JP2008212461A - Orthopedic instrument set - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an orthopedic instrument set having a simple structure, facilitating the attachment/detachment relative to an implant and capable of executing a sure operation to the implant. <P>SOLUTION: This orthopedic instrument set is characterized in that an operation instrument 50 is provided with an abutment member 54 configured to project toward a sleeve member 30 engaged with a fixed member with the operation instrument mounted on the fixing member 40, and the abutment member abuts on the sleeve member in its projecting state to retain the engagement state between the sleeve member and the fixing member. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an orthopedic surgical instrument set, and in particular, includes a shaft-like member engaged and fixed to a bone, and a sleeve through-hole that accommodates the shaft-like member so as to be movable in the axial direction. A sleeve member provided with a side engagement portion, a fixed side engagement portion engaged with the sleeve side engagement portion, and a fixed plate portion extending from the fixed side engagement portion, The present invention relates to a structure of an operating instrument used when using an implant system including a fixing member having a fixing side opening that communicates with the sleeve through-hole in a fixing side engaging portion.

  Generally, a sleeve having a shaft-shaped member made of a bone screw or the like called a lag screw, and a sleeve through-hole that accommodates the shaft-shaped member so as to be movable in the axial direction, and a sleeve-side engagement portion provided on the base end side thereof A fixed side engaging portion that engages with the sleeve side engaging portion; and a fixing plate portion extending from the fixed side engaging portion; There is known an implant system for bone surgery including a fixing member having a fixing side opening communicating with a hole (for example, see Patent Documents 1 to 3 below).

  In the implant system configured as described above, the sleeve member configured to be able to insert the shaft-shaped member engaged and fixed to the bone and the fixing member fixed to the outer surface of the bone are provided separately. Therefore, the shaft-like member and the sleeve member can be introduced and fixed in the bone first, and then the fixing member can be engaged with the sleeve member. There is an advantage that the burden on the patient can be reduced by reducing the size, and the minimally invasive plate fixation (MIPO: Minimally Invasive Plate Osteosynthesis) following the flow of recent minimally invasive surgery (MIS). It has a structure suitable for implementation.

On the other hand, in this implant system, it is necessary to securely engage the sleeve side engaging portion of the sleeve member and the fixed side engaging portion of the fixing member within the body, but these engaging operations must be performed manually. Is difficult, and it is also difficult to confirm that the two are securely engaged. Therefore, in order to facilitate the engagement operation of such an implant system, a first instrument attached to the sleeve member and a second instrument attached to the fixing member are provided, respectively. There has been proposed an apparatus configured so that the sleeve member and the fixing member can be reliably engaged by positioning the first instrument and the second instrument via the third instrument (for example, The following patent document 4).
U.S. Pat. No. 4,438,762 JP-A-8-98846 JP 2002-65687 A JP 2005-511116 A

  However, in the apparatus including the first to third instruments described above, the first instrument and the second instrument are mounted after the first instrument is attached to the sleeve member and the second instrument is attached to the fixing member. Since the sleeve member and the fixing member are completely engaged with each other by positioning through the third instrument, the attaching and removing operations of the first to third instruments with respect to the implant are complicated. There was a problem.

  On the other hand, when a plurality of instruments as described above are not used, it is difficult to accurately position and engage the sleeve member and the fixing member both embedded in the body, and the sleeve member and the fixing member are engaged with each other. Even if they are combined, it is necessary to confirm whether or not the complete engagement state is reached while holding the fixing member, so that it becomes a complicated work and skill of the operator is required. There is a problem. Furthermore, since skill is required for confirmation with an X-ray image or the like, the fixing plate portion of the fixing member is screwed onto the femur in a state where the sleeve member and the fixing member are not completely engaged, that is, incompletely engaged. As a result of the fixation, there were cases where the surgery had to be repeated.

  Therefore, the present invention solves the above-mentioned problems, and its object is to provide an orthopedic surgical instrument set that has a simple structure, can be easily attached to and detached from the implant, and can be reliably operated on the implant. There is.

  In view of such circumstances, the orthopedic surgical instrument set of the present invention includes a shaft-shaped member and a sleeve through hole that accommodates the shaft-shaped member so as to be movable in the axial direction, and a sleeve-side engagement portion is provided on the proximal end side. A provided sleeve member, a fixed side engaging portion provided near one end so as to be engageable with the sleeve side engaging portion of the sleeve member, and the fixed side engaging portion A fixing member having a fixing plate portion extending from the other side to the other, the fixing member engaging portion including a fixing side opening communicating with the sleeve through-hole, and the sleeve side engaging portion including the fixing side An orthopedic surgical instrument set comprising: an operating instrument configured to be capable of mounting the fixing member in a manner in which an engaging portion can be engaged, wherein the operating instrument is attached to the fixing member. Before engaging the fixing member in the mounted state A contact member configured to protrude toward the sleeve member, and the contact member is in contact with the sleeve member in the protruding state to maintain the engagement state of the sleeve member and the fixing member; And

  According to the present invention, the contact member is protruded toward the sleeve member engaged with the fixed member in a state in which the operating instrument is mounted on the fixed member, and the contact member is engaged with the sleeve member by setting the protruded state. In order to maintain the engagement state between the sleeve member and the fixing member, the engagement state between the sleeve member and the fixing member can be confirmed by setting the contact member in the protruding state, and the engagement state is maintained. Therefore, it is not necessary to hold the operating instrument in a predetermined position with respect to the sleeve member. Therefore, the surgeon knows that the sleeve member and the fixing member are in an engaged state without referring to an X-ray image or the like during the operation, and can continue the operation with peace of mind, and the sleeve member and the fixing member are engaged. It is also possible to prevent the fixing member from being erroneously fixed to the bone in a state that is not in a state. Further, separate first and second instruments are attached to and detached from the sleeve member and the fixing member, respectively, and the first instrument and the second instrument are relatively positioned by the third instrument. Since it becomes unnecessary, the structure as a tool can be easily configured and the attachment / detachment work is facilitated.

