JP2012045417A - Tool for artificial knee joint replacement surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To reproduce contents decided from a reference point of a thigh bone knee joint using a special jig installed perioperatively in an intramedullary alignment rod after the position and angle of a distal osteotomy surface to which the intramedullary alignment rod is used is decided accurately by properly reflecting individual differences of a patient.SOLUTION: The tool for artificial knee joint replacement surgery includes: an abutting part 31 which abuts on the reference point of the knee joint of a thigh bone; mounting sections 33 and 34 where the intramedullary alignment rod (IM) to be inserted in the intramedullary of the thigh bone is mounted; and an arm section 32 which connects the abutting part 31 and the mounting sections and is adjustable according to parameters about the insertion of the intramedullary alignment rod (IM) at the mounting position and mounting angle on the mounting sections 33 and 34 decided preoperatively.

Description

  The present invention relates to a prosthetic knee joint replacement jig for planning and performing an artificial knee joint replacement operation on a human knee using medical tomographic images.

  Recently, medical tomographic image diagnostic apparatuses such as an X-ray CT apparatus and an MRI apparatus have become widespread, and it has become possible to observe and diagnose various parts of the body using them. On the other hand, with the aging of the world as well as Japan, osteoarthritis of the knee has been increasing, and surgery to replace the affected knee joint with an artificial joint made of artificial metal or ceramics is today. Widely used. The key to this knee replacement is to place a prosthesis with the optimal shape and size for the patient at the optimal angle and position.

  However, the surgical plan for that purpose is to superimpose a template in which a two-dimensional shape of an artificial joint is drawn on a transparent film on a simple X-ray image from the two-dimensional front and side surfaces, or on a simple X-ray image film. At present, the size, installation position, installation direction, osteotomy amount, and osteotomy position of the artificial joint are obtained by measuring using a ruler.

  However, manual measurement using a template or a ruler based on a two-dimensional simple X-ray image has insufficient measurement accuracy of the size and installation position, and the installation position and amount of osteotomy are three-dimensional. Moreover, since it is difficult to grasp quantitatively, considerable experience and accumulation of technology are required.

  Therefore, it has been difficult for all orthopedic surgeons to perform accurate and highly accurate surgical planning and operations quickly. In particular, the accuracy of the position and orientation of the prosthetic joint has a significant impact on the durability of the prosthetic joint, and the patient should continue to live a healthy life without any discomfort on a daily basis for 10 to 20 years after surgery. It is the most important element in order to be able to.

  However, in the method using the two-dimensional template, it is difficult to perform such processing.

  On the other hand, there is a technique for performing a three-dimensional simulation using a personal computer as described below in order to assist an operator to easily know an ideal tibia osteotomy surface in artificial knee joint replacement. It is considered. (For example, Patent Document 1)

JP 2004-008707 A

  Conventionally, a method of using an intramedullary alignment rod (hereinafter referred to as “intramedullary rod”) to be inserted into a bone is used to determine the installation angle of a femoral side (artificial joint) component during surgery. The angle of the distal osteotomy surface that defines the varus / valgus angle and flexion / extension angle of the same component due to the difference between the axial direction of the rod and the functional axis direction of the femur. Has been determined.

  At this time, when determining the varus / valgus angle, the angle formed with the intramedullary rod can be adjusted to some extent according to the target installation angle of the component, but the bending / extension angle cannot be adjusted and the insertion angle of the intramedullary rod can be adjusted. Fully dependent on. This means that the installation angle of the femoral component depends on the insertion angle of the intramedullary rod.

  However, in this method using an intramedullary rod, since there are individual differences in bone shape, the insertion angle of the intramedullary rod is different in each case, and the distal osteotomy surface is always created at the planned angle. There is a flaw that does not mean.

  Furthermore, the rotational angle of the clinically critical femoral component is determined within the distal osteotomy plane, and if the distal osteotomy surface itself is inaccurate, the rotational angle is necessarily inaccurate. It becomes.

  In this regard, the above-mentioned Patent Document 1 in which the technique on the tibia side is described does not describe any of the above-mentioned problems due to the use of an intramedullary rod on the femur side.

