JP2011010831A - Fixing tool for cranial bone - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a flap type fixing tool which can easily perform fine adjustment in an operation method for fixing the cranial bone flaps at the prescribed position of a cranial bone craniotomy part.SOLUTION: The fixing tool for cranial bone includes: an inner flap 10 placed so as to stride over the cranial bone flaps and a cranial bone craniotomy part edge on the inner face side of the cranial bone; an outer flap 20 placed so as to stride over the cranial bone flaps and the cranial bone craniotomy part edge on the cranial bone outer face side; a shaft 30 penetrating the inner flap 10 and the outer flap 20; and a movable tube body 40 which moves along the shaft 30 when pressed with a finger but stops when not pressed. On one end of the shaft 30, there is an inside stopper 31 and a movement in a direction to the inside the head part of the inner flap 10 is stopped. By pressing the tube body 40, a position in the shaft 30 of the outer flap 20 is finely adjusted, is fixed temporarily, and then, is cut at the contact point of the outer flap 20 and the movable tube body 40. The cranial bone flaps are finally fixed by an outside stopper for stopping the movement of the outer flap 20 with respect to the shaft 30.

Description

  The present invention relates to a skull fixation jig used for fixing a skull valve cut out during craniotomy to an open head after surgery.

  It may be accompanied by craniotomy in the medical field. For example, craniotomy may be performed for the treatment of cerebral aneurysms and the like in neurosurgery. Craniotomy involves incising the patient's scalp to expose the skull, drilling a plurality of perforations called barholes around the perimeter of the craniotomy, and cutting the skull between these perforations to the osteotomy line saw It is common to cut the skull flap from the skull by cutting, etc. Then, through the craniotomy formed after the skull flap is cut off, the internal dura mater is incised, and the brain tissue is treated. After the intracranial treatment, the bone flap is returned to the opening and fixed again, and the wound on the scalp is stitched together.

To repair the craniotomy after the treatment of the brain tissue is completed, it is necessary to fit the cranial flap to the cranial head after covering the dura mater, but the skull cut with a drill and osteotomy line saw etc. Since a gap is formed between the valve and the skull, the skull valve cannot be fixed to the skull simply by fitting.
Thus, in the prior art, mainly two types of skull flap fixation are used.
The conventional first skull flap fixation method is a method of filling a gap by embedding a tapered bar hole button that tapers toward the insertion side into the perforation. For example, a barhole button whose main material is a porous calcium phosphate compound is known (Patent Document 1, etc.).

  The conventional second skull flap fixing method is a skull valve fixing method using a flap type fixing jig. The flap type fixing jig is a jig in which two opposing flaps are connected by one shaft, and the size of the flap is selected to be larger than the size of the bar hole. The shaft is passed through the barhole, and both the front and back surfaces of the barhole are closed with flaps, and the flap interval is fixed as the thickness of the skull perforation edge and skull bone flap so that they are sandwiched between two flaps. Thus, the skull bone flap is fixed at a predetermined position of the skull drilling (Patent Document 2). There are various mechanisms for moving and fixing the flap with respect to the shaft. For example, in Patent Document 2, a ratchet type movable adjustment mechanism is provided between the shaft and the flap. If the ratchet movement is stopped when the flap is moved to a ratchet relative to the shaft and the flap interval becomes the thickness of the skull perforation edge and skull bone flap, the flap interval is approximately the thickness of the skull perforation edge and skull bone flap. Can be fixed. Thereafter, the remaining shaft portion is cut and removed.

JP-A-5-237137 JP 2004-008804 A

However, the conventional skull fixation method has the following problems.
The above-described conventional skull fixation method using a barhole button is a so-called “crimped state” in which a tapered surface is pushed into the gap between the skull valve and the skull from the outside, so that the gap is widened. . Therefore, the skull valve can be fixed to the skull in the direction along the surface, but it is difficult to fix the skull valve to the skull in the thickness direction. For this reason, after craniotomy, due to the micromotion of the brain in the skull, etc., the caulking state loosens over time, and the barhole buttons and fillers fall off, and the skull valve sinks at the craniotomy . In order to prevent this dropout and sinking, it is preferable to use metal wire or fiber wiring or suturing in combination, resulting in a complicated surgical procedure and a large burden on the patient.

  Further, since the bar hole button is pushed into the bar hole and fixed at a stretch, it cannot be temporarily fixed, and once it is driven, fine adjustment is difficult. Since there are at least three bar holes, as the bar hole buttons are sequentially driven, there is a problem that it is difficult to finely adjust the position of the bar hole button that has been previously driven.

  Next, in the skull flap fixing method using the conventional flap type fixing jig, the skull valve can be firmly fixed in the thickness direction compared to the conventional method using the barhole button. Although it is an advantageous method, with the conventional flap type fixing jig, so-called temporary fixing or the like cannot be performed, and the flap type fixing jig is pressed and fixed one at a time, so fine adjustment is difficult once fixed. There was a problem. Since there are at least three bar holes, as the fixing of the flap fixing jig proceeds in sequence, there arises a problem that it is difficult to finely adjust the fixing position of the flap fixing jig fixed in advance. The point is the same as in the case of the barhole button.

  In view of the above problems, the present invention adopts a basic structure of a flap-type fixing jig in a skull flap fixing method for fixing a skull bone flap to a predetermined position of skull perforation, and a position for attaching to a plurality of bar holes. It is an object of the present invention to provide an improved flap-type fixing jig that can be easily temporarily fixed while confirming the mounting state or can be loosened again to finely adjust the mounting position and mounting state.

