JP2013526394A - 多軸関節の治療用デバイス、器具および方法 - Google Patents
多軸関節の治療用デバイス、器具および方法 Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
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- A61B17/15—Guides therefor
- A61B17/151—Guides therefor for corrective osteotomy
- A61B17/152—Guides therefor for corrective osteotomy for removing a wedge-shaped piece of bone
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- Oral & Maxillofacial Surgery (AREA)
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- Cardiology (AREA)
- Transplantation (AREA)
- Vascular Medicine (AREA)
- Prostheses (AREA)
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Abstract
Description
Claims (34)
- 手術用ガイドであって、
傾斜面の片方の一端部で終わる本体部であって、該本体部は、該本体部を通って延在する垂直スロットをさらに有し、該垂直スロットは、前記傾斜面を形成する前記一端部から第1所定距離に位置する本体部と、
前記傾斜面を形成する前記一端部から第2所定距離で前記本体部から延在し、2つの関節骨の間に配置されるように構成された仕切り片と
を備える手術用ガイド。 - 請求項1に記載の手術用ガイドにおいて、前記第1所定距離および前記傾斜面の角度が、前記関節の骨から除去する楔形を画定する手術用ガイド。
- 請求項1に記載の手術用ガイドにおいて、前記第2所定距離が前記第1所定距離よりも長い手術用ガイド。
- 請求項1に記載の手術用ガイドにおいて、前記本体部は、前記スロットおよび前記仕切り部の間に前記本体部を通る穴をさらに有し、該穴はKワイヤを貫通させるように構成されている手術用ガイド。
- 請求項3に記載の手術用ガイドにおいて、前記本体部はハンドルに着脱可能に係合するようにさらに構成された手術用ガイド。
- 楔状骨切り術を行う方法であって、
請求項1に記載のガイドを設けるステップと、
前記ガイドの前記仕切り片を、前記関節の2つの骨の間に配置するステップと、
切断ガイドとして前記傾斜面を利用して、前記2つの骨のうちの一つの骨に第1の切断を行うステップと、
切断ガイドとして、前記垂直スロットを利用して前記一つの骨に第2の切断を行うステップと、
前記第1および第2の切断によって生成された楔形を除去するステップと
を含む方法。 - 請求項6に記載の方法において、前記本体部は、前記スロットおよび前記仕切り片部の間の前記本体部を貫通する穴をさらに有し、該方法は、前記本体部を通して前記一つの骨にKワイヤを取り付けて、前記第1の切断を行う前に前記一つの骨に対して前記本体部を安定させるステップをさらに含む方法。
- 楔状骨切り術で使用するシステムであって、
近位固定部および遠位固定部を有するプレートであって、該近位固定部は、前記楔状骨切り術によって残された近位骨片に固定するように構成され、前記遠位固定部は、前記楔状骨切り術によって残された遠位骨片に固定するように構成されたプレートと、
前記近位固定部および前記遠位固定部を接合させるネック部と
を備えるシステム。 - 請求項8に記載のシステムにおいて、前記プレートは、該プレートを通る少なくとも一つの矯正穴をさらに有し、前記プレートを通る該少なくとも一つの矯正穴は、矯正ツールによって係合可能なシステム。
- 請求項9に記載のシステムにおいて、前記近位固定部と前記遠位固定部との間の角度が、前記ネック部を、前記矯正ツールを使って、前記プレートを通して前記少なくとも一つの矯正穴に係合させることによって生成されるシステム。
- 請求項10に記載のシステムにおいて、前記ネック部が前記プレートを骨に固定する前に矯正されるシステム。
- 請求項8に記載のシステムにおいて、前記近位固定部が、前記ネック部において前記遠位固定部に対して角度をなすシステム。
- 請求項10に記載のシステムにおいて、前記前記ネック部が前記プレートを骨に固定した後に矯正されるシステム。
- 請求項8に記載のシステムにおいて、前記楔状骨切り術の切断のための切断ガイドを有するシステム。
