JP2020043955A - Holding tool for osteotomy and spreader for osteotomy - Google Patents

Abstract

To provide a holding tool for osteotomy allowing visual confirmation of a whole depth part of a slit.SOLUTION: A holding tool (220) comprises: a first separation member (221b) comprising a first inner surface (221p) and a first outer surface (221q) which is formed into a wedge-shape becoming gradually thicker from a tip end side to a rear end side with respect to the first inner surface and which come into contact with a bone; and a second separation member (221a) comprising a second inner surface (221p) and a second outer surface (221q) which is formed into a wedge-shaped becoming gradually thicker from a tip end side to a rear end side with respect to the second inner surface and which comes into contact with a bone. The holding tool comprises: a first base part (225b) comprising a guide member (222b) which is provided on a rear end side of the first separation member for guiding opening/closing operations of the first separation member and the second separation member; a second base part (225a) comprising an opening (222c) which is provided on a rear end side of the second separation member and into which the guide member is inserted; and a holding part (223) for holding slide between the guide member and the opening.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an osteotomy holding device and an osteotomy dilator which are used, for example, for correcting the angle of the tibia.

  When correcting an O leg or the like, a high tibial osteotomy (HTO) in which the angle of the tibia is changed is performed. One such high tibial osteotomy is an open wedge method in which a wedge-shaped bone filler is inserted into a cut formed in the tibia near the knee joint to correct the angle of the tibia when standing. In this open wedge method, there has been proposed an open device for osteotomy in which a notch is widened when a bone filling material is inserted (for example, see Patent Documents 1 and 2).

JP 2008-6140 A JP 2004-524098 A

  However, this osteotomy dilator has a large number of parts including a hinge portion, and has a problem that it takes time to perform maintenance such as cleaning. In addition, when the incision of the tibia is kept open by the pair of rocking members left in the notch and the bone filler is inserted into the notch, the tip including the hinge portion of the pair of rocking members is used. However, there is a problem that not only the entire depth of the cut is not visually recognized but also the bone replacement material cannot be inserted into the entire depth of the cut.

  Therefore, the present invention provides a osteotomy holding device and a bone osteotomy that can easily perform maintenance by a simple mechanism, and when the cut is widened and the implant is inserted, the entire depth of the cut is visible. It is an object of the present invention to provide a dilator for osteotomy.

  This embodiment is for an osteotomy in which a first separating member and a second separating member are inserted into cuts formed in a bone, and a holding portion holds an open / closed state of the first separating member and the second separating member. Holding device. The holding device includes a first separating member having a first inner surface, a wedge shape gradually increasing with respect to the first inner surface from the distal end side to the rear end side, and a first outer surface contacting the bone, a second inner surface and a distal end side. And a second separating member formed in a wedge shape gradually thicker with respect to the second inner surface from the rear end side to the second inner surface and having a second outer surface in contact with the bone. In addition, the holding device has a first base provided on a rear end side of the first separation member and having a guide member for guiding an opening and closing operation of the first separation member and the second separation member, and a rear end side of the second separation member. A second base portion provided with an opening into which the guide member is inserted, and a holding portion for holding sliding between the guide member and the opening portion are provided.

  Preferably, the first outer surface and the second outer surface include a rough surface that makes the bone less slippery. Further, it is preferable that the holding portion includes a screw provided on the second base portion and in contact with the outer peripheral surface of the guide member to hold the slide between the guide member and the opening. The guide member of the first base preferably has a stopper member so that the second base cannot be removed from the open end of the guide member. Further, it is preferable that the guide member has an angle scale on which the opening and closing angles of the first separating member and the second separating member can be visually recognized.

  The open device for osteotomy according to the present embodiment includes the holding device for osteotomy described above and one of the first separating member and the second separating member which is disposed on the first separating member and the second separating member. A first opening / closing mechanism for adjusting an opening / closing angle with respect to the other of the members. Further, it is preferable that one of the first separating member and the second separating member is longer than the other.

  The dilator for osteotomy according to the present embodiment includes a blade for enlarging a cut in bone, and a holding device detachably attached to the blade and holding a cut in the expanded bone. It is a large opener. The blade is relatively rotatably connected by a hinge portion disposed at the tip, and has a pair of rotating members having an inner surface and an outer surface on the opposite side, and the holding device has the above-described configuration. Preferably, there is.

  Further, the blade of the present embodiment includes a second opening / closing mechanism that opens and closes the pair of rotating members about the axis of the hinge. Preferably, the outer surfaces of the pair of rotating members include an inclined outer surface that gradually becomes thicker with respect to the inner surface from the front end to the rear end, and a parallel outer surface that is parallel to the inner surface from the front end to the rear end. The first inner surface of the holding device is disposed on one parallel outer surface of the pair of rotating members, and the first outer surface is flush with one inclined outer surface of the pair of rotating members, and the second inner surface of the holding device. Preferably, the inner surface is disposed on the other parallel outer surface of the pair of rotating members, and the second outer surface is flush with the other inclined outer surface of the one rotating member. It is preferable that the blade has a connecting member that is connected to at least one of the first base and the second base of the holding device.

  According to the holding device for osteotomy or the opener for osteotomy of the present invention, maintenance can be easily performed by a simple mechanism, and when inserting the implant by widening the cut, The entire depth of the cut is visible.

(A) is a schematic perspective view showing the holding device for osteotomy of the first embodiment, and (b) is a plan view showing the holding device for osteotomy of the first embodiment. (A) and (b) are first examples of the holding mechanism. (A) is a transparent plan view showing a state before holding of the holding mechanism, and (b) is a transparent plan view showing a state after holding of the holding mechanism. (A) and (b) are second examples of the holding mechanism. (A) is a transparent plan view showing a state before holding of the holding mechanism, and (b) is a transparent plan view showing a state after holding of the holding mechanism. It is a figure showing the state where the holding instrument for osteotomy of a 1st embodiment held the cut which opened. (A) is a schematic plan view in the state of having closed the osteotomy for osteotomy of 2nd Embodiment. (B) is a schematic plan view in a state where the dilator for osteotomy of the second embodiment is expanded. (A) is a schematic sectional drawing of the state which closed the open device for osteotomy of 3rd Embodiment. (B) is the schematic sectional drawing of the state which expanded the dilator for osteotomy of 3rd Embodiment. It is a schematic perspective view of the dilator for osteotomy of 4th Embodiment. (A) is a schematic plan view showing the osteotomy dilator of the fourth embodiment. (B) is a schematic plan view showing the blade in a state where the holding device is removed from the osteotomy dilator. (C) is a CC sectional view of (b). (D) is the schematic back view which shows the dilator for osteotomy, and is the figure which showed another example of the holding instrument fixing pin. It is a figure explaining how to open the blade of the open device for osteotomy inserted in the cut of the bone, and to enlarge the cut. It is a figure explaining how to break connection of a blade and a holding instrument, and to close a blade in the state where a holding instrument opened a notch. It is the figure which showed the state which pulled out the blade from the notch, and held the notch which the holding tool expanded.

  Hereinafter, examples of the holding device for osteotomy and the open device for osteotomy of the present embodiment will be described with reference to the drawings, but the drawings used in the description are schematic to the extent that these inventions can be understood. In some cases, the size, angle, width, and the like are exaggerated. In each of the drawings used for description, the same components are denoted by the same reference numerals, and description thereof is omitted. Further, the shapes, dimensions, materials, and the like described in the following embodiments are merely preferred examples within the scope of the present invention.