In order to achieve the above object, the skull fixation jig of the present invention is a skull fixation jig for fixing the skull bone flap to a predetermined position of the skull open head,
An inner flap arranged to straddle the skull bone flap and the skull cranial margin on the inner surface of the skull;
An outer flap arranged to straddle the skull bone flap and the skull opening edge on the outer surface side of the skull;
A shaft penetrating the inner flap and the outer flap;
An inner restraining body for restraining movement of the inner flap provided at one end on the shaft toward the inner side of the head;
A tube body provided on the shaft in an outward direction of the skull from the outer flap, and is stationary with respect to the shaft by a frictional force between an inner wall surface and the shaft surface, and a pressing force applied from the outside is A movable tube body that moves along the shaft when the frictional force is exceeded,
It is a skull fixing jig capable of fixing the position of the inner flap on the shaft by the inner restraining body and temporarily fixing the position of the outer flap on the shaft by the tube body.

  With the above configuration, the position of the outer flap on the shaft can be finely adjusted, the skull fixing jig can be temporarily fixed at a plurality of (for example, four) bar holes, and the skull bone flap is positioned at a predetermined position of the skull open head. After fitting in, the attachment position of each skull fixing jig can be finely adjusted while checking the overall balance. In this way, the skull fixing jig in the temporarily fixed state is provided with an appropriate clamping force between the outer flap and the inner flap by the movable tube body, and becomes independent by sandwiching the skull bone flap and the skull open head edge. That is, since the skull fixing jig in the temporarily fixed state is independent without being supported by the practitioner's fingers, the skull fixed state can be confirmed before the main fixing without blocking the operator's hand.

  When the skull fixing jig of the present invention is permanently fixed, the movable tube body is in a state of being temporarily fixed so as to straddle the skull flap and the skull head by pressing the movable tube body. And cutting the contact between the outer flap and the outer flap, and dynamically producing an outer restraining body that stops the movement of the outer flap in the outward direction of the skull at the cutting opening. The main fixation is performed with the skull bone flap and the skull open head sandwiched by a flap.

Here, the movable tube body preferably has a throttle structure in which the outer shape of the end facing the outer flap is narrowed down. For example, the throttle structure is preferably a taper structure or a round structure. .
With the above configuration, when the shaft is cut in the main fixing, the movable tube is not easily cut off together, and a chip piece or the like is not generated.

Next, in the structure of the skull fixing jig of the present invention, a structure in which the outer flap and the movable tube body are integrated so as to be separable is preferable.
If the outer flap and the movable tube body are not integrated, the outer flap will play freely on the shaft, and in the operation of fitting the skull bone flap in place on the skull open head, the skull fixing jig should be used. When the inner flap is erected downward, the outer flap that should be above falls down so that it overlaps the inner flap, and it is necessary to fit the skull flap in place on the skull open head while lifting the outer flap upward is there. When the outer flap and the movable tube body are integrated, when the movable tube is stationary on the shaft, since the outer flap is stationary on the shaft together with the movable tube, it is possible to save time and effort to lift the outer flap upward. The outer flap and the movable tube body are preferably separable. This is because it is necessary to separate the outer flap and the movable tube to manufacture the outer restraining body during the main fixing.

Next, a peripheral edge of the outer flap is bent toward the skull side, a peripheral edge of the inner flap is bent toward the skull side, and the outer flap and the inner flap It is preferable that the clamping force between the skull bone flap and the skull opening edge is improved.
If there is such bending, the clamping force between the skull bone flap and the skull open head edge is improved, which is useful for skull perforation.

It is also preferable that a scale is provided on the shaft. When a scale is provided on the shaft, the scale can be read and used as a clue when adjusting the distance between the outer flap and the inner flap in accordance with the thickness of the skull.
Next, the skull fixation method for fixing the skull bone flap using the skull fixation jig of the present invention to a predetermined position of the skull open head is roughly divided into two steps: a skull bone valve temporary fixation procedure and a skull bone valve main fixation procedure. Consists of procedures.

  First, the skull bone flap temporary fixing procedure includes a procedure in which the inner flap is restrained by the inner restraining body so as to straddle the skull bone flap and the skull open head edge on the inner surface side of the skull, and the skull A procedure of fitting a bone flap into a predetermined position of the skull open head; and depressing the movable tube body to move the outer flap in an inward direction of the head, and the outer flap on the outer surface side of the skull. And a procedure for temporarily fixing the valve and the skull opening edge.

  Next, in the skull bone flap main fixing procedure, the shaft is cut while pushing the outer flap in the head inward direction, and the movement of the outer flap in the head outward direction is stopped at the cut portion. This is a procedure for dynamically manufacturing the outer restraining body to fix the outer flap.

Here, as a jig used in the above-described skull fixing method of the present invention, it is preferable to use a fixation assisting instrument including a shaft gripper that holds the shaft and a shaft cutter that cuts the shaft.
With this fixation assisting device, when the shaft is cut in the skull bone flap main fixation procedure, the shaft is clamped by the shaft gripper of the fixation assisting device and is cut by the shaft cutter of the fixation assisting device. By doing so, the cut shaft section can be prevented from falling into the skull.

