JP2018027264A - Insertion device of screw reinforcement material and screw reinforcement material - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable reinforcement of low-invasive percutaneous screw fixing by a percutaneous technique, when inserting a reinforcement material such as a bone prosthesis into a screw hole in screw fixing, by facilitating insertion of a screw reinforcement material into the screw hole regardless of difficulty of straight gaze of a screw puncture hole and insertion inhibition of the reinforcement material such as the bone prosthesis, by a guide wire disposed in the screw hole.SOLUTION: An insertion device of a screw reinforcement material includes an outer cylinder, an inner cylinder, and a guide member and is configured to be slidable with their inserted into one another. The outer cylinder includes: a reinforcement material insertion hole (a bone prosthesis insertion hole) at a distal end for inserting a reinforcement material such as a bone prosthesis; a reinforcement material extraction hole (a bone prosthesis extraction hole) at a proximal end for extracting the reinforcement material (the bone prosthesis); and a lumen for communicating the reinforcement insertion hole to the reinforcement extraction hole in the inside so as to make the inner cylinder slidable therein. The inner cylinder includes: a pressing surface at the distal end for pushing the reinforcement material (the bone prosthesis) therein, and a lumen for communicating opening parts of both ends of the inner cylinder in the inside so as to make the guide member slidable therein.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a device for inserting a reinforcing material such as an artificial bone from a screw insertion hole into a screw hole and a screw reinforcing material in order to reinforce the fixation of the screw in spinal fusion or the like.

  In spinal fusion, fixation of the spine with a screw is known as a standard surgical technique. In screw fixation in conventional spinal fusion, the surgical wound is widely deployed and the spine is exposed widely, so that the operator can confirm the bone form under direct view and use various methods using hooks, wires, artificial bones, etc. The screw can be reinforced. However, since conventional screw fixation is highly invasive to the surgery, there is a large invasion of tissues such as muscles and ligaments around the spine, leading to an increase in blood loss during surgery and exacerbation of postoperative pain.

  In screw fixation, if there is bone vulnerability due to causes such as osteoporosis, there is a problem that it is difficult to obtain and maintain the strong fixation of the screw. Therefore, in the conventional screw fixing, various procedures are performed to reinforce the fixing. For example, a method of inserting rod-shaped hydroxyapatite into a screw hole is known as a conventional reinforcing method using a screw-fixed artificial bone.

  Conventionally, methods for filling artificial bones of various shapes such as powders and granules into bone defects using artificial bones such as hydroxyapatite have been performed in many fields of surgery. Some artificial bone granule filling jigs used in this case are also known. (See Patent Documents 1 and 2)

  On the other hand, due to the recent demand for minimally invasive spinal fusion, MISt (Minimally Invasive Spine Stabilization) is minimally invasive for imbalanced pathology caused by spinal instability and spinal deformity. It has become popular as a technique to improve the stability of the spine by braking. Accordingly, fixation with a percutaneous screw capable of percutaneous insertion with less invasiveness and less burden on the patient compared to conventional screws has become widespread.

JP2015-16276 JP 2014-195632 A

  For spinal fixation and screw fixation to the bone tissue of the extremities and other parts of the surgery, the surgical wound is deployed to expose the bone surface, and the screw is inserted into the bone tissue under direct viewing. Although a technique for inserting a percutaneous screw into a screw hole formed in a bone tissue without doing this is known, any technique requires strong screw fixation.

  When reinforce screw fixation using artificial bone, it is possible to fix both screw fixation to screw holes with exposed bone surfaces and screw fixation to percutaneously prepared screw holes. Reinforcement that enhances is required. However, since there is difficulty in inserting the artificial bone into the screw hole, there is a problem in obtaining strong screw fixing properties.

   (a) For example, in a screw hole on the surface of a bone where a surgical wound has been deployed, in order to reinforce screw fixation using an artificial bone, after inserting an artificial bone such as a rod-shaped hydroxyapatite into the screw hole, Insert.

  However, when a guide wire, a steel wire, or the like is inserted into the screw hole as a guide member for screw insertion, these guide members become an obstacle, making it difficult to insert the artificial bone into the screw hole. . Therefore, even when a guide member such as a guide wire is inserted into the screw hole, an artificial bone is easily inserted into the screw hole, and acquisition and maintenance of strong screw fixing properties are required.

   (b) Also, in percutaneous screw fixation to a screw hole that does not expose the bone surface, reinforcement of screw fixation is accompanied by difficulty, and there is a problem in obtaining strong fixation. For example, in the case of MISt using a percutaneous pedicle screw (PPS) for osteoporotic spine, the surgical wound is small and the spine is not exposed. Reinforcement of the conventional screw fixation using etc. cannot be performed.

  Furthermore, it is difficult to apply a conventional reinforcing method in which a rod-like hydroxyapatite is inserted into a screw hole. When inserting a percutaneous screw, it is difficult to confirm the screw insertion hole on the bone surface under direct observation because the surgical wound is small, and the guide wire inserted into the screw hole becomes an obstacle, and it becomes a rod shape. Cannot be inserted into the screw hole. For this reason, the conventional screw fixation reinforcement using a rod-shaped artificial bone cannot be applied to the percutaneous screw fixation as it is.

  Under these circumstances, even in MISt using PPS for osteoporotic vertebrae, it is difficult to insert an artificial bone into a screw hole, and the artificial bone can be easily inserted into the screw hole to obtain strong screw fixation. Maintenance is required.

  Patent literature describes the use of granular artificial bone. However, in the case of granular artificial bones, as with rod-shaped artificial bones, it is difficult to insert them into the screw holes due to the obstruction caused by the guide wire inserted into the screw holes, regardless of whether they are percutaneous or not. Will have sex. Up to now, there is no known method to effectively reinforce the fixation of screw fixing with guide wire or steel wire as a guide, making it easy to insert the artificial bone into the screw hole, and applicable to screw reinforcement There is no known device.

