JP2016049462A - Surgical instrument for joint prosthesis - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a surgical instrument for joint prosthesis capable of easily removing a body from a surgical member without being affected by a magnetic field.SOLUTION: A driving cam member 8 includes a driving cam part 42 having a first cam surface 47 and a second cam surface 48; and a driven cam member 9 includes a driven cam part 50 including a first cam surface 51 and a second cam surface 52. The driving cam member 8 is displaced, so that the driving cam part 42 presses the driven cam part 50 to remove a fitting part 56 of a fitting member 10 from a fitting recess 4 of a tibial slit member 2, and consequently, a cut guide device 3 is set into a state to be easily removed from the tibial slit member 2.SELECTED DRAWING: Figure 1

Description

  The present invention is used in an operation in which a part or all of a bone constituting a joint such as a knee joint or a hip joint is replaced with an artificial joint, and the surgical operation for an artificial joint in which a surgical member fixed to the bone is detachably held. It relates to equipment.

  Artificial joint replacement is performed as an operation to replace part or all of the joint with a prosthetic joint, such as knee replacement and hip replacement. ing. In artificial joint replacement, in order to place an artificial joint component in the bone that constitutes the joint, procedures such as bone cutting, drilling, and excavation are performed, and an appropriately sized bone component is selected and the artificial joint component is selected. Various surgical members are fixed to a patient's joint according to each purpose such as positioning so as to be arranged at an appropriate position.

  Examples of the surgical member include a cut guide, trial members of various artificial joint components, a spacer, a rotation guide, and a crusher. The cut guide is a member including a slit portion that serves as a guide for guiding a cutting tool to a cutting site when bone is excised. The trial member is a member used for alignment of the artificial joint. The spacer is a member used when confirming a space for arranging the artificial joint. The rotation guide is a member used when adjusting the rotation angle on the other end side of the rod member into which one end is inserted into the bone. A crusher is a member used as a tool that is hit with a hammer when excavating bone.

  Thus, prior to installing a bone component into the joint, the surgeon uses various surgical components to perform procedures such as cutting and excavating the bone, determining the appropriate size of the component, and properly positioning the component. And securing space. Such an operation is often performed while the surgical member is replaced many times during the operation.

  As described above, when installing or replacing a surgical member on a bone, an operator uses a surgical instrument for an artificial joint to detachably hold the surgical member. A surgical instrument for an artificial joint is described in Patent Document 1, for example.

  The surgical instrument for an artificial joint described in Patent Document 1 can be quickly and surely attached to and detached from a surgical member, and is intended to reduce the size and save space. A mating engagement portion is provided on one end side, and a gripping portion to be gripped during manual operation is provided on the other end side, and a plate-like main body having an elongated overall shape, and a protruding direction from the main body toward one end side And a surgical device that is supported so as to be movable relative to the main body in a retracting direction retracting toward the other end side of the main body, and a distal end side that protrudes from the main body is engaged with the surgical member, thereby engaging the engaging portion. A fixing member that fixes the member and the main body, a first magnet provided on the main body, and a second magnet provided on the fixing member, and the fixing member protrudes from the main body by the magnetic force between the first and second magnets. Magnet biasing in the direction Comprising a knitted, provided in the fixed member, to urge the retreat direction fixing member relative to the body by a manual operation, and an operation button for releasing the fixed state relative to the main body of the surgical member.

  With this configuration, in this prior art, the fixing member is urged in the protruding direction with respect to the main body by the magnetic force between the first and second magnets, the distal end side of the fixing member is fitted to the surgical member, and the main body And the surgical member can be quickly fixed, and the fixing member is urged in the retracting direction by operating the operation button to quickly release the fixed state between the main body and the surgical member. Further, it has been proposed that the fixing member can be urged by the magnetic force between the second magnets to reduce the size and space of the configuration.

  Further, as a second conventional technique, a spherical plunger spring-biased in a direction in which the main body protrudes from the main body by a spring is elastically fitted into a fitting recess formed in the surgical member, A surgical instrument for an artificial joint is known in which a surgical member and a main body are fixed and the fixed state can be released by pulling the main body out of the surgical member.

  Further, as a third conventional technique, a surgical instrument for an artificial joint is known in which a surgical member can be detachably held with respect to a main body by a holding tool also called a tab.

JP 2010-125202 A

  In the prior art described in Patent Document 1 described above, the fixing member is urged in the protruding direction with respect to the main body by the magnetic force between the first and second magnets, and the distal end portion of the fixing member is fitted to the surgical member. Therefore, the elements other than the magnet unit must be formed of a material that does not interfere with the magnetic field of the first and second magnets, that is, a non-magnetic material such as resin or stainless steel. In addition to restricting the materials, care must be taken in the arrangement of the equipment and components, etc., taking into consideration the effects of magnetic fields so that the equipment and parts made of magnetic material around the body are not magnetically attracted to the first and second magnets. There is a problem that must be done.

  Further, in the second prior art, the main body is provided with a plunger biased by a spring, and this plunger is configured to fit into the fitting recess of the surgical member. When removing only the main body while it is left in place, the operator must pull out the main body with a large force so that the plunger can be released from the fitting recess against the spring force. Therefore, there is a problem that the surgical member fixed to a predetermined part of the patient's body is displaced.

