JP2010029718A - Operating jig adapted to femur - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an operating jig used for useful artificial hip joint replacing operation. <P>SOLUTION: The head (210) of the operating jig (140) includes a jig positional aligning means having an elongated rod form acting as a spacer (142). The spacer (142) has an end (211). The end (211) is brought into contact with the fossa trochanterica to arrange the slot (143) of the jig (140) at a necessary position. A further jig positional aligning means is provided by a surface (212) constituted so as to receive the constituent part of a bone. This surface (212) is provided by the contour (146) of the base of the head (210) constituted so as to be combined with the contour of a femur. The slot (143) is almost vertically oriented with respect to the longitudinal direction of a rod (142) to function as an operating appliance guide means. This operating jig is preferable because osteotomy is performed in a state that a caput femoris part (3) is still arranged in the acetabulum. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a surgical apparatus for hip replacement surgery, and more particularly to a surgical jig for use in hip replacement surgery.

  Prior art hip replacement surgery techniques typically involve a surgeon first making a large initial incision to expose the hip joint. The surgeon then typically manipulates the patient's leg to remove the hip joint. In order to remove the hip joint, it is often necessary to apply a large force. Excessive manipulation and force may cause collateral damage to the patient, resulting in post-operative pain and / or prolonged duration of healing. Next, the femoral head is cut at the neck. A cavity for receiving a prosthetic acetabular cup (eg, LINK T.O.P. acetabular cup) is reamed at the hip joint, and a prosthetic stem (eg, Link C.F. P. hip joint stem) is inserted. In general, since the surgeon visually aligns the cutting and reaming instrument, a slight misalignment can occur. Therefore, after the prosthesis is attached, there may be a misalignment that cannot be visually perceived between the prosthetic acetabular cup and the prosthetic femoral head. This can lead to problems such as leg misalignment, inaccurate leg length, and / or inaccurate soft tissue tension. Furthermore, in the long term, the misaligned prosthetic component wears quickly, the sterility of the component may be deficient, and surgery may need to be repeated early.

  Throughout this specification, any discussion of the prior art should not be construed as an admission that such prior art is well known or is part of common general knowledge in the art.

  The object of the present invention is to overcome or ameliorate at least one of the disadvantages of the prior art or to provide a useful alternative.

  According to the embodiment of the present invention, the surgical jig applied to the femur at or near the femoral head during the hip replacement for the hip joint that defines the acetabulum is the surgical jig. Jig positioning means configured to be combined with at least the first bone component on the femur so as to be positioned with a predetermined relationship to the bone; Surgical instrument guide means positioned relative to the jig alignment means to guide the surgical instrument toward a predetermined portion of the femur when combined, wherein the femoral head is disposed within the acetabulum The jig alignment means is configured to be combined with the femur,

  Preferably, the jig alignment means includes a spacer configured to contact the first bone component or the second bone component. The spacer includes a bar provided on the head of the surgical jig. The bar defines an end configured to engage the femoral component and positions one or more slots that constitute the jig alignment means in a predetermined relationship with respect to the femoral component.

  Also, in an embodiment of the present invention, the jig alignment means has two or more slots, and the slots are configured to receive and guide cutting blades and other cutting tools that cut through the femoral head. .

  The jig positioning means includes a surface arranged at or near the main body of the surgical jig and configured to engage with a femoral head that is a bone component, the surface being an inverted V-shape. It is. In one aspect, the inverted V-shaped surface is provided by a pair of angled arms that are separated from the body by a laterally extending support member.

  In addition, the surgical jig further includes a surface having a contour arranged in the main body. The contour is configured to match and combine with the natural curvature of the femoral component, ie, the greater trochanter of the femur.

It is a perspective view of the jig by one embodiment of the present invention. It is a top view of the jig | tool shown by FIG. It is a side view of the jig | tool shown by FIG. It is a front view of the jig | tool shown by FIG. A greater trochanter, a femoral neck, and a mark with markings describing where the three usable cutting lines intersect the femoral neck and how the jig engages with the femoral component; It is a figure which shows the femoral head. It is a perspective view of a spacer. FIG. 7 is a plan view of the spacer shown in FIG. 6. It is a perspective view of a spatula. It is a figure which shows a part of process included in the preferable method of performing total hip arthroplasty. It is a figure which shows a part of process included in the preferable method of performing total hip arthroplasty. It is a figure which shows a part of process included in the preferable method of performing total hip arthroplasty. It is a figure which shows a part of process included in the preferable method of performing total hip arthroplasty. It is a figure which shows a part of process included in the preferable method of performing total hip arthroplasty. It is a figure which shows a part of process included in the preferable method of performing total hip arthroplasty. It is a schematic diagram which shows a part of process included in the preferable method of performing hip replacement. It is a schematic diagram which shows a part of process included in the preferable method of performing hip replacement. It is a figure which shows a femur. It is a top view of another spacer. FIG. 19 is a side view of the spacer shown in FIG. 18. It is a front view of another spacer. It is a top view of the spacer of FIG. It is a left view of the spacer of FIG. It is a front view of another spacer. FIG. 6 is a partially enlarged view of the spacer showing how the spacer engages the acetabular cup. It is a side view which shows another embodiment of the jig | tool by this invention. It is a top view which shows another embodiment of the jig | tool by this invention. It is an end view which shows another embodiment of the jig | tool by this invention. It is a top view of a drill. It is a top view of a spatula. It is a top view of an extractor. It is a top view of a punch. It is a side view of a punch. It is a top view which shows the cup holder for lefts. It is a top view which shows the cup holder for right. It is a top view which shows a handle assembly. It is a top view which shows an alignment handle. It is a side view of the 1st spacer. It is a top view of the 1st spacer. It is a side view of the 2nd spacer. It is a top view of the 2nd spacer. It is a side view of a 3rd spacer. It is a top view of the 3rd spacer. It is a side view of an alignment frame. It is a top view of an alignment frame. It is sectional drawing of a punch assembly. It is a top view of a fastener driver. It is an end view of a fastener driver. 48 is a plan view of the drive head of the fastener driver shown in FIGS. 46 and 47. FIG. 48 is an end view of the drive head of the fastener driver shown in FIGS. 46 and 47. FIG. It is a top view which shows the spacer member for a surgery of a left hip joint part. It is a top view which shows the spacer member for a surgery of a right hip joint part. It is a top view of a medium width additional spacer. It is an end view of a medium width additional spacer. It is a top view of the additional spacer of a thick width. It is an end elevation of an additional spacer with a thick width. It is a side view of a pin extractor. It is a top view of a pin. It is an end view of a pin. It is a top view of a screw. It is a top view of a screw. It is a top view of a screw. It is a top view of a screw. It is a side view of another embodiment of the jig by the present invention. It is a top view of another embodiment of the jig by the present invention. FIG. 6 is an end view of another embodiment of a jig according to the present invention. FIG. 5 is a perspective view of a patient immediately before the start of hip replacement, showing the pelvic holder and the initial incision site related to the greater trochanter bulge. It is a perspective view which shows the jig | tool by the deformation | transformation embodiment of this invention applied to the femur before osteotomy of the femoral neck. FIG. 31 is a perspective view showing an end of the extractor of FIG. 30 applied to a femoral head that has been osteotomized. FIG. 6 is a perspective view showing a portion of a cup alignment device applied to a patient's acetabulum. FIG. 3 is a perspective view showing a portion of a spacer alignment device applied to a patient's acetabulum.