  Furthermore, in the case of a percutaneous screw, since the screw insertion hole cannot be directly viewed when the screw is inserted, it is more difficult to confirm an appropriate position for inserting the artificial bone. Until now, no method has been known to effectively reinforce the fixation of the percutaneous screw fixation without impairing the minimally invasiveness, and no device applicable to the reinforcement of the percutaneous screw has been known. .

  SUMMARY OF THE INVENTION Accordingly, an object of the present invention is to solve the above-described conventional problems and facilitate the insertion of a screw reinforcing material such as an artificial bone into a screw hole in screw fixing.

  In addition, it is easy to insert the screw reinforcement into the screw hole, regardless of the difficulty of direct viewing of the screw insertion hole or the hindrance of insertion of the screw reinforcement by the guide wire installed in the screw hole. The purpose is to do.

  It is another object of the present invention to enable reinforcement by a percutaneous technique without impairing the low invasiveness against the minimally invasive percutaneous screw fixation.

  The screw reinforcement insertion device of the present invention is configured to combine the outer cylinder, the inner cylinder, and the guide member in a state of being inserted into each other, and includes a mechanism that allows them to slide relative to each other. In addition, as a guide member, a steel wire etc. can be used other than a guide wire. In addition to artificial bone, autologous bone collected from the patient himself, homogenous bone collected from a person other than the patient, and bone cement that hardens after insertion can be used as the reinforcing material.

  The outer cylinder consists of a hollow cylinder, and of both ends of this cylinder, a proximal end is provided with a reinforcing material insertion port for introducing an artificial bone or other reinforcing material, and a reinforcing material is inserted at the distal end. A reinforcing material insertion / exit opening is provided, and a lumen that communicates the reinforcing material insertion port and the reinforcing material insertion / extraction port is provided. The lumen allows the inner cylinder to slide.

  The inner cylinder is formed of a hollow cylinder, and of the both ends of the cylinder, the inner cylinder has a lumen that communicates internally between the openings on both the proximal end side and the distal end side. The guide member can be slid. The end of the inner cylinder on the distal end side is provided with a pressing surface for pressing the reinforcing material into the screw hole.

  Here, the distal end means an end portion far from the operator when the reinforcing material is inserted into the screw hole, and is an end portion in contact with the screw hole. Further, the proximal end means an end portion on the side close to the operator at the same time, and is an end portion that performs operations such as insertion of a reinforcing material.

The screw reinforcement insertion device of the present invention attaches a screw in the following procedure.
(a) The guide member is previously inserted into the soft tissue and bone tissue, and the insertion portion of the screw is positioned.
(b) A screw hole is formed in the bone tissue from the screw insertion point.
(c) The outer cylinder is inserted along the guide member toward the formed screw hole, and the distal end of the outer cylinder is installed at the screw insertion point and positioned.
(d) The reinforcing material is introduced from the reinforcing material inlet at the proximal end of the outer cylinder into the lumen of the outer cylinder, and is inserted from the reinforcing material insertion port toward the screw hole.
(e) The distal end of the inner cylinder is inserted along the guide member from the reinforcing material inlet at the proximal end of the outer cylinder, and the inner cylinder is slid toward the screw hole in the lumen of the outer cylinder.
(f) The pressing surface at the distal end of the inner cylinder is brought into contact with the reinforcing material inserted into the outer cylinder and pressed into the screw hole.
(g) The inner cylinder is slid along the guide member in the lumen of the outer cylinder and taken out. Further, the outer cylinder is taken out along the guide member.
(h) Insert a screw along the guide member.
(i) Screw the screw into the screw hole with a screwdriver.
(j) Pull out the guide member.

  In the screw reinforcing material insertion device of the present invention, the outer cylinder facilitates the introduction of the reinforcing material into the screw hole, and the pressing surface of the inner cylinder is provided with the reinforcing material in the outer cylinder introduced toward the screw hole. Press to insert the reinforcing material more efficiently into the screw hole.

  The present invention includes first to third embodiments based on the above basic configuration.

(First form)
In the first embodiment, the outer cylinder includes a funnel-shaped portion on the proximal end side of the cylindrical body, and the inner cylinder includes a bulging portion on the proximal end side of the cylindrical body.

  The funnel-shaped portion constitutes a reinforcing material inlet, and smoothly introduces the reinforcing material into the lumen of the outer cylinder. The stepped portion of the bulging portion constitutes a stopper that suppresses insertion of the inner cylinder beyond a predetermined depth by contacting the inner surface of the funnel-shaped portion.

(Second form)
In the second embodiment, the inner cylinder includes a bulging portion on the proximal end side of the cylinder, and the stepped portion of the bulging portion constitutes a stopper that comes into contact with the end portion on the proximal end side of the cylinder. In the lumen of the outer cylinder, the guide member penetrates the groove or the communication portion provided in the massive reinforcing material, so that the reinforcing material can be slid along the guide member in the axial direction in the outer cylinder.

  In the second embodiment, the opening on the proximal end side of the outer cylinder has a reinforcing material insertion port for directly inserting the reinforcing material into the lumen of the outer cylinder without using the funnel-shaped portion provided in the first embodiment. Configure.

  The proximal end of the inner cylinder is provided with a bulging portion. The step portion of the bulging portion abuts on the proximal end portion of the outer cylinder, and constitutes a stopper that suppresses the inner cylinder from being inserted beyond a predetermined depth.

  In the first configuration example and the second configuration example, as long as the reinforcing material can be inserted into the lumen of the outer cylinder, the shape can be used without any particular limitation. For example, it is possible to use reinforcing materials having various shapes such as granules, powders, tablets, and columns.

  When the reinforcing material is inserted into the lumen of the outer cylinder, any shape of reinforcing material can be applied as long as the reinforcing material has a shape that does not hinder the guide member. Specifically, the shape of the reinforcing material is not limited to a granular shape or a powder shape, but a ring shape or a bamboo ring shape having a hollow portion, a C shape having a notch portion in part, a column shape having a groove in the axial direction, etc. A massive reinforcing material formed into a shape that is not obstructed by the guide member is also applicable. In particular, the second form is more suitable for a massive reinforcing material.

