone filling material 14 and the next bone filling material 14 is continuously filled, the filling inserted into the vertebral body 12 through the insertion port 60 is also possible. Without removing the introduction tube 36 of the instrument 18, the guide wire 16 connected to the impactor 38 is engaged with the next bone filling material 14, and then the bone filling material 14 is continuously inserted into the introduction tube 36. The vertebral body 12 can be filled through. That is, each time the bone filling material 14 is filled, the introduction tube 36 does not need to be detached from the vertebral body 12, and the filling operation of the bone filling material 14 can be performed continuously, which is efficient. .

  Further, the impactor 38 is connected to the guide wire 16 by inserting the connecting portion 50 of the impactor 38 into the insertion hole 26 of the connecting block 24 of the guide wire 16, and the protruding portion 54 of the connecting portion 50 is connected to the connecting block 24. It can carry out simply by engaging with the 1st-3rd groove | channels 30, 32, and 34 of these. Similarly, the disconnection of the impactor 38 with respect to the guide wire 16 is similarly performed simply by removing the protrusion 54 engaged with the first groove 30 from the connection block 24 through the second and third grooves 32 and 34. It is possible. That is, after the guide wire 16 is removed from the vertebral body 12, the operation of removing the guide wire 16 from the impactor 38 and replacing it with another guide wire 16 can be performed quickly and easily.

  Furthermore, compared with the case where the fracture portion 56 is filled with calcium phosphate-based bone concrete, hydroxyapatite (HA) block, or the like, the fracture portion is filled by the elastic force by filling the bone prosthetic material 14 made of the coil spring 20. The strength at 56 is not significantly increased, and the strength of the fractured portion 56 can be suppressed within a predetermined range.

  That is, in osteoporosis or the like, generally, the bone strength of other vertebral bodies 12 adjacent to the vertebral body 12 is also reduced in the same manner as the fractured vertebral body 12. Therefore, when the strength of the fractured vertebral body 12 is increased at once by filling with a filler such as bone cement, a load is applied to the other adjacent vertebral body 12, and as a result, The vertebral body 12 may fracture in a chain. In contrast to such a case, according to the present invention, a rapid increase in strength at the fractured portion 56 due to the bone grafting material 14 can be suppressed, so that the other vertebral bodies 12 adjacent to the vertebral body 12 are linked. It is prevented that the bone is broken.

  Furthermore, even when the guide wire 16 is made of a superelastic metal material containing Ni metal and having a large elastic modulus, the guide wire 16 and the impactor 38 are used after the filling operation of the bone grafting material 14 is completed. By removing from the vertebral body 12, the guide wire 16 does not remain in the fractured portion 56, so that the range of material selection can be expanded.

  Further, when the bone filling material 14 is filled in the fracture portion 56 of the vertebral body 12, the bone filling material 14 can be deformed in the fracture portion 56 by the elastic force of the guide wire 16, Even when the bone grafting material 14 abuts against the fractured portion 56, an excessive load is not applied to the fractured portion 56, and it can be suitably guided in a desired direction inside the fractured portion 56. As a result, the bone filling material 14 can be continuously filled into the fractured portion 56.

  Further, since the coil spring 20 constituting the bone prosthesis material 14 can be bent by the elastic force of the guide wire 16 inserted therein, the inner wall surface of the vertebral body 12 is filled when the coil spring 20 is filled. Even when it hits the cancellous bone 62 in the fracture portion 56, the resistance can be overcome and the inside of the fracture portion 56 can be continuously moved.

  Furthermore, by constituting the bone prosthetic material 14 from the coil spring 20, for example, when filling with a filler such as calcium phosphate bone cement, there is no leakage of the filler from the fracture portion 56, which ensures safety. Is done.

  Of course, the bone prosthetic material system according to the present invention is not limited to the above-described embodiment, and various configurations can be adopted without departing from the gist of the present invention.

It is a whole composition perspective view showing the bone grafting material system concerning an embodiment of the invention. It is a whole perspective view which shows the bone grafting material and guide wire which comprise the bone grafting material system of FIG. It is an expansion perspective view of the connection block connected to the edge part of the guide wire shown in FIG. It is an expansion perspective view which shows the connection part of the impactor in the filling instrument which comprises the bone grafting material system of FIG. It is an expansion perspective view which shows the state by which the connection part of the impactor was engaged with the connection block of the guide wire shown in FIG. FIG. 6 is a cross-sectional view taken along line VI-VI in FIG. 5. FIG. 5 is an enlarged perspective view showing a state in which the connecting portion of the impactor of FIG. 4 is inserted into the insertion hole of the connecting block, and the protrusion is inserted into the third groove. 7 is an enlarged perspective view showing a state in which the projecting portion has moved from the end portion of the third groove to the second groove by rotating the impactor including the connecting portion when the connecting portion is further displaced toward the connecting block. It is. It is an expanded sectional view of the vertebral body which opened the insertion port with the puncture needle. FIG. 10 is an enlarged cross-sectional view showing a state where an introduction tube of a filling device is inserted into the vertebral body of FIG. 9 and a bone grafting material is inserted into the introduction tube. FIG. 11 is an enlarged cross-sectional view showing a state in which a fracture material of the vertebral body in FIG. FIG. 12 is an enlarged cross-sectional view illustrating a state where the fracture portion of FIG. 11 is filled with the bone grafting material and the filling operation is completed. FIG. 13 is an enlarged cross-sectional view showing a state where a guide wire is pulled out from the vertebral body of FIG. 12 by an impactor. FIG. 14 is an enlarged cross-sectional view showing a filling state in which a guide wire is extracted from the vertebral body of FIG. 13 and only the coil spring constituting the bone prosthesis material remains in the vertebral body.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 ... Bone prosthesis system 12 ... Vertebral body 14 ... Bone prosthesis 16 ... Guide wire 18 ... Filling instrument 20 ... Coil spring 22 ... Stopper part 24 ... Connection block 28 ... Engagement part 30 ... 1st groove | channel 32 ... 2nd groove | channel 34 ... third groove 36 ... introduction tube 38 ... impactor 50 ... connecting portion 54 ... projection 56 ... fracture portion 58 ... puncture needle 60 ... insertion port 62 ... cancellous bone 64 ... plug

Claims (4)

Bone prosthetic material consisting of a coil body in which strands are spirally wound,
A guide body made of an elastic material and inserted into the bone filling material;
An introduction tube that is inserted into the bone and guides the bone filling material into the bone;
An extruding member that is inserted in a freely displaceable manner with respect to the introduction tube, and pushes out the bone prosthetic material to the inside of the bone;
Engagement means capable of integrally disengaging the pushing member and the guide body;
With
The bone prosthetic material system, wherein the guide body is detachably attached to the push-out member by the engaging means. In the bone grafting material system according to claim 1,
The engaging means includes a first engaging portion provided at an end of the guide body,
A second engagement portion provided at an end of the pushing member facing the guide body and engaged with the first engagement portion;
A bone filling material system comprising: In the bone grafting material system according to claim 2,
The second engagement portion includes a protrusion protruding in the radial direction, and the first engagement portion is formed in a cylindrical shape into which the second engagement portion is inserted, and the protrusion A bone prosthesis system comprising an engaging groove to be engaged. In the bone grafting material system according to claim 3,
The engagement groove extends along the axial direction of the first engagement portion, and the lock in which the engagement state of the first and second engagement portions is maintained when the protrusion is engaged. Groove,
A guide groove that communicates with the lock groove and opens at an end of the one engaging portion;
With
When the second engaging portion is inserted into the first engaging portion, the protrusion is guided to the lock groove through the guide groove.

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