  In the third prior art, since the surgical member is detachably held on the main body by the sandwiching tool, the operator operates the main body with the other hand while holding the sandwiching tool with one hand. There is a problem that it is necessary to remove from the working member, the work of removing the main body is complicated, and workability is poor.

  An object of the present invention is to provide a surgical instrument for an artificial joint that can easily remove a main body from a surgical member without considering the influence of a magnetic field.

The present invention relates to a surgical member having a fitting recess, which is used by being fixed to the joint in surgery for replacing part or all of the joint with an artificial joint,
A main body having a contact surface that is provided on the surgical member so as to be movable along a predetermined first axis, and that contacts the surgical member;
A driving cam member having a base portion displaceably held by the main body, and a driving cam portion provided on the base portion and formed with a cam surface facing the direction of displacement;
A driven cam portion that is pressed by the driving cam portion according to the displacement of the driving cam member, and the driven cam portion is pressed along a second axis perpendicular to the first axis. A driven cam member that moves;
A fitting member fixed to the driven cam member, wherein the driven cam member is fitted into the fitting recess according to the movement of the driven cam member along the second axis, and is detached from the fitting recess. And a fitting member having a fitting portion that is displaceable with respect to the detached position.

  According to the present invention, at least one of the driving cam portion and the driven cam portion has a cam surface parallel to a virtual plane perpendicular to the second axis.

  In the invention, it is preferable that a surface of the fitting portion fitted into the fitting recess is a part of a hemispherical surface.

  The invention further includes a spring member attached to the fitting member so that the fitting portion is spring-biased in a direction in which the fitting portion is displaced from the separation position to the fitting position.

  In the invention, it is preferable that the base portion is formed of a longitudinal member that is held by the main body so as to be linearly displaceable in a direction intersecting the second axis, and the driving cam portion is one end portion in the longitudinal direction of the longitudinal member. It is provided in.

  In the invention, it is preferable that the base portion includes a pair of disk-like members held on the main body so as to be able to rotate and displace around an axis intersecting the second axis, and the driving cam portion includes the pair of disks. It is provided between the shaped members.

  According to the present invention, the surgical member that is used while being fixed to a predetermined portion of the joint is supported on the support surface of the main body so as to be movable along the predetermined first axis. A fitting recess is provided at a predetermined position of the surgical member. The main body is provided with a fitting member and a driving cam member. The fitting member is displaceable along the second axis between the fitting position on the main body from the contact surface and the detaching position separated from the fitting recess. A driven cam member is fixed to the fitting member, and therefore the driven cam member and the fitting member are interlocked.

  When the driving cam member is displaced with respect to the main body, the driving cam portion presses the driven cam portion, whereby the driven cam moves along the cam surface of the driving cam portion, and the fitting portion is moved from the disengagement position to the fitting position. Or from the fitting position to the disengaging position.

  In the state where the fitting portion is disposed at the fitting position, the fitting member is fitted into the fitting recess of the surgical member, so that the surgical member is locked to the main body. Further, in the state where the fitting portion is disposed at the disengagement position, the fitting portion is detached from the fitting concave portion, so that the main body can be easily removed from the surgical member.

  As described above, the surgical instrument for an artificial joint according to the present invention is not configured to use a magnet as in the prior art, so that it is not necessary to consider the influence of the magnetic field, and the main body can be easily removed from the surgical member. And the time required for the removal during operation can be shortened.

  According to the present invention, at least one of the driving cam portion and the driven cam portion is formed with a cam surface parallel to a virtual plane perpendicular to the second axis, so that the driving cam portion and the driven cam portion are the cams. In the state of contact through the surface, displacement of the driven cam portion in the direction along the second axis can be prevented, and displacement of the fitting portion in the direction along the second axis can be prevented. Accordingly, it is possible to prevent the fitting portion from being moved inadvertently, and to prevent the occurrence of a problem that the locked state or the unlocked state between the surgical member and the main body is undesirably released.

  Further, according to the present invention, since the surface to be fitted into the fitting recess of the fitting portion is formed into a part of a hemispherical surface, when the body is attached to or detached from the surgical member, the fitting portion is The fitting recess can be smoothly fitted, or the fitting portion can be smoothly detached from the fitting recess, so that the operability when the main body is attached to and detached from the surgical member can be improved.

  According to the present invention, since the spring member is interposed between the fitting portion and the main body, the fitting portion is spring-biased in the direction of moving from the disengagement position to the fitting position by the spring force of the spring member, The fitting portion can be fitted into the fitting recess without operating the driving cam member, and convenience can be improved.

  Further, according to the present invention, since the fitting member can be moved by linearly displacing the driving cam portion, the operation amount of the operator can be reduced, and operations such as fixing the surgical member and releasing the fixed state are possible. Can be facilitated and facilitated.

  Further, according to the present invention, since the driving cam portion can be rotated to move the fitting member, the operation amount of the operator can be reduced, and operations such as fixing the surgical member and releasing the fixed state can be performed. The accompanying work can be smoothed and facilitated.