  The present invention has been made in view of the above circumstances, and the object of the present invention is to appropriately reflect the individual differences of patients and to use the intramedullary alignment rod to position and angle the distal osteotomy surface. A prosthetic knee that can be accurately determined by reproducing the content determined from the reference point of the femoral knee joint using a dedicated jig attached to the intramedullary alignment rod during the operation. The object is to provide a jig for joint replacement surgery.

  One aspect of the present invention includes a contact portion that contacts a reference point of a knee joint of a femur, a mounting portion that mounts an intramedullary alignment rod to be inserted into a medullary bone of the femur, the contact portion, and the mounting portion And an arm part that can be adjusted according to parameters relating to the insertion of the intramedullary alignment rod, the attachment position and the attachment angle of the attachment part being determined before the operation.

  Another aspect of the present invention includes a contact portion that contacts the reference point of the knee joint of the femur, a mounting portion that mounts an intramedullary alignment rod to be inserted into the bone marrow of the femur, the contact portion, and the above And a connecting portion that can be adjusted in accordance with the parameters relating to the insertion of the intramedullary alignment rod, the attachment angle of the external jig to be attached to the intramedullary alignment rod determined in advance. Features.

  According to the present invention, the position and angle of the distal osteotomy surface using the inserted intramedullary alignment rod and the inserted intramedullary alignment rod accurately corresponding to the individual differences of patients in the preoperative plan are accurately determined. After the determination, an accurate operation can be performed by reproducing the content determined from the reference point of the femoral knee joint using a dedicated jig attached to the intramedullary alignment rod during the operation.

The block diagram which shows the hardware constitutions of the personal computer which installed the preoperative planning program of the artificial knee joint replacement operation which concerns on one Embodiment of this invention. The flowchart which shows the processing content of the program for preoperative planning which concerns on the embodiment. The three-dimensional shape data of the femur, the artificial joint, and the intramedullary rod displayed on the display screen according to the embodiment are illustrated. The figure which illustrates the three-dimensional shape data of the femur, the artificial joint, and the intramedullary rod displayed on the display screen according to the embodiment. The figure which illustrates the image which displayed the position of the intramedullary rod with respect to the femur and artificial joint which concerns on the same embodiment. The figure which illustrates the angle which the functional axis of the femur which concerns on the embodiment forms, and a distal bone axis. The figure which illustrates the bone cross-sectional image of the patellofemoral joint along the plane perpendicular | vertical to the axis | shaft of the intramedullary rod which concerns on the embodiment. The figure which illustrates the offset distance of the said front tangent and rod coordinate center which concern on the embodiment. The figure which illustrates the case where a part of the various parameters preserve | saved concerning the embodiment are read and displayed on a display screen. The structure of the surgical jig | tool (target device) which concerns on the embodiment is shown, FIG. 10 (A) is a perspective view, FIG.10 (B) is a side view. The perspective view (FIG. 11 (A)) which shows the structure of the rod keeper which concerns on the embodiment, and the figure (FIG. 11 (B)) which shows a use condition. The structure of the rotation angle determination jig | tool which concerns on the embodiment is shown, FIG. 12 (A) is a perspective view, FIG.12 (B) is a side view. The structure of the other jig | tool for determination of the rotation angle which concerns on the embodiment is shown, FIG. 13 (A) is a perspective view, FIG.13 (B) is a side view.

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

  FIG. 1 shows a hardware configuration of a personal computer (hereinafter “PC”) 10 in which a preoperative planning program for artificial knee joint replacement surgery is installed. The north bridge 12 is connected to the CPU 11 that controls various processes and the front side bus FSB.

  The north bridge 12 is further connected to the main memory 13 via the memory bus MB and to the graphic controller 14 and the graphic memory 15 via the graphics interface AGP, and is also connected to the south bridge 16 mainly between them. Execute I / O control.

  The south bridge 16 is connected to the PCI bus 17, keyboard / mouse 18, video encoder 19, hard disk device (HDD) 20, network interface (I / F) 21, and multi-disk drive 22. Input / output control with 12 is performed.

  In the hard disk device 20, in addition to the OS (operating system), various application programs, various data files, etc., the preoperative planning program for artificial knee joint surgery and the associated intramedullary rod and various jig shapes It is assumed that data and the like are installed in advance.

  The video encoder 19 generates and outputs an RGB video signal, which is an analog image signal, from a given digital image signal, and is composed of a color TFT (thin film transistor) liquid crystal display panel (not shown). The display unit is driven to display.

