JP2017093974A - Surgical instrument for artificial knee joint replacement surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a surgical instrument for artificial knee joint replacement surgery that is superior in operability.SOLUTION: A surgical instrument for artificial knee joint replacement surgery 1 is configured by including: an index part 2a serving as a reference when fixing a resection guide 80; a body part 4 provided or fixed with the index part 2a; a swinging part 10 having an abutment part coming into abutment with patient's condyles 101a, 101b and constituted so as to swing to the body part 4, and in which the position and angle to the condyles 101a, 101b are determined by the abutment part coming into abutment with the condyles 101a, 101b; and a switching mechanism 20 having an operated part 30 operated by a user, and switching between a fixed state where the swinging part 10 is fixed to the body part 4 by the operated part 30 being operated only along a predetermined direction and a release state where the swinging part 10 becomes a swingable state to the body part 4.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a surgical instrument for artificial knee joint replacement used for artificial knee joint replacement.

  Conventionally, artificial knee joint replacement, which is an operation for replacing a knee joint with an artificial knee joint, has been performed on a patient with an abnormality in the knee joint. The knee prosthesis includes a femoral implant that is secured to the patient's femur and a tibial implant that is secured to the patient's tibia. Procedures for installing the femoral implant in the femur include (1) preoperative planning, (2) osteotomy of the distal femur, (3) mounting the femoral implant on the distal femur, (For example, refer nonpatent literature 1).

  In the configuration described in Non-Patent Document 1, in the preoperative plan of (1), the patient's lower limb is imaged by X-ray imaging. Using this captured image, the operator measures an axis (anatomical axis) passing from the center of the femoral bone marrow cavity to the knee joint center and an axis (functional axis) passing from the femoral head center to the knee joint center. Then, the operator measures the angle (valgus angle) formed by the anatomical axis and the functional axis.

  At the time of osteotomy of the distal part of the femur (2), the operator opens a hole using a reamer in the distal part of the femur. Next, the surgeon attaches the valgus alignment guide to the F rod. The hallux alignment guide has a cylindrical tube portion (inner tube portion) to which the F rod is fixed, and a swinging portion that swings with respect to the inner tube portion. The swinging part is attached to the inner cylinder part via a support shaft extending in the front-rear direction of the patient, and can swing around the support shaft with respect to the inner cylinder part. By adjusting the position around the support shaft with respect to the swing portion, the angle of the swing portion (swing angle) with respect to the inner cylinder portion is set. At this time, the operator sets the swing angle so as to coincide with the valgus angle measured in the preoperative plan, and then fixes the swing portion to the inner cylinder portion. Then, the operator inserts the F rod into the hole formed in the medullary cavity of the femur and brings the swinging portion into contact with the distal portion of the femur. Then, in this state, the operator fixes the swinging portion to the distal portion of the femur. When the valgus alignment guide is installed at the correct position of the femur, the center of the valgus alignment guide is aligned with the femoral head center on the functional axis.

  Next, the operator attaches a slit member (resection guide) to the swinging portion of the valgus alignment guide, positions the resection guide with respect to the femur, and fixes the resection guide to the distal portion. Thereafter, the operator removes the valgus alignment guide and the F rod from the femur. Next, the surgeon performs osteotomy on the distal portion of the femur by moving the oscillator (resecting instrument) along the slit of the resection guide fixed to the femur.

  The surgeon further performs a bone cutting operation according to a predetermined procedure to form a predetermined bone cutting surface at the distal portion. When the femoral implant is mounted on the distal part of the femur (3) above, the femoral implant is fixed to the osteotomy surface.

Kyocera Medical “How to use Bi-surface 5 dedicated instrument”, [online], [searched on November 17, 2015], Internet <URL: http: //kyocera-md.jp/m_professional/yes/medical/pdf/ bs5_manu_v2_0.pdf>

  By the way, as disclosed on page 23 of Non-Patent Document 1 described above, in order to release the engagement between the inner cylinder portion and the swinging portion, an operation of loosening the fixing screw (rotating operation of the fixing screw), And the operation of pushing the fixing screw in two directions are necessary, and the operation is complicated.

  The present invention is to solve the above-described problems, and an object thereof is to provide a surgical instrument for artificial knee joint replacement having excellent operability.

  (1) A surgical instrument for artificial knee joint replacement according to a certain aspect of the present invention for achieving the above object includes an index portion serving as a reference when fixing a resection guide in which a slit for osteotomy is formed; The indicator portion is provided or fixed to the main body portion, and has a contact portion that comes into contact with the patient's condyle and is configured to swing with respect to the main body portion, and the contact portion is the condyle. A swinging portion whose position and angle with respect to the condyles are determined by abutting to the condyle, and an operated portion operated by a user, and the operated portion is operated only along a predetermined direction, whereby the main body A switching mechanism that switches between a fixed state in which the swinging part is fixed with respect to a part and a release state in which the swinging part is swingable with respect to the main body part. Yes.

  In this configuration, after the swinging portion is fixed at an appropriate position with respect to the patient's condyle, the resection guide is attached to the swinging portion. Then, after the resection guide is fixed to the patient's condyle, the surgical instrument for artificial knee joint replacement including the swinging portion is removed from the patient's condyle. In this state, osteotomy is performed along the osteotomy slit formed in the resection guide. Thereby, the suitable position in a patient's knee joint can be cut.

  In this configuration, the operated part is operated only along a predetermined direction, so that the swinging part is fixed to the main body part, and the swinging part is swingable with respect to the main body part. It is possible to switch between a release state that becomes a correct state. That is, according to this configuration, it is possible to easily switch between the fixed state and the released state of the swinging portion.

  Therefore, according to this configuration, it is possible to provide a surgical instrument for artificial knee joint replacement with excellent operability.

  (2) Preferably, the switching mechanism includes a sliding portion that is formed with an engaging portion that engages with an engaged portion formed in the swinging portion and is slidable along the main body portion, When the user operates the operated portion so that the slide portion moves toward the engaged portion, the engaging portion engages with the engaged portion and becomes the fixed state, while the slide portion When the user operates the operated portion so as to move away from the engaged portion, the engagement between the engaging portion and the engaged portion is released and the released state is established.

  In this configuration, by providing a slide part that is slidable along the main body part and sliding the slide part along the main body part, the fixed state and the release state of the swinging part can be easily switched. .

  (3) More preferably, the main body portion has a rod on which the indicator portion is formed, the rod is inserted and can be held on the inner peripheral surface, and the position of the rod in the longitudinal direction is adjusted. And the slide portion is an outer tube portion that slides while sliding with respect to the outer periphery of the inner tube portion.

  In this configuration, since the position of the inner cylinder part and the position of the outer cylinder part in the longitudinal direction of the rod can be adjusted, the inner cylinder part and the outer cylinder part are appropriately connected in a state in which the patient indicator part is indicated by the indicator part of the rod. Can be placed in position. That is, according to this configuration, a surgical instrument for artificial knee joint replacement with excellent operability can be provided.

  (4) More preferably, the switching mechanism further includes a biasing portion that biases the outer cylinder portion in a direction in which the engagement portion moves toward the engaged portion.

  In this configuration, when the surgeon operates the operated portion in a predetermined direction to engage the engaging portion of the outer cylindrical portion with the engaged portion of the swinging portion, the outer cylindrical portion is engaged by the biasing portion. It is moved to the joint side. That is, according to this configuration, the engaging portion and the engaged portion can be reliably engaged only by the operator operating the operated portion in a predetermined direction.

