JP2012024276A - Reconstruction ligament fixture - Google Patents

Abstract

PROBLEM TO BE SOLVED: To firmly fix a suture of a reconstruction ligament.SOLUTION: When inserting a fitting piece 26 in a fitting space X1 of a fixture body 25, an insertion passage into which the suture 11 (14) derived from a fixing bone hole 12 (15) is inserted by the fixture body 25 and the fitting piece 26 is formed, a pressure welding surfaces X2, X3 prepared in the insertion passage are pressure-welded to the suture 11 (14) so that the suture 11 (14) is fixed and held to the insertion passage, and a moderate tension force is given to the suture 11 (14) to be firmly fixed, thereby the reconstruction ligament 8 can be implanted in the condition that it is made to be close to a bone hole 6 (7) for union without gap.

Description

  The present invention relates to a reconstructive ligament fixation device, and more particularly, a reconstructive ligament that can be firmly fixed to a femur or a tibia.

  Conventionally, when an anterior cruciate ligament (ACL) of a knee joint is damaged by extreme sports or the like, a reconstructed ligament having a suture thread or a wire (referred to as a suture thread) joined to both ends is surgically operated. Is inserted into a bone hole drilled in the femur or tibia by surgical operation, and the sutures at both ends are fastened to a fixed portion fixed to the femur or tibia, thereby reconstructing the ligament to the bone tissue of the knee joint A ligament reconstruction technique is used to heal.

JP 2002-272756 A

  However, in this type of conventional ligament reconstruction technique, if the suture as a means for fastening the reconstructed ligament inserted into the bone hole to the femur or tibia cannot be stably fixed to the fixing portion, There is a problem that it takes a long time to unite the bone tissue of the reconstructed ligament with the insufficient degree of closeness.

  The present invention has been made in consideration of the above points, and proposes a reconstructed ligament fixing device that can more surely unite the reconstructed ligament with a bone hole.

  In order to solve such a problem, in the present invention, a large-scale fusion bone having a fitting space X1 and drilled in the femur 2 or tibia 3 on the bone surfaces 2A and 3A of the femur 2 or tibia 3 is provided. The sutures 11 and 14 joined to the femoral side end or the tibial side end of the reconstructed ligament 8 inserted into the holes 6 and 7 are led out to the bone surfaces 2A and 3A from the tips of the healing bone holes 6 and 7. The fixing tool main bodies 25, 61, 71, 83, 98, 117, 133, 143, 152 provided at the outlet positions of the small-diameter fixing bone holes 12, 15 drilled in this way, When fitted in the fitting space X1, together with the fixing tool main body, an insertion passage for inserting the sutures 11 and 14 led out from the fixing bone holes 2A and 3A is formed, and a pressure contact surface (28A) provided in the insertion passage 29A), (64, 61C), (87A, 87B), ( 22A to 122D, 125), (103A to 103D), (136, 133), (146A, 143), and (152, 154) are pressed against the suture threads 11 and 14 to bring the suture threads 11 and 14 into the insertion passages. The fittings 26, 62, 73, 85, 99, 118, 134, 144, and 154 that are fixedly held are provided.

  According to the present invention, when the fitting is fitted into the fitting space of the fixture main body, the insertion passage through which the suture thread led out from the fixing bone hole is inserted by the fixture main body and the fitting is formed and inserted. The pressure contact surface provided in the passage is pressed against the suture, so that the suture is fixedly held in the insertion passage, thereby giving an appropriate tension to the suture, and the reconstructed ligament is attached to the fusion bone hole. Can be transplanted in close contact with no gap.

It is a rough-line sectional drawing which shows the transplantation structure of the reconstruction ligament with respect to a joint. It is a perspective view which shows the whole structure of a side fixing tool. It is a perspective view which shows the cross-section of a fixing tool. It is a basic diagram with which it uses for description of insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is an approximate line figure showing operation which draws a fitting child to a fixture main part. It is a basic diagram which shows fitting operation of the fitting with respect to a fixing tool main body. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread. It is a basic diagram which shows the suturing operation with respect to fixation of a suture thread. It is an approximate line sectional view for description of a comparative example. It is a perspective view which shows 2nd Embodiment of a fixing tool. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread. It is a perspective view which shows 3rd Embodiment of a fixing tool. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by a fitting. It is the perspective view and cross section which show 4th Embodiment of a fixing tool. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by a fitting. It is the perspective view and cross section which show 5th Embodiment of a fixing tool. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread. It is a perspective view which shows 6th Embodiment of a fixing tool. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread. It is sectional drawing which shows 7th Embodiment of a fixing tool. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread. It is sectional drawing which shows 8th Embodiment of a fixing tool. It is a top view which shows the arrangement | positioning relationship of a through-hole of a fixing tool main body and a fitting. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread. It is sectional drawing which shows 9th Embodiment of a fixing tool. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread. It is sectional drawing which shows 10th Embodiment of a fixing tool. It is a top view which shows the arrangement | positioning relationship of a fixing tool main body and a fitting. It is a basic diagram which shows insertion operation of the fixing tool main body with respect to a suture thread, and a fitting. It is a basic diagram which shows the fastening operation by the fitting with respect to a suture thread.

  Hereinafter, an embodiment of the present invention will be described in detail with reference to the drawings.

(1) Implanted structure of the reconstructed ligament In FIG. 1, 1 generally indicates an implanted structure of the reconstructed ligament for the anterior cruciate ligament of the knee, and the outer side of the femur 2 from the joint 4 side between the femur 2 and the tibia 3. Between the large-diameter healing bone hole 6 drilled in the condyle 5 and the large-diameter healing bone hole 7 drilled in the tibia 3 from the joint 4 side, for example, a bone-cap patella tendon (bone- Patellar tendon-bone (BTB) or both ends of the reconstructed ligament 8 taken from hamstrings are respectively inserted.

  The suture thread 11 joined to the end of the reconstructed ligament 8 on the femur 2 side passes through the small-diameter fixation bone hole 12 drilled outward from the distal end surface 6A of the fusion bone hole 6, and the femur The bone side end portion is fastened to the femoral side fixing tool 13 set on the bone surface 2A while having an appropriate tension force in the outward direction.

  The inner diameter of the fusion bone hole 6 on the side of the femur 2 has a large thickness (that is, a large diameter) that matches the thickness of the end of the femoral side of the reconstruction ligament 8, and is often circular in cross section with a diameter. It is selected as 9 to 12 [mm] for one bundle and 5 to 8 [mm] for a double bundle.

  On the other hand, the fixing bone hole 12 through which the suture thread 11 is inserted has a small thickness (that is, a small diameter) that matches the outer diameter of the suture thread 11. In this embodiment, the bone hole 12 has a circular cross section and is 2.4. To 4.5 [mm].

  The inner end of the fixation bone hole 12 communicates with the distal end surface 6A of the fusion bone hole 6 and the outer end is a bone formed by making a small incision 32 in the skin 31 covering the outer condyle 5 of the femur 2. It is exposed on the surface 2A.