  For example, when a columnar reinforcing material having a groove in the axial direction is used, the reinforcing material slides along the guide member in the lumen of the outer cylinder by arranging the reinforcing material so that the guide member guides the groove. It becomes possible.

(Third form)
In the third embodiment, the outer cylinder includes a branch portion communicating with the lumen on the side surface on the proximal end side of the cylindrical body, and the inner cylinder includes a bulging portion on the proximal end side of the cylindrical body.

  The branch portion constitutes a reinforcing material input port and a holding portion, and after the reinforcing material is temporarily held by the holding portion, the reinforcing material is smoothly introduced into the lumen of the outer cylinder. The reinforcing material introduction port where the branch portion and the lumen formed in the side surface of the outer cylinder merge can be opened and closed by the inner cylinder inserted into the lumen of the outer cylinder. The opening and closing of the reinforcing material introduction port can be performed by sliding the inner cylinder in the lumen of the outer cylinder.

  The inner cylinder is inserted into the lumen of the outer cylinder, and the outer surface of the inner cylinder closes the reinforcing material inlet, thereby holding the reinforcing material introduced into the reinforcing material inlet in the branch portion. By sliding the inner cylinder in the direction of pulling out from the inner cavity of the outer cylinder and opening the reinforcing material introduction port, the reinforcing material held in the holding portion of the branch portion is introduced into the inner cavity of the outer cylinder.

  The step provided in the bulging part of the inner cylinder is located at the position where it contacts the proximal end of the outer cylinder, and the side surface of the cylindrical body of the inner cylinder closes the reinforcing material introduction port of the branch part, and enters the holding part of the branch part. A stopper is configured to hold the reinforcing member and suppress the inner cylinder from being inserted beyond a predetermined depth.

  In the third embodiment, various shapes of reinforcing material can be used as long as the shape of the reinforcing material can be introduced into the outer cylinder via the branch portion without being obstructed by the guide member in the outer cylinder. In particular, the reinforcing material is more preferably in the form of granules or powder because the reinforcing material is introduced through the branching portion.

As explained above, by using the screw reinforcement insertion device of the present invention,
(1) In screw fixation, a reinforcing material can be easily inserted into a screw hole.
(2) The reinforcing material can be reliably and easily inserted into the screw hole regardless of the difficulty of direct viewing of the screw insertion hole and the obstruction of the reinforcing material inserted by the guide member disposed in the screw hole. .
(3) When sufficient screw fixation cannot be obtained due to bone fragility, it is possible to obtain and maintain strong fixation.
(4) In contrast to a minimally invasive percutaneous screw fixation, it is possible to reinforce percutaneously without impairing the minimally invasiveness.

It is sectional drawing for demonstrating the 1st structural example of the insertion apparatus of the reinforcing material of the screw of this invention. It is sectional drawing for demonstrating the operation example of the 1st structural example of the insertion apparatus of the reinforcement material of the screw of this invention. It is sectional drawing for demonstrating the 2nd structural example of the insertion apparatus of the reinforcing material of the screw of this invention. It is sectional drawing for demonstrating the operation example of the 2nd structural example of the insertion apparatus of the reinforcement material of the screw of this invention. It is sectional drawing for demonstrating the 3rd structural example of the insertion apparatus of the reinforcing material of the screw of this invention. It is sectional drawing for demonstrating the operation example of the 3rd structural example of the insertion apparatus of the reinforcement material of the screw of this invention. It is a figure for demonstrating the example of the reinforcing material used for the insertion apparatus of the reinforcing material of the screw of this invention. It is a figure for demonstrating the extraction strength of the screw by the insertion apparatus of the reinforcing material of the screw of this invention.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. Hereinafter, the schematic configuration and operation example of the first configuration example of the screw reinforcing material insertion device of the present invention will be described with reference to FIGS. 1 and 2, and the screw reinforcement of the present invention will be described with reference to FIGS. A schematic configuration and an operation example of the second configuration example of the material insertion device will be described, and a schematic configuration and an operation example of the third configuration example of the screw reinforcing material insertion device of the present invention will be described with reference to FIGS. 5 and 6. Will be explained. In each of the following configuration examples, an artificial bone is described as an example of the reinforcing material. However, the reinforcing material is not limited to the artificial bone, but is an autologous bone sampled from the patient himself, a homogenous bone sampled from a person other than the patient, and an insertion. A material such as bone cement that hardens later can be used. In each of the following configuration examples, a percutaneous screw will be described as an example, but the same can be applied to a normal screw as well as a percutaneous screw.
In the description of each configuration example below, the reinforcing material insertion port, the reinforcing material insertion port, and the reinforcing material introduction port are shown as an artificial bone insertion port, an artificial bone insertion port, and an artificial bone introduction port, respectively, and a guide wire as a guide member The example which uses is shown.

(First configuration example of the screw reinforcing material insertion device)
FIG. 1 is a diagram for explaining an outline of a first configuration example of a screw reinforcing material insertion device according to the present invention, and FIG. 2 is a diagram for explaining an operation example, both of which show a cross section.

  In the first configuration example and the second configuration example to be described later, any artificial bone used as a reinforcing material can be used without particular limitation in shape and state as long as it can be inserted into the lumen of the outer cylinder. is there. For example, artificial bones such as granules, powders, pastes, and liquids can be used.

  FIG. 1 is a schematic diagram of a first configuration example. 1A shows an outer cylinder, FIG. 1B shows an inner cylinder, and FIG. 1C shows a guide wire. FIGS. 1D and 1E show a state in which the outer cylinder, the inner cylinder, and the guide wire are inserted into each other, and FIG. 1E shows a state in which the artificial bone is inserted.

  The screw reinforcing material insertion device 1A according to the present invention includes an outer cylinder 10, an inner cylinder 20, and a guide wire 30 that are slidable in a state of being inserted into each other.

  1A and 1B, the outer cylinder 10 includes a cylinder body 11. The opening 13 on the proximal end side of the cylindrical body 11 is provided with an artificial bone insertion port 15 for inserting the artificial bone 40, and the artificial bone insertion port 16 for inserting the artificial bone 40 is provided on the distal end side. The artificial bone insertion port 15 and the artificial bone insertion / extraction port 16 are communicated with each other through the lumen 12 so that the inner cylinder 20 can slide.