  In the present specification, in order to insert a bone filling material into a cut formed in the tibia near the knee joint of a knee osteoarthritis patient, the cut is opened using the osteotomy dilator of the present embodiment. A description will be given of a case where the size is increased and a case where the state where the cut is widened is held by a holding device for osteotomy.

<< 1st Embodiment >>
<Structure of holding device for osteotomy>
FIG. 1 (a) shows a cut formed in a deformed femur or tibia of a knee osteoarthritis patient using a blade 210 described later, a conventionally proposed osteotomy dilator of Patent Document 1, and FIG. 11 is a perspective view showing a holding device 220 for osteotomy, which holds a state where a cut is widened by a retractor assembly or the like of Patent Document 2. FIG. 1B is a plan view of the holding device 220.
The holding device 220 shown in FIGS. 1A and 1B includes a pair of separating members 221 (221a, 221b), a sliding mechanism 222, a holding mechanism 223, and a pair of bases 225 (225a, 225b).
The holding device 220 for osteotomy is made of a metal material such as stainless steel, a precious metal alloy, a cobalt chrome alloy, titanium, and a titanium alloy. The osteotomy retainer 220 may be constructed of a rigid plastic material.

(About separation members)
Each of the pair of separating members 221 has an inner surface 221p and an outer surface 221q formed in a wedge shape gradually thicker than the inner surface 221p. The shape formed by the inner surface 221p and the outer surface 221q of the pair of separating members 221 is not limited to the wedge shape, and may be a flat plate shape having a uniform or substantially uniform thickness. A pair of bases 225 are formed on the rear end side (+ X axis side) of the pair of separating members 221. The length LX2 of the pair of separating members 221 is generally 30 mm to 70 mm in the X-axis direction, preferably 40 mm to 60 mm, and more preferably 45 mm to 55 mm. The length LX2 is also preferably changed as appropriate according to the physique of the patient, and is particularly preferably a length that sufficiently contacts the tibial cortical bone such as the femur. Since the length LX2 of the separating member 221 is shorter than the depth inserted by the osteotomy dilator for enlarging the cut, the entire depth of the cut K1 of the tibia K can be easily seen and a bone filling material (for example, , A small-sized bone filler or a granular bone filler) can be easily inserted into the cut. The inner surface 221p of the separating member 221a and the inner surface 221p of the separating member 221b face in parallel in a closed state. In FIG. 1B, the distance between the inner surface 221p of the separating member 221a and the inner surface 221b of the separating member 221b is separated by the distance Dp, but does not have to be.

  The width Wp of the pair of separating members 221 is appropriately set so as to maintain the thickness of the bone and the expanded state. The pair of bases 225 are formed with a width Wr, and the width Wr is wider than the width Wp. The sliding mechanism 222 and the holding mechanism 223 are provided on the enlarged base 225.

  When the bone replacement material is inserted, the holding device 220 holds the cut bone. Therefore, as shown in FIG. 1A, the outer surfaces 221q of the pair of separating members 221 are preferably roughened so as not to slip on the bone. The rough surface of the outer surface 221q is preferably, for example, a fine lattice-like groove formed by knurling, a fine linear groove extending in the Z-axis direction, or a random fine uneven groove formed by sandblasting.

(Sliding mechanism)
The base 225 has a sliding mechanism 222, and the sliding mechanism 222 has a guide member base 222a, a guide member 222b, and an opening 222c. One of the pair of base portions 225 has a guide member base portion 222a, and has an arc shape that draws an arc around the Z-axis line at the intersection where the outer surfaces 221q of the pair of separation members 221 extend toward the −X-axis side. An (arch-shaped) guide member 222b is fixed. In addition, the upper surface (+ Z side surface) of the arch-shaped guide member 222b has a scale indicating an angle between the separation member 221a and the separation member 221b. The angle scale may also be provided on the lower surface (-Z side surface) of the guide member 222b. The outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the arch-shaped guide member 222b is preferably roughened. As described later, this is because the holding mechanism 223 is in contact with the outer peripheral surface 222f to ensure that the pair of separating members 221 are held at an angle. The rough surface of the outer circumferential surface 222f is preferably a fine lattice-like groove, a fine linear groove, or a random fine uneven groove.

  The outer peripheral surface 222f of the guide member 222b and the inner peripheral surface 222g facing the outer peripheral surface 222f preferably have an arc shape (arch shape), but may have a rectangular shape in which the outer peripheral surface 222f and the inner peripheral surface 222g are parallel. Good. As long as the opening / closing angle of the pair of separating members is up to about 25 degrees, the implant can be inserted into the notch K1 of the tibia K when the guide member 222b has an arc-shaped (arch-shaped) length. A stobber member 222h is provided at the end of the arc of the guide member 222b. The guide member 222b and the opening 222c are not separated due to the presence of the stop bar member 222h. That is, the pair of separating members 221a and 221b are not separated. This prevents a medical worker from accidentally dropping one of the pair of separating members 221 on the floor or the like. In FIG. 1A, the stobber member 222h is a cylindrical pin, but may have another shape. The stobber member 222h is disposed so as to protrude on the lower surface (-Z side surface) of the guide member 222b, but is protruded and disposed on the outer peripheral side (+ X axis side) or the inner peripheral side (-X axis side) of the guide member 222b. It may be.

  The other 225a of the pair of bases 225 has an opening 222c. The guide member 222b enters the opening 222c, and the opening 222c supports sliding of the arc-shaped (arch-shaped) guide member 222b. 1A and 1B, the opening 222c has a structure that covers the upper surface, the lower surface, the inner peripheral surface, and the outer peripheral surface of the guide member 222b. The structure which does not cover the upper surface of the member 222b may be sufficient.

(About the holding mechanism)
A holding mechanism 223 is provided in the opening 222c + X-axis direction. The holding mechanism 223 includes a first fixing screw 223a of the first example and a second fixing screw 223b of the second example. The first fixing screw 223a has a hexagonal hole in the + X axis direction, and the second fixing screw 223b has a hexagonal hole in the + X axis direction. For this reason, a medical worker can easily hold the pair of separating members 221 by the holding mechanism 223 from the + X axis direction.

First Example A first example of the holding mechanism 223 will be described with reference to FIGS. 2 (a) and 2 (b) are drawn in a state where the periphery of the base 225 is seen through, and the guide member 222b of the opening 222c and the first fixing screw 223a are drawn. FIG. 2A shows a state in which the first fixing screw 223a is not in contact with the outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the guide member 222b. FIG. 2B shows a state in which the first fixing screw 223a is in contact with the outer peripheral surface 222f of the guide member 222b.

  Since the first fixing screw 223a has a hexagonal hole (see FIG. 1A), the first fixing screw 223a can be turned with a hexagon wrench (not shown). As shown in FIG. 2A, when the tip of the first fixing screw 223a is not in contact with the outer peripheral surface 222f, the guide member 222b can slide in the opening 222c, and a pair of separating members is provided. 221a and 221b relatively move. As shown in FIG. 2B, when the tip of the first fixing screw 223b is in contact with the outer peripheral surface 222f, the pair of separating members 221a and 221b are held. Even if the outer peripheral surface 222f is not roughened, the outer peripheral surface 222f can be held by the first fixing screw 223a. However, in order to ensure that the first fixing screw 223a keeps the angle of the pair of separating members 221, it is preferable that fine lattice-like grooves, fine linear grooves, or random fine uneven grooves are formed on the outer peripheral surface 222 f. . In addition, instead of the first fixing screw 223a having a hexagonal hole, a Phillips screw or a hexagonal bolt may be used.