  In this way, the small-diameter fixing bone hole 12 having a small diameter communicates from the distal end surface 6A of the large-diameter healing bone hole 6 having a large diameter. A step portion 6B is formed at the boundary position between the fusion bone hole 6 and the fixation bone hole 12, and the femoral end portion of the reconstructed ligament 8 is stepped by the tension applied from the suture thread 11 on the distal end surface 6A. 6B and its periphery are held in close contact with no gap.

  The suture thread 14 joined to the tibia side end of the reconstructed ligament 8 passes from the large-diameter healing bone hole 7 through the small-diameter fixing bone hole 15 while having an appropriate tension force in the outward direction. It is fixed to the tibial fixture 16.

  Similarly to the femur 2 side, the diameter of the fusion bone hole 7 on the tibia 3 side is large enough to match the thickness of the tibia side end of the reconstruction ligament 8 (in the case of this embodiment, the diameter is a bundle). 9-12 [mm] for double bundles and 5-8 [mm] for double bundles), and the thickness of the fixation bone hole 15 is small enough to match the outer diameter of the suture 14 (this In the case of the embodiment, the diameter is selected to be 2.4 to 4.5 [mm].

  The inner end of the fixation bone hole 15 communicates with the distal end surface 7A of the fusion bone hole 7, and the outer end is exposed to the bone surface 3A formed by making a small incision 32X in the skin of the tibia 3.

  Thus, similarly to the case of the fusion bone hole 6 on the femur 2 side, a step 7B is formed at the boundary position between the fusion bone hole 7 and the fixation bone hole 15 on the tibia 3 side, and the tibia of the reconstructed ligament 8 The side end portion is held in close contact with the stepped portion 7B and its peripheral portion without a gap by the tension applied from the suture 14.

(2) Structure of fixing device As shown in FIGS. 2 and 3, the femoral side fixing device 13 (or tibial side fixing device 16) has a cylindrical shape and is disposed on the bone surface 2A (or 3A). And a cylindrical fitting 26 that is fitted and held in the center hole 25A of the fixture main body 25 from the outside (above).

  In the fixing body 25, four through holes 27A to 27D penetrating along the direction of the center line of the cylindrical shape are drilled at positions at equal angular intervals of 90 [°], whereby the reconstructed ligament 8 Each of the four sutures 11 (or 14) joined to the end of the femur 2 or tibia 3 is penetrated from the lower surface side to the upper surface side.

  In the case of this embodiment, each suture thread 11 (or 14) is a structure in which a number of suture fibers are twisted to a predetermined thickness or a bundle of a plurality of twisted suture fibers is further twisted. It has a wire configuration.

  On the inner surface of the central hole 25A of the fixture main body 25, four shallow arcs 28A to 28D having an arcuate cross section extending in the vertical direction along the through holes 27A to 27D are formed.

  On the outer peripheral surface of the fitting 26, shallow split grooves 29 </ b> A to 29 </ b> D having an arcuate cross-section so as to face the through holes 27 </ b> A to 27 </ b> D of the fixture body 25 have a 90 ° angle with the center hole 26 as the center, It is drilled at the interval position.

  Thus, the center hole 25A of the fixture main body 25 forms a fitting space X1 in which the fitting 26 is fitted, and the split grooves 28A to 28D drilled in the inner peripheral surface of the center hole 25A are formed by the fitting 26. When fitted from above, the split grooves 29A to 29D drilled in the outer peripheral surface of the fitting 26 become the crimping surface X2, and the split grooves 28A to 28D drilled in the inner peripheral surface of the center hole 25A are clamped. The surface 11 becomes the surface X3, and the suture thread 11 (or 14) is sandwiched between them.

  As a result, the press-holding means X4 is formed which holds the suture thread 11 (or 14) sandwiched between the split grooves 29A to 29D as the crimping surface X2 and the split grooves 28A to 28D as the sandwich receiving surface X3. The

  In the case of this embodiment, as shown in FIG. 3, a locking step portion 25 </ b> B is formed on the inner peripheral surface of the center hole 25 </ b> A of the fixture body 25 so that the inner diameter slightly increases from the upper side to the lower side. As a result, when the fitting 26 is fitted to the fixture body 25, the fitting 26 is locked to the locking step 25B.

  Further, at the lower end of the fitting 26, as shown in FIG. 3, when the fitting 26 is fitted into the center hole 25A of the fixture body 25, the distal end in the insertion direction is used to facilitate this. A slipping inclined surface 38 is provided on the main body 25, so that the fitting body 26 can be easily aligned with the center hole 25A (and thus the fitting space X1) when the fitting 26 is fitted.

(3) Fastening the suture to the fixing device The femoral side fixing device 13 (or the tibial side fixing device 16) is a bone hole for fixing the femur 2 (or tibia 3) according to the procedure shown in FIGS. The suture 11 (or 14) drawn from the bone 12 (or 15) onto the bone surface 2A (or 3A) (in the case of this embodiment, consisting of four strands of suture fibers) is transferred to the bone surface 2A ( Or fix to 3A).

  First, as shown in FIG. 4, four sutures led out from the bone surface 2A (or 3A) exposed to the outside through the small incision 32 (or 32X) through the fixing bone hole 12 (or 15). 11 (or 14) is inserted through the through holes 27A to 27D of the fixture body 25, respectively, so that the fixture body 25 is placed on the outlet of the fixation bone hole 12 (or 15) on the bone surface 2A (or 3A). Set.

  The distal ends of the four sutures 11 (or 14) that have passed through the through holes 27A to 27D are drawn upward through the center hole 26A of the fitting 26.

  Subsequently, the fitting 26 inserted in the distal end portion of the suture thread 11 (or 14) is shifted along the suture thread 11 (or 14) inserted through the center hole 26A as shown in FIG. It is drawn in the direction of the fixture body 25.

  Eventually, when the fitting 26 comes to the position of the fixture body 25, the diameter of the fitting 26 is selected to be slightly smaller than the diameter of the central hole 25A of the fixture body 25, as shown in FIG. The lower end of the fitting 26 is fitted into the center hole 25A of the fixture body 25 that forms the fitting space X1.

  At this time, the four suture threads 11 (or 14) extending upward through the through holes 27 </ b> A to 27 </ b> D of the fixture body 25 are split grooves 28 </ b> A to 28 </ b> D formed on the inner surface of the fixture body 25. And are folded while being in sliding contact so as to be sandwiched between the split grooves 29 </ b> A to 29 </ b> D formed on the outer surface of the fitting 26.

  The folding of the four sutures 11 (or 14) between the split grooves 28A to 28D and 29A to 29D is a wall portion formed between the split grooves 29A to 29D of the fitting 26 and the center hole 26A. The lower end surface of the knives is folded while pulling the sutures 11 (or 14) downward while slidingly contacting the corresponding four sutures 11 (or 14).

  In the folding operation of the lower end surface of the fitting 26, the lower end surface passes the four sutures 11 (or 14) through the through holes 27 </ b> A to 27 </ b> D of the fixture main body 25. 15) A force is applied to pull the inner suture thread 11 (or 14) upward.

  As shown in FIG. 7, the fitting 26 is fixed to the fixture main body 25 while applying an appropriate tension force to pull out the suture thread 11 (or 14) from the fixing bone hole 12 (or 15) upward. The center hole 25A is fitted and held.