  (5) More preferably, the operated portion is a nut operated in a rotation direction, and the outer cylinder portion is formed with a male screw that is screwed with a female screw of the nut, and the switching mechanism is And a nut pressing portion that is fixed to the inner cylinder portion and holds the nut sandwiched between the swinging portion.

  In this configuration, since the nut is held between the swinging portion and the nut pressing portion, the nut does not slide along the longitudinal direction of the rod even when the nut is rotated. The outer cylinder part screwed into the nut slides. That is, according to this structure, the structure for sliding the outer cylinder part along the longitudinal direction of the rod can be realized by using a member having a relatively simple shape such as a nut and a nut pressing part.

  (6) Preferably, the said to-be-operated part is a knob part which is being fixed to the said outer cylinder part, and is operated in the sliding direction which is the direction in which the said outer cylinder part slides.

  In this configuration, it is possible to easily switch between the fixed state and the released state of the swinging portion only by moving the knob portion as the operated portion along the longitudinal direction of the rod.

  (7) More preferably, the switching mechanism is configured such that the outer cylinder portion is in a position of the outer cylinder portion with respect to the inner cylinder portion and the engagement portion is engaged with the engaged portion. It is configured to be switchable between a first position and a second position in a state where the engaging portion is separated from the engaged portion by a predetermined distance.

  In this configuration, the outer cylinder portion can be switched between the first position and the second position by the switching mechanism, so that the fixed state and the released state of the swinging portion can be switched.

  (8) More preferably, the switching mechanism is formed in the outer cylinder part, which is fixed to the case part accommodating the part of the outer cylinder part where the knob part is formed, and the case part. And a positioning mechanism that switches the position of the outer cylinder portion to one of the first position and the second position by fitting into one of the first recess and the second recess.

  With this configuration, positioning of the outer cylinder portion positioned at either the first position or the second position can be easily realized by the case portion and the positioning mechanism.

  (9) Preferably, the indicator is inserted into the medulla of the patient's femur.

  In this configuration, the position and angle of the swinging portion can be appropriately determined with reference to the medullary cavity formed in the medullary cavity of the patient's femur.

  (10) Preferably, the indicator portion is a portion that indicates the center of the femoral head of the patient's femur.

  In this configuration, it is possible to appropriately determine the position and angle of the rocking portion with reference to the center of the femoral head of the patient.

  (11) Preferably, the surgical instrument for artificial knee joint replacement further includes a position adjustment mechanism capable of adjusting the position of the contact portion.

  According to this configuration, the abutting portion can be reliably brought into contact with the condyle of the patient's femur by the position adjusting mechanism. Thereafter, when the swinging portion is fixed to the patient's femur with a pin or the like, The possibility that the angle of the swinging portion with respect to the inner cylinder portion is shifted can be reduced.

  (12) More preferably, the position adjusting mechanism has a plurality of thickness adjusting members having different thicknesses.

  In this configuration, a configuration for reliably bringing the surgical instrument into contact with the patient's condyles can be easily realized by a plurality of thickness adjusting members having different thicknesses.

  (13) Preferably, the swinging portion has a swinging portion main body that is swingably supported by a swinging shaft portion with respect to the main body portion, and the position adjusting mechanism includes the contact portion with the contact portion. It is configured to be slid with respect to the swinging part main body.

  In this configuration, the surgical instrument can be reliably brought into contact with the patient's condyle by configuring a position adjustment mechanism that slides the contact portion with respect to the swinging portion main body.

  According to the present invention, it is possible to provide a surgical instrument for artificial knee joint replacement having excellent operability.

It is a front view which shows an example of the usage type of the surgical instrument which concerns on this embodiment. It is a perspective view of an example of the usage type of the surgical instrument shown in FIG. FIG. 2 is a front view of the surgical instrument shown in FIG. 1, in which a distal end side portion and a part of a handle portion of an intramedullary rod are omitted, and a swinging portion is fixed to an inner cylinder member. It is a figure which shows a state. It is a perspective view of the surgical instrument shown in FIG. 1, Comprising: It is a figure which abbreviate | omits and shows a part of the front end side in an intramedullary rod, and a part of handle part. It is a perspective view of an inner cylinder member. It is a perspective view of a rocking | swiveling part. It is a perspective view of an outer cylinder part. It is a perspective view of a nut. It is a perspective view of each of a plurality of thickness adjusting members. FIG. 3 is a front view of the surgical instrument, a part of which is omitted, and is a view showing a state where the swinging part is fixed to the inner cylinder member. It is a front view of the surgical instrument which concerns on a modification, it is a figure which abbreviate | omits that part, and is a figure which shows the state by which the rocking | swiveling part is being fixed with respect to the inner cylinder member. It is a figure which shows a case part, a part of outer cylinder part, and a knob part in a cross section among each component shown in FIG. It is a figure which shows the case part shown in FIG. 11, and the plunger fixed to this case part, Comprising: (A) is the figure seen from upper direction, (B) is sectional drawing in the XIIIB-XIIIB line | wire of A. It is a figure which shows only a case part and is a cross section. It is a front view of the outer cylinder part shown in FIG. It is a front view of the surgical instrument which concerns on a modification, and is a figure which shows the state by which fixation of the rocking | swiveling part with respect to an inner cylinder member is cancelled | released, and shows a case part, a part of outer cylinder part, and a knob part in a cross section FIG. It is a front view of the surgical instrument which concerns on a modification, Comprising: It is a figure which abbreviate | omits and shows it. It is a perspective view which shows a part of rocking | swiveling part main body of the surgical instrument shown in FIG. It is a perspective view of the paddle part shown in FIG.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings. The present invention can be widely applied as a surgical instrument for artificial knee joint replacement for replacing a knee joint of a patient with an artificial knee joint.

  The surgical instrument 1 according to the present embodiment is used in artificial knee joint replacement. Artificial knee joint replacement is an operation in which a knee joint is replaced with an artificial knee joint for a patient who has an abnormality in the knee joint. In this operation, after the distal part of the patient's femur and the proximal part of the tibia are cut at appropriate positions to form an installation surface, the installation surface (femoral resection surface) of the distal femur is While the bone implant (not shown) is fixed, the tibial implant (not shown) is installed on the installation surface of the proximal portion of the tibia. Thereby, a knee joint of a patient can be replaced with an artificial knee joint. In the surgical instrument 1 according to the present embodiment, the resection guide used to form the installation surface on which the implants of the above-described artificial knee joint are installed has an appropriate position and direction with respect to the femur. In addition, the resection guide is for attaching to the distal part of the femur.

[overall structure]
FIG. 1 is a front view showing an example of a usage pattern of the surgical instrument 1 (surgical instrument for artificial knee joint replacement) according to the present embodiment. FIG. 2 is a perspective view of an example of a usage pattern of the surgical instrument 1 shown in FIG. FIG. 3 is a front view of the surgical instrument 1 shown in FIG. 1, and is a view in which a portion on the distal end side of the intramedullary rod 2 and a part of the handle portion 2 b are omitted. It is a figure which shows the state by which the rocking | swiveling part 10 is being fixed with respect to it. FIG. 4 is a perspective view of the surgical instrument 1 shown in FIG. 1, in which the distal portion of the intramedullary rod 2 and a part of the handle portion 2 b are omitted.

  In FIGS. 1 and 2, the above-described resection guide 80 is also illustrated along with the surgical instrument 1. Also, in each drawing described below, for the sake of convenience of explanation, the direction indicated by the arrow described above is indicated as upper or upper, the direction indicated by the arrow indicated as lower is indicated as lower or lower, and right. The direction indicated by the arrow is indicated on the right or right side, the direction indicated by the arrow indicated as left is indicated on the left side or left side, the direction indicated by the arrow indicated as front is indicated by the arrow indicated as front side or front, and the rear side. The direction to do is called back side or back. The up-down direction, the left-right direction, and the front-rear direction correspond to the up-down direction, the left-right direction, and the front-rear direction based on the patient's human body.