  The inner cylinder 20 includes a cylinder body 21. The cylinder 21 of the inner cylinder 20 has a pressing surface 27 at the end on the distal end side, and a gap between the openings of the proximal opening 23 and the distal opening 24 at both ends of the cylinder 21 of the inner cylinder 20 inside. And a lumen 22 through which the guide wire 30 can slide.

  The outer cylinder 10 includes a neck portion 17 and a funnel-shaped portion 14 on the proximal end side of the cylindrical body 11, and the funnel-shaped portion 14 constitutes an artificial bone insertion port 15. The artificial bone 40 is introduced from the side of the opening 13 having a large diameter, and the artificial bone 40 is introduced from the funnel-shaped portion 14 into the lumen 12 of the outer cylinder 10. The artificial bone insertion port 16 inserts the artificial bone 40 introduced into the lumen 12 of the cylindrical body 11 of the outer cylinder 10 into the screw hole 105 side (FIG. 1 (e)).

  The inner cylinder 20 includes a bulging portion 25 on the proximal end side of the cylindrical body 21, and the step portion 26 of the bulging portion 25 abuts on the inner surface of the funnel-shaped portion 14, so that the inner cylinder 20 has a predetermined depth or more. The stopper which suppresses being inserted in is comprised.

  The distal end means an end portion far from the operator when the artificial bone 40 is inserted into the screw hole, and is an end portion in contact with the screw hole. Similarly, the proximal end means an end portion on the side close to the operator when the artificial bone 40 is inserted into the screw hole, and is an end portion that performs operations such as insertion of the artificial bone 40.

  In FIG.1 (b), the inner cylinder 20 is provided with the press surface 27 which pushes the artificial bone 40 in a distal end. Further, the inner tube 20 includes a lumen 22 that internally communicates between both the proximal opening 23 and the distal opening 24 at both ends of the inner cylinder 20, and a guide wire 30 (FIG. 1C) can be slid therein. And

  The inner cylinder 20 includes a bulging portion 25 at the proximal end. The step portion 26 connecting the inner cylinder 20 and the bulging portion 25 is in contact with the inner surface of the funnel-shaped portion 14 and constitutes a stopper that suppresses the inner cylinder 20 from being inserted beyond a predetermined depth.

  In FIGS. 1D and 1E, when the inner cylinder 20 is pushed down and moved in the distal direction, the pressing surface 27 presses the artificial bone 40 inserted into the screw hole 105, and the artificial bone is inserted into the screw hole 105. 40 is inserted efficiently. Further, the artificial bone 40 is vibrated by tapping the upper surface of the proximal opening of the inner cylinder 20 with a hammer or the like (not shown) several times with the pressing surface 27 in contact with the artificial bone 40. It is possible to insert the artificial bone 40 efficiently up to the deep part in the screw hole 105 by applying pressure while applying.

  In FIG. 1 (e), the cylinder 11 of the outer cylinder 10 passes through the soft tissue 101 and is then inserted into a position where it slightly contacts the bone tissue 102, and the end of the distal end of the cylinder 21 of the inner cylinder 20. Is in a state of projecting in the distal direction by a few millimeters from the same position as the distal end of the cylindrical body 11 of the outer cylinder. For example, the protrusion amount is preferably in the range of 0 to 10 mm, and more preferably 1 to 2 mm.

  Also, in FIG. 1 (e), the position where the outer tube 10 is inserted in the soft tissue 101 is the insertion point 103, and the hole on the bone surface where the screw is inserted in the bone tissue 102 is the screw insertion hole 104. A hole into which the screw is inserted into the bone tissue 102 is a screw hole 105.

As shown in FIGS. 2A to 2J, the first configuration example of the screw reinforcing material insertion device of the present invention performs screw insertion and reinforcement in the following procedure.
(a) Using a needle or the like (not shown), the guide wire 30 is inserted into the insertion point 103 and positioned.
(b) The soft tissue 101 is expanded through the guide wire 30 through a dilator (not shown), and a screw hole 105 is formed in the bone tissue 102 using Owl or the like (not shown).
(c) Insert the outer cylinder 10 along the guide wire 30 and install the distal end of the outer cylinder 10 in the screw hole 105.
(d) The artificial bone 40 is introduced into the inner cavity 12 of the outer cylinder 10 from the artificial bone insertion port 15 at the proximal end of the outer cylinder 10, and the artificial bone 40 is fed toward the screw hole 105.
(e) The distal end of the inner cylinder 20 is inserted along the guide wire 30 from the artificial bone insertion port 15 at the proximal end of the outer cylinder 10, and the inner cylinder 20 is slid within the lumen 22 of the outer cylinder 10. .
(f) The pushing surface 27 at the distal end of the inner cylinder 20 is brought into contact with the inserted artificial bone 40, the inner cylinder 20 is pushed in the distal direction, and the artificial bone 40 is pushed into the screw hole 105.
(g) The inner cylinder 20 is slid along the guide wire 30 in the lumen 12 of the outer cylinder 10 and taken out. Further, the outer cylinder 10 is also taken out along the guide wire 30. In addition, you may take out the inner cylinder 20 and the outer cylinder 10 simultaneously.
(h) The screw 50 is inserted into the screw hole 105 along the guide wire 30.
(i) Screw the screw 50 with a screwdriver (not shown). Thereby, the screw 50 is attached in the screw hole 105 together with the artificial bone 40.
(j) Pull out the guide wire 30. At this time, the screw 50 is held in the screw hole 105 together with the artificial bone 40.

(Second configuration example of the screw reinforcing material insertion device)
FIG. 3 is a diagram for explaining an outline of a second configuration example of the screw reinforcing material insertion device of the present invention, and FIG. 4 is a diagram for explaining an operation example. 3 and 4 show cross sections.