Second Example A second example of the holding mechanism 223 will be described with reference to FIGS. 3 (a) and 3 (b) are drawn in a state where the periphery of the base 225 is seen through, and the guide member 222b of the opening 222c and the second fixing screw 223b are drawn. FIG. 3A shows a state in which the second fixing screw 223b is not tightened. FIG. 3B shows a state in which the second fixing screw 223b is tightened.

  Unlike the first example shown in FIG. 2, in the second example, a slit 223s extending in the Y-axis direction is formed in the base 225a, and the slit 223s penetrates to the opening 222c. The second fixing screw 223b is longer in the X-axis direction than the first fixing screw 223a. The second fixing screw 223b can be turned with a hexagon wrench (not shown). As shown in FIG. 3A, when the first fixing screw 223b is not tightened, the interval SX between the slits 223s is wide, the guide member 222b can slide in the opening 222c, and the pair of separation members 221a and 221b can move relatively. As shown in FIG. 3B, when the second fixing screw 223b is tightened, the interval SX between the slits 223s becomes narrow, and the guide member 222b is held in the opening 222c. Therefore, the pair of separating members 221a and 221b are held. The outer peripheral surface 222f may or may not be roughened.

<How to use the holding device for osteotomy of the first embodiment>
How to use the holding device 220 for osteotomy will be described with reference to FIG.
The medical worker attaches the distal end of the osteotomy expander 200 (described later) or a conventionally proposed osteotomy expander (retractor assembly) to the notch K1 of the tibia K at the back of the tibia K. To make contact. Thereafter, the incision K1 is widened by the osteotomy dilator 200 or the like.

Next, the medical worker inserts the osteotomy holding device 220 with the pair of separating members 221 closed in a predetermined depth (for example, into contact with the tibial cortical bone of the femur). To the desired depth).
Next, the medical worker spreads the outer surfaces 221q of the pair of separating members 221 of the holding device 220 for osteotomy to an angle where the outer surfaces 221q abut on the expanded bone. At this time, since the distal end of the first fixing screw 223a is not in contact with the outer peripheral surface 222f, the opening and closing operation of the holding device 220 for osteotomy by the sliding mechanism is performed smoothly. Further, the pair of separating members 221 of the holding device 220 for osteotomy open and close while the distal ends are kept separated.

  Next, the medical worker rotates the first fixing screw 223a until the tip of the first fixing screw 223a contacts the outer peripheral surface 22f in order to maintain the expanded state. Accordingly, the pair of separating members 221a and 221b are held at a predetermined angle, so that the cut K1 of the tibia K can be maintained in an expanded state.

  Next, the healthcare worker extracts the osteotomy dilator 220 from the cut K1. FIG. 4 is a view showing a state in which the dilator 220 for osteotomy is removed, and only the holding device 220 for osteotomy remains in the cut K1 of the tibia K. Since the blade 210 is removed, the medical staff can visually recognize the depth of the cut K1 of the tibia K, and can insert the bone replacement material into the depth. If the outer surfaces 221q of the pair of separating members 221a and 221b are roughened, the tibia K and the separating members 221a and 221b are less likely to slip when inserting the bone replacement material.

  After inserting the bone replacement material, the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of separating members 221a and 221b, and removes the holding device 220. The health care professional may insert additional bone replacement material into the space formed by extracting the holding device 220.

<< 2nd Embodiment >>
<Structure of the open device for osteotomy>
FIGS. 5A and 5B are plan views showing the osteotomy dilator 320 according to the second embodiment. FIG. 5A shows a state in which the osteotomy expander 320 is closed, and FIG. 5B shows a state in which the osteotomy expander 320 is open. In the second embodiment, the longitudinal direction of the osteotomy expander 320 is the X axis, the opening / closing direction of the first opening / closing mechanism 327 is the Y axis, and the width direction of the osteotomy expander 320 is Z. It will be described as an axis.

  In the osteotomy dilator 320 of the second embodiment, the first opening / closing mechanism 327 is attached to the osteotomy holding instrument 220 described in the first embodiment.

  The osteotomy dilator 320 of the second embodiment is basically similar to the osteotomy retainer 220 of the first embodiment. Therefore, in the dilator 320 for osteotomy, members having the same functions are denoted by the same reference numerals as the members of the holding device 220 of the first embodiment. The description of the same reference numerals is omitted. In the dilator 300 for osteotomy, the length LX2 of the pair of separating members 221 (221a, 221b) is also the same as the holding device 220 of the first embodiment.

(About the first opening / closing mechanism)
As shown in FIGS. 5A and 5B, a first opening / closing mechanism 327 is provided on the base 325a. The first opening / closing mechanism 327 has a screw hole 327a provided in the base 325a, a screw shaft 327c that passes through the screw hole 327a and is screwed, and a hexagon hole 327h provided at one end of the screw shaft 327c. The hexagonal hole 327h of the screw shaft 327c may be a Phillips screw or a hexagonal bolt. The first opening / closing mechanism 327 may be provided on the other base 325b instead of the base 325a.

  The screw shaft 327c which is a male screw can insert a hexagon wrench driver (not shown) into a hexagon hole 327h provided at one end of the screw shaft 327c. Then, the screw shaft 327c is rotated by a driver or the like. The other end of the screw shaft 327c is formed in a hemispherical shape, and is in contact with a wall surface (+ Y-axis surface) that is a plane of the base 325b. Since the other end of the screw shaft 327c is hemispherical, even if the angle of the screw shaft 327c changes from the state shown in FIG. 5A to the state shown in FIG. 5B, the screw shaft 327c stably contacts the wall surface of the base 325b. . When the screw shaft 327c is rotated, the first opening / closing mechanism 327 increases the distance from the other hemispherical end of the screw shaft 327c to the base 325a, and the base 325a is moved relative to the base 325b in the + Y-axis direction in FIG. Go to

<How to use the osteotomy for osteotomy of the second embodiment>
How to use the open device 320 for osteotomy will be described. The medical staff inserts the osteotomy dilator 300 into the cut K1 of the tibia K. At this time, the medical worker ensures that the outer surfaces 221q of the pair of separating members 221 sufficiently contact the tibial cortical bone such as the femur. The medical worker does not need to insert the osteotomy expander 320 into the back of the femur or the like, and does not have to hit the osteotomy expander 320 with a hammer.

  After inserting the dilator 300 for osteotomy into the cut K1 of the tibia K, the medical worker fits a hexagon wrench driver into the hexagon hole 327h of the screw shaft 327c. The medical worker then turns the hex wrench driver. Then, the screw shaft 327c extends, the separating members 221a and 221b relatively open, and the cut K1 is enlarged. The pair of separating members 221 of the osteotomy expander 320 can widen the cut K1 while maintaining the separated state on the distal end side. When the bone substitute is opened to an angle enough to insert the bone filling material into the cut K1, the medical worker stops the rotation of the hexagon wrench driver and rotates the first fixing screw 223a. Then, the first fixing screw 223a and the guide member 222b are held.

  The medical staff can visually recognize the depth of the cut K1 of the tibia K, and can insert a bone substitute into the depth. After inserting the bone replacement material, the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of separation members 221a and 221b, and removes the osteotomy expander 320. .

<<< 3rd Embodiment >>>
<Structure of the open device for osteotomy>
FIGS. 6A and 6B are cross-sectional views showing the osteotomy dilator 300 according to the third embodiment. To facilitate understanding, the guide member 222b and the first fixing screw 223a are drawn by dotted lines, and the screw shaft 327c is drawn by solid lines. 6A shows a state in which the osteotomy dilator 300 is closed, and FIG. 6B shows a state in which the osteotomy dilator 330 is opened. Also in the third embodiment, the longitudinal direction of the osteotomy expander 330 is the X axis, the opening / closing direction of the first opening / closing mechanism 327 is the Y axis, and the width direction of the osteotomy expander 330 is Z. It will be described as an axis.