- 請求項14に記載のシステムにおいて、前記切断ガイドが、
傾斜面の一端部で終わる本体部であって、該本体部は、該本体部を通って延在する垂直のスロットをさらに有し、該垂直のスロットは、前記傾斜面を形成する前記一端部から第1所定距離に位置する本体部と、
前記傾斜面を形成する前記端部から、第2所定距離に前記本体部から延在し、2つの関節骨の間の配置されるように構成される仕切り片と
を有するシステム。 - 楔状骨切り術を行う方法であって、
骨の近位片と遠位片との間から楔状の骨を除去するステップと、
請求項8に記載のシステムを設けるステップと、
前記プレートの前記近位固定部を前記近位片に固定するステップと、
前記プレートの前記遠位固定部を使用して、前記近位片を前記遠位片に対して所望の位置に操作するステップと、
前記使用するステップの後に、前記遠位固定部を前記遠位片に固定するステップと
を含む方法。 - 請求項16に記載の方法において、前記近位片の操作の際には、前記遠位固定部を使って、前記近位片を前記遠位片に対して所望の位置に動かす方法。
- 請求項16に記載の方法において、前記プレートが矯正穴をさらに有し、該方法は、
矯正ツールを提供するステップと、
前記矯正ツールを使用して、前記矯正穴を係合させて前記プレートを曲げるステップと
をさらに含む方法。 - 請求項16に記載の方法において、前記除去するステップは、前記骨の前記近位片と前記遠位片との間から前記楔状の骨を切断する際に、切断ガイドを使用するステップを含む方法。
- 関節の第1骨用の人工関節であって、
前記関節の第2骨とつなぐように構成されたヘッド部であって、該ヘッド部は、前記第1骨の骨切り術後に本来の関節面を再現する関節面を有するヘッド部と、
前記第1骨の髄腔への挿入のために構成されたステム部と
を有する人工関節。 - 請求項20に記載の人工関節において、前記ヘッド部が背リップおよび掌リップを有し、前記人工関節の該背リップおよび掌リップと接する平面は、前記人工関節の縦軸に対して約105度の角度で背側に遠位的に傾斜している人工関節。
- 請求項20に記載の人工関節において、前記ステム部が、近位円錐部と弾丸状遠位部とを有する人工関節。
- 請求項22に記載の人工関節において、前記ステム部が、該ステム部が髄管内で回転するのを防ぐように構成された竜骨をさらに有する人工関節。
- 請求項20に記載の人工関節において、前記関節面が、前記背・掌面に環状に凹状で、横・内面に環状に凸状の鞍型形状関節面を有する人工関節。
- 請求項24に記載の人工関節において、前記ヘッド部が、概ね卵形の、前記ヘッド部を囲む連続した曲線の周面を有しており、曲線の少ない該卵形部の棒部は、背側の方向を向いている人工関節。
- 請求項20に記載の人工関節において、前記ヘッド部が、撓側手根屈筋(Flexor−Carpi Radialis:FCR)腱を通すように構成された横溝を有する人工関節。
- 請求項20に記載の人工関節において、前記ヘッド部が、該ヘッド部を背側から掌側の方向に横切る少なくとも一つの縫合穴を有する人工関節。
- 請求項27に記載の人工関節において、前記少なくとも一つの縫合穴が、前記ヘッド部の前記横溝内に配置される人工関節。
- 種々の解剖学的構造を収容するための種々のサイズの人工関節のセットであって、人工関節の該セットの各々の人工関節は、請求項20に従って構成される人工関節のセット。
- 人工関節を取り付ける方法であって、
関節の第1骨を、該骨の関節面の下で露出し、切除するステップと、
請求項20に記載の人工関節を設けるステップと、
前記ヘッド部の平面が前記切除した第1骨に当接するまで、前記人工関節の前記ステムを前記髄管に挿入するステップと
を含む方法。 - 請求項30に記載の方法において、前記ステム部は、髄管内における該ステム部の回転を防ぐように構成された竜骨を有する方法。
- 請求項30に記載の方法において、少なくとも一つの人工関節のトライアル品を使用して、最終的な人工関節のサイズの選択を助ける方法。
- 請求項30に記載の方法において、
前記挿入ステップの前に、縫合糸を使って少なくとも一つのロック縫いを前記FCR腱に配置するするステップと、
前記縫合の自由端を前記少なくとも一つの縫合穴に通し、該縫合を張ったままにするステップと、
前記挿入ステップ後に、前記縫合糸を前記人工関節の背側で結ぶステップと
を含む方法。 - 請求項33に記載の方法において、前記人工関節の前記ヘッド部が横溝をさらに有し、該横溝は、その中に前記縫合糸を通し、前記結びステップにおいて結ぶ、少なくとも一つの縫合穴を有する方法。
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