  The multi-disc drive 22 can reproduce and record an optical disc medium in accordance with, for example, a CD (Compact Disc) standard and a DVD (Digital Versatile Disc) standard. It is assumed that the three-dimensional shape data of the patient's lower limb can be input and recorded on the hard disk device 20 by reproducing and reading the optical disk medium on which the information is recorded.

  It should be noted that the individual elements constituting the PC 10 are very general well-known techniques, and therefore description thereof is omitted.

Next, the operation of the above embodiment will be described.
FIG. 2 shows the processing contents of the present invention executed mainly by the CPU 11 when a doctor who is a user of the PC 10 activates a preoperative planning program stored in the hard disk device 13.

  When this preoperative planning program is executed, the 3D bone shape data of the patient's lower limb created from the 2D tomographic image data slice imaged by the X-ray CT apparatus or the MRI apparatus is read and stored in the hard disk device 20. It shall be.

  In this program, 3D lower limb bone shape data created based on a series of 2D tomographic images of the lower limbs of the human body, the head center, the posterior condylar sphere center of the knee joint, the tibial intercondylar protuberance, Major landmarks such as inner and outer edge points of the distal joint surface are set as three-dimensional reference points, and the coordinate system of the femur and tibia is set using these reference points. The three-dimensional positional relationship between the femur and tibia, that is, the alignment itself, may be in a standing position or a prone position.

  As a coordinate system, an absolute definition is not particularly required, but the following coordinate system is used here for convenience of explanation. As for the femoral coordinate system, the origin is the center of a straight line connecting the center of the posterior condyle sphere inside and outside, the X-axis is the direction on the right body side of the straight line, and the Y-axis is the vector product of the vector connecting the origin and head center. And Therefore, the front of the Y axis is positive. The Z axis is defined from the X axis and the Y axis.

  With respect to the tibial coordinate system, the line connecting the center of the line connecting the inner and outer edges of the distal joint surface of the tibia and the center of the tibial intercondylar bulge is taken as the Z axis. The proximal direction, that is, the upward direction is positive. The Y axis is a line connecting the posterior tibial cruciate ligament attachment portion and the tibial rough surface, and the front of the body is positive. The X axis is determined from the Y axis and the Z axis.

  Further, three-dimensional shape data of the artificial joint is separately prepared and stored in the hard disk device 20. Similar to the femur and tibia, the femoral prosthesis and the tibia prosthesis have their own coordinate systems.

  Specifically, in the femoral prosthesis, for example, the proximal direction or the vertical direction is the Z axis, the body front direction is the Y axis, and the body side right direction is the X axis. However, the coordinate axes do not necessarily have such an arrangement, and may be defined differently. A similar coordinate system is defined for the tibial prosthesis.

  Then, when the preoperative planning program of FIG. 2 is started, a GUI (graphical user interface) is displayed, and the desired three-dimensional shape data in the standing or prone position of the lower limb displayed on this GUI is displayed. select.

  This is performed by designating a folder storing the three-dimensional shape data of the lower limbs, which is used in a general PC program. Further, the three-dimensional shape data of the femur and the three-dimensional shape data of the tibia are correctly arranged in advance in the three-dimensional positional relationship (three-dimensional alignment) in the standing position in the weighted state and the decubitus position in the extracted state. Shall.

  Next, the selected three-dimensional shape data of the femur of the lower limb is read from the folder of the hard disk device 20 into the main memory 13 (step S101), and an image of the three-dimensional shape data viewed from an appropriate viewpoint is displayed on the display screen. (Step S102). In this display, a three-dimensional image or three-dimensional shape data obtained by perspective projection can be two-dimensionally displayed in a cross section in a plane parallel to the coordinate axis.

  Next, three-dimensional shape data of an artificial joint for a femoral joint having an appropriate size and shape is selected (step S103), and the data is read from the hard disk device 20 and displayed on the display screen (step S104).

  Next, the three-dimensional shape data of the femoral prosthesis is appropriately translated and rotated by an operation with the keyboard / mouse 18, and placed at an optimal position with respect to the three-dimensional shape data of the femur.