Furthermore, when this fixing support device is used, the cutting surface of the shaft is caulked by the shaft cutter of the fixing support device when the fixing support device is cut by the shaft cutter, and the outer restraining body is dynamically moved. Produced.
Note that when the shaft is cut in the skull bone flap main fixing procedure, the fixation assisting instrument presses the outer flap in the head inward direction, and the pressing force is applied to the skull bone flap and the skull craniotomy. It is preferable that the force is such that the skull bone flap and the skull opening edge are clamped by the outer flap and the inner flap without damaging the edge.

According to the skull fixing jig of the present invention, the position of the outer flap on the shaft can be finely adjusted, the skull fixing jig can be temporarily fixed at a plurality of bar holes, and the skull bone flap is attached to the skull open head. After fitting into a predetermined position, the attachment position of each skull fixing jig can be finely adjusted while checking the overall balance. In this way, the skull fixing jig in the temporarily fixed state is provided with an appropriate clamping force between the outer flap and the inner flap by the movable tube body, and becomes independent by sandwiching the skull bone flap and the skull open head edge. That is, since the skull fixing jig in the temporarily fixed state is independent without being supported by the practitioner's fingers, the skull fixed state can be confirmed before the main fixing without blocking the operator's hand.
According to the skull fixing method for fixing the skull bone flap using the skull fixing jig of the present invention to a predetermined position of the skull open head, there are roughly two procedures: a skull bone valve temporary fixing procedure and a skull bone valve main fixing procedure. It is possible to temporarily fix the skull fixation jig for multiple bar holes at the stage of the skull bone flap temporary fixation procedure, and attach each skull fixation jig while checking the overall balance. The position can be finely adjusted. At the stage of the skull bone flap main fixation procedure, the skull bone flap and the skull open margin are firmly clamped, which is useful for skull perforation.

The figure which shows typically the structural example of the skull fixing jig 100 of this invention which concerns on Example 1. FIG. The figure which shows making it move on the shaft 30 by pressing down the movable tube body 40 with fingers. The figure which shows typically the procedure of the temporary fixation of the skull bone flap using the skull fixing jig 100 of this invention (the 1) The figure which shows typically the procedure of the temporary fixation of the skull bone flap using the skull fixing jig 100 of this invention (the 2) The figure which showed the fixation assistance instrument 200 typically The figure which showed typically the procedure of this fixation of the skull bone flap 320 using the skull fixing jig 100 of this invention. The bird's-eye view of how the skull bone flap 320 is fitted to the skull open head 300 using the skull fixing jig 100 of the present invention (No. 1) FIG. 2 is a bird's-eye view of a state where the skull bone flap 320 is fitted into the skull open head 300 using the skull fixing jig 100 of the present invention (part 2). The figure which showed typically the external appearance of the skull fixing jig 100a concerning Example 2. FIG. The figure which showed typically the external appearance of the other skull fixing jig 100b concerning Example 2. FIG. The figure which showed typically the external appearance of the skull fixing jig 100c concerning Example 3. FIG. The figure which showed the structural example of the skull fixing jig 100d concerning Example 4. FIG.

  Hereinafter, examples of the skull fixing jig and the fixation assisting device of the present invention will be described. The present invention is not limited to these configuration examples.

First, the skull fixation jig 100 and the fixation support instrument 200 according to Example 1 of the present invention will be described.
FIG. 1 is a diagram schematically illustrating a configuration example of a skull fixing jig 100 according to the first embodiment of the present invention.
As shown in FIG. 1 (a), the skull fixing jig 100 according to the first embodiment has an inner flap 10, an outer flap 20, a shaft 30, an inner restraining body 31, before the skull bone flap is fixed (before use). A movable tube body 40 is provided.

The basic shape of the inner flap 10 is a flat plate member. In this configuration example, a petal-like cut is formed on the outer peripheral edge. After treatment, a hard and highly antibacterial metal that does not elute with body fluid is preferable because it is embedded in the skull. For example, pure titanium is preferable. The size according to a use location is used for the size of the inner flap 10. For example, if it is applied to a bar hole, the size is larger than the diameter of the bar hole. Further, for example, if it is applied to the gap between the skull open head edge and the skull bone flap, the size thereof is larger than the width of the gap. By selecting a size larger than the location to be applied in this way, it is possible to place the size so as to straddle the skull bone flap and the skull craniotomy edge at the location on the inner side of the skull as will be described later.
Moreover, as shown in FIG.1 (b), the inner flap 10 is provided with the through-hole 11 of a diameter a little larger than the diameter of the shaft 30 mentioned later. In this configuration example, the outer peripheral edge of the inner flap 10 has a petal-like cut.

Next, as with the inner flap 10, the outer flap 20 is a flat plate-like member. In this configuration example, the outer peripheral edge has a petal-like cut. After the treatment, it is in a state of being in close contact with the outer surface of the skull, and therefore, a hard metal having high antibacterial properties that does not elute with body fluid is preferable. For example, pure titanium is preferable. The size of the outer flap 20 is assumed to be larger than the size of the application portion such as the bar hole and the gap between the skull open head edge and the skull bone flap, like the inner flap 10. By selecting a size larger than the application location, the outer flap 20 does not pass through the gap between the barhole or the skull open head edge and the skull bone flap, and the skull at the application location on the outer side of the skull as will be described later. It can be placed across the bone flap and the skull open margin.
Moreover, as shown in FIG.1 (c), the outer flap 20 is provided with the through-hole 21 of a diameter a little larger than the diameter of the shaft 30 mentioned later. In this configuration example, the outer peripheral edge of the outer flap 20 has a petal-like cut.