  In the present invention, the abutting member abuts on an inner surface portion of the inner surface of the sleeve through-hole in the protruding state, which is on the opposite side to the engaging direction of the fixing member with respect to the sleeve member. It is preferable to maintain. According to this, the engagement state of the sleeve member and the fixing member can be reliably maintained even with a simple structure by bringing the contact member in a protruding state into contact with the inner surface portion of the sleeve through hole.

  In the present invention, the abutting member is configured to apply a pressing force to the sleeve member in the projecting process, and to drive the sleeve member and the fixing member relatively to the engaged state. It is preferable. According to this, a pressing force is applied to the sleeve member in the process of projecting the contact member, and the sleeve member and the fixing member can be driven toward the engaged state relatively. Even if the final engagement state is not set in advance, it is possible to obtain the final engagement state simply by projecting the contact member during the engagement of both members. Work can be performed easily.

  In the present invention, among the corresponding contact portions of the sleeve member and the contact member, at least one of the contact portions has an inclined surface portion inclined with respect to the protruding direction of the contact member, and the inclined surface portion It is preferable that a driving force component toward the engagement state is generated between the contact portion and the other contact portion in the projecting process of the contact member based on the pressing force. In this case, at least one of the contact portions of the sleeve member and the contact member is formed with an inclined surface portion inclined with respect to the protrusion direction of the contact member, so that the pressing force is different in the direction different from the protrusion direction. However, when the component is a component in the direction toward the engaged state, the sleeve member and the fixing member can be driven toward the engaged state. Therefore, since the degree of freedom in the protruding direction of the contact member is enhanced by the inclined surface portion, it is possible to easily design the operating instrument, such as configuring the operating instrument without providing a complicated structure.

  In this invention, it is preferable that the said contact member is attached with respect to the main-body part of the said operation instrument so that advancing / retreating is possible by the screwing structure provided with the axis line along a protrusion direction. According to this, the contact member can be easily protruded with respect to the main body portion of the operating instrument by rotating the contact member.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, an implant system including a shaft-like member, a sleeve member, and a fixing member according to the present invention will be described with reference to FIGS. 4A is a side view showing the assembled state of the implant system, FIG. 4B is a front view of the assembled state, FIG. 5A is an exploded front view of the sleeve member and the fixing member, and FIG. ) Is an exploded bottom view, FIG. 6A is an exploded longitudinal sectional view of the implant system, FIG. 6B is a rear view of the fixing member, FIG. 6C is a plan view of the fixing member, and FIG. ) Is a bottom view of the fixing member, and FIG. 6E is a longitudinal sectional view of the sleeve member.

  The implant system is engaged with and fixed to a bone in a state where the implant system is introduced into the bone. The shaft-shaped member 10 is composed of, for example, a bone screw (lag screw), and the shaft-shaped member 10 can be moved in the axial direction. The sleeve member 30 is provided with a sleeve through-hole 30a to be accommodated in the sleeve, and a sleeve side engagement portion 32 is provided on the proximal end side thereof, and the sleeve side engagement portion 32 of the sleeve member 30 can be engaged with the sleeve member 30. The fixed side engaging portion 41 provided near one end of the fixed member and the fixed side extending from the fixed side engaging portion 41 toward the other side in a direction having an obtuse angle with respect to the axial direction of the shaft member 10. A plate-shaped fixing member 40 having a plate portion 42 and including a fixed-side opening 41 a communicating with the sleeve through-hole in the fixed-side engaging portion 41. Each of these members is preferably composed of a biocompatible material, such as stainless steel, pure titanium, titanium alloy, or the like.

  This shaft-shaped member 10 has a screw 11 as a bone engaging element at the distal end and a tool engaging portion 12 at the proximal end, and is provided with a shaft hole 10a extending uniformly from the distal end to the proximal end. . The screw 11 is a tapping screw that engages with the inside of the bone, and fixes the shaft-like member 10 in the axial direction with respect to the bone while being screwed into the bone. Further, the tool engagement portion 12 is provided with an engagement hole 12a opened at the end, and the engagement hole 12a is rotationally driven in a state of being engaged with a rotary tool (not shown). The shaft hole 10a is for allowing a guide wire (not shown) to pass therethrough. With the guide wire inserted through the shaft hole 10a, the shaft-like member 10 is screwed into the bone while being guided by the guide wire.

  The shaft-like member 10 is configured as a bone screw in the illustrated example, but any shaft-like member that is introduced into the bone and engaged and fixed to the bone may be used. For example, it is configured with a diameter-expandable or inflatable tip engaging portion that is engaged and fixed to a bone, or a bone nail having various cross-sections that are driven into and fixed to a bone. Is also possible.

  The sleeve member 30 includes a cylindrical portion 31 and a hook-shaped sleeve side engaging portion 32 connected to an end portion of the cylindrical portion 31. The sleeve member 30 is provided with a sleeve through hole 30a that penetrates the cylindrical portion 31 and the sleeve side engaging portion 32. The sleeve through hole 30a can be inserted into the tool engaging portion 12 and the shaft portion 13 of the shaft member 10. It is comprised so that. As shown in FIG. 6E, a retaining portion 31a configured so that the inner diameter of the sleeve through hole 30a is smaller than the other diameter is formed at the distal end portion of the cylindrical portion 31, and this retaining portion 31a. Is configured so that the tool engaging portion 12 of the shaft-like member 10 cannot pass through. Thus, in the case of the illustrated example, the shaft-like member 10 and the sleeve member 30 are assembled so as to be able to protrude and retract in the state shown in FIGS. 4A and 6A, but not separated from each other.