Here, the optimum position is an orthopedic optimum position proposed by the academic society and each artificial joint manufacturer, and is a relative installation position of the artificial joint with respect to each of the femur and the tibia. . This position is the optimum position for installing the artificial joint during the operation, and osteotomy is performed based on this installation position. (Step S105)
More specifically, it is generally recommended that the distal articular surface of the femoral component (prosthetic joint) and the proximal articular surface of the tibial component be perpendicular to the functional axis on the coronal section. However, regarding the angle on the sagittal section (bending / extending angle), there is no constant consensus for both components, and it is necessary for the doctor to appropriately determine according to the shape of the joint of the individual patient. As for the axial rotation angle, it is recommended that the X axis of the femoral component be installed in parallel with the femoral transcondylar axis (hereinafter referred to as TEA). This installation position may be set by a doctor who is a user of this program in an interactive manner on the program, or a portion that can be automated using a reference point or the like may be automatically arranged.

  Next, the three-dimensional shape data of the artificial joint for the appropriate size of the tibial joint is selected (step S106), read from the hard disk device 20, and displayed on the display screen (step S107).

  Next, similarly to the above femur side, the three-dimensional shape data of the tibial prosthesis is translated and rotated by the operation with the keyboard / mouse 18 and arranged at the optimum position with respect to the three-dimensional shape data of the tibia. (Step S108).

  Regarding this installation, a doctor who is a user of this program may set the program interactively, or a portion that can be automated using a reference point or the like may be automatically arranged.

  As described above, in the present embodiment, it is possible to easily install each artificial joint at an ideal position three-dimensionally with respect to the lower limb bone, and to obtain quantitative installation parameters and osteotomy parameters.

  Next, the three-dimensional shape data of the intramedullary rod stored in advance is read from the hard disk device 20 (step S109) and displayed on the display screen (step S110).

  A mark indicating the depth is previously set in the three-dimensional shape data of the intramedullary rod. A coordinate system is also defined for the rod. The major axis direction is the Z axis, and the front is the Y axis. The vector product of the Y axis and the Z axis is taken as the X axis. This coordinate system is also for convenience and other definitions may be used.

  It is assumed that the read three-dimensional shape data of the intramedullary rod can be translated distally and proximally, medially outward, anteriorly and posteriorly, and internally and externally rotated, varusally valgus, and bent and extended.

  On this display screen, the three-dimensional shape data of the intramedullary alignment rod is appropriately rotated and translated by an operation with the keyboard / mouse 18, and is appropriately placed in the marrow of the three-dimensional shape data of the femur (step S111). ).

  That is, the intramedullary rod is placed at an appropriate position in the medulla with respect to the femoral shape data. In other words, the insertion position, direction and depth of the intramedullary rod are arranged at an optimal angle and position in three dimensions. The optimal angle / position here refers to adjusting the insertion point, varus / valgus angle, and insertion depth as much as possible in the intramedullary insertion depth under conditions that match the bending / extension installation angle of the selected artificial joint. Angle and position.

  Actually, the position is such that the Z axis of the intramedullary rod exists in a plane parallel to the XZ plane. As a result, if the rotation angle is set accurately, the angle in the flexion / extension direction coincides between the artificial joint and the intramedullary rod.

  FIG. 3 illustrates the three-dimensional shape data of the femur, the artificial joint, and the intramedullary rod displayed on the display screen at this time. In the figure, the optimal position of the artificial joint CP is selected and arranged at the knee joint portion of the femur FM, and the intramedullary rod IM is inserted into the femur FM.

  Thereafter, the three-dimensional shape data of the intramedullary rod IM is moved with respect to the femur FM and the artificial joint CP by the operation with the keyboard / mouse 18 (step S111), and the arrangement at the optimum position is completed. Whether or not is determined by, for example, the presence or absence of an instruction of the “OK” button during GUI display (step S112).

  Otherwise, the process returns to step S111 and repeats the position movement of the intramedullary rod IM by the operation to wait for the intramedullary rod IM to be optimally arranged in the medulla of the femur FM.

  As described above, the optimal arrangement of the intramedullary rod IM is such that the Z axis that matches the planned installation angle of the artificial joint CP, that is, the Z axis that coincides with the axial direction of the intramedullary rod IM, is the femoral prosthesis CP. It is parallel to the XZ plane of the coordinate system, and a doctor as a user can repeat the processes in steps S111 and S112 with this program to achieve an optimal arrangement.