  At this time, the femur side fixing tool 13 (or the tibial side fixing tool 16) is fitted with the fitting grooves 26 in the fitting space X1 of the fixing tool main body 25, so that the split grooves 28A to 28D of the fixing tool main body 25 and An insertion passage for inserting the suture thread 11 (or 14) is formed between the split grooves 29A to 29D of the fitting 26, and the split grooves 28A to 28D and 29A to 29D on both sides of the insertion passage are sutured. As a result, the suture 11 (or 14) is fixedly held in the insertion passage.

  Thus, the reconstructed ligament 8 is given an appropriate tension in the direction of the femoral side fixing device 13 (or tibial side fixing device 16) by the suture thread 11 (or 14) in the healing bone hole 6 (or 7). Thus, the reconstructed ligament 8 has the femoral side end surface (or tibial side end surface) in contact with the stepped portion 6B (or 7B) of the fusion bone hole 6 (or 7) and its peripheral portion without any gap. The femoral side end (or tibial side end) is transplanted in a state of being in close contact with the inner surface of the end of the fusion bone hole 6 (or 7).

  In addition to this, in the state where the fitting 26 is fitted in the center hole 25A of the fixture body 25, the four sutures 11 (or 14) led out from the center hole 26A of the fitting 26 are shown in FIG. As shown in FIG. 8, the thighs are sutured so as to be twisted with each other, and the stitching portion 40 is formed so as to be in close contact with the outer surface of the fitting 26 and the fixture main body 25, whereby the thigh with respect to the suture 11 (or 14). The fastening strength to the bone side fixing tool 13 (or the tibial side fixing tool 16) is further reinforced.

(4) Effect of transplantation of the reconstructed ligament According to the fixture 13 (or 16) for the reconstructed ligament 8 of the above-described embodiment, the fusion bone hole 6 of the femur 2 to which the reconstructed ligament 8 is implanted and the fusion of the tibia 3 The femoral side (or tibial side) end of the reconstructed ligament 8 can be firmly transplanted to the bone hole 7 so as to be intimately contacted without gaps while applying appropriate tension, so that the reconstructed ligament after transplantation Thus, the fusion time to the femur 2 and the tibia 3 can be made shorter and more reliable.

  As a comparative example, a comparison with a case where a reconstructed ligament is transplanted based on the conventional method described in Patent Document 1 will be described. As shown in FIG. On the other hand, a healing bone hole 45 having a diameter of 7 [mm] is opened using a healing bone hole 44 having a diameter of 7 [mm] opened in the tibia 43.

  In this case, a fastener 48 marketed under the trade name “End Button” is previously joined to the distal end of the suture thread 47 joined to the femoral end of the reconstructed ligament 46 to be transplanted, and the femur It is pulled out to the bone surface 50 of the femur 42 through a fixing bone hole 49 having a diameter of 4.5 mm opened at the tip of the side fusion bone hole 45.

  The suture thread 51 joined to the tibia side end portion of the reconstructed ligament 46 is fixed to a fixing tool 52 that is led out from the healing bone hole 44 on the tibia side and fixed on the tibia 43.

  In the case of the comparative example of FIG. 9, when inserting into the fusion bone hole 45 of the reconstructed ligament 46, the fixing tool 48 formed of an end button is attached to the bone by a lead wire passing through the fixation bone hole 49 from the outside of the bone surface 50. By pulling it out to the surface 50, the reconstructed ligament 46 is drawn into the healing bone hole 45 of the femur 42 from the healing bone hole 44 side of the tibia 43.

  The fixing device 48 composed of an end button is a vertically long elliptical plate-like member, and has a configuration in which a suture thread 47 is tied to an attachment hole formed in the plate-like member, and is used for fusion in the vertically long direction. The fixing tool 48 pulled out to the bone surface 50 side while passing through the bone holes 44 and 45 is rotated 90 [°] so that the plate surface in the longitudinal direction closes the fixing bone hole 49, and then the reconstruction ligament. The fixing tool 48 is set on the bone surface 50 of the femur 42 by pulling 46 46 back from the healing bone hole 44 side on the tibia side with the suture thread 51.

  According to the graft structure 41 of the comparative example of FIG. 9, when the fixing device 48 is set on the bone surface 50 of the femur 42, the direction of the fixing device 48 with respect to the suture thread 47 is rotated and fixed on the bone surface 50. Therefore, the reconstructed ligament 46 must be pulled back to the healing bone hole 44 side on the tibia 43 side.

  Thus, the reconstructive ligament 46 inserted into the fusion bone hole 45 of the femur 42 has a void with a pullback length LX (about 10 mm), the distal end of the reconstructive ligament 46 and the fusion bone hole of the femur 42. It is transplanted into the healing bone hole 45 in a state of being spaced from the tip of 45.

  If there is a void of this pullback length LX, there is a problem that it takes a considerable time to unite the reconstructed ligament 46 with respect to this void.

  In addition to this, when the reconstructive ligament 46 is inserted through the fusion bone hole 44 of the tibia 43 and the fusion bone hole 45 of the femur 42, when the fixing tool 48 on the distal end side is pulled toward the bone surface 50 side. In order to pass at least the fixing device 48, the width of the fusion bone holes 44 and 45 must be increased by the width thereof, so that the fusion bone holes 44 and 45 of the reconstruction ligament 46 are brought into close contact with each other. Therefore, there is a problem that the reconstructed ligament 46 after the transplantation cannot be stably fixed in the healing bone holes 44 and 45.

  Compared with the comparative example of FIG. 9 described above, if the femoral side fixing device 13 (or the tibial side fixing device 16) according to the above-described embodiment is used, the end portion of the reconstruction ligament 8 and the healing bone hole 6 ( Alternatively, transplantation can be performed so as to closely contact with 7).

  Thus, according to the above-described embodiment, it is possible to realize a reconstruction ligament fixture that can more firmly fix the reconstruction ligament 8 as compared with the comparative example.

(5) Other Embodiments of Fixing Device Other embodiments of the fixing device will be described below with reference to the drawings in which the same reference numerals are assigned to the portions corresponding to those in FIGS.

(5-1) Second Embodiment FIG. 10 shows a femoral side fixing device 13A (or a tibial side fixing device 16A) of the second embodiment, and a center hole 61A of a cylindrical fixing device body 61 is fitted. It has the structure which fits the cylindrical fitting 62 as the joint space X1.

  In the fitting 62, four through holes 63A to 63D through which the four sutures 11 (or 14) of the reconstructed ligament 8 are respectively inserted are 90 [°] around the central columnar portion 64 extending in the vertical direction. It is provided at a position where the corners are equally spaced.

  The fitting space X1 formed by the central hole 61A of the fixture main body 61 has an upper half 61AX formed in a columnar shape, whereas the lower half 61BX is tapered toward the center as it goes downward. An inclined frustoconical inclined surface 61C is provided.

  The fitting 62 has an outer shape that fits into the space of the center hole 61A of the fixture main body 61. With this, the through-holes 63A to 63D have a cylindrical cross section by the upper half 61AX, while In the half portion 63BX, the cylindrical shape of the through holes 63A to 63D is shaped to be scraped from the outside.