  Moreover, as shown in FIG.6 (e), a pair of flat inner surface part 31b is formed in the inner surface of the retaining part 31a on both sides across the axis. The inner surface portion 31b is engaged with a pair of outer surface portions 13a provided on the shaft portion 13 of the shaft-shaped member 10, thereby restricting the shaft-shaped member 10 from rotating around the axis. However, when the tool engaging portion 12 of the shaft-shaped member 10 is engaged with the retaining portion 31a and the shaft-shaped member 10 is protruded most from the sleeve member 30, the inner surface of the retaining portion 31a is the shaft. The small-diameter neck portion 13b of the cylindrical member 10 is opposed to this, so that the anti-rotation action of the axial member 10 by the inner surface portion 31b is released, and the axial member 10 is configured to be rotatable with respect to the sleeve 30 member. It has become.

  Further, the sleeve side engaging portion 32 of the sleeve member 30 is configured to be able to be engaged with and disengaged from the fixed side engaging portion 41 of the fixing member 40 by sliding in the vertical direction in the figure. Here, as shown in FIG. 5A, an engagement mark 32t is formed on an opening edge provided in the sleeve side engagement portion 32 of the sleeve through hole 30a. In the case of the illustrated example, the engagement mark 32t is configured in a closed curve shape surrounding the fixed side opening 41a, and is preferably formed in a shape along the fixed side opening 41a, for example, an ellipse or an ellipse. The engagement mark 32t is desirably formed by removing a surface film (for example, an oxide film of pure titanium or a titanium alloy) covering the surface of the sleeve member 30 with a laser beam or the like.

  As shown in FIGS. 5 and 6, the sleeve side engaging portion 32 and the fixed side engaging portion 41 have tapered engaging surfaces 32 s and 41 s, and the fixing member 40 is engaged with the sleeve member 30 as described above. By sliding in the upward direction, which is the direction, both members are engaged in the state of overlapping in the thickness direction. Specifically, an inverted trapezoidal convex portion protrudes from the sleeve side engaging portion 32 in the thickness direction, and the engaging surface 32s is formed on the outer peripheral side surface of the convex portion. In addition, an inverted trapezoidal concave portion is formed in the fixed-side engaging portion 41 so as to fit in the thickness direction with the convex portion, and the engaging surface 41s is formed on the inner peripheral side surface of the concave portion. The engaging surfaces 32 s and 41 s are each formed in a U shape in plan view, and restrict the sleeve member 30 and the fixing member 40 from being separated in the thickness direction over a wide range. Further, the sleeve side engaging portion 32 and the fixed side engaging portion 41 have substantially the same width within a planar overlapping range, and the boundary line between both engaging portions is the side portion of the overlapping portion of both engaging portions. It is configured to appear only in

  The fixed member 40 includes the fixed side engaging portion 41 and a fixed plate portion 42 extending from the fixed side engaging portion 41. The fixed side engaging portion 41 is provided with a fixed side opening 41 a formed so as to communicate with the sleeve through hole 30 a of the sleeve member 30 in a state where the sleeve member 30 and the fixed member 40 are engaged. The fixed side opening 41a is configured such that the tool engaging portion 12 of the shaft-like member 10 or the proximal end side of the shaft portion 13 can pass through in the assembled state. When the sleeve member 30 and the fixing member 40 are completely engaged as shown in FIG. 4, the engagement mark 32t is hidden or visually recognized inside the fixed side opening 41a. Thus, it can be confirmed whether or not the sleeve side engaging portion 32 and the fixed side engaging portion 41 are completely engaged. In the case of the illustrated example, the sleeve-side engaging portion 32 and the fixed-side engaging portion 41 are completely engaged (the fixed-side engaging portion 41 is inserted to the innermost portion of the sleeve-side engaging portion 32 and hits it). In FIG. 4, the engagement mark 32t is configured to be hidden. However, the engagement mark 32t may be visually recognized along the inner edge of the fixed side opening 41a in the complete engagement state. Good. That is, the engagement mark 32t only needs to be able to determine the complete engagement state between the sleeve side engagement portion 32 and the fixed side engagement portion 41.

  The opening range of the fixed side opening 41a is formed in an extended shape (elliptical or oval) extending along the extending direction of the fixed member 40. The fixed side opening 41a communicates with the sleeve through hole 30a of the sleeve member 30, and at least a part of the opening range of the fixed side opening 41a is the opening of the sleeve through hole 30a when viewed along the axis of the sleeve through hole 30a. It is configured to have an opening range that matches the range. That is, even if the base end side of the shaft-shaped member 10 (the tool engaging portion 12 and the shaft portion 13) protrudes from the sleeve through hole 30a toward the fixed side engaging portion 41, the fixed side engaging portion 41 is not touched. It is configured to pass through the fixed side opening 41a. Here, of the inner surface of the fixed-side opening 41a, the inner surface portion on the one end portion (upper end in FIG. 4) side and the inner surface portion on the other end portion (lower end in FIG. 4) (opposing inner surface portion described later) are both. It is inclined parallel to the axis of the sleeve through hole 30a. In particular, the inner surface portion on one end side is an inclined inner surface portion 41t that is inclined toward the sleeve member 30 over the entire thickness direction of the opening edge of the fixed-side opening 41a. In the assembled state, there is a gap between the inclined inner surface portion 41t and the sleeve-side engagement portion 32 (the front-side end surface thereof or the opening surface of the sleeve through hole 30a that opens to this). Further, in the illustrated example, the inclined inner surface portion 41t is formed in a concave curved surface shape along the inner surface of the sleeve through hole 30a, and preferably continuous with the inner surface in the assembled state. The inclined inner surface portion 41t only needs to be engageable with an engagement member 51 of the operation instrument 50 described later, and therefore, the inclined inner surface portion 41t faces the sleeve member 30 and is spaced from the sleeve side engagement portion 32. What is necessary is just to become the overhanging inner surface part which has. For example, it may be a surface that faces the sleeve side engaging portion 32 with a gap in an opposed posture.