  4 and 5 switch the display state in the process of obtaining the appropriate arrangement, and display the position of the intramedullary rod IM with respect to the femur FM and the artificial joint CP along the two-dimensional plane based on the three-dimensional shape data. This is an example of an image.

  In FIG. 4, the cross section viewed from the side passing through the central axis (Z axis) of the intramedullary rod IM and the cross section viewed from the front are displayed together with the original three-dimensional shape in the screen.

  FIG. 5 illustrates the positional relationship between the artificial joint CP and the intramedullary rod IM with respect to the entire femur FM extracted from the GUI environment display screens also shown in FIGS. 3 and 4. This shows a state in which the intramedullary rod IM is inserted to the deepest (upward in the standing human body) in the bent marrow.

  Thus, when the optimal arrangement state of the intramedullary rod IM is obtained and the user instructs that it is optimal, in step S111, this is determined, and the Z axis that is the axis of the intramedullary rod IM and the artificial joint CP are determined. The angle (inner and outer valgus angle) made with the Z axis is calculated on the coronal plane (step S113).

  FIG. 6 illustrates this varus / valgus angle, which corresponds to the angle formed by the functional axis FA and the distal bone axis FP in the femoral coordinate system, and is usually about 7 ° (in the figure, “7.68 °”). )), But depending on individual differences, there may be even greater differences.

  Next, the rotation angle is determined. The femoral posterior condyle tangent to be referred during the operation and the X axis of the prosthetic joint CP are projected onto a plane perpendicular to the axis of the intramedullary rod IM, and the angle formed by these (hereinafter referred to as “posterior condyle tangent—artificial joint angle”). ) Is calculated (step S114).

  As a result, the doctor who is the user of this program knows how many times he should rotate around the intramedullary rod IM from the state in which the X axis of the artificial joint CP is parallel to the axis of the posterior condyle during operation. be able to.

  In addition, as another preparation method for determining the rotation angle, a plane perpendicular to the axis of the intramedullary rod IM (referred to as plane “R”) is located several millimeters proximal from the proximal end of the patellofemoral joint. A bone cross-sectional image is displayed, and the tangent of the two vertices of the part where the frontal cortex is bimodal is obtained from the digitization of the two vertices, and the angle between the tangent and the X axis of the artificial joint (hereinafter, (“Anterior tangent—artificial joint angle”) is calculated, and an offset distance from the center of the rod coordinate of the plane R is calculated (step S115).

  FIG. 7A shows the plane R, and FIG. 7B is a front tangent TL in the plane R. The position where the front tangent TL is located is on the side that can be directly seen at the time of surgery, and is not affected by the presence or absence of cartilage, and thus can be used as one of the reference points that can be recognized very easily.

  FIG. 8 shows the front tangent TL and the offset distance from the center of the rod coordinate (“17.24 [mm]” in the figure).

  As described above, the artificial joint placement operation before the operation is planned, and necessary various parameters are calculated and stored (step S116), and these various parameters are used in the actual operation using the surgical instrument. Thus, it is possible to perform an optimal osteotomy.

FIG. 9 exemplifies a case where some of the stored various parameters are read and displayed on the display screen. That is, the parameter value that should be calculated by the preoperative planning program is
(1) Intramedullary rod insertion point information: Intramedullary from a flat portion (approximated to a plane) of about 30 [mm] proximal to the femoral patella joint at the front portion of the distal femur where the target device is installed ΔY value to the insertion point of the rod, that is, the distance when projected on the YZ plane of the femoral coordinate system
(2) Depth of rod insertion, that is, length from insertion point to rod tip
(3) The rotation angle of the X-axis of the rod with respect to the femoral PCA (Positioner Axis) and the anterior tangent-artificial joint angle
(4) Angle (coronal plane) formed by the Z-axis of the rod and the Z-axis (three-dimensional functional axis) of the component
(5) Angle (sagittal plane) between the Z axis of the rod and the Z axis of the component (three-dimensional functional axis)
including.

  During actual surgery using a surgical instrument, a jig called a target device is used as a first jig in a flat portion closer to the proximal side from the upper end of the femoral patella in order to determine the insertion point of the intramedullary rod. .

  FIG. 10 illustrates the shape of the target device 30 used at this time. FIG. 10 (A) is a perspective view, and FIG. 10 (B) is a side view. The target device 30 includes a contact part 31, an arm part 32, and a mounting part 33.