  As a result, as shown in FIG. 11, the fixing tool body 61 is disposed on the bone surface 2A (or 3A) of the femur 2 (or tibia 3), and is led out from the fixing bone hole 12 (or 15). As shown in FIG. 12, the four sutures 11 (or 14) to be inserted are inserted through the center hole 61A of the fixture main body 61 and the through holes 63A to 63D of the fitting 62 are inserted into the extended ends thereof. When the fitting 62 is fitted into the fitting space X1 formed by the center hole 61A of the fixture body 61 from above, the lower half 61BX of the center hole 61A of the fixture body 61 forms a tapered space in a truncated cone shape. By doing so, the suture thread 11 (or 14) is restricted by the inclined surface 16C of the through holes 63A to 63D so that the passage of the lower half portion 63BX of the through holes 63A to 63D is narrowed.

  At this time, the femoral side fixing tool 13A (or the tibial side fixing tool 16A) is fitted into the inclined surface 61C of the fixing tool main body 61 by passing the fitting 62 into the fitting space X1 of the fixing tool main body 61. An insertion passage for the suture thread 11 (or 14) is formed between the inner wall of the holes 63A to 63D and the wall surface of the central column upper portion 64, and the inclined surface 61C and the central column upper portion 64 on both sides of the insertion passage. The wall surface becomes a pressure contact surface that presses against the suture thread 11 (or 14), and as a result, the suture thread 11 (or 14) is fixedly held in the insertion passage.

  When the fitting 62 is tightened along the suture 11 (or 14) from the state shown in FIG. 11 where the fitting 62 is separated upward from the fixture main body 61 to the tightening position shown in FIG. 12, the suture 11 (or 14). Moderate tension on the suture 11 (or 14) passing through the fixation bone hole 12 (or 15) by pulling the suture 11 (or 14) outward from the fixation bone hole 12 (or 15) Can be given.

  Thus, according to the femoral side fixing device 13A (or tibial side fixing device 16A) having the configuration shown in FIGS. 10 to 12, the reconstructed ligament 8 is in close contact with the fusion bone hole 6 (or 7) without any gap. It is possible to realize a fixture that can firmly fix the.

(5-2) Third Embodiment FIG. 13 shows a third embodiment, and a substantially central position in the vertical direction on the inner surface of the center hole 71A serving as the fitting space X1 of the cylindrical fixture body 71. An annular fitting and engaging groove 72 having an arc shape in cross section is formed, and a spherical fitting 73 made of a flexible material and having a through hole 75 in the vertical direction is fitted into the engaging element engaging groove 72.

  The fixing tool main body 71 has four through holes 74A to 74D at 90 [deg.] Angular equidistant positions centered on the central hole 71A.

  In the above configuration, when the suture thread 11 (or 14) is to be fastened to the femur 2 (or tibia 3) by the femur side fixing tool 69 (or tibial side fixing tool 70), as shown in FIG. After the four sutures 11 (or 14) led out from the fixing bone hole 12 (or 15) are inserted through the through holes 74A to 74D of the fixture main body 71, the distal end side is the through hole of the fitting 73. 75 is inserted.

  In this state, as shown in FIG. 15, the fitting 73 is fitted into the fitting locking groove 72 from above through the center hole 71 </ b> A of the fixture main body 71.

  At this time, since the fitting 73 is made of a flexible material, the fitting 73 is pushed into the fitting locking groove 72 having a wide diameter through the center hole 71A having a narrow diameter while being deformed.

  When the fitting 73 is pushed into the fitting locking groove 72, the four sutures 11 (or 14) inserted from below into the through-hole 75 of the fitting 73 have a peripheral portion of the through-hole 75. The suture thread 11 (or 14) (FIG. 14) between the through holes 74A to 74D of the fixture main body 71 and the through holes 75 of the fitting 73 becomes the central hole 71A of the fixture main body 71 as a folding surface. Fold it in.

  At this time, the folded suture thread 11 (or 14) is respectively connected to the outer surface of the fitting 73 and the inner surface of the engagement element locking groove 72 of the fixing body 71 from the upper end positions of the through holes 74A to 74D of the fixing body 71. It is folded to pass between.

  At this time, the femur side fixing tool 69 (or the tibial side fixing tool 70) is fitted with the fitting element locking groove 72 of the fixing tool main body 71 by fitting the fitting element 73 into the fitting space X1 of the fixing tool 71. An insertion passage for inserting the suture thread 11 (or 14) is formed between the outer surface of the fitting 73 and the outer surfaces of the fitting locking grooves 72 and the fitting 73 on both sides of the insertion passage. The pressure contact surface presses against the suture thread 11 (or 14), and as a result, the suture thread 11 (or 14) is fixedly held in the insertion passage.

  During the folding operation of the suture thread 11 (or 14), the suture thread 11 (or 14) led out from the fixation bone hole 12 (or 15) is moved upward from the fixation bone hole 12 (or 15). In such a state that the fixing tool main body 71 is in contact with the bone surface 2A (or 3A) of the femur 2 (or tibia 3) by applying a pulling force to the reconstructed ligament 8 by the suture thread 11 (or 14). The suture 11 (or 14) can be fastened to the femur side fixing tool 69 (or the tibial side fixing tool 70) in a state where an appropriate tension force is applied to the femur.

  According to the above configuration, the suture thread 11 (or 14) led out from the reconstructed ligament 8 is moderately tensioned by performing an operation for fitting the fitting 73 into the fixture main body 71. By being able to fasten firmly while giving, the reconstruction ligament 8 can be firmly fixed to the fusion bone hole 6 (or 7) in close contact with no gap.

(5-3) Fourth Embodiment FIG. 16 shows a fixing device according to a fourth embodiment, and a femoral side fixing device 81 (or a tibial side fixing device 82) is shown in FIG. As described above, the cylindrical fixture main body 83 is provided, and four fittings 84A to 84D are provided at angularly equidistant positions of 90 ° around the center line.

  As shown in FIG. 16C, the fittings 84 </ b> A to 84 </ b> D have a configuration in which the large diameter portion 87 and the small diameter portion 88 are connected along the through hole 86 by a columnar material having the through hole 86 at the center position.

  A notch 89 is provided so as to communicate with the through hole 86 over a range from the upper end of the large diameter portion 87 to the center position of the small diameter portion 88, and from both sides sandwiching the notch 89 from the outside with respect to the large diameter portion 87. When a pressing force is applied, the pair of opposed surfaces 87A and 87B of the through-hole 86 provided in the large diameter portion 87 are close to each other.

  As shown in FIG. 16 (B), the fittings 84A to 84D are configured so that the four through holes 89A to 89D drilled in the fixture main body 83 can be inserted from above as fitting spaces X1, Of the through holes 89A to 89D, an inclined surface is formed such that the inner diameter of the portion corresponding to the large diameter portion 87 of the fittings 84A to 84D gradually decreases as it goes downward, whereby the through holes 89A to 89D. When the fittings 84A to 84D are pushed in, the large-diameter inner surface 90 of the through holes 89A to 89D applies a pressing force from the side surface to the opposing surfaces 87A and 87B of the large-diameter portion 87 of the fitting members 84A to 84D. As a result, the interval between the notches 89, and thus the diameter of the through hole 86, is reduced.