  The surgical instrument 1 includes an intramedullary rod 2, a hallux alignment guide 3, a fixed state switching mechanism 20 (switching mechanism), and a plurality of thickness adjusting members 35a, 35b, 35c, and 35d (position adjusting mechanism). Yes.

  The intramedullary rod 2 is a straight member that extends straightly and is inserted into a medullary cavity 102 formed in the medullary cavity of the femur 100 of the patient. The intramedullary rod 2 is inserted into the medullary cavity 102 and used to indicate the anatomical axis S1 of the femur 100. The intramedullary rod 2 is inserted into the medullary cavity hole 102 of the femur 100 so as to be aligned with the anatomical axis S1 while being attached to the valgus alignment guide 3. A portion of the intramedullary rod 2 that is inserted into the medullary cavity 102 is provided as an index portion 2a. A handle portion 2b is attached to a proximal end portion of the intramedullary rod 2 (a portion opposite to the side inserted into the medullary cavity hole portion 102).

  The hallux alignment guide 3 has an inner cylinder member 4 and a swinging portion 10.

  The valgus alignment guide 3 is installed at the distal portion 101 of the femur 100, and supports the intramedullary rod 2 so as to be swingable around a swinging shaft portion 19 described later, whereby the position of the intramedullary rod 2 is adjusted. The femoral 100 can be adjusted in the valgus direction B1. The valgus angle direction B1 refers to a direction around the intersection (the central axis of the swinging shaft portion 19) between the anatomical axis S1 and the functional axis S2 in the front view. The hallux alignment guide 3 is made of stainless steel, but can also be made of synthetic resin or the like.

  FIG. 5 is a perspective view of the inner cylinder member 4. The inner cylinder member 4 is a member formed in a substantially cylindrical shape, and the intramedullary rod 2 is inserted therein. The inner cylinder member 4 has an inner cylinder part 5 (main body part) and a box part 6 (nut holding part), which are integrally formed.

  The inner cylinder part 5 is a part formed in the substantially cylindrical shape extended in an up-down direction. As shown in FIG. 4, the inner cylinder portion 5 is disposed between a front plate portion 13 and a rear plate portion 14 of the swinging portion 10 described later in detail. As shown in FIG. 5, a swing shaft hole 5 a to which the swing shaft portion 19 is inserted and fixed is formed in the upper portion of the inner cylinder portion 5. In addition, a spring receiving pin hole 5b is formed in the central portion of the inner cylinder portion 5 in the vertical direction, and a spring receiving pin 5c as a spring receiving portion is inserted and fixed therein. Further, a flat surface 5d is formed on the front side portion and the rear side portion in the central portion of the inner cylinder portion 5 in the vertical direction. The flat surface 5d is slidably contacted with a front flat surface 24a of the outer cylinder portion 21 described later in detail.

  The box part 6 is a box-like part fixed to the lower end part of the inner cylinder part 5, and the outer shape is formed in a substantially rectangular parallelepiped shape that is slightly longer in the front-rear direction. The box portion 6 is formed with a through-hole penetrating the box portion 6 in the vertical direction. This through hole is provided as a rod through hole 6a into which the intramedullary rod 2 is inserted. Further, the box portion 6 is formed with a hole portion extending from the front side surface toward the rear side in the box portion 6. This hole portion is provided as a button hole portion 6b into which a button portion 7 described later in detail is inserted.

  The button part 7 is a columnar member inserted in the button hole 6b with reference to FIG. When the button portion 7 is not pressed by the user, the button portion 7 is urged in a direction (front side) protruding from the box portion 6 by a coil spring or the like (not shown) to hold the intramedullary rod 2 with the box portion 6. The intramedullary rod 2 is fixed to the inner cylinder member 4. On the other hand, when the button portion 7 is pressed by the user, the button portion 7 enters the box portion 6 and releases the fixation of the intramedullary rod 2 to the inner cylinder member 4. Thereby, the intramedullary rod 2 can be slid up and down with respect to the inner cylinder member 4.

  FIG. 6 is a perspective view of the swinging unit 10. The swinging part 10 is a part provided so as to be swingable with respect to the inner cylinder member 4, and is a part fixed to the distal part 101 of the femur 100. The oscillating portion 10 is formed in a substantially T shape when viewed from the front. The swinging part 10 has a base part 11, a front plate part 13, and a rear plate part 14.

  The base part 11 is provided as a part extending in the left-right direction of the patient. Specifically, the base portion 11 includes a right base portion 11R that is a right portion of the base portion 11 and a left base portion 11L that is a left portion of the base portion 11. The base portion 11 is disposed at the distal end of the distal portion 101 of the femur 100 and is fixed to the distal portion 101 using a pin member (not shown). A front plate portion 13 and a rear plate portion 14 extend from the base portion 11.

  The right base portion 11R and the left base portion 11L are formed with a right groove portion 12R and a left groove portion 12L, respectively. Each groove part 12R, 12L is formed to extend in the front-rear direction in the back side part (the part opposite to the part where the condyles are in contact) in each base part 11R, 11L. Engagement main body portions 36a of thickness adjusting members 35a, 35b, 35c, and 35d, which will be described in detail later, are fitted into these groove portions 12R and 12L. Upper surfaces 11a and 11b of the base portions 11R and 11L are provided as contact portions that contact the patient's condyles 101a and 101b, respectively.

  The front plate portion 13 is continuous with the front portion of the base portion 11 and extends away from the femur 100. The rear plate portion 14 is continuous with the rear portion of the base portion 11 and extends away from the femur 100. The left and right end portions of the front end portion of the front plate portion 13 and the left and right end portions of the front end portion of the rear plate portion 14 are connected by side wall portions 15 and 16. The upper part of the front plate portion 13 is formed with a round through hole that penetrates the part in the front-rear direction. This through hole is provided as a rocking shaft hole portion 13a into which the rocking shaft portion 19 is inserted. In addition, a valgus scale 17 is formed on the front surface of the front plate portion 13.

  The valgus angle scale 17 forms a display portion that indicates a swing angle that is an angle of the center line of the swing portion 10 with respect to the center line of the intramedullary rod 2. The front plate portion 13 and the rear plate portion 14 are each formed with a through hole. Of the peripheral portions of these through holes, swinging portion side teeth 18 (engaged portions) are formed at portions facing the femur 100, respectively. The oscillating portion side tooth portion 18 is a sector gear that is provided to fix the inner cylinder member 4 and the oscillating portion 10 to each other and that has the oscillating shaft portion 19 as a center.

  The inner cylinder member 4 and the swinging part 10 described above are connected to each other by a swinging shaft part 19 so as to be swingable. The swing shaft portion 19 is a shaft-like member, and is provided in both the swing shaft hole portion 5 a formed in the inner cylinder member 4 and the swing shaft hole portion 13 a formed in the swing portion 10. It is inserted. The oscillating shaft portion 19 is fixed to one of the oscillating shaft holes 5a and 13a, and is rotatably provided to the other oscillating shaft hole portions 13a and 5a.

[Configuration of fixed state switching mechanism]
The fixed state switching mechanism 20 includes a fixed state in which the swinging portion 10 is fixed to the inner cylinder member 4 and a release state in which the swinging portion 10 is not fixed to the inner cylinder member 4. It is a mechanism for switching between states. The fixed state switching mechanism 20 includes an outer cylinder portion 21 (slide portion), a coil spring 28 (biasing portion), a nut 30 (operated portion), and the box portion 6 described above.