It is an expanded sectional view showing a part of surgical instrument 1 for artificial joints of one embodiment of the present invention. It is a perspective view which shows a part of surgical instrument 1 for artificial joints. 1 is a perspective view showing an entire prosthetic surgical instrument 1. FIG. It is a left view of the surgical instrument 1 for artificial joints. It is a front view of the surgical instrument 1 for artificial joints. It is a figure for demonstrating the outline | summary of an example of the bone cutting procedure by the surgical instrument 1 for artificial joints. It is the perspective view which looked at the tibial slit member 2 from the downward direction. It is the perspective view which looked at the tibial slit member 2 from the upper part. 3 is a front view of a tibial slit member 2. FIG. 6 is a bottom view of the tibial slit member 2. FIG. 3 is a front view of a driving cam member 8. FIG. 3 is a perspective view of the driving cam member 8 as viewed from above. FIG. 4 is a perspective view of the driving cam member 8 as viewed from below. FIG. 6 is a bottom view of the driving cam member 8. FIG. FIG. 12 is a side view of the driving cam member 8 as viewed from the right in FIG. 11. 3 is a front view of the driven cam member 9 and the fitting member 10. FIG. It is a figure which shows operation | movement of the driven cam member 9 accompanying operation of the driving cam member 8. FIG. It is a partial expanded sectional view which shows other embodiment of this invention. It is a figure which shows the fitting state to the fitting recessed part 4 of the fitting part 56 when not using a spring member. It is a figure which shows the fitting state to the fitting recessed part 4 of the fitting part 56 when not using a spring member. It is sectional drawing which shows the surgical instrument for artificial joints of further another embodiment of this invention. It is a figure which shows the attachment or detachment operation | movement of the neck trial 72 with which the ball trial 71 is mounted | worn. It is a figure which shows the attachment and removal procedure to the broach trial 73 of the ball trial 71 and the neck trial 72. FIG. It is an expanded sectional view showing a part of surgical instrument 1a for artificial joints of other embodiments of the present invention. It is a perspective view which shows the external appearance of the whole surgical instrument 1a for artificial joints shown by FIG. It is an expansion perspective view of the cut guide main body 7a vicinity. It is the perspective view which looked at the drive cam member 8a from the front side. It is the perspective view which looked at the drive cam member 8a from the back side. It is a front view of the driving cam member 8a. It is sectional drawing perpendicular | vertical to the axis line of the drive cam member 8a. It is sectional drawing which shows the state which the driven cam member 9 fitted to the driving cam member 8a. It is a figure which shows the state by which the tibial slit member 2 was fixed to the cut guide apparatus 3 by operation of the drive cam member 8a. It is a figure which shows the state in the middle of canceling | releasing the fixed state to the cut guide apparatus 3 of the tibial slit member 2 by operation of the drive cam member 8a. It is a figure which shows the state by which the fixed state to the cut guide apparatus 3 of the tibial slit member 2 was cancelled | released by operation of the drive cam member 8a. It is a partial expansion perspective view which shows other embodiment of this invention. It is a partial expansion perspective view which shows other embodiment of this invention.

  FIG. 1 is an enlarged cross-sectional view showing a part of an artificial joint surgical instrument 1 according to an embodiment of the present invention. In the present embodiment, as an example, a surgical instrument 1 for an artificial joint used for positioning an artificial knee joint in an artificial knee joint replacement operation in which a knee joint is replaced with an artificial knee joint will be described. In the following description, in artificial knee joint replacement, a tibial slit member 2 which is a surgical member used for cutting a tibia performed to install an implant for a knee joint is cut including a cut guide main body 7 which is a main body. A configuration for detachably holding the guide device 3 will be described.

  The surgical instrument 1 for an artificial joint according to this embodiment is provided with a tibial slit member 2 in which a fitting recess 4 is provided and a tibial slit member 2 that is movable along a predetermined first axis L1. A cut guide body 7 having a contact surface 6 that forms a plane with which the bottom surface 5 on which the fitting recess 4 is formed contacts, and a vertical direction that intersects the cut guide body 7 with a second axis L2 perpendicular to the first axis L1. Motive cam member 8 as an operation member provided movably in the directions of arrows A1 and A2 along the third axis L3, which is a simple direction, and movement of motive cam member 8 by the manual operation in the directions of arrows A1 and A2 Accordingly, the driven cam member 9 moves in the directions of the arrows B1 and B2 along the second axis L2, and the fitting member 10 fixed to the driven cam member 9 is configured.

  2 is a perspective view showing a part of the surgical instrument 1 for artificial joints, FIG. 3 is a perspective view showing the entire surgical instrument 1 for artificial joints, and FIG. 4 is a left side view of the surgical instrument 1 for artificial joints. FIG. 5 is a front view of the surgical instrument 1 for artificial joints. The cut guide device 3 includes a spike rod 12 for fixing the upper end of the tibia 11, an ankle clamp 13 for fixing the lower end of the tibia 11, and a slit guide body 14 for holding the tibial slit member 2 and the spike rod 12. The main shaft 15 on which the slit guide body 14 is pivotally supported at the upper end portion, the main shaft guide member 16 that holds the main shaft 15 so as to be movable in the axial direction, and the ankle clamp holding member 17 that is fixed to the lower end portion of the main shaft guide member 16. It is comprised including.