  In the second configuration example, the artificial bone insertion port at the proximal end of the outer cylinder has a configuration in which the artificial bone is directly inserted into the lumen of the outer cylinder without going through the funnel-shaped portion of the first configuration example. is there.

  According to this configuration, as in the first configuration example, any artificial bone that can be inserted into the lumen of the outer cylinder can be used without particular limitation in shape and state. For example, in addition to granular or powdered artificial bone, hollow artificial rings, bamboo rings, C-shapes, columnar shapes with grooves in the axial direction, etc. can also be used. Is possible. However, since the opening has a small diameter, a massive artificial bone is preferable, and a granular or powder artificial bone is not preferable.

  For example, when using a columnar artificial bone 41 having a groove portion 41a in the length direction (axial direction) as shown in FIGS. 3 and 4, the columnar artificial bone 41 is arranged so that the guide wire 30 guides the groove portion 41a. Thus, the columnar artificial bone 41 can slide along the guide wire 30 in the lumen 12 of the cylindrical body 11.

  In the first configuration example and the second configuration example, a plurality of artificial bones having the various shapes described above can be used simultaneously.

  The screw reinforcing material insertion device 1B according to the present invention is slidably provided with the outer cylinder 10, the inner cylinder 20, and the guide wire 30 inserted into each other. In the following description, members having the same or similar functions as the components used in the first configuration example are given the same reference numerals.

  3A shows the outer cylinder 10, FIG. 3B shows the inner cylinder 20, and FIG. 3C shows a guide wire. 3 (d) and 3 (e) show a state in which the outer cylinder, the inner cylinder, and the guide wire are inserted into each other in the second configuration example, and FIG. 3 (e) shows a state in which the artificial bone 41 is inserted. Show.

  3A and 3B, the outer cylinder 10 includes a cylinder body 11. An artificial bone insertion port 15 for inserting the columnar artificial bone 41 is provided on the proximal end side of the cylindrical body 11 of the outer cylinder 10, and an artificial bone insertion port 16 for inserting the columnar artificial bone 41 is provided on the distal end side. The artificial bone insertion port 15 and the artificial bone insertion / extraction port 16 are communicated with each other through the lumen 12 so that the inner cylinder 20 can slide.

  3A, the outer cylinder 10 has an artificial bone insertion port 15 at the proximal end, an artificial bone insertion port 16 at the distal end side, and the artificial bone insertion port 15 and the artificial bone insertion port 16 communicate with each other. A lumen 12 is provided. The columnar artificial bone 41 introduced from the artificial bone insertion port 15 into the lumen 12 is inserted into the screw hole side (FIG. 3E) from the artificial bone insertion port 16 after passing through the lumen 12. In addition, the inner cavity 12 of the outer cylinder 10 allows the inner cylinder 20 to slide inside.

  In FIG. 3B, the inner cylinder 20 includes a cylinder body 21. The cylindrical body 21 of the inner cylinder 20 is internally between the pressing surface 27 at the end on the distal end side and the openings of the proximal opening 23 and the distal opening 24 at both ends of the cylindrical body 21 of the inner cylinder 20. And a lumen 22 through which the guide wire 30 can slide. Further, the inner cylinder 20 includes a bulging portion 25 on the proximal end side of the cylindrical body 21, and the stepped portion 26 of the bulging portion 25 abuts on a flange portion at an end portion on the proximal end side of the outer cylinder 10. Thus, a stopper that prevents the inner cylinder 20 from being inserted beyond a predetermined depth is configured.

  3 (d) and 3 (e), when the inner cylinder 20 is pushed down and moved in the distal direction, the pressing surface 27 presses the columnar artificial bone 41 from the lumen 12 of the outer cylinder 10 toward the screw hole 105, Further, the columnar artificial bone 41 inserted into the screw hole 105 is pressed, and the columnar artificial bone 41 is efficiently inserted into the screw hole 105. Further, with the pressing surface 27 in contact with the columnar artificial bone 41, the upper surface of the proximal opening of the inner cylinder 20 is tapped a plurality of times with a hammer or the like (not shown) to thereby form the columnar artificial bone 41. By applying pressure while applying vibration, the columnar artificial bone 41 can be efficiently inserted to a deep portion in the screw hole 105.

  In FIG. 3 (e), as in the first configuration example, the cylinder 11 of the outer cylinder 10 penetrates the soft tissue 101 and is then inserted into a position where it slightly touches the bone tissue 102. The end of the distal end of the body 21 protrudes in the distal direction by a few millimeters from the same position as the end of the distal end of the cylinder 11 of the outer cylinder 10. For example, the protrusion amount is preferably in the range of 0 to 10 mm, and more preferably 1 to 2 mm. 3 (e), the position where the outer tube 10 is inserted in the soft tissue 101 is the insertion point 103, and the hole on the bone surface where the screw is inserted in the bone tissue 102 is the screw insertion hole 104. A hole into which the screw is inserted into the bone tissue 102 is a screw hole 105.

  As shown in FIG. 3E, in the case of using the columnar artificial bone 41 having the groove portion 41a in the length direction (axial direction), the columnar artificial bone 41 is arranged so that the guide wire 30 guides the groove portion 41a. The columnar artificial bone 41 can slide along the guide wire 30 in the lumen 12 of the cylindrical body 11 of the outer cylinder 10.