  The contact portion 31 is a portion for contacting the front tangent line, and the arm portion 32 is fixedly connected to the contact portion 31. Then, a mounting portion 33 is attached to the tip of the arm portion 32 and is movable in the direction of the arrow I in the figure, which is orthogonal to the axial direction of the arm portion 32 and parallel to the front tangent.

  The mounting portion 33 includes a rod mounting portion 34 that can be translated along the axial direction of the mounting portion 33 and the direction of the arrow II perpendicular to the arrow I, as shown in FIG. The offset amount (distance) from the bottom surface of the contact portion 31, that is, the front tangent position where the contact portion 31 abuts, is scaled, for example, in millimeters. The rod attachment portion 34 can adjust the offset amount from the front tangent line by adjusting the screw 35 and the attachment angle thereof as indicated by an arrow III.

  Then, an intramedullary rod or an insertion position marker having the same shape as that of the intramedullary rod is attached to the rod mounting portion 34, and the intramedullary rod puncture of the intercondylar portion from the approximate plane calculated in (1) above. The insertion point can be determined by measuring and marking the distance to the entry point.

  By drilling the marked insertion point position using a drill bit (not shown), an insertion port is formed, and the intramedullary rod IM is inserted into the intramedullary bone of the femur FM from the insertion port by the previously calculated depth. Insert into.

At this time, a rod keeper 40 as shown in FIG. 11A may be used so that the intramedullary rod IM does not move carelessly.
The rod keeper 40 shown in FIG. 11 (A) has a two-stage cylindrical shape with different outer diameters, and the center shaft portion is hollow through the intramedullary rod IM, and extends downward from the lower bottom surface side of the large diameter side cylindrical portion 41. As shown in FIG. 11B, the spike 41a is formed so as to project into the puncture site of the femur FM (represented by a three-dimensional model here) with the intramedullary rod IM penetrated.

  In addition, a plurality of, for example, three screw holes 43 are formed through the small diameter side cylindrical portion 42 so as to form a uniform central angle in the radial direction centering on the axial position, as shown in FIG. By screwing screws (not shown) into the respective screw holes 43 as described above, the intramedullary rod IM inserted from the puncture opening of the femur FM can be held without causing rattling or the like.

  Thereafter, an existing osteotomy jig (not shown) is attached to the intramedullary rod IM. At this time, this osteotomy jig is adjusted in advance to the valgus angle described in the above (4), which is calculated in advance for the intramedullary rod IM, and the distal resection paddle of this jig is used. The horizontal axis of the plane portion referred to as “X” coincides with the X axis of the intramedullary rod IM and the X axis of the artificial joint CP, and when this plane coincides with the planned distal osteotomy surface, the planned distal bone Cutting is performed.

FIG. 12 shows the configuration of the rotation angle determination jig 50 to be mounted from the distal side with respect to the osteotomy jig, together with the rod keeper 40 and other jigs. FIG. 12 (A) is a perspective view. 12 (B) is a side view.
In the rotation angle determination jig 50, a pair of paddles 52 are provided integrally with the connection portion 53 on the lower end side of the mounting portion 51 that penetrates the intramedullary rod IM. These paddles 52 come into contact with both the medial and lateral posterior condyles of the femur FM, and as shown in FIG. 12 (B), a pair of paddles 52 are rods as shown by an arrow IV in the drawing. The connecting portion 53 is slidably attached to the mounting portion 51 so that the distance from the shaft portion can be adjusted.

  Moreover, the rotation part 54 which provided rotatably with respect to the said mounting part 51 and penetrated the intramedullary rod IM similarly is provided. The rotating portion 54 is located on the front side of the mounting portion 51 and has a pointer 54a attached in the radial direction, and a scale 51a is formed on the mounting portion 51 side.

  However, the turning angle determination jig 50 is mounted from the distal side of the osteotomy jig, and the angle formed by the osteotomy jig and the rotation angle determination jig 50 and the preoperative planning program are calculated. The intramedullary rod IM and the osteotomy jig are rotated by adjusting the angle of the rotation part 53 with respect to the mounting part 51 so that the “posterior condyle tangent-artificial joint angle” is equal.