  The reason why the opening edge of the fixed-side opening 41a is configured as described above is that stress applied to the shaft-shaped member 10 near one end of the fixing member 40 (the shaft-shaped member 10 on the bone head of the femur). 4 is transmitted through the sleeve member 30 in order to secure rigidity capable of withstanding the stress, the fixed side is secured to the fixed side. This is because the opening edge portion on one end side of the opening edge of the opening 41a needs to be particularly thick. That is, in order to ensure the rigidity of one end portion of the fixing member 40 so that the base end side of the shaft-shaped member 10 can pass through the fixed-side opening 41a, it is inclined within a range that does not hinder the passage of the shaft-shaped member 10. It is required to increase the protruding amount of the inner surface portion 41t. In this case, the most preferable aspect for securing the rigidity of one end portion is that the inclined inner surface portion 41t is constituted by an inner surface portion inclined over the entire thickness direction as shown in the figure, and the inclined inner surface portion 41t is a sleeve. It is continuous with the inner surface of the through hole 30a (note that there is a slight step between them in the illustrated example).

  Further, in the present embodiment, the fixed plate portion 42 extends from the fixed side engaging portion 41 in an obtuse angle direction with respect to the axis 10x of the shaft-like member 10, so that the protruding inner surface portion such as the inclined inner surface portion 41t. It is advantageous to increase the rigidity of the fixing member by providing the one on the one end portion side of the fixing member 40 of the fixing side opening 41a. In this case, even if the base end side of the shaft-like member 10 is configured to be able to pass through the fixed side opening 41a, a sufficient amount of overhanging of the overhanging inner surface portion can be secured, and in particular, the inclined inner surface portion 41t is set to the axis 10x. This is because the thickness of one end portion of the fixing member 40 can be sufficiently ensured if it is formed so as to be inclined along the sleeve through hole 30a. Furthermore, if the inclined inner surface portion 41t is formed in a concave curved surface shape along the inner surface of the sleeve through hole 30a, the rigidity of the fixing member 40 can be further increased.

  On the other hand, the fixed plate portion 42 has a plurality of screw holes 42a. These screw holes 42a are configured to engage with the bone screw head when passing through a bone screw shaft (not shown), and the fixing plate portion 42 is fixed on the outer surface of the bone by the bone screw. Is done.

  The implant system configured as described above is used, for example, as follows when treating a fracture near the femoral head of the femur. First, a guide wire (not shown) is inserted from the outer surface of the femur into the bone head, and a hole is made in the bone with a drilling device such as a reamer using this guide wire as a guide means. At this time, the hole drilled in the bone has a smaller hole diameter corresponding to the shaft-shaped member 10 in the inner part, and a larger hole diameter corresponding to the outer diameter of the cylindrical part 31 of the sleeve member 30. A stepped hole shape having Thereafter, the guide wire is inserted through the assembly of the shaft member 10 and the sleeve member 30 shown in FIG. 6A, and the shaft member 10 is introduced (screwed) into the bone using the guide wire as a guide means. Then, the rotation operation portion at the tip of the rotary tool (not shown) is inserted into the sleeve through hole 30a and engaged with the tool engagement portion 12 of the shaft-like member 10. At this time, the sleeve member 30 is pulled out to the hand side of the rotary tool, and the shaft portion 10 is opposed to the sleeve member 30 by the neck portion 13b facing the retaining portion 31a and the flat portion 31b of the tubular portion 31. So that it can be rotated freely.

  In this state, the rotary tool is rotated to introduce (screw) the shaft-like member 10 into the bone. Confirm that the shaft-like member 10 has been introduced (screwed) to a sufficient depth (that is, that the tip of the screw 11 has reached the vicinity of the cortex in the bone head) with a fluoroscopic image such as an X-ray image. Then, the installation work is finished.

  After that, the sleeve member 30 is pushed into the bone, the inner surface portion 31b of the cylindrical portion 31 is engaged with the outer surface portion 13a of the shaft-shaped member 10, and the shaft-shaped member 10 and the sleeve member 30 are fixed around the axis. Like that. Then, the back surface of the sleeve side engaging portion 32 of the sleeve member 30 is brought into close contact with the bone surface. Thereafter, the fixing member 40 is inserted into the body, and the fixing side engaging portion 41 is slidably engaged with the sleeve side engaging portion 32 of the sleeve member 30 along the outer surface of the femur. Finally, the fixing plate portion 42 of the fixing member 40 is fixed on the outer surface of the femur (along the longitudinal direction of the tubular bone) by a bone screw (not shown).

  In the present embodiment, as described above, the outer surface portion 13a of the shaft-shaped member 10 and the inner surface portion 31b of the sleeve member 30 are engaged with each other in the rotational direction, so that the shaft-shaped member 10 is in the axis 10x direction with respect to the sleeve member 30. It can slide, but it cannot rotate. However, if it is not necessary to prevent the rotation of the bone head due to the rotation of the shaft-shaped member 10, the above-described engagement structure in the rotation direction of the shaft-shaped member 10 and the sleeve member 30 is not necessary. It is in a state of being rotatably connected.

  In the present embodiment, since the sleeve side engaging portion 32 and the fixed side engaging portion 41 are engaged in the thickness direction by the engaging structure (convex portion and concave portion) disposed therein, the sleeve side engaging portion is engaged. The overlapping part of the part 32 and the fixed side engaging part 41 is reduced in size (narrowed), and in particular, the burden on the patient is reduced even in an operation for an Oriental with a small femur size or an elderly person with weak bone strength. The effect that it can do is acquired.

  Furthermore, in this embodiment, since the width | variety and length of the sleeve side engaging part 32 can be reduced, the incision range at the time of a surgery can be reduced and the minimal invasiveness of a surgery can be improved. In particular, in the implant system according to the present embodiment, the sleeve member 30 and the fixing member 40 are separated from each other, and these are configured to be detachable. By reducing the length (dimension in the vertical direction in FIG. 5A) and the width (dimension in the horizontal direction in FIG. 5A) of the sleeve side engagement portion 32 of the member 30, the incision range is further reduced. This can further improve the minimally invasive surgery.