  Preferred embodiments of the present invention will now be described, by way of example only, with reference to the accompanying drawings.

Referring to FIG. 1, a surgical jig 1 is configured to be applied to a femur 2. As best shown in FIG. 17, the femur 2 includes a femoral head 3, a femoral neck 4 and a greater trochanter 5 (which (but not limited to) is often a cutting site). The surgeon may provide a link T.P. O. P. Acetabular cup and C.I. F. P. If the use of a stem is selected, the femoral head 3 must be incised (ie “cut”), and this cut is made at about 1.5 cm from the base of the greater trochanter 5. This is done along a line that crosses the neck. Of course, MARGRON THR
And other prostheses such as the SP2 brace may require cutting other parts of the femur 2, such as those that cross the greater trochanter 5. The geometry of the jig 1 is configured for such an application as required.

  The jig 1 includes jig alignment means 6 configured to be combined with bone components 3, 4 and 5 to align the jig 1 in a predetermined relationship with the bone 2. The jig 1 further includes a surgical instrument guide means 7, and the surgical instrument guide means 7 is related to the jig positioning means 6 when the jig 1 is combined with the bone components 3, 4 and 5. Surgical instrument guide means is arranged to guide a surgical instrument such as a reciprocating blade toward a predetermined part of the bone component.

  The jig 1 includes a main body 8. One aspect of the jig alignment means 6 takes the form of first and second opposing projections 9 and 10 provided on the body 8. The protrusions 9 and 10 are configured to be combined with the femoral neck 4. Each of the projections 9 and 10 has a longitudinal dimension, and when the jig 1 is combined with the femoral neck 4, the longitudinal direction of the projections 9 and 10 is substantially the same as the longitudinal direction of the femoral neck 4. It is oriented so that This is best shown in FIG. 5, where lines 11 and 12 indicate where the protrusions 9 and 10 engage the femoral neck, respectively. The protrusions 9 and 10 are engageable so as to snap into the femoral neck 4. Each of the protrusions 9 and 10 is arcuate, and its center of curvature extends along the longitudinal direction.

  Another aspect of the jig alignment means 6 is a surface 13 configured to receive a bone component such as, for example, the femoral head 3. In the preferred embodiment, the surface 13 defines an inverted V shape, as best shown in FIG. The inverted V-shaped surface 13 is provided by an inverted V-shaped member 14 disposed on the main body 8 via a member 16 extending laterally. The inverted V-shaped member 14 is disposed on the side of the protrusions 9 and 10. Line 15 in FIG. 5 shows a cross section of the femoral head 3 to which the inverted V-shaped member 14 is applied.

  Yet another aspect of the jig alignment means 6 is a side wall 17 of the body 8 that is shaped to be combined with a bone component. More specifically, the side wall 17 has an arcuate shape with a curvature that abuts against the natural curvature of the greater trochanter 5. The line where the side wall 17 substantially abuts against the natural curvature of the greater trochanter 5 is best shown by line 18 in FIG.

Accordingly, the preferred embodiment of the jig 1 shown in FIGS. 1 to 5 is combined with the components of the femur 2 through the following elements.
Projections 9 and 10, which engage the femoral neck
A V-shaped member that engages a portion of the femoral head, and an arcuate sidewall 17 that abuts the natural curvature of the greater trochanter.

  In order to assist in the alignment of the osteotomy of the femoral neck 4, these alignment means combine to allow the jig 1 to be accurately placed on the femur 2 and reliably maintained in the proper position. . Alternatively, the jig 1 may be oriented in the opposite direction so that the inverted V-shaped member 14 contacts the femoral neck 4 and the projections 9 and 10 contact the femoral head. The jig 1 may be further fixed in the correct position by driving one or more fasteners such as a pin that reaches the femoral head 3 through the main body 8 or the protrusions 9 and 10. Since the femoral head 3 is cut, there is no problem even if the femoral head 3 is damaged by the fastener. As will be described in detail later, the jig 1 fixed to the femoral head 3 with a pin can also be used for assistance when removing the femoral head after cutting.

  As shown in FIGS. 1 to 5, the surgical instrument guide means 7 is provided between the inverted V-shaped member 14 and the protrusions 9 and 10. This helps prevent rotation or misalignment of the jig 1 due to the force that can be transmitted from the surgical instrument to the jig 1. The surgical instrument guide means 7 takes the form of one or more slots 20 provided in the body 8. The preferred embodiment has three slots 20. Each slot is provided at a different position in the lateral direction of the body 8 so that the slot 20 can guide the surgical instrument to two or more predetermined sites of the bone component. These predetermined sites are selected to correspond to different sized prostheses. For example, one type of prosthesis requires osteotomy of the femoral neck 4 at a position 1.5 cm from the base of the greater trochanter 5, so that one of the slots 20 is operated towards this position. Provided to guide the instrument. Each slot 20 extends across the body 8 and is configured to receive and guide a surgical instrument such as a reciprocating blade, such as a thread saw. Line 21 in FIG. 5 shows the placement of the slot 20 after the jig 1 has been combined with the femur 2. Another preferred embodiment (not shown) is configured to guide different instruments, for example one instrument guide means is a tubular member for guiding the blades of a rotary drill.