  FIG. 6 is a diagram for explaining an outline of an example of a bone cutting procedure using the surgical instrument 1 for artificial joints. In the cutting of the tibial bone performed to install the tibial implant for the knee joint, as shown in FIG. 6 (1), the skin is incised, the upper end of the tibia 11 is exposed, and the surgical instrument 1 for the artificial joint is removed. Place on the tibia 11. The upper end of the tibia 11 is fixed by a spike rod 12, and the lower end of the tibia 11 is fixed by an ankle clamp 13. Thereafter, the shaft portion of the spike rod 12 is moved with respect to the holding portion 18 so that the main shaft 15 and the main shaft guide member 16 are parallel to the tibia 11, and the ankle clamp 13 is moved with respect to the shaft portion by the lock release button 19. The locked state is released, and the positions of the arrows A1 and A2 are adjusted.

  Next, as shown in FIG. 6 (2), the amount of osteotomy is confirmed using a height gauge 21 and a slit gauge 22, and a height adjusting nut 23 provided on the main shaft 15 and a lock provided on the main shaft guide member 16. Using the release button 24 and the lock release button 25 provided on the height gauge 21, the height of the osteotomy surface is adjusted.

  When the adjustment of the height of the osteotomy surface is completed, the tibial slit member 2 is fixed to the tibia 11 by the pin 26 and only the tibial slit member 2 is left on the tibia 11 as shown in FIG. The device 3 is removed from the tibia 11 and, as shown in FIG. 6 (4), a saw blade 29 as a cutting tool of the cutting device 28 is inserted into the slit 27 of the tibial slit member 2 fixed to the tibia 11 by a pin 26. Insert and perform osteotomy.

  In this manner, the cut guide device 3 can be smoothly removed from the tibial slit member 2 in a state where the tibial slit member 2 is secured to the joint of the tibia 11 with the pin 26 and placed.

  7 is a perspective view of the tibial slit member 2 as viewed from below, FIG. 8 is a perspective view of the tibial slit member 2 as viewed from above, FIG. 9 is a front view of the tibial slit member 2, and FIG. 6 is a bottom view of the tibial slit member 2. FIG. The tibial slit member 2 has a slit 27, and a slit portion 31 that is curved in a hook shape along the surface shape of the fastening portion in the joint of the tibia 11 and the slit portion 31 are integrally provided, and the fitting recess is formed on the bottom surface 5. 4, a pair of side wall portions 33, 34 having a L-shaped cross section projecting on both sides of the bottom surface 5 of the base portion 32, and perpendicular to one end side of each side wall portion 33, 34. And an end wall portion 35 projecting from the base portion 32. A plurality of pin holes 36 and 37 for inserting the pins 26 are formed in the lower surface of the slit portion 31 and the base portion 32, respectively. Such a tibial slit member 2 is made of, for example, stainless steel or a titanium alloy.

  11 is a front view of the driving cam member 8, FIG. 12 is a perspective view seen from above the driving cam member 8, FIG. 13 is a perspective view seen from below the driving cam member 8, and FIG. FIG. 15 is a bottom view of the driving cam member 8, and FIG. 15 is a side view of the driving cam member 8 seen from the right side of FIG. Referring also to FIG. 1, the driving cam member 8 includes a long base portion 41 having a rectangular cross section perpendicular to the axis and a driving cam portion 42 formed integrally with one end portion in the longitudinal direction of the base portion 41. Of the arrows C1 and C2 along the third axis L3 perpendicularly intersecting the axis L2, the fitting member 10 is formed so as to protrude in the direction C2 (downward in FIG. 1) away from the tibial slit member 2. And a grasping portion 43 formed integrally with the other end portion in the longitudinal direction of the base portion 41 and grasped by the operator. The grip portion 43 protrudes outward from the slit guide body 14 and is formed to have a substantially T shape in plan view with respect to the base portion 41.

  The slit guide body 14 is formed with a guide hole 44 in which the base portion 41 and the driving cam portion 42 are accommodated so as to be movable in the directions of arrows A1 and A2 along the first axis L1. The slit guide body 14 is also provided with an operation guide display unit 46, such as “release” and “fixed”, which is engraved on one surface facing the upper side of the base 41 (upper side in FIG. 1). The opening 45 is formed.

  The driving cam portion 42 is inclined in the arrow C2 direction (downward in FIG. 1) from the other axial end of the base 41 toward one axial end in a virtual plane including the second axis L2 and the third axis L3. The first cam surface 47 and the second cam surface 48 that is connected to the edge of the first cam surface 47 on the one end side in the axial direction and parallel to a virtual plane perpendicular to the second axis L2 are formed.

  FIG. 16 is a front view of the driven cam member 9 and the fitting member 10. The driven cam member 9 is a short base 49 having a rectangular cross section at right angles to the shaft, and a driven cam 50 formed integrally with one end of the base 49 in the axial direction. The driven cam member 9 has arrows C1, along the second axis L2. Among the C2 directions, the fitting member 10 has a driven cam portion 50 formed so as to protrude in the direction C1 (upward in FIG. 1) close to the tibial slit member 2.