  FIG. 7 is a longitudinal sectional view showing a modification of the implant system mounted on the femur. Here, in the illustrated implant system, only the structure of the fixing member 40 'is different from that of the above-described embodiment, and the other shaft-like member 10 and the sleeve member 30 have the same structure as that of the above-described embodiment. Further, the state of engagement and fixation of the shaft-like member 10 with respect to the femur and the manner of fixing using the bone screw 48 on the outer surface of the femur of the fixing plate portion 42 of the fixing member 40 'are the same as in the previous embodiment. .

  The fixing member 40 ′ includes a fixed side engaging portion 41 and a fixed plate portion 42 similar to those of the previous embodiment, but further extends from the fixed side engaging portion 41 to the side opposite to the fixed plate portion 42. It differs from the said embodiment by the point provided with the extension part 43. FIG. The extension portion 43 is provided with one or a plurality of screw holes 43a, and another bone screw (lug screw) 47 can be inserted into the screw holes 43a so as to be engaged and held. Such a structure is preferable in that a plurality of pieces of bone can be securely fixed, particularly when a complicated fracture has occurred at the proximal end of the femur. This is also preferable in that it can be prevented from rotating around the shaft-like member 10 (lag screw).

  The implant system according to the present embodiment is configured to function without trouble when in the fully engaged state. In general, however, not only the completely engaged state but also the sleeve side engagement. If the engagement depth of the fixed-side engagement portion 41 with respect to the portion 32 functions without any trouble within a predetermined range, the case within the range is referred to as an “engagement state” in the present invention.

  Next, the structure of the operating instrument that can be used in the implant system will be described in detail. FIG. 1A is a partial cross-sectional view of an operating instrument 50 constituting a part of the orthopedic surgery system according to the present invention, and FIG. 1B is a side view of the operating instrument 50 of FIG. FIG. 2 is an explanatory diagram showing a holding and fixing operation of the operating instrument 50 with respect to the fixing member 40, and FIG. 3 is an explanatory diagram showing a protruding operation (abutment operation or pressing operation on the sleeve member 30) of the operating instrument 50.

  The operating instrument 50 includes a mounting portion 50A and a gripping portion 50B connected to the proximal end of the mounting portion 50A. The mounting portion 50A includes an engaging member 51, a holding member 52, and an engaging member 51. It has a main body portion provided with a moving member 53 for relatively moving the holding member 52. In addition, the main body portion is configured to be able to protrude toward the sleeve member 30 when the fixing member 40 is engaged with the sleeve member 30 with the mounting portion 50A mounted on the fixing member 40. A contact member 54 is attached. On the other hand, the grip portion 50B is provided with a grip handle 55 and an operation knob 56 that is rotatably attached to the tip of the grip handle 55.

  The engaging member 51 includes a wedge-shaped inner surface engaging portion 51b that engages with the fixing member 40 at an end portion 51a (lower end in the drawing). The inner surface engaging portion 51b has an engaging outer surface portion 51s having a shape substantially matching with the inclined inner surface portion 41t. In the case of the illustrated example, the engaging outer surface portion 51s has an outer surface shape inclined in the thickness direction corresponding to the inclined surface of the inclined inner surface portion 41t, and more specifically, a concave curved surface shape along the inner surface of the sleeve through hole 30a. It is comprised by the convex curved surface shape fitted to 41t of inclined inner surface parts. The end portion 51a is configured to be introduced into the fixed side opening 41a, and has an opening shape corresponding to a virtual range obtained by extending the opening range of the fixed side opening 41a as it is in the axial direction (for example, an elliptical shape or an oval shape). )have. Further, a screw hole 51 c is provided on the proximal end side of the engagement member 51, and a portion where the screw hole 51 c is provided is accommodated inside the holding member 52. In the state where the operating instrument 50 is mounted on the fixing member 40, the end surface of the end portion 51a is a flat surface parallel to the opening surface of the fixing side opening 41a of the fixing member 40, and the sleeve member 30 in this state. The engaging member 51 can move in a direction away from the holding member 52 to a degree sufficient to allow the fixing member 40 to be detached without interfering with the holding member 52.

  The holding member 52 has a flat end surface 52a formed at the tip, and a holding convex portion 52b protruding from the edge of the end surface 52a. A contact inner surface portion 52s is provided inside the holding convex portion 52b. The abutting inner surface portion 52 s has a concave curved inner surface shape that fits into an outer surface portion of one end portion of the fixing member 40. A receiving hole 52c for receiving the base portion of the engaging member 51 is opened in the end face 52a. The accommodating hole 52c accommodates the engaging member 51 in a posture in which the end portion 51a protrudes from the end surface 52a, and the engaging outer surface portion 51s of the engaging member 51 and the abutting inner surface of the holding member 52 The engagement member 51 is formed in a predetermined shape or with a margin so that the engagement member 51 can move in the direction in which the distance from the portion 52s increases or decreases. Further, the holding member 52 is provided with an insertion hole 52d communicating with the accommodation hole 52c.

  The moving member 53 is composed of a shaft body as a whole, and has a screw portion 53a that is screwed into the screw hole 51c of the engaging member 51 at the distal end portion, and its proximal end extends from the holding member 52 and extends above. It is inserted into the grip handle 55 of the grip portion 50B and is connected and fixed to the operation knob 56. The base end portion of the moving member 53 may be connected to an operation knob provided separately without being inserted through the inside of the gripping portion 50B. Alternatively, the base end portion is constituted by, for example, a hexagonal concave hole. A tool engaging portion to be provided may be provided, and the tool engaging portion may be configured to rotate the moving member 53 using a tool such as a wrench (not shown). An elastic member 57 composed of a coil spring or the like inserted through the moving member 53 is inserted between the engaging member 51 and the holding member 52, and the engaging member 51 is always attached to the holding member 52. It is pressed (biased) in a direction protruding from the receiving hole 52c. The set screw 58 is a retainer for holding the moving member 53 on the holding member 52.

  Therefore, by rotating the operation knob 56, as shown in FIGS. 2A and 2B, the moving member 53 can be rotated to move the engaging member 51 in the direction of appearing and retracting from the accommodation hole 52c. become. More specifically, when the moving member 53 rotates in the screwing direction with respect to the engaging member 51, the engaging member 51 is drawn into the accommodation hole 52c as shown in FIG. 2b, the engaging member 51 protrudes from the accommodation hole 52c by the pressing force of the elastic member 57, as shown in FIG.