  Although not shown in FIGS. 1-4, a preferred embodiment includes a handle provided on the body 8. The handle has a length sufficient to extend from the patient to the outside when the jig 1 is assembled to the bone component. This allows the surgeon to operate the jig 1 to combine it with the femur 2 beyond the body of the patient.

The preferred surgical procedure is particularly suitable for hip replacement in cases of osteoarthritis, rheumatoid arthritis and osteonecrosis. However, it is not generally recommended in the following situations: -Use for patients with large anatomical deformations in the femoral head or femoral neck, or
• If the patient is obese, it will be difficult to confirm anatomical landmarks by palpation.

  In a preferred method of performing hip replacement on a patient, a posterior-lateral surgical approach is preferred, but other surgical approaches are sufficient. In fact, other surgical approaches may be necessary if, for example, severe damage to the previous sciatic nerve prohibits the posterior-lateral surgical approach.

  The preferred method begins with step a) exposing the greater trochanter 5 and the femoral neck 4 of the patient. This entails making an initial incision in the patient's thigh with a length of 3 cm to 7 cm, preferably 5 cm. One end of the incision begins approximately 1 cm to 3 cm after the greater trochanter 5 and curves backward therefrom. The posterior outer surface of the femoral neck 4 is exposed by removing the tendon of the patient's triceps. The triceps tendon may be labeled for later reattachment. In order to completely expose the femoral neck 4, a capectomy is also performed. It is important to note that the femoral head 3 is not removed at this stage. The patient's leg is preferably maintained at about 45 degrees from the vertical by a leg holder. It may also be useful for the surgeon to use a headlight.

  Step b) includes applying the jig 1 having the surgical instrument guide means 7 to the femur 2 such that the surgical instrument guide means 7 is adjacent to the femoral neck 4 as shown in FIG. . A preferred jig 1 is as described above. By appropriately combining the jig 1 with the femur 2, the surgical instrument guide means 7 is arranged at a substantially predetermined distance from the base of the greater trochanter 5. More specifically, this predetermined distance is between 10 mm and 20 mm, and in a preferred embodiment, at least one of the slots 20 is located 15 mm from the base of the greater trochanter 5.

  Depending on the situation, the surgeon may form a notch 22 on the side of the femoral head 3 of the osteotomy site 26 of the femoral neck 4 to assist in the continuous removal of the femoral neck from the acetabulum. Good. It is preferable that the notch 22 is formed before osteotomy. The notch may be formed by slightly pressing a reciprocating thread saw blade against the femoral neck 4 or the femoral head 3.

  Step c) includes using surgical instrument guide means to guide the cutting instrument to cut the femoral neck. In general, the saw blade is fed through one of the slots 20 so that it strikes the osteotomy site of the femoral neck 4, although other cutting means may be used. Next, the saw blade is actuated to reciprocate the cutting blade, and the saw blade is guided by the slot 20 and gradually moved across the femoral neck 4 to the femoral head 3. A part is cut off.

  Step d) involves removing the severed femoral head from the patient's hip joint. Many different techniques can be used to accomplish this. For example, the cut femoral head 4 may be removed from the hip joint using a spatula 23 as shown in FIG. As shown in FIG. 10, the notch 22 may provide a convenient site for the spatula 23 to move the femoral head 3 by lever. In order to assist the cutting of the tendon 25 holding the femoral head 3 in the hip joint portion 26, the portion 24 of the spatula 23 may be provided with a cutting means such as a sharp edge. A sharp edge 24 is provided between the two protrusions 27 and 28 to assist the surgeon in manipulating the spatula 23 so that the sharp edge 24 is directed toward the tendon 25. That is, the surgeon places the spatula 23 so that the protrusions 27 and 28 are located on both sides of the tendon 25, and then changes the position of the spatula toward the tendon 25 along its long axis. Edge 24 cuts tendon 25.

  As described above, when the jig is fixed to the femoral head 3 with a pin, another method for removing the femoral neck 4 may be used. In this case, a force may be applied to the jig 1, and the force is transmitted to the femoral head 3 via the pin. This force alone may be sufficient to remove the femoral head 3 from the hip joint. Alternatively, this force may assist other removal means such as the spatula 23 described above.

  Removing the cut femoral head 3 after first cutting the femoral neck 4 avoids the damage it can do by avoiding the need to first remove the hip joint in the prior art or Those skilled in the art will appreciate that it is preferable in terms of minimizing and simplifying the surgical procedure. Following removal of the severed femoral head 3, the hip replacement may be completed according to the prior art. However, a summary of many further improvements to known surgical procedures is given below.

A prior art method of implanting a prosthetic stem in the femoral shaft involves passing a bone compressor through the femoral canal. An alternative preferred method is
e) placing a guide wire 29 in the femoral canal 30 of the patient's femoral shaft 31 (see FIG. 11);
f) guiding the flexible reamer 32 to provide an aperture in the femoral canal 30 using the guide wire 29;
g) inserting the prosthetic stem 33 into the aperture such that the first end 34 of the prosthetic stem 33 protrudes from one end of the femoral shaft 31;
including. Alternatively, a detachable trial stem can be used in place of the final stem 33. In this case, if the replacement of the hip joint is checked and a satisfactory result is obtained, the actual part is implanted instead of the removable trial part.

A prior art method for reaming a cavity in an acetabulum involves visually aligning a reaming instrument. On the other hand, the preferred step of reaming the acetabulum to receive the prosthetic acetabular cup is:
h) placing the first end 34 in the patient's acetabulum;
i) inserting a spacer 35 (also referred to as a lollipop) between the end of the femoral shaft 31 and the acetabulum;
j) using the spacer 35 to determine a reference point 36 on the patient's acetabulum (see FIG. 12);
k) providing guidance for reaming the acetabulum using the reference point 36;
including.