  The base 49 is inclined in an arrow C1 direction (upward in FIG. 1) from the other axial end of the base 49 toward one axial end in a virtual plane including the second axis L2 and the third axis L3. A first cam surface 51 and a second cam surface 52 that is connected to the edge of the first cam surface 51 on the other axial end side and that is parallel to a virtual plane perpendicular to the second axis L2 are formed. The first cam surface 51 of the driven cam portion 50 is opposed to the first cam surface 47 of the driving cam portion 42 in the direction of the third axis L3 and can slide smoothly in a state of surface contact with each other. Further, the second cam surface 52 of the driven cam portion 50 and the second cam surface 48 of the driving cam portion 42 are parallel to each other and can slide smoothly while being in surface contact with each other.

  The fitting member 10 includes a fitting position in which the driven cam member 9 is fitted in the fitting recess 4 in accordance with the movement of the arrows A1 and A2 along the third axis L3, and a separation position in which the driven cam member 9 is detached from the fitting recess 4. A substantially hemispherical fitting portion 56 that is freely displaceable in the direction of the arrows B1 and B2 and a right cylindrical guide shaft 57 having one end in the axial direction fixed to the center of the bottom surface of the fitting portion 56. A base portion 49 of the driven cam member 9 is screwed to, for example, a screw (not shown) at the intermediate portion in the axial direction of the guide shaft 57, and the driven cam member 9 is fixed perpendicularly to the guide shaft 57 of the fitting member 10.

  The surface of the fitting portion 56 that fits into the fitting concave portion 4 forms a part of a hemispherical surface, and is formed slightly smaller toward the apex side than the hemispherical surface. Accordingly, by inserting the tibial slit member 2 along the contact surface 6 at the fitting position where the fitting portion 56 protrudes from the contact surface 6, the pressing force is applied to the fitting portion 56 in the direction of displacement toward the disengagement position. It can prevent that the fitting recessed part 4 is hooked on the fitting part 56, and cannot be inserted.

  A spring member 58 is attached to the guide shaft 57 between the fitting portion 56 and the driven cam member 9. The spring member 58 is realized by a compression coil spring. The slit guide body 14 is formed with a cylindrical accommodation hole 59 in which the fitting portion 56 and the spring member 58 are accommodated, and a guide shaft 57 movably inserted therein, and a shaft hole 60 orthogonal to the guide hole 44. One end portion of the spring member 58 attached to the guide shaft 57 is supported by the bottom surface of the receiving hole 59, and the other end portion of the spring member 58 is elastically contacted and supported by the bottom surface of the fitting portion 56. The fitting portion 56 of the combined member 10 is spring-biased in a direction (arrow B1 direction) that protrudes from the disengagement position toward the fitting position.

  FIG. 17 is a view showing the operation of the driven cam member 9 in accordance with the operation of the driving cam member 8. In a state where the driving cam member 8 is not operated and no external force is applied to the driving cam member 8, as shown in FIG. 17A, the first cam surface 47 of the driving cam portion 42 and the first cam surface 50 of the driven cam portion 50 are used. The cam surface 51 is opposed to and in contact with the driving cam portion 42 and the driven cam portion 50. In this state, the fitting portion 56 protrudes from the contact surface 6 by the spring force of the spring member 58 and is fitted into the fitting recess 4 of the slit guide body 14, so that the tibial slit member 2 is fixed to the cut guide device 3. Yes.

  When the tibial slit member 2 is placed on the tibia 11 and the cut guide device 3 is taken out, as shown in FIG. 17 (2), the operator grasps the grasping portion 43 of the driving cam member 8 and moves forward (arrow). When the driven cam member 9 is pulled in the direction of the mark A1, the first cam surface 51 of the driven cam portion 50 is pressed by the first cam surface 47 of the driving cam portion 42, and the fitting member 10 moves in the direction of the arrow B2. First, when the grip portion 43 is further pulled, the first cam surface 47 of the driving cam portion 42 comes into contact with the second cam surface 52 of the driven cam portion 50 from above as shown in FIG. The member 10 is pushed down in the direction of the arrow B2, the fitting portion 56 is detached from the fitting recess 4, the locked state of the tibial slit member 2 with respect to the cut guide device 3 is released, and the tibial slit member 2 is attached to the tibia 11 The cut guide device 3 can be easily and It is possible 抜去Ru to speed.

  In a virtual plane including the second axis L2 and the third axis L3, the angle θ1 formed by the first cam surface 47 and the second cam surface 48 of the driving cam portion 42 is selected to be 5 ° or more and 60 ° or less, preferably Is selected to be 30 °. Further, the angle θ2 formed by the first cam surface 51 and the second cam surface 52 of the driven cam portion 50 is selected from 5 ° to 60 °, preferably 30 °, similarly to the angle θ1. . By forming the first cam surfaces 47 and 51 at such angles θ1 and θ2, the force in the third axis L3 direction caused by the operation when pulling the driving cam member 8 is directed downward in the second axis L2 direction (arrow B2 Direction), and the lock state of the cut guide device 3 with respect to the tibial slit member 2 can be released with an appropriate operation amount and operation force.

  In another embodiment of the present invention, the first cam surfaces 47 and 51 described above may not be flat surfaces, may be curved surfaces that are convex in directions close to each other, and one of the first cam surfaces is a flat surface. The other first cam surface may be a curved surface that is convex in the direction approaching one first cam surface.