  FIG. 7 is a perspective view of the outer cylinder portion 21. The outer cylinder part 21 is a member formed in a substantially cylindrical shape. The outer cylinder part 21 has the square cylinder part 22, the external thread part 23, and the indicator part 25, and these are integrally formed.

  The rectangular tube portion 22 is an upper portion of the outer tube portion 21, and the outer peripheral surface thereof is a portion formed in a rectangular shape when viewed from the vertical direction. That is, the front side surface 22a, the rear side surface (not shown in FIG. 7), the right side surface (not shown in FIG. 7), and the left side surface 22b constituting the outer peripheral surface of the rectangular tube portion 22 are flat surfaces. The front side surface 22 a is in sliding contact with the front plate portion 13 of the swinging portion 10, and the rear side surface is in sliding contact with the rear plate portion 14 of the swinging portion 10. That is, the rectangular tube portion 22 is sandwiched between the front plate portion 13 and the rear plate portion 14 in the front-rear direction.

  The male screw portion 23 is a lower portion of the outer cylinder portion 21, and a male screw 23 a into which the female screw of the nut 30 is screwed is formed on the outer peripheral surface thereof. A male screw is not formed on the front portion of the male screw portion 23, and a flat surface 23b continuous with the front side surface 22a of the rectangular tube portion 22 is formed. Similarly, no male screw portion is formed on the rear portion of the male screw portion 23, and a flat surface (not shown) that is continuous with the rear side surface of the rectangular tube portion 22 is formed.

  A through hole 24 is formed in the rectangular tube portion 22 and the male screw portion 23 so as to penetrate them in the vertical direction. The through hole 24 includes a front flat surface 24a that is a front portion, a rear flat surface 24b that is a rear portion, and a right curved surface 24c that is a right portion of the inner peripheral surface forming the through hole 24. , And a left curved surface 24d which is a left portion. The front side plane 24a and the rear side plane 24b are formed in a rectangular shape elongated in the vertical direction. The right curved surface 24c and the left curved surface 24d are provided as part of the inner peripheral surface of the cylinder and are formed to extend in the vertical direction. The outer peripheral surface of the inner cylinder portion 5 is in sliding contact with the inner peripheral surface of the through hole 24.

  The indicator portion 25 is a portion that bulges outward from the upper portion of the front side surface 22 a and the rear side surface of the rectangular tube portion 22. An outer tube portion side tooth portion 26 (engagement portion) that meshes with the swinging portion side tooth portion 18 is formed in a lower portion of the indicator portion 25. In addition, an arrow-shaped instruction part 27 that extends from the upper side to the lower side and indicates the lower part is formed at the center in the left-right direction of the indicator part 25.

  With reference to FIG. 4, the coil spring 28 is disposed with respect to the inner cylinder portion 5 so as to surround the outer peripheral surface of the inner cylinder portion 5. A portion on one end side of the coil spring 28 is in contact with the spring receiving pin 5 c, while a portion on the other end side of the coil spring 28 is in contact with an upper portion of the outer cylinder portion 21. That is, the coil spring 28 is sandwiched and held between the spring receiving pin 5c and the outer cylinder portion 21 in the vertical direction. As a result, the coil spring 28 urges the outer cylinder portion 21 downward.

  FIG. 8 is a perspective view of the nut 30. The nut 30 includes a nut main body portion 31 that is a cylindrical portion extending in the vertical direction, and a grip portion 32 that is formed so as to expand radially outward from an upper portion of the nut main body portion 31. Are integrally formed. On the inner peripheral surface of the nut main body 31, a female screw 33 that is screwed with the male screw 23 a formed on the outer cylinder portion 21 is formed. The grip portion 32 is formed with a recess 34 that is recessed inward from the outer peripheral portion of the grip portion 32. Six recesses 34 are formed so as to be equally spaced when viewed from above and below (in the example shown in FIG. 8, at intervals of 60 degrees).

  With reference to FIG. 4, the nut 30 is sandwiched and held between the swinging portion 10 and the box portion 6 in a state where the male screw 23 a of the outer cylinder portion 21 is screwed to the female screw 33. That is, the nut 30 is not displaced in the vertical direction with respect to the inner cylinder member 4, and the lower end portion thereof is in contact with the box portion 6.

  FIG. 9 is a perspective view schematically showing a plurality of (four in the case of the present embodiment) thickness adjusting members 35a, 35b, 35c, and 35d of the surgical instrument 1.

  Each of the thickness adjusting members 35a to 35d includes an engaging portion 36 and spacer portions 37a, 37b, 37c, and 37d that are integrally formed with the engaging portion 36. The plurality of thickness adjusting members 35a to 35d are the same as each other except that the thicknesses h1, h2, h3, and h4 of the spacer portions 37a to 37d included in the members 35a to 35d are different. Each thickness adjusting member 35a, 35b, 35c, 35d is given an Arabic numeral from 1 to 4, respectively. Specifically, an Arabic numeral “1” is attached to the thickness adjusting member 35a, an Arabic numeral “2” is attached to the thickness adjusting member 35b, and an Arabic numeral “3” is attached to the thickness adjusting member 35c. The thickness adjusting member 35d is given an Arabic numeral “4”.

  The engaging portion 36 is formed to engage with the groove portions 12R and 12L formed in the right base portion 11R and the left base portion 11L of the swinging portion 10, respectively. Specifically, the engaging portion 36 includes an engaging main body portion 36a that slides in the groove portions 12R and 12L along a direction in which the groove portions 12R and 12L extend, and the engaging main body portion 36a and the spacer portions 37a to 37d. Are connected to each other, and are integrally formed. The engagement main body portion 36a is a portion that is formed in a substantially strip shape extending in the same direction as the groove portions 12R and 12L. The connection part 36b has connected the engagement main-body part 36a and each spacer part 37a-37d.

  The spacer portions 37 a to 37 d are portions formed in a plate shape having a predetermined thickness in the vertical direction, with the shape viewed from the vertical direction formed in a substantially tongue shape. The back surfaces (surfaces on the engagement portion 36 side) of the spacer portions 37a to 37d are formed into flat surfaces that are in close contact with the upper surfaces 11a and 11b of the base portions 11R and 11L. The upper surfaces 38a, 38b, 38c, and 38d of the spacer portions 37a to 37d are formed in a flat surface parallel to the rear surfaces of the spacer portions 37a to 37d. Upper surfaces 38a to 38d of the spacer portions 37a to 37d are provided as contact portions that contact the condyles 101a and 101b.

  The plurality of spacer portions 37a to 37d have different thicknesses h1 to h4. Specifically, the thickness of the spacer part 37a is h1, the thickness of the spacer part 37b is h2, the thickness of the spacer part 37a is h3, and the thickness of the spacer part 37a is h4. The thicknesses h1 to h4 have a relationship of h1 <h2 <h3 <h4.

[How to use surgical instruments]
Procedures for placing the femoral implant in the femur 100 include: (i) preoperative planning, (ii) cutting of the distal portion 101 of the femur 100, and (iii) to the distal portion 101 of the femur 100. The installation of femoral implants. (Ii) In osteotomy of the distal portion 101 of the femur 100, a method of determining the swing angle of the swing portion 10 with reference to the intramedullary rod 2 (hereinafter referred to as method A), As a reference, a method of determining the swing angle of the swing unit 10 (hereinafter referred to as method B) can be mentioned. If the surgical instrument 1 according to the present embodiment is used, the swing angle of the swinging portion 10 (swing with respect to the center line of the intramedullary rod 2) can be used regardless of the method A or the method B described above. The swinging portion 10 can be easily fixed to the inner cylinder member 4 so that the angle of the center line of the moving portion 10 becomes a desired valgus angle.