  In this configuration example, as shown in the side view of FIG. 1A, both the inner flap 10 and the outer flap 20 are bent. The inner flap 10 is provided with a flexure bent toward the skull side, that is, upward, and the outer flap 20 is provided with a flexure bent toward the skull side, ie, downward. When the inner flap 10 and the outer flap 20 are bent in this way, as described later, when the outer flap 20 is pushed down, it acts as a kind of elastic body such as a spring, and the skull bone valve 320 is operated. And the skull open head edge 310 can be firmly clamped.

  The shaft 30 is a shaft that penetrates the inner flap 10 and the outer flap 20. Since it has a rod shape and stays in the bar hole after the treatment, it is preferably a hard and highly antibacterial metal that does not elute with body fluids. For example, pure titanium is preferable. The diameter of the shaft 30 should be strong enough not to be broken even when a load that firmly holds the skull bone flap and the skull open head edge between the inner flap 10 and the outer flap 20 is applied.

  As shown in FIG. 1A, the shaft 30 penetrates the inner flap 10 and the outer flap 20, respectively, and holds the inner flap 10 and the outer flap 20 so as to be movable in the axial direction. As described above, the inner flap 10 and the outer flap 20 are restricted from moving in the axial direction by the inner stopper 31 and the movable tube 40 provided on the shaft 30.

  The inner restraining body 31 is a structure provided in the head 30 inwardly of the inner flap 10 in the shaft 30 (in the direction opposite to the skull). The lower end portion is caulked to become flat and deformed to a size that the through hole 11 does not pass through. By providing the inner stop 31 in this manner, the inner flap 10 is restricted from moving in the axial direction at the end of the shaft 30.

  The movable tube body 40 is a tube body provided on the shaft 30 in the outward direction of the head from the outer flap 20 (the direction opposite to the skull). The tube body 40 has a function of finely adjusting the position of the outer flap 20 on the shaft 30 in order to restrict the movement of the outer flap 20 in the head outward direction and move on the shaft 30.

  The material of the movable tube body 40 is preferably a resin material subjected to antibacterial treatment, for example, a silicon resin. The inner diameter of the movable tube body 40 is substantially the same as the shaft diameter of the shaft 30 and is designed so that a frictional force is generated between the inner wall surface and the shaft surface of the shaft 30 as described later. Moreover, the outer diameter of the movable tube body 40 is larger than the diameter of the through-hole 21 of the outer flap 20, and if the movable tube body 40 exists, the movement of the outer flap 40 is restricted.

  The movable tube body 40 generates a frictional force between the inner wall surface of the tube and the surface of the shaft 30. This frictional force makes it possible to stand still on the shaft 30. As long as the pressing force applied from the outside does not exceed the frictional force, the shaft 30 is held. When the pressing force applied from the outside exceeds the frictional force, it moves along the shaft 30.

FIG. 2 is a diagram illustrating a state in which the movable tube body 40 is pushed down with a finger or the like to move on the shaft 30. As shown in FIG. 2 (a), when a pressing force that exceeds the frictional force is applied to the movable tube body 40 in a stationary state, the movable tube body 40 moves on the shaft 30 as shown in FIG. 2 (b). When the pressing force falls below the frictional force, it stops again as shown in FIG.
As will be described later, the frictional force generated in the movable tube body 40 is temporarily fixed by erecting the entire skull fixing jig 100 while holding the skull flap and the skull open head edge between the inner flap 10 and the outer flap 20. Therefore, it is designed to generate a force for pressing the outer flap 20.
As described above, by using the movable tube body 40, the position of the outer flap 20 on the shaft 30 can be finely adjusted.

Next, a procedure for fixing the skull bone flap using the skull fixing jig 100 will be described. Here, a description will be given assuming that the skull fixing jig 100 is permanently fixed using the skull fixing jig 200.
3 and 4 are diagrams schematically showing a procedure for temporarily fixing the skull bone flap using the skull fixing jig 100 of the present invention. It is shown in a sectional view for easy understanding.
As a premise, in this example, for example, three hole holes are provided by the skull craniotomy, and the skull bone flap is cut out, and three skull fixing jigs 100 are attached to these bar holes to fix the skull bone flap. It is an art form.

(Procedure 1) Attaching the inner flap 10 When holding the skull fixing jig 100 with the inner flap 10 on the lower side, the inner flap 10 drops and moves to the lowermost end of the shaft 30 and is caught by the inner restraining body 31 and stopped. Become. At this time, the outer flap 20 is kept upward so as not to fall and move together with the inner flap 10. In a state where the inner flap 10 is restrained by the inner restraining body 31, the inner flap is put on the inner surface side of the skull of the bar hole. Each of the inner flaps 10 is placed in three bar holes. The skull fixing jig 100 is arranged so as to stand on the skull. In FIG. 3A, a skull open head edge 310 is schematically drawn on the left side of the skull open head 300. As shown in FIGS. 3A to 3B, the inner flap 10 of the skull fixing jig 100 is attached to a predetermined position.