  More specifically, examples of spacers 35 used in step i) are shown in FIGS. These objectives are to place the femur in an approximately appropriate position for the femur to take after completion of the surgery. The mark 40 of the spacer 35 provides guidance for determining the reference point in step j). The reference point 36 is preferably baked onto the acetabulum using a heating element that is functionally similar to the heated tip of the soldering iron. The spacer 35 includes a handle 37 and a slot 38 for placement in the first end 34 of the prosthetic stem 33.

  The center of the reference point 36 set in step j) gives the starting point for the acetabular reaming in step k). This provides a more accurate and consistent alternative to prior art reaming techniques that align visually.

  FIGS. 20-24 show another example 100 of spacers that can be used in step i) and step j). These spacers 100 include a peripheral edge 123 having a radius of curvature that substantially corresponds to the radius of curvature of the prosthetic acetabular cup 104. In the preferred embodiment, the radius of curvature of the peripheral edge 123 matches the radius of curvature of the smallest of the series of prosthetic acetabular cups 104. In step j), the surgeon uses the edge 123 as a guide when baking the reference point 36 on the acetabulum before reaming in step k).

  Prior art hip replacement procedures include a surgeon making empirical estimates regarding the size of the prosthetic component required, such as prosthetic neck / head length and acetabular cup size. . In this case, the hip joint is temporarily assembled using a trial part having an estimated size. If the resulting trial joint is not satisfactory, for example due to inaccurate tissue tension, the joint is disassembled and a different sized trial part is used. The preferred method provides an alternative procedure to this prior art procedure, again utilizing spacers 35. As best shown in FIG. 18, one or more spacers 35 or 45 have a spherical surface 48 provided in the center. The spherical surface 48 imitates the shape of the femoral head so as to function as a trial femoral head. In some embodiments, the spherical surface 48 is half the shape of a hemisphere (hemisphere) that partially corresponds to the prosthetic head. A spacer 35 or 45 having a spherical surface 48 is disposed at the first end 34 of the stem 33 closest to the acetabular cup so that the spherical surface 48 faces the acetabular cup. The thickness 39 of each spacer 35 is selected with respect to the size of available prosthetic parts. For example, one of the prior art prosthetic parts is available in three sizes: 40 mm, 43.5 mm and 47 mm. In this case, the thickness 39 of the at least two spacers 35 is 3.5 mm to accommodate the size increment between available prosthetic parts. These two spacers have parallel planes 46 and 47. By using different numbers or thicknesses of spacers 41, the effect of using different sizes of prosthetic components may be simulated. For example, FIG. 14 shows the edges of three spacers 35 applied to the first end 34 of the prosthetic stem 33. This mimics the spacing obtained using a 47 mm prosthetic component. When two spacers 35 are used, it is similar to the interval associated with a 43.5 mm prosthetic component, and so on. As best shown in FIG. 14, another spacer 45 is wedge shaped. This wedge shape determines the anteversion (or “orientation”) of the prosthetic acetabular cup and prosthetic femoral stem. If an anterior or anterolateral surgical approach is employed, an inverted wedge shape is required. The wedge shape tapers from a maximum width of 14 mm to a minimum width of about 3.5 mm.

  Another embodiment of a spacer 100 configured to control the anteversion of the prosthetic acetabular cup 104 is shown in FIGS. The spacer 100 includes a handle 101 that defines a first end 102. Positioning means 103 is provided at or near the first end 102. The alignment means 103 is configured to be combined with the prosthetic acetabular cup 104 such that, in use, the cup 104 is placed in a predetermined relationship with the patient's acetabulum.

  The alignment means 103 defines a plane 105 configured to abut the corresponding plane 106 of the prosthetic acetabular cup 104. The alignment means 103 includes engagement means in the form of one or more protrusions 119 configured to engage the concave inner surface 120 of the prosthetic acetabular cup 104. The plane 105 is defined by a semicircular surface 107 and is disposed at an acute angle 111 with respect to the plane 112 defined by the handle 101. Accordingly, the alignment means 103 takes the form of a wedge-shaped member 110 provided at the first end 102. Angle 111 is preferably in the range of 5 to 25 degrees. More preferably, angle 111 is in the range of 10 degrees to 20 degrees, and in a preferred embodiment, angle 111 is about 15 degrees. This angle 111 is selected to correspond to the natural tilt angle of the hip joint.

  In a preferred embodiment, the geometry of the alignment means relative to the handle is selected to suit the posterior-lateral surgical approach for hip surgery. Of course, other surgical approaches may require slightly different geometries, for example, different handle geometries shown at 23 are suitable for other surgical approaches as compared to FIG. The general goal is that when the spacer 100 is applied to the exposed end 34 of the prosthetic femoral stem 33, the alignment means 103 replaces the prosthetic acetabular cup 104 with the desired prosthetic cup 104 upon completion of the operation. It is ensured that they are arranged with a forward tilt substantially the same as the forward tilt.

  The alignment means 103 includes a slot 108 configured to receive the protruding end 34 of the prosthetic femoral stem 33. Once the end 34 of the stem 33 is placed in the slot 108, the spacer 100 engages the stem 33, similar to the way the spacer 45 engages the end 34 of the stem in FIG.

  The angular inclination of the prosthetic acetabular cup with respect to the prosthetic stem 33 should reflect the natural geometry of the hip joint as accurately as possible. As the spacer 100 rotates about the axis of rotation 118, the direction of the 15 degree angle tilt changes. Orientation guidance means 109 are provided at or near the second end 113 of the spacer 100 to give the surgeon guidance as to whether the alignment means 103 has been placed in the predetermined relationship to the patient's acetabulum. It is done. The orientation guidance means 109 includes a downward swing 114 provided rotatably on the spacer 100 so as to be suspended substantially vertically under the influence of gravity. The downward swing 114 is rotatably attached to the circular member 115 of the spacer 100 by a pin 116. A reference point 117 is provided on the spacer 100, and when the alignment means 103 is arranged in the predetermined relationship with the patient's acetabulum, the downward swing 114 is suspended along with the reference point 117. It has come to be. That is, as shown in FIGS. 20 and 23, when the spacer 100 takes a necessary rotational position with respect to the rotation shaft 118, the downward swing 114 is suspended in a state of being aligned with the reference point 117. Thus, when the patient is in the recumbent position, the slot 108 is associated with the end 34 of the femoral shaft and the spacer 100 is rotated about the shaft 114 until the downward swing 114 is aligned with the reference point 117, so that the prosthetic acetabular cup 104 Will have the necessary forward tilt with respect to the stem 33. That is, the correct use of the spacer ensures that the thicker end 121 of the wedge-shaped member 110 is positioned toward the front of the patient and the thinner end 122 is positioned toward the rear of the patient. Thus, the 15 degree tilt is directed outwardly of the patient and reflects the natural geometry of the hip joint.