  The osteotomy dilator 320 of the second embodiment and the osteotomy dilator 330 of the third embodiment are different in the separating member 321b and the base 325b of the osteotomy dilator 330. . Further, a screw hole 327a is formed in the base 325a of the osteotomy dilator 320 according to the second embodiment, but the base 325a according to the third embodiment is different in that it has a top member 327f.

  The osteotomy dilator 330 of the third embodiment is similar to the osteotomy holding device 220 of the first embodiment. For this reason, in the dilator 300 for osteotomy, members having the same functions are denoted by the same reference numerals as the members of the holding device 220 of the first embodiment.

(About separation member 321)
Each of the separating members 321 paired with the separating member 221a has an inner surface 321p and an outer surface 321q formed in a wedge shape gradually thicker than the inner surface 321p. A pair of bases 325b are formed on the rear end side (+ X axis side) of the separating member 321. The length LX1 of the separating member 321 is the same as the length LX1 of the rotating member 211 of the blade 210 of the first embodiment. An abutting portion 328 is provided at the distal end of the separating member 321, and the abutting portion 328 is a portion that abuts on the back of the tibia. The thickness Db (Y-axis direction) of the separation member 321 is larger than the thickness Da of the separation member 321. This is for ensuring the strength for hitting the osteotomy dilator 330 with a hammer or the like and the abutting portion 328 to abut the tibia as described later. It is preferable that a fine lattice-like groove, a fine linear groove, or a fine uneven groove is formed in a range indicated by LX2 in the outer surface 321q.

  The base 325b on the rear end side of the separation member 321 has a guide member base 222a and a recess 329. The recess 329 has a semicircular cross section in the Z-axis direction, and is provided for smoothing the movement of the screw shaft 327c and for defining the movement range. Further, as shown in FIG. 6A, the base 325b is longer than the end of the first fixing screw 223a provided on the base 325a in the + X-axis direction by the length LX3. The base 325b also serves as a striking block, and prevents the hammer or the like from hitting the first fixing screw 223a when the rear end (+ X axis side) of the base 325b is hit with a hammer or the like. Although not particularly shown, the separating member 221a and the separating member 321 may be interchanged.

(About opening and closing mechanism)
As shown in FIGS. 6A and 6B, a first opening / closing mechanism 327 is provided on the base 325a. The first opening / closing mechanism 327 passes through a through hole 327d provided in the base 325a, a top member 327f rotatably provided at an intermediate position of the through hole 327d, and a female screw hole provided in the top member 327f. The screw shaft 327c has a hexagonal hole 327h provided at one end of the screw shaft 327c. The top member 327f preferably has a cylindrical shape extending in the Z-axis direction. The hexagonal hole 327h of the screw shaft 327c may be a Phillips screw or a hexagonal bolt.

  When the screw shaft 327c is rotated by a driver or the like, the distance from the other hemispherical end of the screw shaft 327c to the base 325a increases. The other end of the hemispherical shape of the screw shaft 327c enters the recess 329, and the angle of the screw shaft 327c can be changed by approximately ± 5 degrees with the top member 327f. Therefore, the rotation of the screw shaft 327c can be made smooth. In the first opening / closing mechanism 327, the base 325a moves in the + Y-axis direction in FIG. 6 with respect to the base 325b.

<How to use the osteotomy for osteotomy of the third embodiment>
How to use the open device 330 for osteotomy will be described. The medical worker inserts the osteotomy dilator 300 into the cut K1 of the tibia K. The medical worker hits the rear end of the base 325b with a hammer (not shown) or the like to bring the contact portion 328 of the separation member 321 of the osteotomy expander 330 into contact with the back of the tibia K.

  After inserting the dilator 300 for osteotomy into the cut K1 of the tibia K, the medical worker fits a hexagon wrench driver into the hexagon hole 327h of the screw shaft 327c. The medical worker then turns the hex wrench driver. Then, the screw shaft 327c extends, the separating members 221a and 321 relatively open, and the cut K1 is enlarged. The pair of separation members 221 of the osteotomy dilator 300 can open the cut K1 while maintaining the distal end in the separated state. When the bone substitute is opened to an angle enough to insert the bone filling material into the cut K1, the medical worker stops the rotation of the hexagon wrench driver and rotates the first fixing screw 223a. Then, the first fixing screw 223a and the guide member 222b are held.

  The medical staff can visually recognize the depth of the cut K1 of the tibia K, and can insert a bone substitute into the depth. After inserting the bone replacement material, the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of separating members 221a and 321 and removes the osteotomy opener 330. .

<< 4th Embodiment >>
<Structure of the open device for osteotomy>
FIG. 7 is a perspective view showing an open device 200 for osteotomy according to the fourth embodiment. In the fourth embodiment, the longitudinal direction of the osteotomy expander 200 is the X axis, the opening and closing direction of the second opening / closing mechanism 212 is the Y axis, and the width direction of the osteotomy expander 200 is Z. It will be described as an axis.

  The osteotomy dilator 200 of the fourth embodiment has a blade 210 and a holding device 220. The blade 210 and the holding device 220 are configured such that the blade 210 and the holding device 220 are fixed or the blade 210 and the holding device 220 are separated. The holding device 220 may be configured to be fixed to the blade 210 by a connecting member 213 (213a, 213b) provided on the striking block 215 (215a, 215b). The blade 210 can be opened by a second opening / closing mechanism 212 provided on the striking block 215.

  The dilator 200 for osteotomy is made of a metal material such as stainless steel, a precious metal alloy, a cobalt chrome alloy, titanium, or a titanium alloy. The osteotomy dilator 200 may be constructed of a hard plastic material.

  In addition, the dilator 200 for osteotomy is inserted into a notch formed in a deformed femur or tibia of a knee osteoarthritis patient to open the notch. 7 is 100 mm to 180 mm in the X-axis direction. It is preferable that the size is appropriately changed according to the physique of the patient.

<Structure of blade>
FIG. 8A is a plan view showing the osteotomy dilator 200 in which the holding device 220 is mounted on the blade 210. FIG. 8B is a plan view showing the blade 210 in a state where the holding device 220 is separated, and FIG. 8C is an enlarged cross-sectional view of the blade 210 shown in FIG. . FIG. 8D is a rear view of the blade 210 showing another example of the holding instrument fixing pin.

  In the osteotomy dilator 200 shown in FIG. 8A, the striking block 215 is cut into the tibia K with a hammer (not shown) while the holding device 220 is mounted on the blade 210. Plug in. The blade 210 can widen the cut in the bone while the holding device 220 is operated by the second opening / closing mechanism 212. Thereafter, after the holding device 220 holds the open state of the notch, the blade 210 is returned to the closed state by the second opening / closing mechanism 212 and is extracted from the notch.

  8B includes a pair of rotating members 211, one second opening / closing mechanism 212, holding instrument fixing pins 213a and 213b, and a striking block 215. The pair of rotating members 211 (211a, 211b) are relatively rotatably connected by a hinge portion 211d arranged at the distal end 211c.

(About the rotating member)
Each of the rotating members 211a and 211b has an impact block 215a and 215b on the opposite side (+ X axis side) from the hinge 211d. The length LX1 of the pair of rotating members 211 inserted into the tibia K is generally 50 mm to 90 mm in the X-axis direction. It is preferable that the length LX1 is appropriately changed according to the physique of the patient. Each of the rotating members 211a and 211b has an inner surface 211r and an outer surface (211p, 211q) based on the X-axis direction from the hinge portion 211d. The outer surface in the ± Y-axis direction has a parallel outer surface 211p and an inclined outer surface 211q. The parallel outer surface 211p has a shape parallel to the inner surface 211r, and the inclined outer surface 211q has a shape that becomes gradually thicker with respect to the inner surface from the front end side (−X axis side) to the rear end side (+ X axis side).