  In the above configuration, the bone surface 2A (or 3A) of the femur 2 (or tibia 3) is derived from the fixation bone hole 12 (or 15) with respect to the femur side fixing device 81 (or tibial side fixing device 82). When trying to fasten the sutures 11 (or 14), the four sutures 11 (or 14) are inserted through the through holes 89A to 89D of the fixture body 83, as shown in FIG. The through holes 86 of the four fittings 84A to 84D are inserted through the distal end sides.

  Thereafter, as shown in FIG. 18, the four fittings 84A to 84D are pulled out along the suture thread 11 (or 14) to the positions of the through holes 89A to 89D of the fixture main body 83 and pushed into the through holes 89A to 89D.

  At this time, the large diameter portions 87 of the fittings 84A to 84D are compressed so that the interval between the notches 89 is narrowed according to the inclination of the large diameter inner surface 90 of the through holes 89A to 89D of the fixture body 83.

  At this time, the femur side fixing tool 81 (or the tibial side fixing tool 82) is fitted with the fittings 84A to 84D in the fitting space X1 of the fixing tool body 83, whereby the through holes 86 of the fittings 84A to 84D. An insertion passage for inserting the suture thread 11 (or 14) is formed between the opposing surfaces 87A and 87B, and the opposing surfaces 87A and 87B on both sides of the insertion passage press against the suture thread 11 (or 14). As a result, the suture 11 (or 14) is fixedly held in the insertion passage.

  According to the above configuration, the fitting members 84A to 84D are pushed into the through-holes 89A to 89D of the fixture main body 83, respectively, so that they are placed on the bone surface 2A (or 3A) of the femur 2 (or tibia 3). The set fixture body 83 can be firmly fastened.

  At the time of fastening, an appropriate tension can be applied to the suture thread 11 (or 14) passing through the fixation bone hole 12 (or 15), so that the end of the reconstructed ligament 8 is used for fusion. It can be firmly fixed without a gap between the bone hole 6 (or 7).

(5-4) Fifth Embodiment FIG. 19 shows a fifth embodiment. As shown in FIG. 19B, the femoral side fixing device 95 (or the tibial side fixing device 96) The cylindrical fixture body 98 has a configuration in which the fitting 99 is fitted with the center hole 98A as the fitting space X1.

  As shown in FIG. 19A, the fitting 99 has an annular suture pinching portion 100 and a pinching operation portion 101 protruding downward from the lower surface thereof.

  The suture pinching portion 100 has four pinching holes 103A to 103D drilled in the vertical direction at 90 [°] angular equidistant positions with the center hole 102 as the center, and each pinching hole 103A. The cuts 104A to 104D are formed so as to cut the suture pinching portion 100 into four divided members 105A to 105D in the vertical and horizontal directions so as to allow the central hole 112 to communicate with each other.

  Thus, when the pressing force is applied from the outer surface side to the inner side of the suture pinching portion 100, the interval between the four cuts 104A to 104D is narrowed so that the inner diameters of the pinching holes 103A to 103D are reduced. Has been made.

  The divided members 105A to 105D divided by the four cuts 104A to 104D in this way are swingably supported by the bottom plate portion 107 by the support plate portions 106A to 106D protruding downward.

  In the case of this embodiment, four through holes 108A to 108D are formed in the support plate portions 106A to 106D so as to penetrate the thickness.

  The bottom plate 107 is provided with through-holes 109A to 109D at 90 ° angular equidistant positions with the center hole 107A as the center so as to face the clamping holes 103A to 103D of the suture clamping part 100. Yes.

  The center hole 98A of the fixture main body 98 has an insertion hole portion 110 having a truncated cone space that follows the outer diameter shape of the clamping operation portion 101 of the fitting 99, and a pressing force application having a cylindrical shape connected to the upper portion thereof. It consists of a hole 111.

  The inner diameter of the pressing force applying hole 111 is selected to be smaller than the diameter of the suture pinching portion 100 of the fitting 99, whereby the fitting 99 is fixed from the pinching operation portion 101 side having a truncated cone shape. When fitted into the pressing force applying portion 111 or the insertion hole portion 110 of the tool main body 98, the pressing force is applied to the suture pinching portion 100 having a large outer diameter from the outside to the inside.

  In the above configuration, as shown in FIG. 20, the suture thread 11 (or 14) led out from the fixation bone hole 12 (or 15) on the bone surface 2 A (3 A) of the femur 2 (or tibia 3) When the bone side fixing device 95 (or the tibial side fixing device 96) is to be fastened, the suture thread 11 (or 14) is inserted through the fitting space X1 formed by the central hole 98A of the fixing device main body 98, and the upper end thereof. A state is obtained in which the insertion holes 103A to 103D are inserted through the through holes 109A to 109D of the bottom plate portion 107 of the fitting 99.

  In this state, the fitting 99 is drawn along the suture thread 11 (or 14) toward the fixture main body 98, and the fitting 99 is fitted into the fitting space X1 of the fixture main body 98 as shown in FIG. Match.

  At this time, the dividing members 105A to 105D of the suture pinching portion 100 of the fitting 99 receive an inward pressing force by the pressing force applying hole portion 111 of the fixture main body 98, so that the intervals between the cuts 104A to 104D are narrowed. To work.

  Such an operation of the divided members 105A to 105D is performed by pressing so that the pair of facing surfaces 112A and 112B on both sides of the four sutures 11 (or 14) inserted through the sandwiching holes 103A to 103D are sandwiched. Operate.

  At this time, the femoral side fixing tool 95 (or the tibial side fixing tool 96) is fitted into the center hole 98 of the fixing tool main body 98 by fitting the fitting 99 into the fitting space X1 of the fixing tool main body 98. An insertion passage for inserting the suture thread 11 (or 14) is formed between the narrow fitting holes 103A to 103D of the joint 99, and the notches 104A to 104D of the narrow fitting holes 103A to 103D on both sides of the insertion passage are formed. The opposing surface that is sandwiched and opposed is a pressure contact surface that presses against the suture thread 11 (or 14), and as a result, the suture thread 11 (or 14) is fixedly held in the insertion passage.

  According to the above configuration, the fitting 99 is led out from the fixing bone hole 12 (or 15) simply by fitting the fitting 99 to the fixing body 98 set on the bone surface 2A (or 3A). The suture thread 11 (or 14) can be firmly fastened to the bone surface 2A (or 3A) while applying an appropriate tension, whereby both ends of the reconstructed ligament 8 are fused with the bone hole 6 (or 7) for fusion. It can be in close contact with no gap.

(5-5) Sixth Embodiment FIG. 22 shows a sixth embodiment. The femoral side fixing device 115 (or the tibial side fixing device 116) is a central hole of a cylindrical fixing device main body 117. 117A is used as the fitting space X1, and a hat-shaped fitting 118 is fitted from above.

  In the bottom plate portion 120 of the fixture main body 117, four through holes 121A to 121D are formed at equal angular intervals of 90 ° with the center hole 120A as the center.