  In the case of the illustrated example, the inclination direction of the engaging outer surface portion 51s is configured to be parallel to the inclination direction of the inclined inner surface portion 41t when the operating instrument 50 is attached to the fixing member 40. Thereby, since the contact area of both when the engaging outer surface part 51s engages with the inclined inner surface part 41t increases, the engagement strength can be increased.

  In the state where the engaging member 51 is disposed at the position shown in FIG. 2B, the distance between the engaging outer surface portion 51s and the abutting inner surface portion 52s is separated, so that the inner surface engaging portion 51b is connected to the fixed side opening 41a. The inner surface engaging portion 51b can be introduced into the fixed side opening 41a from the outside. On the other hand, in the state where the engaging member 51 is disposed at the position shown in FIG. 2A, the distance between the engaging outer surface portion 51s and the abutting inner surface portion 52s is close, so that the inner surface engaging portion 51b is fixed to the fixed side. It is impossible to escape from the opening 41a, and conversely, the inner surface engaging portion 51b cannot be introduced into the fixed side opening 41a from the outside.

  Therefore, the end 51a of the engaging member 51 is introduced into the fixed side opening 41a in the state of FIG. 2B, and then the moving member 53 is operated to move the engaging member 51 to the position shown in FIG. The inner surface engaging portion 51b engages with the inclined inner surface portion 41t and the contact inner surface portion 52s contacts the fixing member 40, so that the end portion 51a cannot escape from the fixed side opening 41a. The operating instrument 50 is held by the fixing member 40.

  In the present embodiment, the engagement inner surface portion 51s of the engagement member 51 is configured to have a convex curved surface shape that fits into the concave curved surface shape of the inclined inner surface portion 41t, so that the engagement inner surface portion 51s is in close contact with the inclined inner surface portion 41t. By doing so, the holding posture of the fixing member 40 attached to the operating instrument 50 can be regulated. However, since the end portion 51a of the engaging member 51 has an extended shape that can be fitted into the opening range of the extended shape of the fixed side opening 41a, the engaging inner surface portion 51s is not in close contact with the inclined inner surface portion 41t. The posture of the fixing member 40 with respect to the operating instrument 50 is roughly regulated only by inserting the end portion 51a of the combined member 51 into the fixing side opening 41a.

  Here, in the illustrated example, the engaging member 51 is formed with a concave groove 51d (see FIG. 1) that does not interfere with the abutting member 54. Therefore, the end 51a also has an opening of the concave groove 51d. The contact member 54 is formed and protrudes from the opening as described later.

  The above-described operating instrument 50 is suitable for the fixing member 40 shown in FIGS. 4 to 6. However, when the fixing member 40 ′ of the modified example shown in FIG. 7 is used, the holding protrusion of the holding member 52 is used. This can be dealt with by changing the position of the portion 52 b and the shape of the abutting inner surface portion 52 s so as to fit the tip of the extension portion 43. For example, the holding convex portion 52 is fitted in the screw hole 43 a provided in the extension portion 43, and the fixing member 40 is held by the operating instrument 50 by the contact inner surface portion 52 s contacting the inner surface of the screw hole 43 a. It is good also as a structure. The moving member 53 provided with the screw hole 51c, the insertion hole 52d, and the male screw 53a of the engaging member 51, and the elastic member 57 used as necessary, fix the operating instrument 50 to the fixing member. The mounting means for mounting on 40 is configured.

  Referring to FIG. 1A again, the holding member 52 is formed with a screw hole 52e that communicates with the receiving hole 52c and opens on the outer surface of the holding member 52. The contact member 54 is inserted into the screw hole 52e. It is screwed. The contact member 54 includes a screw portion 54a that is screwed into the screw hole 52e, and a projection portion 54b that protrudes from the screw portion 54a into the accommodation hole 52c. The screw portion 54a is formed with a tool engaging portion (for example, a square hole) facing outward, and engages with a tool (not shown) such as a wrench tool. It is comprised so that it may move along. The protrusion 54b protrudes into the receiving hole 52c and is configured to protrude from the opening of the receiving hole 52c in accordance with the rotation operation. A tapered surface 54c having a conical shape or a truncated cone shape is formed at the tip of the protruding portion 54b. The tapered surface 54c corresponds to the inclined surface portion.

  In the present embodiment, when the operating instrument 50 is mounted on the fixing member 40, when the contact member 54 does not protrude from the accommodation hole 52c as shown in FIG. And the fixing member 40 can be brought into an engaged state, or conversely, the engaged state can be released to separate the two members. On the other hand, as shown in FIG. 3 (b), when the contact member 54 is protruded from the accommodation hole 52c toward the sleeve member 30 in the above-mentioned engaged state, the operation tool 50 is fixed. Even if the distal end portion of the abutting member 54 is introduced into the sleeve through hole 30a through the fixed side opening 41a of the member 40 and the engagement state is to be released, the distal end portion of the inner surface of the sleeve through hole 30a has the above engagement. It is regulated to abut against the inner surface portion 30c (see FIGS. 4 and 6) on the opposite side to the mating direction, and the engaged state is maintained. As described above, the state of the contact member 54 that protrudes toward the sleeve member 30 and is in a position where the engagement state can be maintained is referred to as a “projection state” in the present invention.

  In the present embodiment, since the tapered surface 54c is formed at the tip of the abutting member 54, the sleeve member 30 and the fixing member 40 are not in an engaged state but are engaged insufficiently (engagement depth). If the taper surface 54c is in a range where the tapered surface 54c hits the upper edge of the inner surface portion 30c (this is also the upper edge of the sleeve through hole 30a), the contact member 54 is in the protruding state. When the taper surface 54c comes into contact with the upper edge in the process of projecting toward the upper side, a driving force component in the engagement direction is generated between the sleeve member 30 and the fixing member 40. The sleeve member 30 and the fixing member 40 can be relatively driven in the direction toward the engagement state by the force component. Therefore, although it is limited to the above range, even if the sleeve member 30 and the fixing member 40 are not in the engaged state, the engaging member 54 is engaged with the sleeve member 30 only by protruding the contact member 54. It is possible to move in the direction and obtain the final engagement state.