  FIG. 18 is a partial enlarged sectional view showing another embodiment of the present invention. Note that the same reference numerals are given to portions corresponding to the above-described embodiment. In the present embodiment, as shown in FIG. 18 (1), the driving cam portion 42 of the driving cam member 8 is formed so as to protrude toward the side close to the contact surface 6, and the driven cam member 9 is driven. The cam portion 50 is formed so as to protrude toward the side away from the contact surface 6.

  According to such a configuration, by pulling the driving cam member 8 in the direction of the arrow A1, the fitting member 10 is displaced in the direction of the arrow B1, as shown in FIG. When the fitting portions 56 are fitted into the fitting recesses 4 with the surfaces 48 and 52 overlapped, and the driving cam member 8 is returned in the direction of the arrow A2, the driven cam member 9 and the fitting member 10 are lowered by their own weight. Can be returned to the unoperated state shown in FIG. 18 (1), and the spring member can be omitted.

FIGS. 19 and 20 are views showing a fitting state of the fitting portion 56 to the fitting recess 4 when no spring member is used. As described above, when the spring member is not used, the protrusion amount ΔH of the fitting portion 56 from the contact surface 6 is a state in which the second cam surfaces 48 and 52 face each other from a state in which the first cam faces 47 and 51 face each other. driving cam portion 42 and the driven cam 50 is dependent on the amount of movement L _H of the second axis line L2 direction of the driven cam member 9 when the relative displacement in. In other words, as if the movement amount L _H to the second axis L2 direction above the driven cam member 9 (arrow B1 direction) is small, as shown in FIG. 19 (1), the contact surface of the fitting portion 56 6 As shown in FIG. 19B, the fitting state of the fitting portion 56 into the fitting recess 4 is incomplete, and the tibial slit member 2 is securely attached to the cut guide device 3. It cannot be fixed. Further, when the moving amount L _H to the second axis L2 direction above the driven cam member 9 is large, as shown in FIG. 20 (1), a fitted state to the fitting recess 4 of the fitting portion 56 20 (2), the first cam surface 47 of the fitting member 10 is strongly pressed against the first cam surface 51 of the driven cam member 9, and the upper portion of the driven cam member 9 is slit. There is a possibility that the driving cam member 8 cannot be operated because the guide hole 44 of the guide body 14 is brought into pressure contact with the top surface 14a facing from above and is in a biting state.

Therefore, the first cam surface 47 and the second cam surface 48 of the driving cam portion 42 and the first cam surface 51 and the second cam surface 52 of the driven cam portion 50 are suitable for the fitting concave portion 4 in the fitting portion 56. and is configured such that the amount of movement L _H in contact with a pressing force.

  FIG. 21 is a cross-sectional view showing a surgical instrument for artificial joints according to still another embodiment of the present invention, FIG. 22 is a view showing an attaching / detaching operation of a neck trial 72 to which a ball trial 71 is attached, and FIG. It is a figure which shows the attachment and removal procedure to the broach trial 73 of the trial 71 and the neck trial 72. FIG. The surgical instrument for an artificial joint according to this embodiment is implemented as a configuration for attaching a ball trial 71 and a neck trial 72 to a broach trial 73 embedded in a femur 74. Note that the same reference numerals are given to portions corresponding to the above-described embodiment.

  The neck trial 72 has a cylindrical shaft portion 75 on which the ball trial 71 is mounted, and a driving cam portion 42 a formed integrally with the shaft portion 75. A first cam surface 47 and a second cam surface 48 similar to those of the above-described embodiment are formed on the driving cam portion 42a. The broach trial 73 includes a base portion 77 having a shaft hole 76, and a movable body 80 having a fixed claw 78, a guide shaft 79, and a driven cam portion 50a. A spring member 81 is attached to the guide shaft 79. The spring member 81 is realized by a compression coil spring and biases the movable body 80 in a direction away from the base 77. The driven cam portion 50a is formed with a first cam surface 51 and a second cam surface 52 similar to those in the above-described embodiment.

  In the surgical instrument for an artificial joint configured as described above, the second trial of the driven cam portion 50a is caused by the first cam surface 47 of the driving cam portion 42a by pulling out the ball trial 71 as in the above-described embodiment. The cam surface 52 is pressed, and the movable body 80 is displaced in the direction in which the fixed claw 78 is embedded (leftward in FIG. 21) against the spring force of the spring member 81, so that the fixed claw 78 is locked to the broach trial 73. The ball trial 71 and the neck trial 72 can be easily detached from the broach trial 73 without requiring a large force.

  FIG. 24 is an enlarged cross-sectional view showing a part of a surgical instrument for artificial joint 1a according to another embodiment of the present invention, and FIG. 25 is a perspective view showing the overall appearance of the surgical instrument for artificial joint 1a shown in FIG. FIG. 26 is an enlarged perspective view of the vicinity of the cut guide body 7a. In this embodiment, instead of the cut guide main body 7 having the driving cam member 8 that performs the push-pull operation of the previous embodiment, the present embodiment includes a cut guide main body 7a having the driving cam member 8a that rotates. In this respect, parts corresponding to those of the above-described embodiment are denoted by the same reference numerals, and redundant description is omitted.