  The through holes 121A to 121D are formed so as to bite into the inner wall of the center hole 120A, and the dividing grooves 122A to 122D having an arcuate cross section are formed at the upper edge of the center hole 117A so as to communicate with the bited portion. Therefore, it communicates with the upper surface of the fixture main body 117.

  An annular enclosing member 123 is provided on the upper surface of the fixture main body 117 so as to make a round around the outer peripheral edge thereof, and thus split grooves 122A to 122D communicating with the through holes 121A to 121D. Is communicated with the stepped portion 124 formed by the surrounding member 123 on the upper surface of the fixture main body 117.

  A fitting 118 having a hat shape includes a cylindrical portion 125 fitted into the central hole 117A of the fixture main body 117, and a flange portion 126 extending radially outward from the upper end edge of the cylindrical portion 125 to the position of the surrounding member 123. Have

  Thus, when the cylindrical portion 125 is fitted into the center hole 117A of the fixture main body 117, the flange portion 126 covers the step portion 124 while the lower surface of the flange portion 126 is opposed to the step portion 124. A closed space is formed by the upper surface, the inner surface of the surrounding member 123, and the lower surface of the flange portion 126.

  In the enclosing member 123, suture lead-out holes 127A to 127D are formed at positions facing the upper edges of the through holes 121A to 121D. Thus, the split grooves 122A to 122D are respectively formed from the through holes 121A to 121D of the fixture main body 117. The suture thread that has passed through and reached the step portion 124 can be led out through the step portion 124 to the outside from the suture thread outlet holes 127A to 127D.

  At the same time, on the outer line of the collar portion 126 of the fitting 118, suture lead-out notches 128A to 128D are provided in the vertical direction at positions corresponding to the suture lead-out holes 127A to 127D, thereby the suture lead-out holes 127A to 127A. The suture reaching 127D can be pulled out upward via the suture lead-out notches 128A to 128D.

  In the above-described configuration, the suture thread 11 (or 14) led out from the fixation bone hole 12 (or 15) is fastened to the bone surface 2A (or 3A) of the femoral side fixing tool 115 (or tibial side fixing tool 116). 23, the suture thread 11 (or 14) passes through the through holes 121A to 121D provided in the bottom plate portion 120 of the fixture main body 117 so as to be along the split grooves 122A to 122D. And a fitting 118 is prepared on the upper end side of the suture 11 (or 14) so that the suture lead-out notches 128A to 128D are aligned with the suture lead-out ports 127A to 127D.

  In this state, as shown in FIG. 24, the cylindrical portion 125 of the fitting 118 is fitted into the center hole 117 </ b> A that forms the fitting space X <b> 1 of the fixture main body 117.

  At this time, the four sutures 11 (or 14) are pressed by the outer peripheral surface of the cylindrical portion 125 so as to pass through the split grooves 122A to 122D formed on the inner surface of the center hole 117A communicating with the through holes 121A to 121D. At the same time, in a state of being pressed against the stepped portion 124 by the lower surface of the flange portion 126 of the fitting 118, the suture lead-out holes 127A to 127D or the suture lead-out notches 128A to 128D are pulled out to the outside.

  At this time, the femoral side fixing tool 115 (or the tibial side fixing tool 116) is fitted with the fitting holes 118 in the fitting space X1 of the fixing tool main body 117, so that the through holes 121A to 121D of the fixing tool main body 117 and The suture thread 11 (or 14) between the split grooves 122A to 122D, the space between the step portion 124 and the hook portion 126 of the fitting 118, and the suture thread outlets 127A to 127D and the suture thread leading notches 128A to 128D. ), And the outer surfaces of the split grooves 122A to 122D and the cylindrical portion 125 on both sides of the insertion passage, and the step portion 124 and the hook portion 126 are attached to the suture thread 11 (or 14). As a result, the suture 11 (or 14) is firmly fixed and held in the insertion passage.

  According to the above configuration, when the fitting 118 is fitted to the fixture main body 117 and the suture thread 11 (or 14) is tightened into the femoral side fixture 115 (or tibial side fixture 116), Since the suture thread 11 (or 14) passing through the fixation bone hole 12 (or 15) can be firmly tightened while applying an appropriate tension, the end of the reconstructed ligament 8 is joined to the fusion bone hole 6 (or 7). ) Without any gaps.

(5-6) Seventh Embodiment FIG. 25 shows a seventh embodiment. As shown in FIG. 25 with the same reference numerals given to the corresponding parts to FIG. The fitting 118 of the tibial fixing device 116X) has four through-holes in the collar portion 126 so as to penetrate from the upper side to the stepped portion 124 side at an equiangular interval position of 90 ° around the center hole 118A. 129A to 129D are drilled.

  These through holes 129A to 129D are provided in place of the suture thread outlet holes 127A to 127D and the suture thread outlet notches 128A to 128D as means for leading the suture 11 (or 14) to the outside. It has been.

  In the case of this embodiment, the fitting member 118 is fitted to the fixture body 117 at a position shifted clockwise or counterclockwise by a predetermined angle with respect to the split grooves 122A to 122D of the fixture body 117. The fitting 118 is fitted into the center hole 117A of the fixture main body 117 so that there are through holes 129A to 129D.

  In the above configuration, when the suture thread 11 (or 14) is to be fastened to the femur side fixing tool 115X (or tibial side fixing tool 116X), as shown in FIG. ) Through the four through holes 121A to 121D of the fixture main body 117 along the corresponding split grooves 122A to 122D, and then the upper end portions thereof are inserted into the through holes 129A to 129D of the fitting 118.

  In this state, as shown in FIG. 27, the fitting 118 is pulled along the suture thread 11 (or 14) in the direction of the fixture main body 117, and the fitting 118 is slightly shifted in the clockwise direction, for example, to move the fitting 118. The cylindrical portion 125 is fitted into the center hole 117 </ b> A of the fixture main body 117.

  Thus, when the cylindrical portion 125 of the fitting 118 is fitted into the center hole 117A of the fixture main body 117, the suture thread 11 (or 14) is extended along the split grooves 122A to 122D by the outer surface of the cylindrical portion 125. Is tightened in a state of pressing against the split grooves 122A to 122D.

  As a result, the portion of the suture thread 11 (or 14) protruding from the split grooves 122A to 122D to the step portion 124 is the step portion from the through hole 129A to 129D of the fitting 118 at a position shifted from the split grooves 122A to 122D. It is crimped and held between 124 and the lower surface of the flange 126.

  At this time, the femoral side fixing tool 115X (or the tibial side fixing tool 116X) is fitted with the through holes 121A to 121D of the fixing tool main body 117 by fitting the fitting 118 into the fitting space X1 of the fixing tool main body 117. An insertion passage for inserting the suture thread 11 (or 14) is formed between the split grooves 122A to 122D, the space between the step portion 124 and the flange portion 126 of the fitting 118, and the through holes 129A to 129D. The outer surfaces of the split grooves 122A to 122D and the cylindrical portion 125 on both sides of the insertion passage, and the stepped portion 124 and the flange portion 126 become pressure contact surfaces that press against the suture thread 11 (or 14). As a result, the suture thread 11 (or 14) is fixedly held in the insertion passage.