As shown in FIGS. 4A to 4J, the second configuration example of the screw reinforcing material insertion device of the present invention performs screw insertion and reinforcement in the following procedure.
(a) Using a needle or the like (not shown), the guide wire 30 is inserted into the insertion point 103 and positioned.
(b) The soft tissue 101 is expanded through the guide wire 30 through a dilator (not shown), and a screw hole 105 is formed in the bone tissue 102 using Owl or the like (not shown).
(c) Insert the outer cylinder 10 along the guide wire 30 and install the distal end of the outer cylinder 10 in the screw hole 105.
(d) An artificial bone (columnar artificial bone 41) is introduced into the lumen 12 of the outer cylinder 10 from the artificial bone insertion port 15 at the proximal end of the outer cylinder 10, and the artificial bone (columnar artificial bone 41) is inserted into the groove 41a. Is slid by being guided by the guide wire 30 and inserted into the screw insertion hole 104 and the screw hole 105.
(e) The distal opening 24 at the distal end of the inner cylinder 20 is inserted along the guide wire 30 from the artificial bone insertion port 15 at the proximal end of the outer cylinder 10, and the inner cylinder 20 is inserted into the inner cylinder 10. Slide in cavity 12.
(f) The pressing surface 27 at the distal end of the inner cylinder 20 is brought into contact with the artificial bone (columnar artificial bone 41) inserted into the inner cavity 12, and the inner cylinder 20 is pushed in the distal direction, whereby the artificial bone The (columnar artificial bone 41) is pressed into the screw hole 105. At that time, depending on the shape of the artificial bone (columnar artificial bone 41), the artificial bone (columnar artificial bone 41) may be crushed by being pressed, but the columnar artificial bone is crushed when the screw is inserted. Therefore, even if it is crushed by the pressing surface 27, there is no problem.
(g) The inner cylinder 20 is slid along the guide wire 30 in the inner cavity 12 of the outer cylinder 10 and taken out. Further, the outer cylinder 10 is also taken out along the guide wire 30. In addition, you may take out the inner cylinder 20 and the outer cylinder 10 simultaneously.
(h) The screw 50 is inserted into the screw hole 105 along the guide wire 30.
(i) Screw the screw 50 with a screwdriver (not shown). Thereby, the screw 50 is attached in the screw hole 105 together with the artificial bone (columnar artificial bone 41).
(j) Pull out the guide wire 30. At this time, the screw 50 is held in the screw hole 105 together with the artificial bone (columnar artificial bone 41).

(Third configuration example of the screw reinforcing material insertion device)
FIG. 5 is a diagram for explaining a third configuration example of the screw reinforcing material insertion device of the present invention, and FIG. 6 is a diagram for explaining an operation example. 5 and 6 show cross sections.

  The third configuration example is a configuration suitable for granular, powder, paste, and liquid artificial bones. For example, as shown in FIG. 5 and FIG. An artificial bone in the form of granules or powder is introduced into the cavity. Here, the granular artificial bone may be any size as long as it can pass through the artificial bone insertion port or the artificial bone introduction port provided in the branching portion.

  Similar to the first and second configuration examples, the screw reinforcing member insertion device 1 </ b> C according to the present invention includes the outer cylinder 10, the inner cylinder 20, and the guide wire 30 that are slidable. In the following, members having the same or similar functions as the constituent elements used in the first and second configuration examples are given the same reference numerals.

  The outer cylinder 10 includes a branch portion 18 that communicates with the inner cavity 12 on the side surface on the proximal end side of the cylinder body 11, and the inner cylinder 20 includes a bulging portion 25 on the proximal end side of the cylinder body 21. The branch portion 18 includes an artificial bone insertion port 15 into which the artificial bone 40 is inserted, a holding portion 18a that temporarily holds the inserted artificial bone 40, and the artificial bone 40 that is held by the holding portion 18a. Provided with an artificial bone introduction port 18b to be introduced into the inner cavity 12.

  A stepped portion 26 of the bulging portion 25 of the inner cylinder 20 abuts against an end portion on the proximal end side of the cylindrical body 11 of the outer cylinder 10 to prevent the inner cylinder 20 from being inserted beyond a predetermined depth. Configure.

  5A shows the outer cylinder 10, FIG. 5B shows the inner cylinder 20, and FIG. 5C shows the guide wire 30. FIGS. 5D and 5E show a state in which the outer cylinder 10, the inner cylinder 20, and the guide wire 30 are inserted into each other in the third configuration example, and FIG. The inserted state is shown.

  In FIG. 5A, the outer cylinder 10 includes a branch portion 18 on the side surface of the cylinder body 11. The branch portion 18 includes an artificial bone insertion port 15 into which the artificial bone 40 is introduced, a holding portion 18a that temporarily holds the inserted artificial bone 40, and the artificial bone 40 that is held in the holding portion 18a. An artificial bone introduction port 18b for smoothly introducing the inside is provided. The artificial bone introduction port 18b allows the holding portion 18a and the lumen 12 to join and communicate with each other spatially. The artificial bone introduction port 18 b can be opened and closed by sliding the cylinder 21 of the inner cylinder 20 in the lumen 12 of the cylinder 11.

  5B and 5D, the proximal end of the inner cylinder 20 includes a bulging portion 25. The step portion 26 of the bulging portion 25 closes the artificial bone introduction port 18b of the branching portion 18 at a position where it contacts the proximal end portion of the outer cylinder 10, and holds the artificial bone 40 in the holding portion 18a. The stopper which suppresses that the inner cylinder 20 is inserted more than predetermined depth is comprised.

  The inner cylinder 20 is inserted into the lumen 12 of the outer cylinder 10, and the outer surface of the inner cylinder 20 closes the artificial bone introduction port 18b, whereby the artificial bone 40 introduced from the artificial bone insertion port 15 is contained in the holding portion 18a. Hold on. When the inner cylinder 20 is slid in the direction of pulling out from the lumen 12 of the outer cylinder 10, the artificial bone introduction port 18 b is opened, and the artificial bone 40 held in the holding portion 18 a of the branch portion 18 is replaced with the artificial bone. It introduces into the lumen 12 of the cylinder 11 through the introduction port 18b.

  In FIG. 5 (e), the pressing surface 27 presses the artificial bone 40 from the inner cavity 12 of the outer cylinder 10 into the screw hole 105, and efficiently inserts the artificial bone 40 into the screw hole 105. At that time, the artificial bone 40 can be pushed into the screw hole 105 by moving the inner cylinder 20 in the distal direction. Further, with the pressing surface 27 in contact with the artificial bone 40, the upper surface of the proximal opening 23 of the inner cylinder 20 is tapped a plurality of times with a hammer or the like (not shown) to thereby apply the artificial bone 40 to the artificial bone 40. It is possible to insert the artificial bone 40 efficiently up to the deep part in the screw hole 105 by applying pressure while applying vibration.