  In the preoperative plan of (i), a patient's leg is image | photographed by X-ray imaging. Using this captured image, the surgeon uses the center of the medullary cavity portion 102 of the femur 100 to pass through the knee joint center (anatomical axis S1), and the axis from the femoral head center 103 to the knee joint center. (Function axis S2) is measured. Then, the operator measures an angle (valgus angle θ) formed by the anatomical axis S1 and the functional axis S2 when the patient is viewed from the front.

  At the time of osteotomy in (ii), first, the operator uses the reamer on the end surface of the distal portion 101 of the femur 100 to form a medullary cavity portion 102 by making a hole so as to coincide with the axis of the medullary cavity. To do. Next, the operator inserts the intramedullary rod 2 with the valgus alignment guide 3 attached into the medullary cavity hole 102, and then the valgus alignment guide 3 is moved to the distal portion of the femur 100 by a fixing pin. Fix to 101.

[Method of determining swing angle by method A]
When the swing angle of the swing portion 10 is determined based on the method A, that is, the intramedullary rod 2, the surgeon moves the valgus alignment guide 3 to the distal portion 101 of the femur 100 by the following procedure. Fix it.

  First, the operator instructs the swing angle of the swing portion 10 (that is, the instruction portion 27 so that the swing angle of the swing portion 10 with respect to the intramedullary rod 2 matches the valgus angle according to the preoperative plan. The oscillating angle scale) is adjusted, and the swinging portion 10 is fixed to the inner cylinder member 4.

  Here, when performing such work using a conventional surgical instrument (surgical instrument 1 disclosed in Non-Patent Document 1 described above), the operator refers to page 23 of Non-Patent Document 1, After the fixing screw (corresponding to the nut 30 of the present embodiment) is rotated and loosened, the fixing screw can be pushed to the valgus alignment side to release the swinging portion from being fixed to the inner cylinder member. Thereafter, the surgeon swings the swinging part so that the swinging angle of the swinging part matches the valgus angle, and then fixes the swinging part to the inner cylinder member. Specifically, the surgeon weakens the pressing force on the fixing screw and displaces the fixing screw downward, and then rotates and tightens the fixing screw. That is, when a conventional surgical instrument is used, when fixing or releasing the swinging portion, an operation of rotating the fixing screw (rotating operation of the fixing screw) and an operation of sliding the fixing screw up and down ( Operation in two directions (sliding operation of the fixing screw) is necessary, and the operation is complicated.

  With respect to this point, according to the surgical instrument 1 according to the present embodiment, the operator can simply rotate the nut 30 (that is, only operate the nut 30 only in the rotational direction), and the swinging portion with respect to the inner cylinder member 4. Ten fixing or unlocking can be performed. Specifically, for example, in a state where the swinging portion 10 is fixed to the inner cylinder member 4 (the state shown in FIG. 3), when the operator rotates the nut 30 in the direction of loosening, the fixed state switching mechanism 20. Works as follows. Specifically, in the fixed state switching mechanism 20, the outer cylinder part 21 is pushed upward against the urging force of the coil spring 28, and the swinging part side tooth part 18 and the outer cylinder part side tooth part 26 engage with each other. Canceled. Thereby, the rocking | swiveling part 10 will be in a release state. The outer cylinder portion 21 has a front portion (front side surface 22a) and a rear portion (rear side surface) sandwiched between the front plate portion 13 and the rear plate portion 14, so that the rotation of the nut 30 is performed. Does not rotate with.

  In this state, the surgeon oscillates the oscillating unit 10 so that the oscillating angle of the oscillating unit 10 matches the valgus angle, and then places the oscillating unit 10 in a fixed state. Specifically, the surgeon rotates the nut 30 in the tightening direction. Then, in the fixed state switching mechanism 20, the outer cylinder part 21 is pushed downward by the urging force of the coil spring 28, and the swinging part side tooth part 18 and the outer cylinder part side tooth part 26 are engaged with each other. As a result, the oscillating portion 10 is in a fixed state in a state where the oscillating angle of the oscillating portion 10 coincides with the valgus angle.

  Next, the surgeon moves the valgus alignment guide 3 so that the upper surface 11a of the right base portion 11R of the valgus alignment guide 3 and the upper surface 11b of the left base portion 11L are close to the condyles 101a and 101b of the patient. Is inserted into the medullary cavity 102. At this time, when the upper surfaces 11a and 11b of the base portions 11R and 11L are appropriately in contact with the condyles 101a and 101b of the distal portion 101 of the patient's femur 100, the operator is in that state. The valgus alignment guide 3 can be appropriately fixed to the distal portion 101 of the femur 100 by fixing the base portion 11 to the distal portion 101 using a pin member (not shown).

  However, even if the upper surfaces 11a and 11b of the base portions 11R and 11L of the valgus alignment guide 3 are brought into contact with the patient's condyles 101a and 101b as described above, the degree of cartilage wear of the patient's condyles 101a and 101b is reduced. In some cases, the upper surfaces 11a and 11b of the base portions 11R and 11L cannot be brought into contact with the patient's condyles 101a and 101b, and a gap is formed between the patient's condyles 101a and 101b and the valgus alignment guide 3. May occur.

  In this regard, in the surgical instrument 1, a member having an appropriate thickness h <b> 1 to h <b> 4 is selected from the plurality of thickness adjusting members 35 a to 35 d and is engaged with the base portion 11. A gap between the condyles 101a and 101b and the valgus alignment guide 3 can be eliminated. Thereafter, the operator can fix the valgus alignment guide 3 to the distal portion 101 of the femur 100 by fixing the base portion 11 to the distal portion 101 using a pin member (not shown).

  Finally, the operator attaches the resection guide 80 to the valgus alignment guide 3, positions the resection guide 80 with respect to the femur 100, and fixes the resection guide 80 to the distal portion 101. Thereafter, the operator removes the surgical instrument 1 including the intramedullary rod 2 and the valgus alignment guide 3 from the femur 100. Next, the surgeon performs osteotomy on the distal portion 101 of the femur 100 by moving an oscillator (resecting instrument) along the slit of the resection guide 80 fixed to the femur 100. The surgeon further performs a bone cutting operation according to a predetermined procedure to form a predetermined bone cutting surface on the distal portion 101. When the femoral implant of (iii) is mounted, the femoral implant is fixed to the osteotomy surface.

[Method of determining swing angle by method B]
By the way, when the swing angle of the swing portion 10 is determined by the method A, the following problems may occur. Specifically, when the degree of curvature of the femur of the patient is large, the actual valgus is determined when the swing angle of the swing portion 10 is determined with reference to the intramedullary rod 2 inserted into the medullary cavity 102. It is generally known that an angle different from the angle is set.

  In this regard, according to Method B, the knee joint alignment is appropriately set by determining the rocking angle of the rocking unit 10 based on the joint line (the contact surface between the patient's femur and tibia). be able to. And according to the surgical instrument 1 which concerns on this embodiment, even if it is a case where the method B is used, the rocking | fluctuation angle of the rocking | swiveling part 10 can be determined easily.