  As shown in FIG. 8C, the thickness (Y-axis direction) from the parallel outer surface 211p of the rotating member 211a to the parallel outer surface 211p of the rotating member 211b is the thickness Dp. The thickness from the inclined outer surface 211q of the rotating member 211a to the inclined outer surface 211q of the rotating member 211b is a thickness Dq, and the thickness Dq gradually increases from the front end to the rear end. Therefore, the thickness Dq of the pair of rotating members 211 in the closed state gradually increases from the distal end side in plan view. Because of the wedge shape, the pair of rotating members 211 can easily insert their distal ends into the notches formed in the femur or tibia. The shape of the pair of rotating members 211 is not limited as long as they are relatively rotatably connected by hinge portions 211d arranged on the distal end side. Although the parallel outer surface 211p and the inclined outer surface 211q are formed in the first embodiment, the inclined outer surface may not be inclined, and may be another parallel outer surface having a different height from the parallel outer surface 211p in the Y-axis direction. Is also good.

  As shown in FIG. 8C, in the width direction (Z-axis direction), the rotating members 211a and 211b have a parallel outer surface 211p having a width Wp (a distance from the front surface 211s to the intermediate surface 211t) and a width Wq ( (Distance from the intermediate surface 211t to the back surface 211u). The width Wp of the parallel outer surface 211p is formed according to the width of the holding device 220. The width Wq and the width Wp may be the same width or different widths. It is preferable that the width (Z-axis direction) of each of the impact blocks 215a and 215b is a width obtained by adding the width Wp and the width Wq. The width Wq and the width Wp are appropriately changed according to the physique of the patient, but generally each is preferably 10 mm to 20 mm.

(About the second opening / closing mechanism)
As shown in FIG. 8B, the impact block 215 is provided with one second opening / closing mechanism 212. The impact blocks 215a and 215b have screw holes 212a (see also FIG. 7) and 212b on their ± Y-axis side surfaces, respectively. As shown in FIG. 7, the screw holes 212a and 212b formed on the surface on the ± Y-axis side are preferably formed on the −Z-axis side (rear side in FIG. 8) of the impact blocks 215a and 215b. And the 2nd opening / closing mechanism 212 has the screw shaft 212c which penetrates each screw hole 212a and 212b and is screwed.

  The screw shaft 212c, which is a male screw, is wound in the opposite direction at the point where the screw shaft 212c is screwed with the screw holes 212a and 212b, and has a so-called "normal screw" and "reverse screw" relationship. A hexagonal hole (see FIG. 7) is provided at an end of the screw shaft 212c, and the screw shaft 212c can be rotated by fitting a hexagon wrench driver or the like. The screw holes 212a and 212b, which are female screws, are a “normal screw hole” and a “reverse screw hole” according to the winding direction of the screw shaft 212c. The screw holes 212a and 212b are provided with an inclination so that the rotation of the screw shaft 212c is not restricted when the blade 210 is opened. Therefore, when the second second opening / closing mechanism 212 rotates the screw shaft 212c, the rotating members 211a and 211b relatively rotate to open and close the pair of rotating members 211 smoothly. A hexagonal hole is provided at the end of the screw shaft 212c, but may be a hexagonal bolt shape or the like.

(About holding fixture fixing pin)
The impact blocks 215a and 215b have holding instrument fixing pins 213a and 213b as connecting members. The holding instrument fixing pins 213a and 213b are preferably formed on the + Z axis side of the impact blocks 215a and 215b so as to avoid the screw holes 212a and 212b (see FIG. 7). As shown in FIG. 7, the block on the + X axis side of the holding instrument fixing pins 213a and 213b is preferably formed on the same plane as the surface of the striking block 215 so as to be easily struck by a hammer (not shown). Also, as shown in FIG. 8B, recessed holes 213g and 213h are formed on the tip side (−X axis side) of the holding instrument fixing pins 213a and 213b. The ball plunger (not shown) of the holding device 220 enters the recessed holes 213g and 213h, and the holding device 220 is held by the blade 210. Notch surfaces 213d and 213e are formed in a part of the holding instrument fixing pins 213a and 213b. The notched surfaces 213d and 213e specify the + Z-axis direction of the concave holes 213g and 213h. Although the fourth embodiment has the pair of holding instrument fixing pins 213a and 213b, the blade 210 may hold the holding instrument 220 with only one holding instrument fixing pin.

  Also, as shown in FIG. 8D, instead of the holding device fixing pins 213a and 213b, holding device fixing pins 213c and 213d are provided at the rear end side of the pair of rotating members 211 at the position of the back surface 211u. Is also good. The holding instrument fixing pins 213c and 213d are movable within the pair of rotating members 211 by a predetermined distance from the −Z axis side in the + Z axis direction. The holding device fixing pins 213c and 213d move from the blade 210 toward the holding device 220, and the tip side (+ Z axis side) protrudes from the intermediate surface 211t (see FIG. 8C), and is held on the blade 210. The instrument 220 can be held. When the expander 220 for osteotomy is inserted into the tibia K by hitting the striking block 215 with a hambar (not shown), the striking direction (X-axis direction) and the moving direction of the holding instrument fixing pins 213c and 213d (Z-axis) Direction) is not coaxial. For this reason, the holding instrument fixing pins 213c and 213d can prevent separation between the blade 210 and the holding instrument 220 when the osteotomy dilator 200 is driven. In another example, the holding tool 220 has a pair of holding tool fixing pins 213c and 213d. However, the holding tool 220 may be held on the blade 210 with only one holding tool fixing pin.

  Although the fourth embodiment has the pair of holding instrument fixing pins 213a and 213b, the blade 210 may hold the holding instrument 220 with only one holding instrument fixing pin. Further, instead of the fixing pin, the holding device 220 may be fixed to the blade 210 by an adhesive, a magnetic force, or the like, instead of the fixing pin. When the striking block 215 is hit with a hammer (not shown) to insert the osteotomy dilator 220 into the tibia K, it is sufficient that the holding device 220 does not come off the blade 210 from the blade 210. If the holding device 220 does not come off the blade 210 even when the hitting block 215 is hit, the connecting member may be omitted. Further, when the blower 215 for osteotomy is inserted into the tibia K by hitting the striking block 215 with a hambar (not shown), in order to prevent the holding instrument 220 from coming off the blade 210 more reliably, The holding tool fixing pins 213c and 213d may be inserted into the rear end side of the blade 210 from the blade 210 toward the holding tool 220 (−Z-axis direction) to fix the blade 210 and the holding tool 220. .

<Configuration of holding device>
The holding device 220 is the same as the holding device for osteotomy of the first embodiment, and will be described with reference to FIGS. 1 (a) and 1 (b).
FIG. 1A is a perspective view showing the holding tool 220 removed from the blade 210. FIG. 1B is a plan view of the holding device 220.

  The holding device 220 shown in FIGS. 1A and 1B is placed on the parallel outer surface 211p of the rotating members 211a and 211b. The holding device 220 is linked to the opening operation of the pair of rotating members 211. The holding device 220 has a pair of separating members 221 (221a, 221b), a sliding mechanism 222, a holding mechanism 223, and a pair of bases 225 (225a, 225b).