More specifically, a preferred method for determining the size of the required prosthetic part is:
l) placing the trial head 41 at the first end 34;
m) placing a trial acetabular cup 42 on the reamed acetabulum (see FIG. 13); n) placing the trial head 41 in the trial acetabular cup 42;
o) Inserting one or more spacers 35 between the end of the femoral shaft 31 and the trial head 41 until the required fit between the trial head 41 and the trial acetabular cup 42 is obtained. (See FIGS. 13, 14, 15 and 16)
p) correlating the number or size of spacers 35 with the size of the required prosthetic component;
including.

  Whether the surgeon has obtained the necessary fit between the trial head 41 and the trial acetabular cup 42 in step o) by examining factors such as tissue tension, part alignment, leg length, etc. Determine. Once the required prosthetic part size is determined in step n), the trial prosthetic parts 41 and 42 (FIG. 15) are replaced with the final prosthetic parts 43 and 44 (FIG. 16), but the acetabular cup is now Is not inserted. In addition, the spacer 35 is used to determine the final precise orientation of the cup 44 relative to the stem 33 and then securely inserted so that the cup 44 is permanently set in place. A liner is placed in the acetabular cup 44 and then the prosthetic head 43 is repositioned. Once the range of motion of the new joint is confirmed, these layers are closed and the triceps tendon is reattached.

  With reference to FIGS. 25-65, the instrument constitutes a set of embodiments for performing a preferred surgical procedure. The instrument set includes another embodiment jig 140 that is applied to the femur 2 in the acetabulum to define the optimal site of the femoral neck 4 to be cut. This preferred surgical procedure begins by placing the patient in a lateral position, best shown in FIG. 66, with the side to be operated on top. A pelvic holder 230 is preferably used to keep the patient in the required position. In addition, it is preferable to lower the temperature of the patient's lower limbs before and during the operation.

  Surgical site exposure begins with a long incision of about 5 cm along line 231 provided about 2 cm after the protuberance of the greater trochanter 5 (indicated by line 232 in FIG. 66). Next, the tension muscle fascia is incised and the surgeon performs a blunt dissection until the neck 4 of the femur 2 is exposed. A self-holding device is used intermittently under the skin line. By peeling off the triceps tendon and the short lateral rotator muscle (which are labeled for later reattachment), the posterior outer surface of the femoral neck 4 is exposed. Craniotomy exposes the trochanter fossa (ie, the base of the greater trochanter 5), exposes the femoral neck 4, and then removes the acetabular osteophytes in a treatable position. . Unlike the prior art hip replacement surgery, the head 3 is not removed at this point. The surgeon may choose to use headlights to aid visibility. Any irrigation solution used during surgery is preferably cooled to minimize bleeding.

  The legs are placed in the leg holder and kept at about 45 degrees with respect to the vertical. The surgeon grasps the handle 141 of the jig 140 and manipulates the jig head 210 through the patient's wound to the femoral neck 4 as best shown in FIG. The head 210 of the jig 140 includes jig alignment means in the form of an elongated bar that acts as the spacer 142. The spacer 142 has an end 211, the end 211 abuts on the trochanter fossa, and the slot 143 of the jig 140 is disposed at a required position. This required position is in the preferred embodiment 5 mm to 25 mm from the trochanter fossa, most preferably 15 mm.

  The first version of the jig 140 shown in FIG. 67 is configured for use with the patient's left hip joint. Another version of the jig 140 is configured for use with the patient's right hip joint. The only substantial difference between the two versions is that a spacer 142 is provided on the opposite side of the head 210.

  Additional jig alignment means are provided by a surface 212 configured to receive a bone component. This surface 212 is provided by a base contour 146 of the head 210 that is configured to mate with the femoral contour.

  When the jig is correctly arranged, fixing means 143 such as a pin is driven into the femoral head 3 through the hole 144 of the head 210 of the jig 140 as shown in FIGS.

  The slot 143 is oriented at an acute angle with respect to the longitudinal direction of the rod 142. This angle depends on the angle required for the cut that is tailored to the particular prosthetic component used in the surgery. The slot 143 functions as a surgical instrument guide means, and is placed at the correct position for osteotomy of the femoral neck 4 by the jig 140. As described above, osteotomy is performed with the femoral head 3 still placed in the acetabulum. If deemed necessary, the surgeon may perform a secondary proximal wedge osteotomy in the vicinity.

  Following osteotomy of the femoral neck 4, the femoral head 3 is bent forward and removed using one or more of many possible options. A hole 233 may be made in the femoral head 3 using a drill 147 as shown in FIG. In that case, the self-tapping screw member 148 of the extractor 149 is screwed into the hole 233 by turning the handle 150 of the extractor 149. Once placed in the femoral head 3, the surgeon applies an outward force on the handle 150 that extends to the femoral head 3 and removes the femoral head 3. Another option is provided by spatula 151 that may or may not be used in conjunction with extractor 149. The distal end 152 tapers toward the edge and can be pushed under the femoral head 3 to assist in pushing the femoral head 3 out of the acetabulum. It is also possible to cut the tendon holding the femoral head 3 in the acetabulum using the tapered end 152. Other options for removal include sectioning or dicing the femoral head 3.

For the next surgical process, the patient's leg is supported perpendicular to the operating table. The proximal femur is prepared using trocar perforations and guides according to standard prior art. On either side of the femoral neck 4, a pointed Hohmann (or retractor) is placed. Alternatively, the femoral neck 4 may be lifted by applying a wide blunt Hohmann under the femoral neck 4.