  Since the protruding direction of the contact member 54 is set parallel to the axis of the sleeve through hole 30a, when the sleeve member 30 and the fixing member 40 are engaged, the contact member 54 enters the sleeve through hole 30a. Even if the insertion depth increases, the contact state with the inner surface portion 30c does not change. Therefore, the engagement state can be confirmed easily and safely by inserting the contact member 54 consciously deeply into the sleeve through hole 30a.

  Further, the tapered surface 54c, which is an inclined surface portion, engages the fixing member 40 with respect to the sleeve member 30 by contact with the inner surface portion 30c (upper edge in the illustrated example) of the sleeve member 30 in the process of projecting the contact member 54. Although a driving force component that drives in the combined direction (upward direction in FIG. 4) is generated, a method for generating such a driving force component is not limited to the illustrated example. For example, instead of the tapered surface 54c of the contact member 54, a tapered surface may be formed in the vicinity of the upper edge of the sleeve through-hole 30a (upper part of the inner surface portion 30c).

  FIGS. 8 to 10 are schematic process diagrams showing work procedures when performing surgery using the operating instrument 50. First, the body surface is incised to form a skin opening a and an incision range A shown in FIG. The incision range A is formed obliquely from the skin opening a to the outer surface of the femur along the axis 10x of the shaft-shaped member 10. The inclination angle of the incision range A is usually about 130 to 150 degrees with respect to the outer surface of the femur (this is the angle between the axis 10x of the shaft member 10 and the extending direction of the fixed plate portion 42). (The obtuse angle corresponds to the obtuse angle.), And the position of the skin opening a and the inclination angle are preliminarily used as a fluoroscopic image such as an X-ray image by using a positioning tool (not shown) such as an angle template (angle checker). Is set based on After that, as described above, the guide pin is introduced from the outer surface of the femur, the reamer processing for forming the stepped hole, and the introduction of the shaft member 10 are sequentially performed, and the shaft member as shown in FIG. 10 and sleeve member 30 are introduced into the bone.

  Next, the operating tool 50 is engaged with the fixing member 40 in the state shown in FIG. 2B, and the operating member 50 is shifted to the state shown in FIG. Attach to 50. Then, the distal end of the fixing plate portion 42 is introduced into the body through the skin opening a, and the fixing plate portion 42 is inserted distally along the outer surface of the femur as shown in FIG. It is assumed that the fixed-side engaging portion 41 is disposed more distally than the sleeve-side engaging portion 32 of the sleeve member 30. Thereafter, as shown in FIG. 10, the fixing member 40 is slid proximally along the outer surface of the femur to engage the fixing side engaging portion 41 with the sleeve side engaging portion 32.

  As described above, the sleeve member 30 and the fixing member 40 are engaged with each other. At this time, in the operating instrument 50, the contact member 54 is protruded from the position shown in FIG. 3A. When the contact member 54 is pushed, the fixed-side engagement portion 41 of the fixed member 40 is driven in the engagement direction with respect to the sleeve-side engagement portion 32 of the sleeve member 30 by the pressing force of the contact member 54, and the above-described engagement Can be in a state.

  Here, if the contact member 54 can be brought into a protruding state by operating the contact member 54, it can be confirmed that the sleeve member 30 and the fixing member 40 are in an engaged state. You can continue your surgery without worrying about it.

  Further, since the contact member 54 is in the protruding state, the sleeve member 30 and the fixing member 40 are maintained in the engaged state, so that preparation work for confirming an X-ray image or the like or fixing the fixing plate portion is performed. There is no need to keep gripping the operating instrument 50 when performing the operation. Further, in the above-described state, the sleeve member 30 can be brought into close contact with the bone surface by applying an impact to the operating instrument 50, for example, the mounting portion 50A thereof, with a tool (not shown) and using the operating instrument 50 instead of the impactor. In particular, it is preferable to apply the impact in the axial direction of the sleeve member 30 by inserting the tip of the axial tool into the tool engaging portion (square hole) at the base end portion of the contact member 54. Conventionally, it has been necessary to use a dedicated impactor to bring the sleeve member 30 into close contact with the bone surface. In this case, it is necessary to apply the impact by engaging the dedicated impactor with the screw hole of the fixed plate portion 42. Therefore, there is a problem that the operation is complicated and the sleeve member 30 is lifted from the bone surface when the dedicated impactor is removed. In the present embodiment, by using the operation instrument 50 that is previously mounted on the fixing member 40 as a part of the impactor, it is possible to avoid the complexity of the work, and the operation is performed as it is even after the sleeve member 30 is in close contact with the bone surface. Since the instrument 50 is continuously held by the sleeve member 30 and the fixing member 40, the possibility that the sleeve member 30 is lifted from the bone surface is reduced.

  When the engaged state is obtained as described above, the bone instrument is inserted into the femur by inserting the bone screw into at least one screw hole 42a of the fixing plate portion 42 of the fixing member 40 while the operating instrument 50 is attached to the fixing member 40. By doing so, the fixing member 40 is fixed. At this time, when the first bone screw is inserted into any one of the screw holes 42a of the fixing plate portion 42 and screwed into the bone, the opening edge on the proximal side of the screw hole 42a is pressed by the head of the bone screw. In addition, by allowing the fixing member 40 to be compressed proximally, the sleeve side engaging portion 32 and the fixed side engaging portion 41 are completely engaged (the slide engaging structure is engaged most deeply). State) can be obtained more reliably.