(About separation members)
Each of the pair of separating members 221 has an inner surface 221p and an outer surface 221q formed in a wedge shape gradually thicker than the inner surface 221p. A pair of bases 225 are formed on the rear end side (+ X axis side) of the pair of separating members 221. The length LX2 of the pair of separating members 221 is generally 30 mm to 70 mm in the X-axis direction, preferably 40 mm to 60 mm, more preferably 45 mm to 55 mm, and is longer than the length LX1 of the rotating member 211. short. The length LX2 is also preferably changed as appropriate in accordance with the physique of the patient, and is particularly preferably a length that sufficiently contacts the tibial cortical bone such as the femur. Since the length LX2 of the separation member 221 is shorter than the length LX1 of the rotating member 211, the entire depth of the cut K1 of the tibia K can be easily seen, and a bone replacement material (for example, a small size bone replacement material or granular Bone replacement material) can be easily inserted into the cut. The inner surface 221p of the separating member 221a and the inner surface 221p of the separating member 221b face in parallel in a closed state and are separated by a distance Dp. This distance Dp matches the thickness Dp from the parallel outer surface 211p of the rotating member 211a to the parallel outer surface 211p of the rotating member 211b shown in FIG. 82 (c).

  The width Wp of the pair of separating members 221 matches the width Wp of the parallel outer surfaces 211p of the pair of rotating members 211 (see FIG. 8C). That is, when the holding device 220 is placed on the blade 210, the inner surfaces 221p of the separation members 221a and 221b are in contact with the parallel outer surfaces 211p of the rotating members 211a and 211b. The pair of bases 225 are formed with a width Wr, and the width Wr is wider than the width Wp. The sliding mechanism 222 and the holding mechanism 223 are provided on the enlarged base 225.

  Here, the outer surfaces 221q of the pair of separating members 221 will be described. As shown in FIG. 8A, the outer surface 221q of the holding device 220 and the inclined outer surface 211q of the rotating member 211 gradually become thicker from the distal end side in plan view, and the thickening angles coincide. That is, the outer surface 221q of the holding device 220 is flush with the inclined outer surface 211q of the rotating member 221. Since the surfaces are the same, the second opening / closing mechanism 212 allows the bone to be expanded while the outer surface 221q of the separating member 221 and the inclined outer surface 211q of the rotating member 211 are in contact with the cut bone. In other words, since there is no step between the outer surface 221q and the inclined outer surface 211q, a relatively large contact surface with the bone can be secured, so that the load on the bone at the time of enlargement is reduced. When the wedge-shaped bone filling material is inserted, the blade 210 is removed, so that the outer surface 221q of the separating member 221 may be slightly thicker than the inclined outer surface 211q of the rotating member 211.

  When the bone replacement material is inserted, the holding device 220 holds the cut bone. Therefore, as shown in FIG. 1A, the outer surfaces 221q of the pair of separating members 221 are preferably roughened so as not to slip on the bone. The rough surface of the outer surface 221q is preferably, for example, a fine lattice-like groove formed by knurling, a fine linear groove extending in the Z-axis direction, or a random fine uneven groove formed by sandblasting.

(Sliding mechanism)
The base 225 has a sliding mechanism 222, and the sliding mechanism 222 has a guide member base 222a, a guide member 222b, and an opening 222c. One of the pair of base portions 225 has a guide member base portion 222a, and an arc-shaped (arch-shaped) guide member 222b that draws an arc along the axis of the hinge portion 211d (see FIG. 7) is fixed. Have been. In addition, the upper surface (+ Z side surface) of the arch-shaped guide member 222b has a scale indicating an angle between the separation member 221a and the separation member 221b. The angle scale may also be provided on the lower surface (-Z side surface) of the guide member 222b. The scale indicating this angle is also an angle around the axis of the hinge 211d (see FIG. 7). The outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the arch-shaped guide member 222b is preferably roughened. As described later, this is because the holding mechanism 223 is in contact with the outer peripheral surface 222f to ensure that the pair of separating members 221 are held at an angle. The rough surface of the outer circumferential surface 222f is preferably a fine lattice-like groove, a fine linear groove, or a random fine uneven groove.

  Since the scale indicating the angle is also an angle around the axis of the hinge portion 211d (see FIG. 7), the outer peripheral surface 222f of the guide member 222b and the inner peripheral surface 222g corresponding to the outer peripheral surface 222f have an arc shape (arch shape). Preferably, the outer peripheral surface 222f and the inner peripheral surface 222g may be in a rectangular shape parallel to each other. The arcuate (arch-shaped) length of the guide member 222b allows the implant to be inserted into the notch K1 of the tibia K as long as the angle around the axis of the hinge 211d is about 25 degrees. A stobber member 222h is provided at the end of the arc of the guide member 222b. The guide member 222b and the opening 222c are not separated due to the presence of the stop bar member 222h. That is, the pair of separating members 221a and 221b are not separated. This prevents a medical worker from accidentally dropping one of the pair of separating members 221 on the floor or the like. In FIG. 1A, the stobber member 222h is a cylindrical pin, but may have another shape. The stobber member 222h is disposed so as to protrude on the lower surface (-Z side surface) of the guide member 222b, but is protruded and disposed on the outer peripheral side (+ X axis side) or the inner peripheral side (-X axis side) of the guide member 222b. It may be.

  The other 225a of the pair of bases 225 has an opening 222c. The opening 222c supports the sliding of the arc-shaped (arch-shaped) guide member 222b. 1A and 1B, the opening 222c has a structure that covers the upper surface, the lower surface, the inner peripheral surface, and the outer peripheral surface of the guide member 222b. The structure which does not cover the upper surface of the member 222b may be sufficient.

(About the holding mechanism)
A holding mechanism 223 is provided in the opening 222c + X-axis direction. The holding mechanism 223 includes a first fixing screw 223a of the first example and a second fixing screw 223b of the second example. The first fixing screw 223a has a hexagonal hole in the + X axis direction, and the second fixing screw 223b has a hexagonal hole in the + X axis direction. For this reason, when the dilator 200 for osteotomy is inserted into the cut K1 formed in the femur or the tibia K, the medical worker can use the pair of separating members 221 by the holding mechanism 223 from the + X axis direction. Easy to hold work.

First Example A first example of the holding mechanism 223 will be described with reference to FIGS. 2 (a) and 2 (b) are drawn in a state where the periphery of the base 225 is seen through, and the guide member 222b of the opening 222c and the first fixing screw 223a are drawn. FIG. 2A shows a state in which the first fixing screw 223a is not in contact with the outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the guide member 222b. FIG. 2B shows a state in which the first fixing screw 223a is in contact with the outer peripheral surface 222f of the guide member 222b.

  Since the first fixing screw 223a has a hexagonal hole (see FIG. 1A), the first fixing screw 223a can be turned with a hexagon wrench (not shown). As shown in FIG. 2A, when the tip of the first fixing screw 223a is not in contact with the outer peripheral surface 222f, the guide member 222b can slide in the opening 222c, and a pair of separating members is provided. 221a and 221b relatively move. As shown in FIG. 2B, when the tip of the first fixing screw 223b is in contact with the outer peripheral surface 222f, the pair of separating members 221a and 221b are held. Even if the outer peripheral surface 222f is not roughened, the outer peripheral surface 222f can be held by the first fixing screw 223a. However, in order to ensure that the first fixing screw 223a maintains the angle of the pair of separating members 221, it is preferable that fine lattice-like grooves, fine linear grooves, or random fine uneven grooves are formed on the outer peripheral surface 222 f. . In addition, instead of the first fixing screw 223a having a hexagonal hole, a Phillips screw or a hexagonal bolt may be used.