  By this rotation, the rotation angle of the artificial joint CP can be realized. At this point, drilling the femoral condyle perpendicularly to the plane of the jig at two points on the horizontal axis of the osteotomy jig (coincident with the X axis of the artificial joint CP) to create a small bone hole, The distal osteotomy is then performed using existing instruments. The two previously created bone holes remain on the distal osteotomy surface, and the rotation angle is determined with reference to the two bone holes, and the posterior osteotomy is performed.

  However, cartilage may remain in the posterior condyles of the femur, and accurate control may be difficult when the posterior condyle tangent is used to determine the rotation angle due to uneven thickness. .

  Therefore, the above-mentioned “front tangent—artificial joint angle” is used as another method for determining the rotation angle. A special rotation angle determination jig that measures how many times the forward tangent is rotated around the rod axis from the distal side of the osteotomy jig is used.

FIG. 13 shows the configuration of a rotation angle determination jig 60 to be mounted from the distal side with respect to the osteotomy jig, together with the rod keeper 40 and other jigs. FIG. 13 (A) is a perspective view. 13 (B) is a side view.
The rotation angle determination jig 60 is provided with a contact portion 64 via a connection portion 62 and an arm portion 63 on the upper end side of the mounting portion 61 that penetrates the intramedullary rod IM. The abutting portion 64 is a portion for abutting on the front tangent, like the abutting portion 31 of the target device 30 in FIG.

  The arm portion 63 having the contact portion 61 formed at one end thereof is arm length with respect to the connection portion 62 as shown by an arrow V in FIG. 13B (interval between the mounting portion 61 and the contact portion 64). Can be arbitrarily variable. In addition, the connecting portion 62 is slidably attached to the mounting portion 51 so that the distance (height) from the rod shaft portion can be adjusted as indicated by an arrow VI in the drawing.

  Moreover, the rotation part 65 provided with the said attachment part 61 so that rotation is possible, and similarly penetrating the intramedullary rod IM is provided. The rotating portion 65 is located on the front side of the mounting portion 61 and has a pointer 65a attached in the radial direction, and a scale 61a is formed on the mounting portion 61 side.

  By using the jig for determining the rotation angle having such a configuration, it is measured how many times the forward tangent exposed at the time of surgery is rotated around the rod axis without being affected by cartilage or the like. By making the angle formed by the front tangent of the osteotomy jig equal to the “front tangent—artificial joint angle” obtained by the preoperative planning program, the correct rotation angle of the osteotomy jig can be obtained.

  In addition, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the invention in the implementation stage. Further, the functions executed in the above-described embodiments may be combined as appropriate as possible. The above-described embodiment includes various stages, and various inventions can be extracted by an appropriate combination of a plurality of disclosed constituent elements. For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, if the effect is obtained, a configuration from which the constituent requirements are deleted can be extracted as an invention.

The invention described in the scope of the claims at the beginning of the application of the invention that becomes the basic application of the present application will be appended.
According to the first aspect of the present invention, an image input step for inputting a two-dimensional tomographic image of a lower limb including a knee joint, and an image reconstruction for reconstructing a three-dimensional image of the femur and tibia from the image input in the image input step A femoral side artificial joint determination step for determining a replacement artificial joint from the three-dimensional image of the femoral knee joint obtained in the image reconstruction step, and a tibia knee joint obtained in the image reconstruction step Based on the tibial artificial joint determining step for determining the artificial joint to be replaced from the three-dimensional image, the artificial joint determined in the femoral side artificial joint determining step, and the reference point of the knee joint are inserted into the femur. And a parameter determination step for determining various parameters used in artificial knee joint replacement using an intramedullary alignment rod. It is a preoperative planning for the program of replacement surgery.

  According to a second aspect of the present invention, in the first aspect of the invention, the parameter determining step determines various parameters by mutual arrangement of the three-dimensional image of the femur and the three-dimensional image of the intramedullary alignment rod. This is a preoperative planning program for artificial knee joint replacement surgery.

  According to a third aspect of the present invention, in the first aspect of the invention, the various parameters determined in the parameter determining step include the insertion position, insertion direction, insertion depth, and insertion depth of the intramedullary alignment rod. A preoperative planning program for artificial knee joint replacement surgery characterized by including the position and rotation angle of the osteotomy surface of the joint with respect to the intramedullary alignment rod.