  Specifically, first, the surgeon confirms the inclination of the joint line in the preoperative plan, and reproduces the joint line using a plurality of thickness adjusting members 35a to 35d. Specifically, when the joint line is tilted so as to descend from the right side toward the left side, the operator fixes the thick thickness adjustment member to the right base portion 11R and the thin thickness adjustment member to the left side. What is necessary is just to fix to the base part 11L (or the thickness adjusting member does not need to be fixed to the left base part 11L). On the other hand, when the joint run is tilted so as to descend from the left side toward the right side, the surgeon fixes the thick thickness adjustment member to the left base portion 11L and the thin thickness adjustment member. What is necessary is just to fix to the right base part 11R (or the thickness adjusting member does not need to be fixed to the right base part 11R).

  Next, the surgeon inserts the intramedullary rod 2 into the medullary cavity 102 in the surgical instrument 1 (see FIG. 10) with the swinging portion 10 in the released state, and the joint line is reproduced as described above. The formed valgus alignment guide 3 is brought into contact with the condyles 101a and 101b. Thereby, it is possible to set an appropriate swing angle based on the joint run. Thereafter, the surgeon can fix the swinging portion 10 by fixing the swinging portion 10 to the inner cylinder member 4 by tightening the nut 30. Work performed thereafter by the surgeon (work for fixing the valgus alignment guide 3 to the distal portion 101 of the femur 100, attaching the resection guide 80 to the valgus alignment guide 3, and fixing the resection guide 80 to the femur 100 The operation to perform, the operation to remove the valgus alignment guide 3 from the femur 100, and the like are the same as the operations when the method A is described, and thus the description thereof is omitted.

[effect]
As described above, in the surgical instrument 1 according to the present embodiment, after the swinging portion 10 is fixed at an appropriate position with respect to the patient's condyles 101 a and 101 b, the resection guide 80 is attached to the swinging portion 10. It is attached. Then, after the resection guide 80 is fixed to the patient's condyles 101a and 101b, the surgical instrument 1 including the swinging part 10 is removed from the patient's condyles 101a and 101b. In this state, osteotomy is performed along the osteotomy slit formed in the resection guide 80. Thereby, the suitable position in a patient's knee joint can be cut.

  In the surgical instrument 1, the nut 30 is operated only along a predetermined direction (the rotation direction of the nut 30), whereby the swinging portion 10 is fixed to the inner cylinder portion 5, and the swinging is performed. It is possible to switch between a release state in which the portion 10 can swing with respect to the inner cylinder portion 5. That is, according to the surgical instrument 1, it is possible to easily switch between the fixed state and the released state of the rocking unit 10.

  Therefore, the surgical instrument 1 can provide a surgical instrument with excellent operability.

  Further, in the surgical instrument 1, the outer cylinder part 21 that can slide is provided along the inner cylinder part 5, and the outer cylinder part 21 is slid along the inner cylinder part 5 to fix the swinging part 10. The state and the release state can be easily switched.

  Moreover, in the surgical instrument 1, since the position of the inner cylinder part 5 and the position of the outer cylinder part 21 in the longitudinal direction of the intramedullary rod 2 can be adjusted, the intramedullary rod 2 is inserted deeply into the medullary cavity 102 of the patient. In the state, the inner cylinder part 5 and the outer cylinder part 21 can be arrange | positioned in an appropriate position. That is, according to the surgical instrument 1, it is possible to provide a surgical instrument with excellent operability.

  Further, in the surgical instrument 1, when the operator rotates the nut 30 to engage the outer tube portion side tooth portion 26 with the swing portion side tooth portion 18, the outer tube portion 21 is moved to the swing portion side by the coil spring 28. It is moved to the tooth part 18 side. That is, according to the surgical instrument 1, the outer tube portion side tooth portion 26 and the swinging portion side tooth portion 18 can be reliably engaged only by the operator rotating the nut 30.

  Further, in the surgical instrument 1, the nut 30 is sandwiched and held between the swinging portion 10 and the box portion 6, so that the nut 30 remains along the longitudinal direction of the intramedullary rod 2 even if the nut 30 is rotated. Instead, the outer cylinder portion 21 screwed into the nut 30 slides. That is, according to the surgical instrument 1, the configuration for sliding the outer cylinder portion 21 along the longitudinal direction of the intramedullary rod 2 is made using a member having a relatively simple shape such as the nut 30 and the box portion 6. Can be realized.

  Moreover, in the surgical instrument 1, the position and angle of the rocking | swiveling part 10 can be determined appropriately on the basis of the medullary cavity 102 formed in the medullary cavity of the patient's femur 100.

  Further, in the surgical instrument 1, the upper surfaces 38a to 38d as the contact portions can be reliably brought into contact with the condyles 101a and 101b of the patient's femur 100 by the plurality of thickness adjustment members 35a to 35d as the position adjustment mechanism. it can. Then, when the rocking | swiveling part 10 is fixed to a patient's femur 100 with a pin member etc. after that, possibility that the angle of the rocking | swiveling part will shift | deviate with respect to an inner cylinder part can be reduced.

  Further, in the surgical instrument 1, a configuration for reliably bringing the surgical instrument 1 into contact with the condyles 101a and 101b of the patient's femur 100 is easily realized by a plurality of thickness adjusting members 35a to 35d having different thicknesses. be able to.

  Although the embodiments of the present invention have been described above, the present invention is not limited to the above-described embodiments, and various modifications are possible as long as they are described in the claims. For example, the following modifications may be made.

[Modification]
(1) FIG. 11 is a front view of a surgical instrument 1a according to a modified example, a part of which is omitted, and shows a state in which the swinging portion 10 is fixed to the inner cylinder member 4. FIG. Moreover, FIG. 12 is a figure which shows the case part 40, a part of outer cylinder part 50 (slide part), and the knob part 55 among each component shown in FIG. 11 in a cross section.

  In the surgical instrument 1 according to the above-described embodiment, the nut 30 is provided as an operation unit for switching between the fixed state and the released state of the inner cylinder member 4 and the swinging unit 10, and the user 30 rotates the nut 30 to fix the state. However, this is not a limitation. Specifically, for example, in the surgical instrument 1a according to this modification, the fixed state and the released state are switched by sliding the knob portion 55 provided as the operated portion of the fixed state switching mechanism 20a in the vertical direction. It is done.

  The surgical instrument 1a according to the present modification is different from the surgical instrument 1 according to the above embodiment in the configuration of the outer cylinder portion. Moreover, the surgical instrument 1a has a configuration in which the nut 30 is omitted from the surgical instrument 1 according to the above-described embodiment, and instead, a case portion 40 and a plunger 46 (positioning mechanism) are provided. It has a configuration. Below, a different point from the surgical instrument 1 which concerns on the said embodiment is demonstrated, and description is abbreviate | omitted about others.

  FIGS. 13A and 13B are views showing the case portion 40 shown in FIG. 11 and the plunger 46 fixed to the case portion 40, where FIG. 13A is a view from above, and FIG. It is sectional drawing in the -XIIIB line | wire, Comprising: It is a figure which shows only the case part 40 in a cross section.

  The case part 40 has a front wall part 41, a rear wall part 42, a right side wall part 43, and a left side wall part 44, which are integrally formed. The front wall portion 41 and the rear wall portion 42 are wall portions formed in a substantially square shape when viewed from the front. The right side wall 43 and the left side wall 44 are slightly elongated walls in the vertical direction. A through hole 45 extending in the vertical direction is formed inside the case portion 40. The outer cylinder part 50 mentioned later in detail penetrates this through-hole 45. As shown in FIG.

  The right side wall 43 and the left side wall 44 are formed with slits 43a and 44a penetrating the side walls 43 and 44 in the thickness direction, respectively. Each slit 43a, 44a is formed in a slit shape elongated in the vertical direction.