(Procedure 2) Fit the skull bone flap into a predetermined position of the skull open head The skull bone valve 320 is fitted into a predetermined position of the skull open head 300 while observing the overall balance. In FIG. 3 (c), the skull open head edge 310 is schematically depicted on the left side of the skull open head 300, and the skull bone flap 320 is depicted on the right side. Here, since the portion where the bar hole 301 is formed is shown, the space between the skull open head edge 310 and the skull bone flap 320 is the bar hole 301. By fitting the skull bone flap 320 into the skull open head 300, each of the inner flaps 10 is disposed so as to straddle the skull bone flap 320 and the skull open head edge 310 (FIG. 3C).

(Procedure 3) Attachment of the outer flap 20 The outer flap 20 maintained above is moved along the shaft 30 toward the skull bone flap 320 and the skull opening edge 310. The outer flap 20 drops and moves on the shaft 30 and comes into contact with the skull bone flap 320 and the skull opening edge 310 and stops. As shown in FIG. 3D, both the inner flap 10 and the outer flap 20 are arranged so as to straddle the skull open head edge 310 and the skull bone flap 320. In addition, at this time, the force which presses down the outer flap 20 is not applied, and it is in the state which is playing.

(Procedure 4) Temporary fixation of the skull bone flap 320 The movable tube body 40 is pushed down to move the outer flap 20 in the head inward direction, and the outer flap 20 is appropriately pressed against the outer surface of the skull. Since an appropriate frictional force is generated between the movable tube body 40 and the shaft 30, the pressing of the outer flap 20 toward the outer surface of the skull by the movable tube body 40 is maintained even when the practitioner releases his / her hand. As a result, a clamping force is generated between the inner flap 10 and the outer flap 20, and the skull flap 320 and the skull opening edge 310 are sandwiched so that the skull fixing jig 100 is temporarily fixed. In the present invention, the above-described procedure 1 to procedure 4 are collectively referred to as a “cranial bone flap temporary fixation procedure”. 4A shows a state in which the movable tube body 40 is pressed and the outer flap 20 is pressed, and FIG. 4B finely adjusts the pressing of the movable tube body 40, and the inner flap 10 and the outer flap 20 are bent. It is a figure which shows a mode that a skew is bent and the skull fixing jig | tool 100 is temporarily fixed.

(Procedure 5) Main fixation of the skull bone flap 320 Following the procedure 4, the outer flap 20 is pushed inwardly of the head, the shaft 30 is cut while pulling up the shaft 30, and the outer restraining body 32 is placed on the cut surface of the shaft 30. It is formed dynamically, and the skull fixing jig is permanently fixed.
Here, an example in which the fixation is performed using the fixation assisting device 200 will be described.

First, prior to the description of the main fixation of the skull bone flap 320, the fixation assisting device 200 will be described.
FIG. 5 is a diagram schematically showing the fixation assisting device 200. As shown in FIG. 5, the fixation assisting device 200 includes a shaft cutter 210 that cuts the shaft 30 and a shaft gripper 220 that holds the shaft 30 when the shaft 30 is cut. In FIG. 5, illustrations of a mechanism for operating the shaft cutter 210 and the shaft gripper 220 are omitted. However, as described below, the shaft 30 is clamped and lifted by the shaft gripper 220, and the shaft is driven by the shaft cutter 210. As long as it has a mechanism for performing the movement of each part, such as a cutting operation, a tool such as a tool that can operate the shaft cutter 210 or the shaft gripper 220 manually or electrically may be used.

The shaft cutter 210 has a blade for cutting the shaft 30 and mechanical structure strength. For example, the shaft cutter 210 has a handle like a soot and can be operated like a scissors blade. . The shaft 30 is formed of a material having high hardness such as pure titanium, but the ability to cut the shaft 30 is required.
Note that the cutting edge of the shaft cutter 210 is configured such that the cut surface of the shaft 30 is caulked when the shaft 30 is cut. An outer stop 32 formed by caulking the shaft 30 has a function of dynamically manufacturing.

  The outer restraining body 32 is for fixing the outer flap 20 by restraining the movement of the outer flap 20, and the diameter of the outer restraining body 32 formed is larger than the diameter of the through hole 21 of the outer flap 20. Thus, the outer flap 20 cannot pass through the outer restraining body 32.

The shaft gripper 220 is a pinching mechanism that pulls up the shaft 30 with an appropriate tension while cutting the shaft 30. For example, the shaft gripper 220 includes two left and right plate members and interlocks with the movement of the cutting edge of the shaft cutter 210. The two left and right plate members approach each other and grip the upper part of the shaft 30.
In this way, the shaft gripper 220 grips the shaft 30 in conjunction with the movement of the cutting edge of the shaft cutter 210, so that the cut section of the shaft 30 can be prevented from falling into the skull.
The main fixation of the skull bone flap 320 is performed using the above-described fixation assisting device 200.

The procedure for fixing the skull bone flap will be described with reference to the drawings.
First, after confirming the position of the skull fixing jig 100 temporarily fixed by the movable tube body 40, the shaft cutter 210 is used to grasp and pull up the shaft 30, and the shaft cutter 210 cuts the remaining portion of the shaft 30 (procedure). 5-1).
6 (a) to 6 (b) show a state in which the blade tip of the shaft cutter 210 is approached while the outer flap 20 is properly pressed down and the shaft 30 is gripped and pulled up by the shaft gripper 220, FIG. 6 (b). FIG. 6C shows a state in which the shaft 30 is cut by the shaft cutter 210 and the upper portion of the shaft 30 is gripped by the shaft gripper 220.