  The operating instrument 50 can also be used when removing the implant system from the body. In this case, the operating instrument 50 is mounted on the fixing member 40, and the fixing member 40 is slid by using the operating instrument 50 in a state where the bone screw or the like engaged with the fixing plate portion 42 is removed. Remove from 30 and take outside. Then, the shaft member 10 and the sleeve member 30 are removed from the bone. If it does in this way, the skin opening a and the incision range A at the time of extraction can be made small, and the burden given to a patient can be reduced. At this time, in the operating instrument 50 of the present embodiment, the mounting operation on the fixing member 40 can be performed more easily than in the past, so it is difficult to mount the operating instrument 50 on the fixing member 40 embedded in the body. Never happen. Further, in the operating instrument 50 according to the present embodiment, the engagement strength (attachment rigidity) with respect to the fixing member 40 can be increased as compared with that using a conventional screw connection or the like, so that a temporary bone is formed when the fixing member 40 is removed. It is possible to prevent accidents such as destruction of the mounting structure due to removal resistance caused by the above.

  In the above embodiment, the inner surface engaging portion 51b of the engaging member 51 is disposed inside the fixed side opening 41a to be engaged with the inclined inner surface portion 41t, and the holding convex portion 52b of the holding member 52 is fixed to the fixing member. The operation instrument 50 is configured to be able to hold the fixing member 40 by contacting the outer surface portion of one end portion of the 40, but the holding member 52 is defined as the inclined inner surface portion 41t of the fixing side opening 41a. You may comprise so that it may contact | abut on the opposite inner surface part on the opposite side. In other words, the holding member 52 is provided with a holding convex portion 52b that comes into contact with the opposed inner surface portion, and the holding convex portion 52b and the inner surface engaging portion 51b of the engaging member 51 push the opening edge of the fixed side opening 41a from the inside. Thus, a structure in which the fixing member 40 is held may be used. In this case, the opposed inner surface portion is not an inner surface portion inclined so as to open to the front side as in the illustrated example, but a surface perpendicular to the opening surface of the fixed side opening 41a or a surface inclined toward the sleeve member 30 side. It is preferable that it is comprised.

  Further, in the above embodiment, as a member moving means that enables the relative movement of the engaging member 51 and the holding member 52, a feed screw mechanism having a moving member 53 and a screw hole 51c as a main structure is provided. The member moving means is not limited to the above embodiment, and can be constituted by various moving mechanisms such as a known slide type moving mechanism and a rotating type moving mechanism. Furthermore, the angle between the axis of the shaft-like member and the extending direction of the fixed member is not limited to an obtuse angle.

The partial sectional view (a) and side view (b) of the orthopedic surgical instrument set of the embodiment. The partial side view (a) and (b) which shows the operation | movement aspect of the engaging member in the mounting part of the operating device. Partial sectional drawing (a) and (b) which shows the operation | movement aspect of the contact member in a mounting part with the operating instrument. The side view (a) and front view (b) which show the assembly state of the implant system of embodiment. The exploded front view (a) and bottom view (b) of the sleeve member and fixing member of the implant system. The exploded sectional view (a) of the implant system, the rear view (b) of the fixing member, the plan view (c) of the fixing member, the bottom view (d) of the fixing member, and the sectional view (e) of the sleeve member. The longitudinal cross-sectional view which shows the structure and usage aspect of a different implant system. The schematic process drawing which shows the use condition 1 of the operating instrument. The schematic process drawing which shows the use condition 2 of the operating instrument. The schematic process drawing which shows the use condition 3 of the operating instrument.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 ... Shaft-shaped member, 30 ... Sleeve member, 30a ... Sleeve through-hole, 30c ... Inner surface part, 31 ... Cylindrical part, 32 ... Sleeve side engaging part, 40 ... Fixed member, 41 ... Fixed side engaging part, 41a ... fixed side opening, 41t ... inclined inner surface part, 42 ... fixed plate part, 50 ... operating instrument, 51 ... engaging member, 51a ... end part, 51b ... inner surface engaging part, 51s ... engaging outer surface part, 51c ... screw Hole 52 ... Holding member 52a ... End face 52b ... Holding convex part 52s ... Contact inner surface part 53 ... Moving member 53a ... Screw part 54 ... Contact member 54c ... Tapered surface (inclined surface part)

Claims (5)

A sleeve member having a shaft-like member, a sleeve through-hole that accommodates the shaft-like member so as to be movable in the axial direction, and a sleeve-side engagement portion provided on the proximal end side, and the sleeve-side engagement of the sleeve member A fixed side engaging portion provided near one end so as to be engageable with the portion, and a fixed plate portion extending from the fixed side engaging portion toward the other, The fixing member can be mounted in such a manner that the fixing side engaging portion can be engaged with the fixing side engaging portion, and the fixing side engaging portion can be engaged with the fixing side engaging portion. An orthopedic surgical instrument set comprising: an operating instrument configured to:
The operating instrument has an abutting member configured to project toward the sleeve member engaged with the fixing member in a state where the operating instrument is mounted on the fixing member, and the corresponding contacting member projects An orthopedic surgical instrument set characterized by maintaining an engaged state between the sleeve member and the fixing member by contacting the sleeve member in a state.   The abutting member abuts on an inner surface of the inner surface of the sleeve through-hole in the protruding state, which is opposite to the engaging direction of the fixing member with respect to the sleeve member, and maintains the engaged state. The orthopedic surgical instrument set according to claim 1.   The contact member is configured to apply a pressing force to the sleeve member in the projecting process, and to drive the sleeve member and the fixing member relatively to the engaged state. The orthopedic surgical instrument set according to claim 1 or 2.   Of the corresponding contact portions of the sleeve member and the contact member, at least one of the contact portions has an inclined surface portion inclined with respect to the protruding direction of the contact member, and the inclined surface portion is the contact surface. The orthopedic surgical instrument set according to claim 3, wherein a driving force component toward the engaged state is generated based on the pressing force between the member and the other contact portion in the projecting process of the member. .   The said abutting member is attached with respect to the main-body part of the said operating instrument so that advancing and retreating is possible by the screwing structure provided with the axis line along a protrusion direction. Orthopedic surgical instrument set as described in 1.

Images