  The plunger 46 has a main body portion 47 and a ball portion 48. The main body portion 47 is a portion formed in a substantially cylindrical shape. The ball portion 48 is a ball-like member disposed so as to cover the opening on one end side of the main body portion 47, and advances and retreats along the longitudinal direction of the main body portion 47 with respect to the main body portion 47. Specifically, the ball portion 48 is a spring provided in the main body portion 47 in a state where an external force (force that presses the ball portion 48 into the main body portion 47) does not act on the ball portion 48. (Not shown), it is located on the advancing direction side, which is the direction protruding from the main body 47 (see FIG. 13). On the other hand, when the ball portion 48 is pressed against the urging force of the spring, the ball portion 48 retracts into the main body portion 47. In the plunger 46, referring to FIG. 13B, the main body portion 47 is fixed in a state of penetrating the left side wall portion 44 so that the ball portion 48 is exposed inside the case portion 40.

  FIG. 14 is a front view of the outer cylinder portion 50 shown in FIG. The outer cylinder part 50 has a rectangular tube main body part 51, an indicator part 25, and a knob part 55.

  The rectangular tube main body 51 is a rectangular tube-shaped portion extending in the vertical direction in the outer tube portion 50. The rectangular tube main body 51 is a portion whose outer peripheral surface is formed in a rectangular shape when viewed in the vertical direction. That is, the front side surface 52, the rear side surface (not shown in FIG. 14), the right side surface 53, and the left side surface 54 constituting the outer peripheral surface of the rectangular tube main body 51 are flat surfaces. The outer peripheral surface of the rectangular tube main body portion 51 is in sliding contact with the inner peripheral surface of the case portion 40. Specifically, the front side surface 52, the rear side surface, the right side surface 53, and the left side surface 54 of the rectangular tube main body 51 are respectively a front wall portion 41, a rear wall portion 42, a right side wall portion 43, and a case portion 40. It is in sliding contact with each of the left side wall portions 44.

  An upper groove 53a (first recess) and a lower groove 53b (second recess) are formed on the right side surface 53 of the rectangular tube main body 51. Each groove part 53a, 53b is formed so that the right side surface 53 may be extended in the front-back direction. Each groove part 53a, 53b is formed at intervals in the up-down direction, and the upper groove part 53a is formed above the lower groove part 53b.

  On the left side surface 54 of the rectangular tube main body 51, an upper groove 54a (first recess) and a lower groove 54b (second recess) are formed. Each groove part 54a, 54b is formed so that the left side surface 54 may be extended in the front-back direction. Each groove part 54a, 54b is formed at intervals in the up-down direction, and the upper groove part 54a is formed above the lower groove part 54b.

  The indicator portion 25 is a portion that bulges outward from the upper portion of the front side surface 52 and the rear side surface of the rectangular tube main body portion 51. Since the configuration of the indicator unit 25 is the same as that of the above embodiment, the description thereof is omitted.

  The knob portion 55 is a rod-shaped portion provided so as to protrude outward from the lower portion of each of the right side surface 53 and the left side surface 54. Each knob portion 55 is fixed to each of the right side surface 53 and the left side surface 54.

[Configuration of fixed state switching mechanism]
The fixed state switching mechanism 20a (switching mechanism) of the present modification includes the above-described case portion 40, plunger 46, and outer cylinder portion 50. In the fixed state switching mechanism 20a, the operator can switch between the fixed state and the released state of the rocking unit 10 only by sliding the knob portion 55 in the vertical direction.

  Specifically, when the swinging part 10 of the surgical instrument 1 is in a fixed state (see FIG. 12), the ball part 48 of the plunger 46 is fitted in the upper groove part 54a of the outer cylinder part 50 ( The outer cylinder portion 50 is in the first position). In this state, when the surgeon pushes the knob part 55 upward, the outer cylinder part 50 slides upward. When the lower groove portion 54b reaches the position of the ball portion 48 of the plunger 46 in the vertical direction, the ball portion 48 is fitted into the lower groove portion 54b (see FIG. 15). Thereby, the swinging portion 10 is in the released state, and the position of the outer cylinder portion 50 in the vertical direction is fixed at the second position.

[effect]
As described above, in the surgical instrument 1a according to this modified example, as in the case of the above-described embodiment, the fixed state and the released state of the swinging portion 10 can be easily switched. Can provide.

  Further, in the surgical instrument 1a, the fixed state and the released state of the swinging portion 10 can be easily switched by simply moving the knob portion 55 as the operated portion along the longitudinal direction of the intramedullary rod 2.

  Further, in the surgical instrument 1a, the fixed state switching mechanism 20a can be used to switch the outer cylinder portion 50 between the first position and the second position, thereby switching between the fixed state and the released state of the swinging portion 10.

  In the surgical instrument 1a, the positioning of the outer cylinder portion 50 positioned at either the first position or the second position can be easily realized by the case portion 40 and the plunger 46 as a positioning mechanism.

  (2) FIG. 16 is a front view of a surgical instrument 1b according to a modified example, with a part thereof omitted. FIG. 17 is a perspective view showing a part of the swing part main body 56 shown in FIG. FIG. 18 is a perspective view showing the paddle portion 60 of the swinging portion 10a shown in FIG.

  In the surgical instrument 1 according to the above-described embodiment, the example in which the gap between the swinging portion 10 and each of the condyles 101a and 101b is eliminated using the thickness adjusting members 35a to 35d has been described. Specifically, the swinging portion 10a of this modification has a swinging portion main body 56 that is swingable with respect to the inner cylinder member 4 via the swinging shaft portion 19, and a contact portion. The paddle portion 60 is slidable in the vertical direction with respect to the swinging portion main body 56. In this modification, the contact portions can be brought into contact with the condyles 101a and 101b by adjusting the vertical position of the paddle portion 60 with respect to the swinging portion main body 56.

  The swing part main body 56 includes a base part 57, a front plate part 13, a rear plate part 14, and side wall parts 15 and 16. The configurations of the front plate portion 13, the rear plate portion 14, and the side wall portions 15 and 16 are the same as those in the swinging portion 10 of the above-described embodiment, and thus description thereof is omitted.

  The base portion 57 is a portion that is rotatably fixed to the inner cylinder member 4 by the swing shaft portion 19. Guide rails 58 extending in the vertical direction are formed on the rear side portions of the right side wall portion and the left side wall portion of the base portion 57, respectively. The guide rail 58 is formed so that the shape seen from the up-down direction is T-shaped. The guide rail 58 is for guiding the paddle portion 60 along the vertical direction.

  In addition, a plurality of base side teeth 59 arranged in the vertical direction are formed on the front side portions of the right side wall portion and the left side wall portion of the base portion 57, respectively. A paddle portion side tooth portion 67 which will be described in detail later meshes with the base portion side tooth portion 59.

  Referring to FIG. 18, paddle portion 60 has a paddle main body portion 61, an advance / retreat portion 66, and a fixing release button 68. The surgical instrument 1 of the present modification has two paddle parts 60, one paddle part 60 is provided on the right side of the base part 57, and the other paddle part 60 is provided on the left side of the base part 57. Yes.

  The paddle body 61 is a blade-shaped part that expands in the horizontal direction. An upper surface 62 (see FIG. 16) of the paddle main body 61 is provided as an abutting portion with which the condyles 101a and 101b abut. Further, a groove portion 63 extending in the vertical direction is formed in an inner portion (side attached to the base portion 57) of the paddle main body portion 61. The groove 63 is provided as a guided groove 63 that slides along the extending direction (vertical direction) of the guide rail 58 in a state where the groove 63 is fitted into the guide rail 58 formed in the base portion 57. As a result, the paddle main body 61 can slide up and down with respect to the swinging main body 56. Further, the paddle main body 61 has an internal space S in which the advance / retreat portion 66 and the fixing release button 68 are accommodated. The paddle main body 61 is formed with an opening 64 that communicates the internal space S with the outside on the inside and front side of the paddle main body 61.