As shown in FIGS. 6A to 6J, the third configuration example of the screw reinforcing material insertion device of the present invention performs screw insertion and reinforcement in the following procedure.
(a) Using a needle or the like (not shown), the guide wire 30 is inserted into the insertion point 103 and positioned.
(b) The soft tissue 101 is expanded through the guide wire 30 through a dilator (not shown), and a screw hole 105 is formed in the bone tissue 102 using Owl or the like (not shown).
(c) Insert the outer cylinder 10 along the guide wire 30 and install the distal end of the outer cylinder 10 in the screw hole 105. After the artificial bone introduction port 18 b on the side surface of the outer cylinder 10 is closed by the inserted inner cylinder 20, the artificial bone 40 is introduced from the artificial bone insertion port 15 of the branch part 18, and the holding part of the branch part 18 The artificial bone 40 is held in 18a.
(d) By sliding the inner cylinder 20 in the proximal direction, the artificial bone introduction port 18 b is opened, the artificial bone 40 is introduced into the lumen 12 of the outer cylinder 10, and the artificial bone 40 is directed toward the screw hole 105. Send it in.
(e) The inner cylinder 20 is slid along the guide wire 30 in the inner cavity 12 of the outer cylinder 10.
(f) The pressing surface 27 at the distal end of the inner cylinder 20 is brought into contact with the artificial bone 40, the inner cylinder 20 is pushed in the distal direction, and the artificial bone 40 is pressed into the screw hole 105.
(g) The cylindrical body 21 of the inner cylinder 20 is slid along the guide wire 30 in the lumen 12 of the cylindrical body 11 of the outer cylinder 10 and taken out. Further, the outer cylinder 10 is also taken out along the guide wire 30. In addition, you may take out the inner cylinder 20 and the outer cylinder 10 simultaneously.
(h) A screw 50 (not shown) is inserted along the guide wire 30.
(i) Screw the screw 50 (not shown) with a screwdriver (not shown). Thereby, the screw 50 is attached in the screw hole 105 together with the artificial bone 40.
(j) Pull out the guide wire 30. At this time, the screw 50 is held in the screw hole 105 together with the artificial bone 40.

(Example of reinforcing material shape)
A shape example of a reinforcing material that can be applied to the screw reinforcing material insertion device of the present invention will be described with reference to FIG. The shape example of the reinforcing material shown in FIG. 7 can be suitably applied to the screw reinforcing material insertion device of the first configuration example and the second configuration example described above. Each of the reinforcing material shape examples includes a groove, a cut portion, an opening, or the like in order to slide the guide wire as a guide. As described above, in addition to the shape shown in FIG. 7, the reinforcing material can be in the form of granules or powder, or in the form of paste or liquid that hardens after insertion. The reinforcing material is not limited to an artificial bone, and materials such as autogenous bone, homogenous bone, and bone cement can be used. In the following example, description will be made using an artificial bone.

(First and second examples)
FIGS. 7A to 7D show first and second examples (columnar artificial bones 41 and 42), and FIGS. 7B and 7D show a state in which the guide wire 30 is passed.

  The columnar artificial bones 41 and 42 are substantially columnar bodies or substantially quadrangular columnar bodies having a substantially C-shaped cross-section with a notch in part, and the notch portions are groove portions 41 a and 42 b through which the guide wire 30 passes. Is configured. By passing the guide wire 30 along the groove portions 41a and 42b, the columnar artificial bones 41 and 42 can be slid using the guide wire 30 as a guide.

(Third example)
FIGS. 7E and 7F show a third example (artificial bone 43), and FIG. 7F shows a state in which the guide wire 30 is passed.

  The artificial bone 43 is a bamboo ring-shaped columnar body having an annular cross-sectional shape having a hole 43a in the center, and the guide wire 30 is passed through the hole 43a in the center. By passing the guide wire 30 through the hole 43a in the center, the artificial bone 43 can be slid using the guide wire 30 as a guide.

  In the third example, instead of the cylindrical body having a circular cross section, the cross section may be a square columnar body having a square shape with a hole in the middle portion.

(Fourth example)
FIGS. 7G and 7H show a fourth example (artificial bone 44), and FIG. 7H shows a state in which the guide wire 30 is passed.

  The artificial bone 44 is a tablet-like body having an annular cross-sectional shape having a central hole 44a, and the guide wire 30 is passed through the central hole 44a. By stacking a plurality of tablet-shaped artificial bones 44 and passing the guide wire 30 through the hole 44a in the center of each artificial bone 44, the artificial bone 44 can be slid using the guide wire 30 as a guide.

(Fifth example)
FIGS. 7 (i) and 7 (j) show a fifth example (artificial bone 45), and FIG. 7 (j) shows a state in which the guide wire 30 is passed.

  The artificial bone 45 is a tablet-like body having a substantially C-shaped cross section with a notch in a part, and the notch constitutes a groove 45 a through which the guide wire 30 is passed. By stacking a plurality of tablet-like artificial bones 45 and passing the guide wire 30 through the groove 45a of each artificial bone 45, the artificial bone 45 can be slid using the guide wire 30 as a guide.

(Sixth example)
FIGS. 7 (k) and (l) show a sixth example (artificial bone 46), and FIG. 7 (l) shows a state in which the guide wire 30 is passed.

  The artificial bone 46 includes two members 46a and 46b, and one member 46a has a notch through which a guide wire passes, and this notch constitutes a groove 46c. By passing the guide wire 30 through the groove 46c, the artificial bone 46 can be slid using the guide wire 30 as a guide.

(Seventh example)
7 (m) and (n) show a seventh example (artificial bone 47), and FIG. 7 (n) shows a state in which the guide wire 30 is passed.

  The artificial bone 47 has a spiral shape, and the central portion forms a passage through which a guide wire is passed. By passing the guide wire 30 through the center of the spiral shape, the artificial bone 47 can be slid as a guide.

(Screw pullout strength)
With reference to FIG. 8, the pull-out strength of the screw by the screw reinforcing material insertion device of the present invention will be described. In the following, an example of a percutaneous screw (PPS) is shown.