  Thus, the suture 11 (or 14) is applied to the femoral side fixing device 115X (or the tibial side fixing device) while applying an appropriate tension to the suture 11 (or 14) led out from the fixing bone hole 12 (or 15). 116X), the end of the reconstructed ligament 8 can be transplanted in close contact with the healing bone hole 6 (or 7) without a gap.

(5-7) Eighth Embodiment FIG. 28 shows an eighth embodiment. As shown in FIG. 28C, the femur side fixing tool 131 (or the tibial side fixing tool 132) A cylindrical fitting main body 133 has a configuration in which a fitting 134 having a cylindrical shape whose upper end is closed by a closing plate portion 136 is fitted from above.

  As shown in FIGS. 28B and 29, the fixture main body 133 has four through holes 135 </ b> A to 135 </ b> D at angularly spaced positions of 90 ° with the center hole 133 </ b> A as the center.

  As shown in FIGS. 28A and 29, the closing plate portion 136 of the fitting 134 is provided with a center hole 136A, and through holes are formed at equal angular intervals of 90 ° around the center hole 136A. 137A to 137D are provided.

  The through holes 135A to 135D of the fixture main body 133 and the center holes 133A and 136A of the through holes 137A to 137D of the fitting 134 are arranged so that the through holes 137A to 137D are located between the through holes 135A to 135D. In this way, they are arranged at positions shifted by a predetermined angle (45 [°] in this embodiment).

  In the above configuration, the femoral side fixing tool 131 (or tibial side fixing tool 132) is led out from the fixing bone hole 12 (or 15) to the bone surface 2A (or 3A) of the femur 2 (or tibia 3). When fastening the suture thread 11 (or 14), as shown in FIG. 30, the four suture threads 11 (or 14) are inserted through the through holes 135A to 135D of the fixture main body 133 and the suture thread 11 is inserted. (Or 14) is inserted into the through holes 137A to 137D of the fitting 134 at the tip portion.

  Thus, a state is obtained in which the suture thread 11 (or 14) is inserted into the fixture main body 133 and the fitting 134, and then the fitting thread 134 is set to the suture thread 11 (or the outer space of the fixture main body 133 as the fitting space X1. 14), the fitting 134 is fitted on the outer side of the fixing body 133 as shown in FIG.

  During this fitting operation, the suture thread 11 (or 14) that has exited the through holes 135A to 135D of the fixture main body 133 has a portion between the through holes 137A to 137D shifted to a position rotated by 45 [°]. The lower surface portion of the portion 136 and the upper surface portion of the fixture main body 133 are strongly sandwiched and held.

  At this time, the femoral side fixing device 115X (or the tibial side fixing device 116X) is fitted with the through holes 135A to 135D of the fixing device main body 133 by fitting the fixing device main body 133 into the fitting space X1 of the fitting 134. , Between the through hole 137A to 137D and the upper surface portion of the fixture main body 133 from the through holes 135A to 135D of the fitting 134 to the through holes 137A to 137D and the lower surface portion of the closing plate 136 of the fitting 134. An insertion passage through which the thread 11 (or 14) is inserted is formed, and the upper surface portion of the fixture main body 133 and the lower surface portion of the closing plate portion 136 of the fitting 134 on both sides of the insertion passage are the suture thread 11 (or 14). ), And as a result, the suture 11 (or 14) is firmly fixed and held in the insertion passage.

  According to the above configuration, when the fitting 134 is fitted into the fixture main body 133, the suture thread 11 (or 14) is strongly tightened by the sandwiched holding portion between the fixture main body 133 and the fitting 134. Thus, the suture thread 11 (or 14) led out from the fixation bone hole 12 (or 15) is firmly fastened to the fixture while applying an appropriate tension force.

  Thereby, the reconstruction ligament 8 can be transplanted in a state where the end of the reconstruction ligament 8 is in close contact with the inner surface of the healing bone hole 6 (or 7) without any gap.

(5-8) Ninth Embodiment FIG. 32 shows a ninth embodiment, and the femoral side fixing device 140 (or the tibial side fixing device 141) is as shown in FIG. The cylindrical fitting body 144 is fitted from above, with the central hole 143A of the cylindrical fixture main body 143 whose lower end is closed by the closing plate portion 142 as the fitting space X1.

  As shown in FIG. 32 (B), the fixture main body 143 has four through holes 145A to 145D at angularly spaced positions of 90 ° around the center hole 143A provided in the closing plate 142. The four sutures can be drawn from below through the through holes 145A to 145D.

  As shown in FIG. 32 (A), the outer peripheral surface of the fitting 144 is perforated so that the shallow split grooves 146A to 146D extend vertically in the angularly equidistant positions of 90 [deg.] Around the center hole 144A. It is installed.

  Cutouts 147A to 147D for pulling out sutures are formed in the upper end edge of the fixing tool main body 143 at angular positions corresponding to the four split grooves 146A to 146D.

  In the above configuration, the suture thread 11 (or 14) led out from the fixing bone hole 12 (or 15) on the bone surface 2A (or 3A) of the femur 2 (or tibia 3) is used as the femoral side fixing device 140 ( Or, when trying to fasten to the tibial side fixing tool 141), as shown in FIG. 33, the four suture threads 11 (or 14) are respectively inserted into the through holes 145A to 145D of the closing plate part 142 and the distal end side thereof. The fitting 144 is prepared so as to face the split grooves 146A to 146D.

  In this state, the fitting 144 is pulled toward the fixture main body 143 along the four sutures 11 (or 14), and the center hole 143A of the fixture main body 143 is inserted into the fitting space X1 as shown in FIG. Fit together.

  At this time, the fitting 144 tightens the suture 11 (or 14) into the central hole 143A of the fixture main body 143 while pressing the four sutures 11 (or 14) against the corresponding split grooves 146A to 146D. .

  When the fitting 144 is finally fitted into the fitting space X1 of the fixture main body 143, as shown in FIG. 34, the femoral side fixing tool 140 (or the tibial side fixing tool 141) causes the fitting 144 to be inserted into the fixture main body. 143 is fitted into the fitting space X1, and the bottom surface of the fixture main body 143 and the fitting 144 between the through holes 145A to 145D and the split grooves 146A to 146D are fitted. An insertion passage through which the suture thread 11 (or 14) is inserted is formed between the space between the lower surfaces of the fittings 144 and the space between the split grooves 146A to 146D of the fitting 144 and the inner surface of the fixture main body 143. The bottom surface of the fixture main body 143 and the lower surface of the fitting 144 on both sides of the passage, and the split grooves 146A to 146D of the fitting 144 and the inner surface of the fixture main body 143 are connected to the suture thread 11 ( 14) to become a pressing surface for pressing, resulting in a state of being firmly fixed and held suture 11 (or 14) in the insertion passage.

  According to the above configuration, the four suture threads 11 (or 14) led out from the fixation bone hole 12 (or 15) fit the fitting 144 into the fixture main body 143, whereby the fixation bone hole 12. (Or 15) The end of the reconstructed ligament 8 is joined to the fusion bone hole 6 (or 7) by being firmly fastened to the fixture while applying appropriate tension to the suture thread 11 (or 14) extending inside. ), The reconstructed ligament 8 can be transplanted in a state of being closely contacted with no gap.