When the shaft 30 is cut by the shaft cutter 210, the shaft 30 is gripped and lifted by the shaft gripper 220 so that the outer flap 20 pressed by the movable tube body 40 is not loosened, and the fixing assisting device 200 is moved to the outer flap. It is preferable to press 20 in the head inward direction. By pulling up the shaft 30 and properly pressing the outer flap 20 in this manner, the skull fixing jig 100 does not unintentionally loosen when moving from temporary fixation to permanent fixation, and the skull bone valve 320 is inserted into the skull as planned. It can be fixed in the open head 300. The pressing force is such that the skull bone flap 320 and the skull opening edge 310 are not damaged, and the skull flap 320 and the skull opening edge 310 are appropriately clamped by the outer flap 20 and the inner flap 10. Preferably it is force.
In addition, since the section | slice of the shaft cut | disconnected by the shaft gripper 220 is hold | gripped, it does not fall to the operative field in a skull.

Next, the outer side stop body 32 is manufactured at the contact point between the outer flap 20 and the movable tube body 40. (Procedure 5-2).
When the shaft 30 is cut, the outer restraining body 32 is manufactured. In this example, the shaft 30 is caulked simultaneously with the cutting of the shaft 30 to produce the outer restraining body 32. FIG. 6D schematically shows how the outer restraining body 32 is manufactured. When the shaft 30 is cut, the cutting opening is caulked, and an outer stop 32 having a diameter larger than the shaft diameter of the shaft 30 is formed.

When the outer stop 32 is formed by the shaft cutter 210, the distance between the inner flap 10 and the outer flap 20 is fixed together with the inner stop 31 formed from the beginning, and the skull flap 320 and the skull craniotomy are fixed. While the positional relationship with respect to the edge 310 is fixed, the clamping force of the skull bone flap 320 and the skull opening edge 310 by the inner flap 10 and the outer flap 20 is determined, so the shaft 30 is cut by the fixation assisting device 200. Before forming the outer restraining body 32, it is necessary to finely adjust the position of each skull fixing jig 100 and the like.
By cutting the shaft 30 by the fixation assisting device 200, the inner restraining body 31 and the outer restraining body 32 are formed at both ends of the skull fixing jig 100, and the skull bone valve 320 is formed by the inner flap 10 and the outer flap 20. The book is fixed against.

FIG. 7 is a bird's-eye view of the manner in which the skull bone flap 320 is fitted into the skull open head 300 that has been opened with three bar holes provided using the skull fixing jig 100 of the present invention.
First, as shown to Fig.7 (a), the barhole 310A, 310B, 310C of the skull open head 300 is provided, and the skull open head 300 is opened. As shown in FIG.7 (b), the skull bone flap 320 which had been cut off will be inserted. Actually, before the insertion of the skull bone flap 320, the inner flaps 10 of the skull fixing jigs 100A, 100B, and 100C are arranged with respect to the bar holes 310A, 310B, and 310C of the skull open head 300. It is necessary to keep.

  Next, as shown in FIG. 8 (a), the outer flaps 20 of the skull fixing jigs 100A, 100B, and 100C are arranged so as to straddle the skull bone flap 320 and the skull open head edge 310, and the skull fixing jig. The movable tube bodies 40 of 100A, 100B, and 100C are pushed down to temporarily fix the skull fixing jigs 100A, 100B, and 100C.

  Next, as shown in FIG. 8 (b), using the fixation assisting device 200, the extra portions are cut while pulling up the shafts 30 of the skull fixing jigs 100 </ b> A, 100 </ b> B, 100 </ b> C, and the outer restraining body 32 is dynamically The skull fixing jigs 100A, 100B, and 100C are permanently fixed.

  As described above, according to the skull fixing jig 100 of the first embodiment, the position of the outer flap on the shaft can be finely adjusted, and the skull fixing jig can be temporarily fixed at a plurality of bar holes. After fitting into a predetermined position of the skull open head, the attachment position of each skull fixing jig can be finely adjusted while checking the overall balance.

  An example in which the movable tube body is devised as the skull fixing jig of the second embodiment will be described. The movable tube body of the skull fixation jig according to the second embodiment is devised to have a “drawing structure” in which the outer shape on the end portion facing the outer flap is narrowed down.

FIG. 9 is a diagram schematically illustrating the appearance of the skull fixing jig 100a according to the second embodiment.
In the example of FIG. 9A, the “throttle structure” at the end of the movable tube body 40a is a tapered structure. As shown in FIG. 9, when the “throttle structure” such as a taper structure is provided at the end of the movable tube body 40a, as described in the first embodiment, in the main fixing of the skull fixing jig 100a, the fixing is performed. When the shaft 30 is cut by the shaft cutter 210 of the support device 200, the end of the movable tube body 40a is less likely to be cut by mistake due to the tip of the shaft cutter 210, and only the shaft 30 is easily cut.

  FIG. 9B is a diagram illustrating a state in which the shaft 30 of the skull fixing jig 100 a is cut by the shaft cutter 210. In the process in which the cutting edge of the shaft cutter 210 approaches the shaft 30 from the left and right, the cutting edge of the shaft cutter 210 easily enters between the movable tube body 40 a and the outer flap 20. Although the end surface of the movable tube body 40a is in contact with the outer flap 20, the cutting edge of the shaft cutter 210 does not cut the end surface of the movable tube body 40a.