  FIG. 8 (a) shows the maximum pull-out strength of the percutaneous screw (PPS) with or without reinforcement using the screw reinforcing material insertion device of the present invention and granular hydroxyapatite (HA) which is an artificial bone. Shows a comparison.

  Fig. 8 (b) shows the percutaneous pattern at each position when the screw is displaced (0.5 mm, 1 mm, 2 mm, 3 mm, 5 mm, 10 mm) in the direction in which the screw is pulled out. The pull-out strength of the screw (PPS) is compared with and without reinforcement using the present invention.

  The percutaneous screw fixation using the screw reinforcement insertion device of the present invention is found to have an improvement of about 20% in maximum pullout strength compared to conventional fixation.

  Further, even when the screw is displaced in the pulling direction, an improvement in the pulling strength is recognized as compared with the conventional fixing by reinforcing the percutaneous screw fixing using the present invention.

  The screw reinforcement insertion device of the present invention enables effective reinforcement of percutaneous screw fixation with a minimally invasive procedure. As a result, it is expected to expand the application of minimally invasive surgery using a percutaneous screw for spinal patients with bone vulnerability.

  The present invention is not limited to the embodiments described above. Various modifications can be made based on the spirit of the present invention, and these are not excluded from the scope of the present invention.

  In the screw reinforcement insertion device of the present invention, the artificial bone to be used is not limited to hydroxyapatite, but can be applied to various artificial bones such as β-TCP (β-tricalcium phosphate) and materials based thereon. Be expected. Furthermore, it is expected to be applied to materials such as artificial bone and bone cement that are paste-like or liquid that do not have a specific form upon insertion and harden after insertion.

  It is also possible to use not only artificial bones but also autologous bones collected from patients who have been used for bone grafts in various operations in the past and homogenous bones collected from humans other than patients as reinforcing materials.

  The screw reinforcing material insertion device of the present invention is expected to be applied to devices used for screw fixation in limbs and other parts in addition to spinal fusion.

  In addition, not only in percutaneous screw fixation surgery, but also in non-percutaneous surgery performed by exposing the bone surface by deploying the surgical wound, when inserting a screw using a steel wire such as a guide wire, It is possible to adapt the present invention.

1, 1A, 1B, 1C Screw reinforcement insertion device 10 Outer cylinder 11 Tubular body 12 Lumen 13 Opening portion 14 Funnel-shaped portion 15 Artificial bone insertion port 16 Artificial bone insertion port 17 Neck portion 18 Branch portion 18a Holding portion 18b Artificial portion Bone introduction port 20 Inner cylinder 21 Cylinder 22 Lumen 23 Proximal opening 24 Distal opening 25 Distended part 26 Step part 27 Pressing surface 30 Guide wire 40 Artificial bone 41, 42 Columnar artificial bone 41a, 41b Groove 43 Artificial Bone 43a Hole 44 Artificial bone 44a Hole 45 Artificial bone 45a Groove 46 Artificial bone 46a, 46b Member 46c Groove 47 Artificial bone 50 Screw 101 Soft tissue 102 Bone tissue 103 Insertion point 104 Screw insertion hole 105 Screw hole

Claims (6)

Each of the outer cylinder, the inner cylinder and the guide member can be slid relative to each other in a state of being inserted into each other,
The outer cylinder includes a cylindrical body, a reinforcing material insertion port for introducing a reinforcing material into the proximal end side of the cylindrical body of the outer cylinder, a reinforcing material insertion port for inserting the reinforcing material into the distal end side, A lumen that allows the inner cylinder to slide through the reinforcing material insertion port and the reinforcing material insertion port;
The inner cylinder communicates internally between a cylinder, a pressing surface for pushing in a reinforcing member at an end of the inner cylinder at the distal end side, and openings at both ends of the cylinder of the inner cylinder. And an insertion device for a screw reinforcing material, comprising: a lumen capable of sliding the guide member.
The outer cylinder includes a funnel-shaped portion on the proximal end side of the cylindrical body of the outer cylinder,
The inner cylinder includes a bulging portion on the proximal end side of the cylindrical body of the inner cylinder,
The funnel-shaped part constitutes the reinforcing material inlet,
2. The screw according to claim 1, wherein the stepped portion of the bulging portion constitutes a stopper that suppresses insertion of the inner cylinder beyond a predetermined depth by contact with the inner surface of the funnel-shaped portion. Reinforcement insert device.
The outer cylinder includes an opening on the proximal end side of the cylindrical body of the outer cylinder,
The inner cylinder includes a bulging portion on the proximal end side of the cylinder of the inner cylinder,
The opening constitutes the reinforcing material inlet,
The guide member is a guide that allows the massive reinforcing material to slide along the axial direction of the cylindrical body of the outer cylinder by penetrating through the communicating portion of the massive reinforcing material in the lumen of the cylindrical body of the outer cylinder. Part
2. The screw reinforcing member insertion device according to claim 1, wherein the stepped portion of the bulging portion constitutes a stopper that comes into contact with an end portion on a proximal end side of the cylindrical body of the outer cylinder.
The outer cylinder includes a branch portion that communicates with the lumen on the side surface of the outer cylinder on the proximal end side.
The inner cylinder includes a bulging portion on the proximal end side of the cylinder of the inner cylinder,
The branch portion constitutes the reinforcing material input port and a holding portion of the reinforcing material,
The step portion of the bulging portion constitutes a stopper that suppresses insertion of the inner cylinder beyond a predetermined depth by contact with the end portion of the outer cylinder on the proximal end side. The screw reinforcing material insertion device according to claim 1.
A screw reinforcing material applied to the screw reinforcing material insertion device according to claim 2 or 4, wherein the screw reinforcing material is in the form of granules, powders, pastes, or liquids. .
It is a reinforcing material applied to the screw reinforcing material insertion device according to claim 3, wherein the massive reinforcing material is in the form of a tablet having a hollow portion or a notch, or a columnar shape, Screw reinforcement.

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