  The advance / retreat portion 66 is a member accommodated in the internal space S in the paddle main body 61. The advance / retreat portion 66 is formed with a paddle portion side tooth portion 67 that meshes with the base portion side tooth portion 59. The advancing / retreating portion 66 is accommodated in the internal space S in the paddle main body portion 61 so that the paddle portion side tooth portion 67 is exposed to the outside from the opening portion 64. The advancing / retreating portion 66 is urged by a coil spring (not shown) in a direction in which the paddle portion side tooth portion 67 protrudes outside through the opening 64.

  The surgical instrument 1b according to this modification includes a position adjustment mechanism 8. The position adjusting mechanism 8 is for adjusting the position in the vertical direction of the upper surface 62 of the paddle main body 61 as a contact portion that contacts the condyles 101a and 101b. The position adjustment mechanism 8 includes the above-described guide rail 58, base portion side tooth portion 59, guided groove portion 63, advance / retreat portion 66, and fixing release button 68.

  In the position adjustment mechanism 8, the paddle portion side tooth portion 67 and the base portion side tooth portion 59 mesh with each other when the fixing release button 68 is not pressed by the user. Thereby, the position of the paddle part 60 with respect to the base part 57 is fixed. On the other hand, when the user presses the fixing release button 68 with a finger or the like, the paddle portion side tooth portion 67 moves in a direction away from the base portion side tooth portion 59 (a direction in which it is retracted into the internal space S). Thereby, since the movement of the guided groove portion 63 in the vertical direction with respect to the guide rail 58 is allowed, the paddle portion 60 can be moved in the vertical direction. Then, after the user moves the paddle part 60 to a desired position in the vertical direction and then releases the fixing release button 68, the paddle part side tooth part 67 and the base part side tooth part 59 are engaged again. The paddle part 60 is fixed at the position.

[effect]
As described above, in the surgical instrument 1b according to this modification, the position adjustment mechanism 8 is configured to slide the paddle part 60 relative to the swinging part main body 56. Accordingly, for example, the surgical instrument 1b can be reliably brought into contact with the patient's condyles 101a and 101b without providing a plurality of thickness adjusting members as in the above embodiment.

  (3) In the above-described embodiment and each modified example, the example in which the swing angle is determined based on the intramedullary rod 2 inserted into the medullary cavity hole portion 102 has been described. The surgical instrument may be configured such that the rocking angle is determined based on a bone head indicating rod whose tip portion indicates the head center 103.

  The present invention can be widely applied as a surgical instrument for artificial knee joint replacement used in artificial knee joint replacement.

1, 1a, 1b Surgical instrument 2a Indicator part 5 Inner cylinder part (main part)
10, 10a Oscillating part 11a, 11b Upper surface (contact part)
20, 20a Fixed state switching mechanism (switching mechanism)
30 Nut (Operated part)
38a, 38b, 38c, 38d Upper surface (contact portion)
55 Knob (operated part)
62 Upper surface (contact part)
80 resection guide 101a, 101b condyle

Claims (13)

An index portion serving as a reference when fixing the resection guide formed with the slit for osteotomy,
A main body provided with or fixed to the indicator portion;
An oscillating portion that has an abutting portion that abuts on a patient's condyle and is configured to oscillate with respect to the main body, and the position and angle with respect to the condyle are determined by the abutting portion abutting on the condyle. When,
A fixed state in which the swinging portion is fixed to the main body by having the operated portion operated by a user and the operated portion is operated only along a predetermined direction; A switching mechanism that switches between a release state in which the swinging portion is swingable with respect to the main body portion, and
A surgical instrument for artificial knee joint replacement, characterized by comprising: The surgical instrument for artificial knee joint replacement according to claim 1,
The switching mechanism includes a sliding portion that is formed with an engaging portion that engages with an engaged portion formed on the swinging portion, and that is slidable along the main body portion, and the sliding portion is the engaged portion. When the user operates the operated portion so as to move to the mating portion side, the engaging portion engages with the engaged portion and enters the fixed state, while the slide portion moves from the engaged portion. When the user operates the operated portion so as to leave, the engagement between the engaging portion and the engaged portion is released and the released state is established. . The surgical instrument for artificial knee joint replacement according to claim 2,
The main body is
A rod on which the indicator portion is formed;
The rod is inserted and can hold the rod on the inner peripheral surface, and has an inner cylinder part capable of adjusting the position in the longitudinal direction of the rod,
The surgical instrument for artificial knee joint replacement, wherein the slide part is an outer cylinder part that slides while sliding with respect to the outer periphery of the inner cylinder part. The surgical instrument for artificial knee joint replacement according to claim 3,
The switching mechanism further includes an urging portion that urges the outer tube portion in a direction in which the engaging portion moves toward the engaged portion. Surgical instruments. The surgical instrument for artificial knee joint replacement according to claim 4,
The operated portion is a nut that is operated in a rotation direction,
The outer cylinder portion is formed with a male screw that is screwed with a female screw of the nut,
The switching mechanism further includes a nut pressing portion that is fixed to the inner cylinder portion and holds the nut sandwiched between the swinging portion and the knee joint replacement surgery, Instruments. The surgical instrument for artificial knee joint replacement according to claim 4,
The operation for artificial knee joint replacement is characterized in that the operated part is a knob part that is fixed to the outer cylinder part and is operated in a sliding direction that is a direction in which the outer cylinder part slides. Instruments. The surgical instrument for artificial knee joint replacement according to claim 6,
The switching mechanism includes a first position in a state where the outer cylinder portion is in a position of the outer cylinder portion with respect to the inner cylinder portion and the engagement portion is engaged with the engaged portion, and the engagement mechanism. A surgical instrument for artificial knee joint replacement, characterized in that the joint portion can be switched to a second position in a state of being separated from the engaged portion by a predetermined distance. The surgical instrument for artificial knee joint replacement according to claim 7,
The switching mechanism is
A case portion that accommodates a portion of the outer cylinder portion where the knob portion is formed;
The position of the outer cylinder portion is fixed to the first position and the second position by being fitted into one of the first recess and the second recess formed in the outer cylinder portion and fixed to the case portion. A positioning mechanism for switching to either one of them;
A surgical instrument for artificial knee joint replacement, characterized by comprising: The surgical instrument for artificial knee joint replacement according to any one of claims 1 to 8,
The surgical instrument for artificial knee joint replacement, wherein the index portion is inserted into the medulla of the patient's femur. The surgical instrument for artificial knee joint replacement according to any one of claims 1 to 9,
The surgical instrument for artificial knee joint replacement, wherein the index portion is a portion indicating the center of the femoral head of the patient's femur. The surgical instrument for artificial knee joint replacement according to any one of claims 1 to 10,
A surgical instrument for artificial knee joint replacement, further comprising a position adjustment mechanism capable of adjusting the position of the contact portion. The surgical instrument for artificial knee joint replacement according to claim 11,
The surgical instrument for artificial knee joint replacement, wherein the position adjusting mechanism has a plurality of thickness adjusting members having different thicknesses. The surgical instrument for artificial knee joint replacement according to claim 11 or 12,
The swing part has a swing part main body swingably supported by a swing shaft part with respect to the main body part,
The surgical instrument for artificial knee joint replacement, wherein the position adjusting mechanism is configured to slide the contact portion relative to the swinging portion main body.

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