  A bone compressor can be attached to the pushing surface 154 of the punch 153 and held in place by a pin 156. The bone compressor is pushed into the longitudinal axis of the femur using punch 153 by tapping proximal end 157 with a hammer, mallet or other suitable instrument. This process creates a cavity in the femoral canal for later attachment of the stem 34 (as described below). The pushing surface 154 of the punch 153 is laterally offset from the elongate longitudinal member 155, making it easier for the surgeon to push the bone compressor in the correct direction while somehow manipulating the punch 153 through the patient's wound. . This helps to minimize the risk that the bone compressor will be pushed into the femur at an angle that can cause the outer edge of the femur to crack. Next, a circular plane is formed at the end of the femoral neck 4 using a distance reamer. This completes the preparation of the femur for inserting the prosthetic stem, which is performed after the insertion of the acetabular cup described later.

  The surgeon then places the patient's lower limb in a neutral position on the operating table to prepare for acetabular reaming. Next, a pointed Homann is placed over the anterior acetabular margin. Next, the acetabulum is reamed while gradually increasing its diameter.

  In order to insert the prosthetic acetabular cup into the reamed acetabulum, the alignment handle 159 shown in FIG. 36, the handle 213 shown in FIG. 35, and shown in FIGS. 33 and 34, respectively. The cup alignment device 167 is assembled from the three parts of the left cup holder 158 or the right cup holder 158 that are being used. The alignment handle 159 includes a body 182 that defines a distal end 161 and a proximal end 223 and a handle 182 between these ends. At the proximal end 223, a gauge in the form of a downward swing 172 is disposed. Gauge 172 is configured to indicate whether the prosthetic acetabular cup is in a predetermined orientation with respect to at least a first plane of the reference system. A connector including an internal thread collar 163 is disposed at the distal end portion 161.

  A left or right cup holder 158 is attached to the alignment handle 159 via attachment means 160 provided at the proximal end 164 of the cup holder 158 as required. More specifically, the attachment means 160 includes a protrusion 169 that is plugged into a connector on the distal end 161 of the alignment handle 159 to ensure correct relative alignment between the two parts. To. When inserted together, the inner thread collar 163 engages with the outer thread 224 of the cup holder 158 to secure the two parts together.

  Handle 213 provides the surgeon with additional means in manipulating cup alignment instrument 167. In order to connect the handle 213 to the cup holder 158, the external screw 163 of the handle 213 and the screw 162 provided in the cup holder 158 are screwed. The resulting cup alignment device 167 is shown in FIG. 69 (although a portion of the cup holder 158 is not visible because it has been inserted into the patient's wound 234).

  In the next step, an appropriately sized prosthetic acetabular cup is attached to the cup alignment device 167. Depending on the size of the prosthetic acetabular cup, spacers 174, 215 or 216 may be required. The spacers of various widths shown in FIGS. 37-42 are engageable with the first end 168 of the boss 170 provided at the distal end 165 of the cup holder 158. More specifically, the protrusion 166 provided on the spacer 174 is engageable so as to be press-fitted into the corresponding aperture 214 provided on the first end 168 of the boss 170.

The surgeon selects a spacer 174, 215, or 216 having an appropriate width that matches the size of the prosthetic cup inserted into the patient's hip. The spacer 174 is not required for the smallest prosthetic acetabular cup. Spacers 174, 215, and 216 are consumables made of plastic material designed to withstand use in a single surgery. The instrument set includes four screws 217, 218, 219 and 220 having different lengths, as shown in FIGS. 59-62, respectively. Thus, this screw and spacer configuration meets the requirements for four sizes of prosthetic acetabular cups, each corresponding to the following configuration.
Prosthetic acetabular cup size 1: Screw 217, no spacer,
Prosthetic acetabular cup size 2: screw 218 and spacer 174,
Prosthetic acetabular cup size 3: screw 219 and spacer 215, and prosthetic acetabular cup size 4: screw 220 and spacer 216.

  The screws 217, 218, 219 and 220 preferably have an Allen head socket 221. Each screw is just long enough to extend axially through the aperture 214 of the boss 170. The screw head 222 is adjacent to the second end 171 of the boss 170. The threaded end 223 exposes just beyond the first end 168 of the boss 170 and just beyond any spacer 174, 215, or 216 that may engage the first end 168. The exposed tip of the threaded end 223 is threadably engageable with the prosthetic acetabular cup 104. In this manner, the prosthetic acetabular cup is attached to the cup alignment device 167. More specifically, the acetabular cup engages the cup holder 158 with the concave surface of the acetabular cup facing the second end 171 of the boss 170.

  The surgeon then manipulates the cup alignment tool 167 into the wound 234 so that the cup is adjacent to the reamed acetabulum, as shown in FIG. At this point, it is necessary to orient the cup alignment device 167 to ensure that the prosthetic acetabular cup is anatomically correct for insertion into the reamed acetabulum. is there. This is accomplished with reference to the gauge 172 of the alignment handle 159 in combination with the alignment frame 176.

  The gauge 172 has a needle 173 that functions as a downward swing. The needle 173 is rotatably provided on the alignment handle 159 so as to be suspended substantially vertically under the influence of a local gravity field. With this gauge, the surgeon places the acetabular cup at least on the first surface by positioning the cup alignment tool 167 so that the rotatable needle 173 of the swing 172 is aligned with a reference point in the form of a fixed needle 175. Can be correctly aligned.

  An alignment frame 176 shown in FIGS. 43 and 44 may be used to accurately align the acetabular cup in a surface other than the surface affected by the down swing 172. The alignment frame 176 includes a frame member 177 that defines a first end 178 and a second end 179. The frame member 177 has a substantially L shape in a side view and an A shape in a plan view. The first end 178 is provided with a contact pad 180, and is configured to contact a flat surface, specifically, a vertical side surface of the operating table. For example, the surgeon uses his knee to press the contact pad 180 against the side of the operating table. The second end 179 of the alignment frame 176 is positioned adjacent to the patient's hip joint.