Second Example A second example of the holding mechanism 223 will be described with reference to FIGS. 3 (a) and 3 (b) are drawn in a state where the periphery of the base 225 is seen through, and the guide member 222b of the opening 222c and the second fixing screw 223b are drawn. FIG. 3A shows a state in which the second fixing screw 223b is not tightened. FIG. 3B shows a state in which the second fixing screw 223b is tightened.

  Unlike the first example shown in FIG. 2, in the second example, a slit 223s extending in the Y-axis direction is formed in the base 225a, and the slit 223s penetrates to the opening 222c. The second fixing screw 223b is longer in the X-axis direction than the first fixing screw 223a. The second fixing screw 223b can be turned with a hexagon wrench (not shown). As shown in FIG. 3A, when the first fixing screw 223b is not tightened, the interval SX between the slits 223s is wide, the guide member 222b can slide in the opening 222c, and the pair of separation members 221a and 221b can move relatively. As shown in FIG. 3B, when the second fixing screw 223b is tightened, the interval SX between the slits 223s becomes narrow, and the guide member 222b is held in the opening 222c. Therefore, the pair of separating members 221a and 221b are held. The outer peripheral surface 222f may or may not be roughened.

<How to use the osteotomy for osteotomy of the fourth embodiment>
How to use the dilator 200 for osteotomy will be described with reference to FIGS. The operation from insertion of the osteotomy dilator 200 into the incision K1 of the tibia K, to the opening of the incision K1 to the holding of the enlarged state after the incision K1 is described. 9 to 11 are explanatory diagrams of the cut K1 as viewed from the front.

  An open osteotomy device 200 for osteotomy in a closed state is provided. The open device 200 for osteotomy is in a state where the holding device 220 is connected to the blade 210 by the holding device fixing pins 213a and 213b. Then, the medical worker inserts the distal end of the osteotomy dilator 200 into the cut K1 of the tibia K. The medical worker hits the striking block 215 with a hammer or the like (not shown) so that the distal end of the osteotomy dilator 200, that is, the distal end of the rotating member 221 of the blade 210 abuts on the back of the tibia K. . That is, the tips of the pair of rotating members 211 are inserted into the cut K1.

  Next, as shown in FIG. 9, the medical worker fits a hexagon wrench driver SD drawn by a solid line into a hexagon hole provided at an end of the screw shaft 212c. Then, the medical worker rotates the hexagon wrench driver SD drawn by the solid line in the direction indicated by the arrow CR1 in FIG. Since the screw shaft 212c has a relationship of “forward screw” and “reverse screw”, the rotating members 211a and 211b rotate in directions indicated by arrows D11 and D12 in FIG. 9, respectively. As the rotating members 211a and 211b relatively open, the holding device 220 also opens in conjunction with it, and the cut K1 is enlarged. FIG. 9 shows a state in which the rotating members 211a and 211b are opened 12 degrees. After opening the bone filling material to an angle enough to insert the bone filling material into the cut K1, the medical worker stops the rotation of the hexagon wrench driver SD drawn by the solid line. Even if the rotation of the screw shaft 212c is stopped and the hexagon wrench driver SD drawn by a solid line is removed from the hexagonal hole of the screw shaft 212c, the rotating members 211a and 211b maintain a relatively open state.

  Next, the medical worker moves the hexagon wrench driver SD drawn in the solid line to the hexagon wrench driver SD drawn in the dotted line, and moves the hex wrench driver SD into the hexagon hole provided at the end of the first fixing screw 223a. Fit the hexagon wrench driver SD drawn by the dotted line. Then, the medical worker rotates the hexagon wrench driver SD drawn by the dotted line in the direction indicated by the arrow CR2 in FIG. Then, the tip of the first fixing screw 223a contacts the outer peripheral surface 222f of the arch-shaped guide member 222b. The first fixing screw 223a and the guide member 222b are held.

  Next, the medical worker releases the connection between the holding device 220 and the blade 210. For this reason, as shown in FIG. 10, the medical worker pulls the holding device fixing pins 213a and 213b in the directions indicated by arrows D13 and D14 in FIG. 10, respectively. Then, the ball plunger (not shown) comes out of the recessed hole 213g of the holding device fixing pin 213a (see FIG. 8B) and the recessed hole 213h of the holding device fixing pin 213b (see FIG. 8B). Thereby, the connection between the holding device 220 and the blade 210 is released.

  Next, the medical worker inserts the hexagonal wrench driver SD into the hexagonal hole provided at the end of the screw shaft 212c, and rotates the hexagonal wrench driver SD in the direction indicated by the arrow CR3 in FIG. , 211b rotate relatively in the closing direction, and the pair of rotating members 211 close. At this time, the connection of the holding device 220 to the blade 210 is released, and the tip of the first fixing screw 223a is in contact with the outer peripheral surface 222f. For this reason, since the pair of separating members 221a and 221b are held at a predetermined angle, the cut K1 of the tibia K is maintained in an expanded state. It should be noted that the pair of rotating members 211 shown in FIG. 10 show a state in which they are moved in the + Y-axis direction in a closed state.

  Next, the medical worker extracts the blade 210 from the cut K1. FIG. 11 is a diagram showing a state in which the blade 210 has been removed and only the holding device 220 remains in the cut K1 of the tibia K. Since the blade 210 is removed, the medical staff can visually recognize the depth of the cut K1 of the tibia K, and can insert the bone replacement material into the depth. If the outer surfaces 221q of the pair of separating members 221a and 221b are roughened, the tibia K and the separating members 221a and 221b are less likely to slip when inserting the bone replacement material.

  After inserting the bone replacement material, the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of separating members 221a and 221b, and removes the holding device 220. The health care professional may insert additional bone replacement material into the space formed by extracting the holding device 220.

  As described above, the osteotomy for osteotomy of the second embodiment to the fourth embodiment is a simple mechanism, so that maintenance such as cleaning can be easily performed. In addition, in this osteotomy dilator, a pair of separating members keep the notch open, so that the entire depth of the notch can be visually recognized and the implant can be easily inserted.

  Although the first to fourth embodiments have been described separately, the configuration of the members may be changed as appropriate between the embodiments. For example, in the second embodiment, the pair of separation members 221a and 221b are not formed thick, but may be thick like the separation member 321 of the third embodiment. The recess 329 may be formed in the base 325b of the second embodiment, and the top member 327f may be provided in the base 325a of the second embodiment.

  In addition, the holding device for osteotomy of the first embodiment described above and the open device for osteotomy of the second to fourth embodiments are not limited to the holding device for osteotomy of the second embodiment to the fourth embodiment. Even with a holding instrument or an open device for osteotomy of configurations B to E, it is possible to easily perform maintenance by a simple mechanism, and it has an effect that it is easy to insert the implant by widening the cut. .

(Configuration A)
A first spacing member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with the bone;
A second spacing member having a second inner surface and a second outer surface provided opposite to the second inner surface and in contact with the bone;
The first separation member includes a guide member that guides an opening and closing operation of the first separation member and the second separation member at a position on a rear end side with respect to a front end side inserted into a cut formed in a bone. Having a first base having
The second separation member has a second base portion having an opening through which the guide member is inserted, at a position on a rear end side with respect to a front end side to be inserted into a cut formed in a bone,
The first separation member and the second separation member are a holding device for osteotomy arranged such that the first inner surface and the second inner surface face each other,
The guide member is fitted into the opening, and the first separating member and the second separating member can be opened and closed according to the shape of the guide member while the distal end side maintains the separated state. Placed in
A holding device for osteotomy, comprising: a holding portion that holds an open / closed state by the first separating member and the second separating member in a predetermined state.