FIG. 10 is a schematic diagram of an external appearance of another skull fixation jig 100b according to the second embodiment.
The example of FIG. 10A is an example in which the “throttle structure” at the end of the movable tube body 40b has a rounded structure. As shown in FIG. 10 (a), when a "drawing structure" such as a round structure is provided at the end of the movable tube body 40b, as in the case of FIG. 9, in the main fixing of the skull fixing jig 100b, When the shaft 30 is cut by the shaft cutter 210 of the fixation assisting device 200, the end of the movable tube body 40b is not easily cut by mistake due to the tip of the shaft cutter 210, and only the shaft 30 is easily cut.

  FIG. 10B is a diagram illustrating a state in which the shaft 30 of the skull fixing jig 100 b is cut by the shaft cutter 210. As in FIG. 9, the cutting edge of the shaft cutter 210 easily enters between the movable tube body 40 b and the outer flap 20. In particular, when the structure is round, the angle of the cutting edge of the shaft cutter 210 and the end surface of the movable tube body 40b are parallel to each other, so that the end surface of the movable tube body 40b is not cut.

An example in which the outer flap 20c and the movable tube body 40c are integrated so as to be separable as the skull fixing jig 100c of the third embodiment will be described.
FIG. 11A is a diagram schematically illustrating the appearance of the skull fixing jig 100c according to the third embodiment. In the example of FIG. 11A, for example, the movable tube body 40c is bonded and integrated with the outer flap 20c by an adhesive or the like. Since the material of the outer flap 20c is a metal such as pure titanium and the movable tube body 40c is a resin material such as silicon resin, it is an adhesive that can bond the interface between the metal and the resin, and should be eluted into the living body. However, it is preferable to use a non-toxic adhesive that does not affect the human body.

  The merit in which the outer flap 20c and the movable tube body 40c are integrated so as to be separable is that the number of practitioners is reduced and it becomes easier to handle in the skull bone flap temporary fixing procedure. In “clamp bone flap 320 temporary attachment procedure 1” shown in Example 1 “attachment of inner flap 10” and procedure 2 “insertion of skull bone flap 320 into a predetermined position of skull open head 300” Although it is necessary to keep the outer flap 20c and the movable tube body 40c upward, the movable tube body 40c can be stationary with respect to the shaft 30 due to the frictional force with the shaft 30, which is shown in the first embodiment. Thus, if the outer flap 20 can move freely on the shaft 30, the outer flap 20c must be supported upward by fingers. Therefore, as shown in the third embodiment, if the outer flap 20c is integrated with the movable tube body 40c, the outer flap 20 does not fall downward even if it is not supported by fingers.

FIG. 11B is a diagram illustrating only a part of a procedure for fixing the skull bone flap 320 to the skull open head 300 using the skull fixing jig 100 c according to the third embodiment.
FIG. 11B is a view showing a state in which the inner flap 10 is arranged so as to straddle the skull bone flap 320 and the skull open head edge 310. Even if the outer flap 20 c is not supported by fingers, it is integrated with the movable tube body 40 c and rests on the shaft 30 together with the movable tube body 40.

Next, FIG. 11C is a diagram showing a state in which the movable tube body 40 is pressed and the outer flap 20 is pressed. Since the outer flap 20c is integrated with the movable tube body 40c, the outer flap 20c is also pressed together by pushing down the movable tube body 40c with fingers or the like, and is pushed down until it comes into contact with the skull bone flap 320 and the skull open head edge 310. It is done.
Since the movements of the outer flap 20c and the movable tube body 40c after FIG. 11 are the same as those in FIGS. 4 and 6 of the first embodiment, they are omitted here.

An example in which a scale is provided on the shaft 30d as the skull fixing jig 100d of the fourth embodiment will be described.
FIG. 12 is a diagram illustrating a configuration example of a skull fixing jig 100d according to the fourth embodiment. The shaft 30d of the skull fixing jig 100d of the fourth embodiment is provided with a scale so that the distance between the outer flap and the inner flap can be grasped at a glance.

  The thicknesses of the skull bone flap 320 and the skull open head edge 310 are slightly different depending on the position of the bar hole or the position of the cutout line of the skull bone flap. In order to finely adjust the outer flap 20 while pressing the movable tube body 40 when temporarily fixing the skull fixing jig 100d, the practitioner adjusts the pressing force of the outer flap 20 based on a delicate sense transmitted to the fingers. It becomes.

  Here, if the thickness of the skull flap 320 and the skull open head edge 310 is known by a prior diagnosis or the like, if the distance between the outer flap 20 and the inner flap 10 can be adjusted to the thickness, It can supplement the sense of fingers. At that time, the gap between the outer flap 20 and the inner flap 10 can be measured by visually observing the scale of the shaft 30d.

  Thus, when the scale is provided on the shaft 30d, if there is a target value of the interval between the inner flap 10 and the outer flap 20 due to a prior diagnosis or the like, the target value is not measured with a measure or the like. Can be easily adapted. In addition, even when there is no target value in advance, it is possible to easily grasp the size of the distance between the inner flap 10 and the outer flap 20 at the position where the skull fixing jig 100d fixed by the surgical method is attached. it can.