  The prosthetic joint surgical instrument 1a of the present embodiment is provided with a tibial slit member 2 provided with a fitting recess 4, and a tibial slit member 2 that is movably provided along a first axis L1 that is predetermined. A cut guide body 7a, which is a main body having a contact surface 6 that forms a flat surface with which the bottom surface 5 on which the fitting recess 4 is formed, and a virtual one plane including the first axis L1 and the second axis L2 in the cut guide body 7a. A driving cam member 8a that can be rotationally displaced in the directions of arrows E1 and E2 around a vertical fourth axis L4, and the second axis L2 according to the movement of the driving cam member 8a in the directions of arrows E1 and E2 by manual operation. A driven cam member 9 that moves in the direction of the arrows B1 and B2 along the direction and a fitting member 10 that is fixed to the driven cam member 9.

  27 is a perspective view of the driving cam member 8a as viewed from the front side, FIG. 28 is a perspective view of the driving cam member 8a as viewed from the rear side, and FIG. 29 is a front view of the driving cam member 8a. 30 is a cross-sectional view perpendicular to the axis of the driving cam member 8a, and FIG. 31 is a cross-sectional view showing a state in which the driven cam member 9 is fitted. The driving cam member 8a has a base 61 that is held by the cut guide body 7a so as to be capable of rotational displacement in the directions of arrows E1 and E2, and a driving cam 62 that is coaxially fixed to the base 61.

  The base 61 is formed on the cut guide body 7a in directions of arrows E1 and E2 around a fourth axis L4 perpendicular to a virtual plane including the first axis L1 and the second axis L2 as an axis intersecting the second axis L2. And a rod-shaped driving cam portion 62 is fixed between the pair of disk-shaped members 63 and 64. One disc-like member 63 is integrally and coaxially formed with a flat columnar shaft portion 66 to which the operation lever 65 is fixed, and the other disc-like member 64 has a retaining flange portion 67. It is formed integrally and coaxially. Each of the disk-like members 63 and 64 is rotatably fitted and held in a shaft hole (not shown) formed in the housing of the cut guide body 7a.

  The driving cam portion 62 is a 1/4 cylindrical rod-shaped body having a fourth axis L4 as a central axis and a radius of, for example, about 3.2 mm and having a cross section perpendicular to the axis of about 1/4 of a virtual cylindrical body. The one disk-shaped member 63 is provided at one end in the axial direction, and the other disk-shaped member 64 is provided at the other end in the axial direction.

  First to sixth cam surfaces 91 to 96 that are continuous with the arrow E2 and parallel to the fourth axis L4 are formed on the outer periphery of the driving cam 62. These first to sixth cam surfaces 91 to 96 constitute the outer peripheral surface of the driving cam portion 62, and the outer peripheral surface constitutes the cam surface. The first cam surface 91, the third cam surface 93, and the fifth cam surface 95 are flat surfaces, the first cam surface 91 and the fifth cam surface 95 are parallel to each other, and the first and fifth cam surfaces 91 and 95 are parallel to each other. And the 3rd cam surface 93 is perpendicular | vertical. A second cam surface 92 is formed between the first cam surface 91 and the third cam surface 93. The second cam surface 92 forms a quarter cylindrical surface of a virtual cylindrical surface having a radius of, for example, 0.5 mm. A fourth cam surface 94 is formed between the third cam surface 93 and the fifth cam surface 95. The fourth cam surface 94 forms a quarter cylindrical surface of a virtual cylindrical surface having a radius of, for example, 0.5 mm.

  The sixth cam surface 96 is formed in a remaining region excluding the first cam surface 91 from a quarter cylindrical surface of a virtual cylindrical surface having a radius of, for example, 3.2 mm. The first cam surface 91 has a width corresponding to a flat bottom surface 97 extending in the direction of the third axis L3 from the end of the first cam surface 51 of the driven cam portion 50 on the guide shaft 57 side, and the fourth axis L4. It is a plane extended along.

  FIG. 32 is a view showing a state in which the tibial slit member 2 is fixed to the cut guide device 3 by the operation of the driving cam member 8a, and FIG. 33 shows the cut guide device 3 of the tibial slit member 2 by the operation of the driving cam member 8a. FIG. 34 is a diagram showing a state in which the fixed state of the tibial slit member 2 to the cut guide device 3 is released by operating the driving cam member 8a.

  As shown in FIG. 32 (1), in the state where the operation lever 65 is horizontal, the first cam surface 91 of the driving cam portion 62 is applied to the first cam of the driven cam portion 50 by the spring force of the spring member 58. The surface 51 abuts to prevent the fitting member 10 from being lowered in the direction of the arrow C2, and the fitting portion 56 is fitted into the fitting recess 4 as shown in FIG. The slit member 2 is maintained in a state of being fixed to the cut guide device 3.