  According to a fourth aspect of the present invention, there is provided an abutting portion that abuts on a reference point of the knee joint of the femur, an attaching portion for attaching an intramedullary alignment rod to be inserted into the medulla of the femur, the abutting portion, and the attaching An artificial knee joint replacement surgery jig characterized in that it comprises an arm portion that is connected to the arm portion and is capable of adjusting the mounting position and the mounting angle of the mounting portion.

  According to a fifth aspect of the present invention, there is provided an abutting portion that abuts on a reference point of the knee joint of the femur, an attaching portion for attaching an intramedullary alignment rod to be inserted into the medulla of the femur, the abutting portion, and the attaching An artificial knee joint replacement surgical jig characterized in that it comprises a connection part that can be connected to a part and that can adjust an attachment angle of an external jig attached to the intramedullary alignment rod.

  The invention according to claim 6 is the artificial knee joint replacement surgery jig characterized in that, in the invention according to claim 4 or 5, the reference point of the femur is a posterior condyle tangent.

  The invention according to claim 7 is the invention according to claim 4 or 5, wherein the reference point of the femur is closer to the proximal end of the patellofemoral joint in a plane substantially perpendicular to the axis of the intramedullary alignment rod. It is the tangent of the two vertices of the part where the cortex of the bone section image of the distal part is bimodal, and the arm part or connection part corresponds to the offset value between the axial position of the intramedullary alignment rod and the tangent line This is an artificial knee joint replacement surgery jig characterized by being adjustable.

  DESCRIPTION OF SYMBOLS 10 ... Personal computer (PC), 11 ... CPU, 12 ... North bridge, 13 ... Main memory, 14 ... Graphic controller, 15 ... Graphic memory, 16 ... South bridge, 17 ... PCI bus, 18 ... Keyboard / mouse, 19 ... Video encoder 20 ... Hard disk device (HDD) 21 ... Network interface (I / F) 22 ... Multi disk drive 30 ... Target device 31 ... Abutting part 32 ... Arm part 33 ... Mounting part 34 ... Rod mounting part, 35 ... screw, 40 ... rod keeper, 41 ... large diameter side cylindrical part, 41a ... spike, 42 ... small diameter side cylindrical part, 43 ... screw hole, 50 ... jig for determining rotation angle, 51 ... mounting part, 51a ... Scale 52 ... Paddle 53 ... Connection part 54 ... Turning part 54a ... Pointer 60 Rotation angle determination jig, 61 ... Mounting portion, 61a ... Scale, 62 ... Connection portion, 63 ... Arm portion, 64 ... Abutting portion, 65 ... Rotation portion, 65a ... Pointer, AGP ... Graphics interface, CP ... Artificial Joint, FA ... functional axis, FM ... femur, FP ... distal bone axis, FSB ... front side bath, IM ... intramedullary rod, MB ... memory bus, TL ... anterior tangent.

Claims (4)

A contact portion that contacts the reference point of the knee joint of the femur;
A mounting part for mounting an intramedullary alignment rod to be inserted into the medulla of the femur;
An arm portion that connects the abutment portion and the mounting portion, and that can be adjusted in accordance with parameters relating to the insertion of the intramedullary alignment rod, in which the mounting position and the mounting angle of the mounting portion are determined before surgery. A featured artificial knee joint replacement jig. A contact portion that contacts the reference point of the knee joint of the femur;
A mounting part for mounting an intramedullary alignment rod to be inserted into the medulla of the femur;
A connecting portion that connects the abutment portion and the mounting portion, and can be adjusted according to a parameter relating to the insertion of the intramedullary alignment rod that has been determined preoperatively as an attachment angle of an external jig to be mounted on the intramedullary alignment rod An artificial knee joint replacement surgical jig characterized by comprising:   3. The artificial knee joint replacement surgical jig according to claim 1, wherein the reference point of the femur is a posterior condyle tangent. The reference point of the femur is a plane in which the cortex of the bone cross-sectional image of the proximal part from the proximal end of the patellofemoral joint is bimodal in a plane substantially perpendicular to the axis of the intramedullary alignment rod. Vertex tangent,
The artificial knee joint replacement surgical treatment according to claim 1, wherein the arm portion or the connection portion can be adjusted in accordance with an offset value between an axial position of the intramedullary alignment rod and the tangent line. Ingredients.

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