  The second end 179 is provided with engagement means in the form of a slot member 181 and is aligned to project toward the patient's hip joint. The open end slot 225 of the slot member 181 defines a semicircular surface 226 having an inner radius of curvature that matches the outer radius of curvature of the body 182 of the alignment handle 159. That is, the slot 225 is sized to receive and direct the body 182 of the alignment handle 159. This geometry is such that the alignment handle 159 engages the engagement means 181 so that the alignment handle 159 is different from the second plane (which is different from the first plane associated with the downward swing 172). It is forced to a predetermined direction. This is because the slot member 181 has a width 227 sufficient to ensure that the longitudinal axis of the main body 182 is aligned with the axis of the slot member 181 when the main body 182 is engaged with the slot member 181. More specifically, when the main body 182 is disposed in the slot member 181, the main body 182 is substantially perpendicular to the side surface of the operating table.

For example, using the pelvic holder 230 and / or other means for fixing the patient's position on the operating table, the patient's hip joint may be kept in place relative to the operating table on the operating table. preferable. When the following conditions are met, the surgeon can be confident that the prosthetic acetabular cup has been correctly placed for insertion into the patient's hip.
The patient's hip joint is in place on the operating table,
The first end 178 of the alignment frame 176 abuts the side of the operating table adjacent to the patient's hip and the slot member 181 faces the patient's hip;
The body 182 of the alignment handle 159 is engaged with the slot member 181 and the rotatable needle 173 of the swinging swing 172 is aligned with the fixed needle 175, and the prosthetic acetabular cup is in a predetermined orientation Is shown.

  At this point, the surgeon inserts the acetabular cup into the reamed acetabulum using a punch assembly 183 as shown in FIG. More specifically, the push head 184 of the punch assembly 183 is placed against the second end 171 of the boss 170 and the insertion surface 185 is hammered while the surgeon grasps the punch assembly 183 via the handle 186. Or tap with similar instruments. This process secures the acetabular cup to the reamed acetabulum.

  As shown in FIGS. 46 and 47, the fastener driver 187 is an Allen key that combines with the Allen socket 221 of the screw 217, 218, 219 or 220 used to secure the acetabular cup to the cup holder 158. Preferably there is. The Allen key 187 has a rounded drive end 188 that can drive the screw 217, 218, 219 or 220 from a range of angles in addition to being straight aligned. This is preferable because it allows the surgeon some degree of freedom to deal with the difficulties associated with tightening the screw through the patient's wound 234. Allen key 187 also has a handle 189 configured to facilitate rotation of drive head 188. After the screws 217, 218, 219 or 220 are removed from the acetabular cup, the cup holder 158 is withdrawn from the patient.

  If desired, the acetabular cup can be further secured to the reamed acetabulum by an optional fastening means such as a screw that is threaded through the patient's pelvis via the acetabular cup. . The liner may then be inserted into the acetabular cup and a blunt Homann inserted under the liner to avoid subsequent misalignment.

  At this point, for example, C.I. F. P. The patient's leg is held in a vertical position so that a stem 33 such as a stem can be inserted into the femoral canal. After insertion, the end 34 of the stem 33 protrudes from the end of the femur.

  At this point, it is necessary to determine the length of the prosthetic neck necessary to obtain the correct post-operative leg length, tissue tension and muscle tension. A short trial head is placed on the stem and the hip joint is repositioned. As best shown in FIG. 70, at this point, the left or right spacer member is optionally attached to the alignment handle 159 in the same manner that the cup holder 158 was previously attached to the handle assembly 159. The spacer alignment tool 189 is assembled by attaching 190. That is, the protrusion 191 is inserted into the aperture provided at 161 at the distal end of the handle assembly 159, and the collar 163 is screwed into the proximal end 192 of the spacer member 190. Similar to the assembly of the previous cup alignment device 167, the handle 162 is screwed into the spacer member internal thread 193 provided at the proximal end 192 of the spacer member 190. That is, to assemble the spacer alignment tool 189, simply start with the cup alignment tool 167 and replace the cup holder 158 with the spacer member 190.

  The spacer member 190 includes a spacer 194 that has a slot 195 configured to engage the end 34 of the stem 33. This places the spacer 194 between the trial head and the femoral end 34 as shown in FIG. 70 (although the trial head is in the reamed acetabular cup and is not visible). . When properly positioned, the trial head is disposed within the hemispherical surface 203. Again, to ensure that the spacer 194 and the trial head are oriented in an anatomically correct manner, the surgeon may use the swing-down 172 and the alignment frame 176 while performing the following tests.

  With the spacer 194 in place, the surgeon tests whether the leg length and / or tissue tension and / or muscle tension is sufficient. If not, the surgeon pulls out the spacer alignment instrument 189 and fastens the medium width additional spacer 196 (as shown in FIGS. 52 and 53) to the spacer 194. The intermediate additional spacer 196 is fastened to the spacer 194 via a press fit component 198 provided in these two parts. If the leg length and / or tissue tension and / or muscle tension is still insufficient, the process is repeated using a thick additional spacer 197 instead of a medium additional spacer 196.

  That is, using a different width (or a different number) of spacers 194, 196 or 197 until an anatomically correct leg length and / or tissue tension and / or muscle tension is obtained. repeat. The surgeon then records the spacer thickness (or number of spacers) that gave the best results and correlates this record with the required prosthetic neck length according to a predetermined correlation scheme. For example, the shortest prosthetic neck length is used if the correct leg length and / or tissue and / or muscle tension is obtained without the need for additional spacers 196 or 197. Once the correct leg length or the like is obtained using the intermediate thickness additional spacer 196, the intermediate prosthetic neck length is used. The longest prosthetic neck length is used once the correct leg length or the like is obtained using the thick additional spacer 197. Of course, other correlation schemes may be devised for other methods.

  This process of confirming the size of the prosthetic component necessary to provide the correct leg length or the like is preferable to the prior art method of repeatedly removing the hip joint until the correct size of the prosthetic component is known.

  The hip joint is removed, and at this point, the trial prosthetic component is replaced with the actual prosthetic component, and the hip joint is repositioned. At this point, the surgeon confirms that the patient's leg moves within the proper range and reaffirms that acceptable leg length, tissue tension, and muscle tension are obtained. The surgeon completes the surgery by reattaching the triceps tendon and the short lateral rotator muscle and closing the various layers in a standard manner. It is recommended to apply cryocuff to the hip area to assist in post-operative functional recovery.