  As shown in FIG. 33 (1), when the operation lever 65 is operated from the horizontal in the direction of the arrow E 2, the first cam surface 51 of the driven cam portion 50 is moved from the third cam surface 93 of the driving cam portion 62 to the second cam surface 93. The first cam surface 91 faces through the two cam surfaces 92, the driven cam portion 50 is pushed down in the direction of the arrow C2 against the spring force of the spring member 58, and as shown in FIG. The joining portion 56 starts to be detached from the fitting recess 4, and the tibial slit member 2 is in a semi-fixed state with respect to the cut guide device 3.

  Further, when the operation lever 65 is operated in the direction of the arrow E2 from the middle state of FIGS. 33 (1) and (2) and moved substantially vertically downward as shown in FIG. 34 (1), the driving cam portion The first cam surface 91 of 62 is opposed to the bottom surface 97 of the driven cam portion 50, and the driven cam portion 50 is pushed down in the direction of the arrow B <b> 2 against the spring force of the spring member 58. As a result, the fitting portion 56 is completely detached from the fitting recess 4, and the fixed state of the tibial slit member 2 to the cut guide device 3 is released, and this state is maintained. When the operation lever 65 is operated in the direction of the arrow E1 in the direction opposite to the direction of the arrow E2, the fitting member 10 is raised in the direction of the arrow B1 by the spring force of the spring member 58, and the tibial slit member 2 is again moved. The fitting portion 56 can be returned to the fixed position to the cut guide device 3.

  As described above, in the present embodiment, the driving cam member 8a is rotated in the same direction by the rotation operation of the operation lever 65 in the directions of the arrows E1 and E2, and is moved to the fitting member 10 fixing position and the fixing releasing position. Therefore, it is possible to reduce the amount of operation of the operation lever 65 by the operator, and it is possible to facilitate and facilitate intraoperative operations such as attachment and removal operations of the tibial slit member 2 from the cut guide device 3.

  35 and 36 are partially enlarged perspective views showing still another embodiment of the present invention. Note that the same reference numerals are given to portions corresponding to the above-described embodiment. The fitting portion 56 of the above-described embodiment is formed in a hemispherical shape. However, in another embodiment of the present invention, as shown in FIG. 35, it may be a quadrangular prism, as shown in FIG. Alternatively, it may be frustoconical. Even in the surgical instrument for an artificial joint provided with such a fitting portion 56, the same effects as those of the surgical instrument for an artificial joint 1, 1a of the above-described embodiment can be obtained.

DESCRIPTION OF SYMBOLS 1 Surgical instrument for artificial joints 2 Tibial slit member 3 Cut guide apparatus 4 Fitting recessed part 5 Bottom face 6 Contact surface 7 Cut guide apparatus 8 Driving cam member 9 Drive cam member 10 Fitting member 11 Tibial 12 Spike rod 13 Ankle clamp 14 Slit guide Body 15 Main shaft 16 Main shaft guide member 17 Ankle clamp holding member 41 Base portion 42, 42a Driving cam portion 43 Holding portion 44 Guide hole 45 Opening 46 Operation guide display portion 47, 51 First cam surface 48, 52 Second cam surface 49, 77 Base 50, 50a Drive cam part 56 Fitting part 57 Guide shaft 58 Spring member 59 Accommodating hole 60, 76 Shaft hole 71 Ball trial 72 Neck trial 73 Broach trial 74 Femur 75 Shaft part 78 Fixed claw 79 Guide shaft 80 Movable body

Claims (6)

In a surgery for replacing a part or all of a joint with an artificial joint, a surgical member having a fitting recess, which is used by being fixed to the joint;
A main body having a contact surface that is provided on the surgical member so as to be movable along a predetermined first axis, and that contacts the surgical member;
A driving cam member having a base portion displaceably held by the main body, and a driving cam portion provided on the base portion and formed with a cam surface facing the direction of displacement;
According to the displacement of the driving cam member, it has a driven cam portion that is pressed by the driving cam portion, and moves along a second axis perpendicular to the first axis by pressing the driven cam portion. A driven cam member that
A fitting member fixed to the driven cam member, wherein the driven cam member is fitted into the fitting recess according to the movement of the driven cam member along the second axis, and is detached from the fitting recess. A surgical instrument for an artificial joint, comprising: a fitting member having a fitting part that is displaceable between the detached position.   2. The surgical instrument for an artificial joint according to claim 1, wherein at least one of the driving cam unit and the driven cam unit has a cam surface parallel to a virtual plane perpendicular to the second axis.   The surgical instrument for an artificial joint according to claim 1 or 2, wherein a surface of the fitting portion that fits into the fitting recess is part of a hemispherical surface.   The spring according to claim 1, further comprising a spring member attached to the fitting member so that the fitting portion is spring-biased in a direction in which the fitting portion is displaced from the separation position to the fitting position. The surgical instrument for an artificial joint according to any one of the above.   The base portion includes a longitudinal member that is held on the main body so as to be linearly displaceable in a direction intersecting the second axis, and the driving cam portion is provided at one longitudinal end portion of the longitudinal member. The surgical instrument for an artificial joint according to claim 1, wherein the surgical instrument is artificial.   The base portion includes a pair of disk-like members held on the main body so as to be capable of rotational displacement about an axis intersecting the second axis, and the driving cam portion is provided between the pair of disk-like members. The surgical instrument for an artificial joint according to claim 1, wherein the surgical instrument is prosthetic.

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