(5-9) Tenth Embodiment FIG. 35 shows a tenth embodiment, and the femoral side fixing device 150 (or the tibial side fixing device 151) is as shown in FIG. The cylindrical fixture body 152 has an outer space as a fitting space X1, and a cylindrical fitting 154 having a closing plate 153 at the upper end is fitted.

  As shown in FIG. 35 (B), the fixture main body 152 has four through holes 155A to 155D at angularly equidistant positions of 90 ° around the center line of the cylinder.

  On the other hand, as shown in FIG. 35A, one through-hole 156 is formed at the center position of the closing plate portion 153 of the fitting 154.

  As shown in FIG. 36, the positional relationship between the four through holes 155A to 155D of the fixture main body 152 and the through hole 156 of the fitting 154 is a part of the through holes 155A to 155D with respect to the through hole 156 of the fitting 154. Are overlapped with each other, and the remaining portion is configured to overlap with the inner surface of the closing plate portion 153 of the fitting 154.

  In the above configuration, the four sutures 11 (or 14) led out from the fixing bone holes 12 (or 15) on the bone surface 2A (or 3A) of the femur 2 (or tibia 3) are fixed on the femur side. When fastening to the tool 150 (or tibial side fixing tool 151), as shown in FIG. 37, the four through holes 155A to 155D of the fixing tool main body 152 are inserted and the distal end side of the fitting 154 is passed through. The hole 156 is inserted.

  In this state, as shown in FIG. 38, the fitting 154 is pulled toward the fixture main body 152 along the suture 11 (or 14), and the fitting 154 is fitted into the fixture main body 152 from above.

  At this time, the suture thread 11 (or 14) inserted through the fixture main body 152 passes through the narrow opening formed by overlapping the through hole 156 of the fitting 154 among the through holes 155A to 155D. Pulled out from above.

  As a result, the suture thread 11 (or 14) is held between the shoulder portions 157A to 157D inside the through holes 155A to 155D and the inner peripheral edge portions 158A to 158D of the through holes 156, respectively. .

  Thus, the suture thread 11 (or 14) led out from the fixing bone hole 12 (or 15) is fastened and fixed onto the bone surface 2A (or 3A) by the fixing body 152 and the fitting 154.

  At this time, the femoral side fixing device 150 (or the tibial side fixing device 151) is fitted with the fitting holes 154 in the fitting space X1 of the fixing device main body 152, so that the through holes 155A to 155D of the fixing device main body 152 are fitted. An insertion passage through which the suture thread 11 (or 14) is inserted is formed between the through hole 156 of the fitting 154, and the shoulders of the through holes 155A to 155D and the through holes 156 on both sides of the insertion passage. The inner peripheral edge portions 158A to 158D serve as pressure contact surfaces that come into pressure contact with the suture thread 11 (or 14), and as a result, the suture thread 11 (or 14) is firmly fixed and held in the insertion passage.

  According to the above configuration, when the fitting 154 is fitted to the fixture main body 152, the narrow opening formed between the through holes 155 </ b> A to 155 </ b> D of the fixture main body 152 and the through hole 156 of the fitting 154. The femoral side fixing device 150 (or the tibia) while applying an appropriate tension force to the suture thread 11 (or 14) passing through the fixation bone hole 12 (or 15) by being led out to the upper outside through. It can be firmly fastened to the side fixture 151), so that the end of the reconstructed ligament 8 can be transplanted in close contact with the healing bone hole 6 (or 7) without any gap.

(6) Other application examples (6-1) In the above-described embodiment, one end of the reconstructed ligament 8 is transplanted into the healing bone hole 6 on the femur 2 side, and the other end is on the tibia 3 side. Although the case where it transplanted to the bone hole 7 for fusion was described, it replaces with this and you may make it apply this invention only about the transplant with respect to the femur 2. FIG.

(6-2) Also in the above-described second to tenth embodiments, the suture 11 (or 14) fastened with the fixture is further fixed as described in the first embodiment with reference to FIG. The fastening force may be further strengthened by forming the stitched portion 40 by stitching on the tool.

  The present invention is applied when a reconstructed ligament is transplanted for a knee joint.

  2 ... Femur, 3 ... Tibia, 4 ... Joint, 5 ... Lateral condyle, 2A, 3A ... Bone surface, 6, 7 ... Bone hole for healing, 6A, 7A ... Tip surface, 6B, 7B: Step, 11, 14 ... Suture, 12, 15 ... Fixing bone hole, 13 ... Femoral side fixing device, 16 ... Tibial side fixing device, 25, 61, 71, 83, 98 117, 133, 143, 152... Fixture body, 26, 62, 73, 84 A to 84 D, 99, 118, 134, 144, 154... Fitting, 27 A to 27 D, 74 A to 74 D, 121 A to 121 D, 135A to 135D, 145A to 145D, 155A to 155D... Through holes on the fixture main body side, 63A to 63D, 75, 86, 129A to 129D, 137A to 137D, 156.

Claims (6)

A femoral side end or a tibial side end of a reconstructed ligament that has a fitting space and is inserted into a large-diameter healing bone hole drilled in the femur or the tibia on the surface of the femur or tibia A fixture main body provided at the position of the outlet of the small-diameter fixation bone hole drilled so as to lead the suture thread joined to the bone surface from the distal end of the fusion bone hole to the bone surface;
When fitted in the fitting space of the fixture main body, together with the fixture main body, an insertion passage through which the suture led out from the fixing bone hole is inserted is formed, and the pressure contact provided in the insertion passage A reconstructive ligament fixing device comprising: a fitting for fixing and holding the suture in the insertion passage by pressing a surface against the suture. The pressure contact surface is formed on the clamping receiving surface formed on the fixture main body and the fitting, and when the fitting is fitted into the fitting space, the suture thread in the insertion passage is interposed therebetween. The reconstructive ligament fixture according to claim 1, comprising a crimping surface sandwiched and held on the sandwiching receiving surface. The pressure contact surfaces are a pair of pressure-bonding surfaces facing each other with the insertion passage interposed therebetween in the fitting, and the pair of pressure-bonding surfaces are close to each other when the fitting is fitted in the fitting space. The reconstruction ligament fixture according to claim 1, wherein the suture is sandwiched and held between the pair of crimping surfaces by being pressed by the fixture main body. The pressure contact surface includes a split groove formed in the wall surface of the fitting space of the fixture body, and the suture thread in the insertion passage into the split groove when the fitting is fitted into the fitting space. The reconstruction ligament fixture according to claim 1, comprising: a side surface of the fitting that is sandwiched and held. The pressure contact surface includes a split groove formed on a side surface of the fitting, and the fixing that holds the suture thread in the insertion passage in the split groove when the fitting is fitted into the fitting space. The reconstruction ligament fixture according to claim 1, comprising: an inner wall surface of a fitting space of the fixture body. 2. The press contact surface according to claim 1, wherein when the fitting is fitted into the fitting space, the upper surface portion of the fixture main body and the lower surface portion of the facing portion of the fitting that faces the upper surface portion. The reconstructed ligament fixture described.

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