  After the femoral head 3 has been removed from the patient, if it is desired to retrieve the pin 143 embedded in the femoral head 3 while previously driven into the femoral head 3, a pin extractor 199 is used. May be. It may be necessary to test the femoral head 3, in which case the pin 143 may need to be removed. By pulling away the tongue 200 and the tongue 201 in the radial direction, the pin 143 can be inserted into the aperture 202 beyond the engagement member 203. Next, the pin extractor 199 is gripped in the radial direction so that the engaging member 203 exerts a lateral force on the notch 228 provided near the end 229 of the pin 143, thereby Grasp the pin 143 firmly. Next, a force in the longitudinal direction is exerted on the pin extractor 199, and this force is transmitted to the pin 143 to assist in pulling out the pin 143 from the cut femoral head 3. This longitudinal force may be applied by hitting the protrusion 204 with a hammer.

  It should be appreciated that this preferred method of hip replacement provides many advantages over prior art methods. Specifically, it eliminates the need to remove the hip joint prior to osteotomy, increases the accuracy and consistency of femoral canal and acetabular reaming, and provides the required prosthetic component sizing and orientation. There is generally little trial and error associated with the process to be established. In general, this results in a surgical procedure that minimizes damage to the patient's ligaments and muscle attachments and allows for faster patient recovery with less post-operative pain. Additional advantages typically associated with preferred embodiments include reduced wounds, reduced blood loss and coagulation, reduced risk of infection, shorter hospital stays, and reduced costs.

  Although the invention has been described with reference to specific examples, those skilled in the art will recognize that the invention may be implemented in many other forms.

Claims (31)

A surgical jig applied to the femur head at or near the femoral head during hip replacement for the hip joint that defines the acetabulum,
Jig positioning means configured to be combined with at least a first bone component on the femur so that the surgical jig is positioned with a predetermined relationship to the femur;
A surgical instrument guide means that is disposed relative to the jig alignment means so as to guide a surgical instrument toward a predetermined site of the femur when the surgical jig is combined with the bone component;
Including
With the femoral head positioned in the acetabulum, the jig alignment means is configured to be combined with the femur.
Surgical jig.   The jig positioning means is configured to position the surgical instrument guide means at a predetermined distance from the first bone constituent part or the second bone constituent part. The surgical jig according to claim 1, comprising a spacer configured to abut against the component.   The surgical jig according to claim 2, wherein the spacer is an elongated rod.   4. The device according to claim 1, wherein the jig positioning means includes a surface configured to receive the first bone component, the second bone component, or the third bone component. 5. The surgical jig according to claim 1.   The surgical jig according to claim 4, wherein the surface includes a contour configured to combine with a contour of the femur.   The surgical jig according to any one of claims 1 to 5, wherein the surgical jig further includes a head provided at a distal end portion of a handle. The surgical jig further includes a head provided at a distal end of the handle;
The surgical jig according to claim 2, wherein the spacer is an elongated bar provided on the head.   The surgical jig according to claim 1, wherein the surgical instrument guide means is provided with one or more slots. The surgical instrument guide means comprises one or more slots;
The surgical jig according to claim 6, wherein the one or more slots are disposed on the head. The surgical instrument guide means comprises one or more slots;
The one or more slots are disposed on the head;
The surgical jig according to claim 7, wherein the longitudinal direction of the bar extends at an acute angle with respect to the longitudinal direction of the slot.   The surgical jig according to any one of claims 8 to 10, wherein each of the one or more slots is configured to receive and guide a reciprocating cutting edge.   12. The head according to any one of claims 8 to 11, wherein the head is provided with two or more slots, and the two or more slots can guide the surgical instrument to two or more predetermined sites on the femur. The surgical jig described in 1.   The surgical jig according to claim 12, wherein each of the predetermined portions on the femur is selected to correspond to a prosthetic component having a different size.   The surgical jig according to claim 1, further comprising fixing means for fixing the surgical jig to the femur at a selected position.   The surgical jig according to claim 14, wherein the fixing means includes a pin that can be driven into the femur through a hole in the head of the surgical jig.   The surgical jig of claim 3, wherein the bar includes an end configured to abut the trochanter fossa of the femur.   The surgical jig according to claim 16, wherein the size of the bar is determined so as to arrange the surgical instrument guide means at a distance of 5 mm to 25 mm from the trochanter fossa.   The surgical jig according to claim 17, wherein the distance is about 15 mm.   The surgical treatment according to any one of claims 1 to 18, wherein the jig positioning means includes first and second protrusions that are opposed to each other and are provided on a main body of the surgical jig. Ingredients.   The surgical jig according to claim 19, wherein the protrusion is configured to be combined with a femoral neck.   Each of the projections has a longitudinal dimension, and when the surgical jig is combined with the bone component, the longitudinal direction of the projection is oriented in substantially the same direction as the longitudinal direction of the femoral neck. The surgical jig according to claim 20.   The surgical jig according to any one of claims 19 to 21, wherein the protrusion is engaged with the bone constituent portion so as to fit in a snap-type manner.   The surgical jig according to claim 21 or 22, wherein the protrusion has an arcuate shape, and a center of curvature of the protrusion extends along the longitudinal direction.   The surgical jig according to claim 4 or 5, wherein the surface defines an inverted V shape.   The surgical jig according to claim 24, wherein the inverted V-shaped surface is provided by an inverted V-shaped member provided on the main body. The jig positioning means includes first and second protrusions provided on the main body of the surgical jig and facing each other,
The surgical jig according to claim 25, wherein the inverted V-shaped member is provided on a side of the protrusion.   27. The surgical jig according to claim 26, wherein the surgical instrument guide means is provided between the inverted V-shaped member and the protrusion.   The surgical jig of claim 6, wherein the handle has a length sufficient to extend outwardly from the patient when the head of the surgical jig is combined with the femur.   The jig alignment means includes a body defining a sidewall configured to combine with the first bone component, the second bone component, the third bone component, or a further bone component. The surgical jig according to any one of Items 1 to 28.   30. The surgical jig of claim 29, wherein the side wall is arcuate.   31. A surgical jig according to claim 30, wherein the arcuate side wall is shaped to abut against the natural curvature of the greater trochanter of the femur.

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