  As mentioned above, although the preferable Example in the structural example of the skull fixing jig of this invention was illustrated and demonstrated, it is understood that various changes are possible without deviating from the technical scope of this invention. Let's go.

  The skull fixation jig and the skull fixation method of the present invention can be widely applied to medical treatments involving skull craniotomy.

DESCRIPTION OF SYMBOLS 10 Inner flap 20 Outer flap 30 Shaft 31 Inner restraint body 32 Outer restraint body 40 Movable tube body 100 Skull fixing jig 200 Fixing support instrument 210 Shaft cutter 220 Shaft gripper 300 Skull opening head 301 Barhole 310 Skull opening head edge 320 Skull bone valve

Claims (13)

A skull fixation jig for fixing the skull bone flap to a predetermined position of the skull open head,
An inner flap arranged to straddle the skull bone flap and the skull cranial margin on the inner surface of the skull;
An outer flap arranged to straddle the skull bone flap and the skull opening edge on the outer surface side of the skull;
A shaft penetrating the inner flap and the outer flap;
An inner restraining body for restraining movement of the inner flap provided at one end on the shaft toward the inner side of the head;
A tube body provided on the shaft in an outward direction of the skull from the outer flap, and is stationary with respect to the shaft by a frictional force between an inner wall surface and the shaft surface, and a pressing force applied from the outside is A movable tube body that moves along the shaft when the frictional force is exceeded,
A skull fixing jig capable of fixing the position of the inner flap on the shaft by the inner restraining body and temporarily fixing the position of the outer flap on the shaft by the tube body.   The movable tube body is pressed to cut the contact point between the movable tube body and the outer flap in a state where the outer flap is temporarily fixed so as to straddle the skull bone flap and the skull open head. A state in which the skull flap and the skull open head are sandwiched between the inner flap and the outer flap by dynamically manufacturing an outer restraining body that restrains the outward movement of the skull in the outward direction of the skull. The skull fixing jig according to claim 1, wherein the skull fixing jig is permanently fixed.   The skull fixing jig according to claim 1 or 2, wherein the movable tube body has a throttle structure in which an outer shape of an end portion facing the outer flap is narrowed down.   The skull fixing jig according to claim 3, wherein the throttle structure is a tapered structure.   The skull fixing jig according to claim 3, wherein the throttle structure is a round structure.   The skull fixing jig according to any one of claims 1 to 5, wherein the outer flap and the movable tube body are integrated so as to be separable.   The outer flap has a bend bent toward the skull side, the inner flap has a bend bent toward the skull side, and the skull bone flap by the outer flap and the inner flap The skull fixing jig according to any one of claims 1 to 6, wherein a clamping force between the head and the skull opening edge is improved.   The skull fixing jig according to any one of claims 1 to 7, wherein a scale is provided on the shaft. A skull fixation method for fixing the skull bone flap to a predetermined position of the skull open head using a skull fixation jig,
The skull fixing jig includes an inner flap, an outer flap, a shaft that penetrates the inner flap and the outer flap, and movement of the inner flap provided at one end on the shaft in the head inner direction. A tube body provided on the shaft in an outward direction of the skull from the outer flap on the shaft, and is stationary with respect to the shaft by a frictional force between an inner wall surface and the shaft surface, When a pressing force applied from the outside exceeds the frictional force, the movable tube body is movable along the shaft,
A procedure of disposing the inner flap on the inner surface side of the skull so as to straddle the skull bone flap and the skull craniotomy margin in a state where the inner flap is restrained by the inner restraint body, and the skull bone flap at a predetermined position of the skull craniotomy head And temporary fixing of the bone flap by pressing the movable tube body and temporarily fixing the outer flap on the skull outer surface side so as to straddle the skull bone flap and the skull open head edge. Procedure and
The shaft is cut at the contact point between the outer flap and the movable tube body while pushing the outer flap in the skull inward direction, and the movement of the outer flap in the skull outward direction is stopped at the cut portion. A skull fixing method comprising: a skull bone flap main fixing procedure in which an outer restraining body is dynamically manufactured and fixed in a state where the skull bone flap and the skull open head are sandwiched between the inner flap and the outer flap. Using a fixing support device provided with a shaft gripper for sandwiching the shaft and a shaft cutter for cutting the shaft,
When the shaft is cut in the skull bone flap main fixing procedure, the shaft is clamped by the shaft gripper of the fixation assisting instrument, and is cut by the shaft cutter of the fixation assisting instrument. The skull fixing method according to claim 9, wherein a shaft section is prevented from falling into the skull.   The cutting support surface of the shaft is caulked by the shaft cutter of the fixing assisting instrument when the fixing assisting instrument is cut by the shaft cutter, and the outer restraining body is dynamically manufactured. The skull fixation method as described.   When cutting the shaft in the skull bone flap main fixing procedure, the fixation assisting instrument presses the outer flap in the head inward direction, and the pressing force is applied to the skull bone flap and the skull open head edge. The skull fixing method according to claim 10 or 11, wherein the skull bone flap and the skull open head edge are clamped by the outer flap and the inner flap without damaging the outer flap.   The movable tube body has a throttle structure in which the outer shape of the end facing the outer flap is narrowed down, and the shaft is cut by the shaft cutter of the fixation assisting instrument in the skull bone flap main fixing procedure. The end of the movable tube body facing the outer flap is difficult to be cut, and a section of the movable tube body is prevented from falling into the skull. Skull fixation method.

Images