(Configuration B)
A first spacing member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with the bone;
A second spacing member having a second inner surface and a second outer surface provided opposite to the second inner surface and in contact with the bone;
The first separation member includes a guide member that guides an opening and closing operation of the first separation member and the second separation member at a position on a rear end side with respect to a front end side inserted into a cut formed in a bone. Having a first base having
The second separation member has a second base portion having an opening through which the guide member is inserted, at a position on a rear end side with respect to a front end side to be inserted into a cut formed in a bone,
The first separating member and the second separating member are osteotomy dilators arranged such that the first inner surface and the second inner surface face each other,
The guide member is fitted into the opening, and the first separating member and the second separating member can be opened and closed according to the shape of the guide member while the distal end side maintains the separated state. Placed in
A holding unit that holds an open / closed state by the first separating member and the second separating member in a predetermined state;
An opening / closing mechanism that is arranged on one of the first separating member and the second separating member, and that adjusts an open / close state of the first separating member and the second separating member;
Osteotomy for osteotomy.

(Configuration C)
A osteotomy dilator comprising a blade for enlarging a cut in a bone, and a holding device detachably attached to the blade and holding the cut in the expanded bone,
The blade is
A pair of pivot members having an inner surface and an outer surface opposite to the inner surface, the pair of pivot members being relatively rotatably connected by a hinge portion disposed at a distal end,
The holding device,
A first spacing member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with the bone;
A second spacing member having a second inner surface and a second outer surface provided opposite to the second inner surface and in contact with the bone;
The first separation member includes a guide member that guides an opening and closing operation of the first separation member and the second separation member at a position on a rear end side with respect to a front end side inserted into a cut formed in a bone. Having a first base having
The second separation member has a second base portion having an opening through which the guide member is inserted, at a position on a rear end side with respect to a front end side to be inserted into a cut formed in a bone,
The first separating member and the second separating member are arranged such that the first inner surface and the second inner surface face each other,
The guide member is fitted into the opening, and the first separating member and the second separating member can be opened and closed according to the shape of the guide member while the distal end side maintains the separated state. Placed in
An osteotomy dilator comprising a holding portion for holding the open / closed state of the first separating member and the second separating member in a predetermined state.

(Configuration D)
A osteotomy dilator comprising a blade for enlarging a cut in a bone, and a holding device detachably attached to the blade and holding the cut in the expanded bone,
The blade is
A pair of pivot members having an inner surface and an outer surface opposite to the inner surface, the pair of pivot members being relatively rotatably connected by a hinge portion disposed at a distal end,
An opening and closing mechanism for opening and closing the pair of rotating members about an axis of the hinge portion,
The outer surfaces of the pair of rotating members include an inclined outer surface that is gradually thicker with respect to the inner surface from the front end side to the rear end side, and a parallel outer surface that is parallel to the inner surface from the front end side to the rear end side,
The holding device,
A first spacing member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with the bone;
A second spacing member having a second inner surface and a second outer surface provided opposite to the second inner surface and in contact with the bone;
The first inner surface is disposed on the parallel outer surface of one of the pair of rotating members, and the first outer surface is flush with the inclined outer surface of one of the pair of rotating members, and The second inner surface is disposed on the other parallel outer surface of the pair of rotating members, and the second outer surface is disposed so as to be flush with the other inclined outer surface of the one rotating member. ,
The first separation member includes a guide member that guides an opening and closing operation of the first separation member and the second separation member at a position on a rear end side with respect to a front end side inserted into a cut formed in a bone. Having a first base having
The second separation member has a second base portion having an opening through which the guide member is inserted, at a position on a rear end side with respect to a front end side to be inserted into a cut formed in a bone,
The first separating member and the second separating member are arranged such that the first inner surface and the second inner surface face each other,
The guide member is fitted into the opening, and the first separation member and the second separation member follow the shape of the guide member while the distal end side is kept separated by the opening / closing mechanism of the blade. It is arranged so that opening and closing operation is possible,
An open bone device for osteotomy, comprising: a holding portion that holds an open / closed state by the first separating member and the second separating member in a predetermined state.

(Configuration E)
The dilator for osteotomy according to Configuration D, wherein the blade has a connecting member that connects to at least one of the first base or the second base of the holding device.

200, 320, 330 ... open device for osteotomy 210 ... blade 211 (211a, 211b) ... rotating member 211d ... hinge part
212 ... opening / closing mechanism (212a, 212b screw hole, 212c screw shaft)
213a, 213b, 213c, 213d ... holding instrument fixing pin (connection member)
220 ... holding device (for osteotomy) 221 (221a, 221b), 321 (321b) ... separating member
222: sliding mechanism (222a: guide member base, 222b: guide member, 222c: opening)
223: holding mechanism (223a: first fixing screw 223b: second fixing screw)
225 (225a, 225b), 325 (325a, 325b) ... Base 372 ... Opening / closing mechanism (327a ... screw hole, 372c ... screw shaft, 327d ... through hole, 327f ... top member)

Next, the medical worker pulls out the osteotomy dilator 200 from the cut K1. FIG. 4 is a view showing a state in which the osteotomy dilator 200 is withdrawn, and only the osteotomy holding device 220 remains in the cut K1 of the tibia K. Since the blade 210 is removed, the medical staff can visually recognize the depth of the cut K1 of the tibia K, and can insert the bone replacement material into the depth. If the outer surfaces 221q of the pair of separating members 221a and 221b are roughened, the tibia K and the separating members 221a and 221b are less likely to slip when inserting the bone replacement material.

Also, as shown in FIG. 8D, instead of the holding device fixing pins 213a and 213b, holding device fixing pins 213c and 213d are provided at the rear end side of the pair of rotating members 211 at the position of the back surface 211u. Is also good. The holding instrument fixing pins 213c and 213d are movable within the pair of rotating members 211 by a predetermined distance from the −Z axis side in the + Z axis direction. The holding device fixing pins 213c and 213d move from the blade 210 toward the holding device 220, and the tip side (+ Z axis side) protrudes from the intermediate surface 211t (see FIG. 8C), and is held on the blade 210. The instrument 220 can be held. When the expander 200 for osteotomy is inserted into the tibia K by hitting the striking block 215 with a hambar (not shown), the striking direction (X-axis direction) and the moving direction of the holding instrument fixing pins 213c and 213d (Z-axis) Direction) is not coaxial. For this reason, the holding instrument fixing pins 213c and 213d can prevent separation between the blade 210 and the holding instrument 220 when the osteotomy dilator 200 is driven. In another example, the holding tool 220 has a pair of holding tool fixing pins 213c and 213d. However, the holding tool 220 may be held on the blade 210 with only one holding tool fixing pin.

Although the fourth embodiment has the pair of holding instrument fixing pins 213a and 213b, the blade 210 may hold the holding instrument 220 with only one holding instrument fixing pin. Further, instead of the fixing pin, the holding device 220 may be fixed to the blade 210 by an adhesive, a magnetic force, or the like as the connecting member. When the striking block 215 is hit with a hammer (not shown) and the dilator 200 for osteotomy is inserted into the tibia K, it is sufficient that the holding device 220 does not come off the blade 210 from the blade 210. If the holding device 220 does not come off the blade 210 even when the hitting block 215 is hit, the connecting member may be omitted. Further, when the opening Taiki 200 for osteotomy banging striking block 215 Humber (not shown) is inserted into the tibia K, more reliably, in order to hold the instrument 220 from the blade 210 does not come off, At the position on the rear end side of the blade 210, the holding device fixing pins 213 c and 213 d may be inserted from the blade 210 toward the holding device 220 (−Z axis direction) to fix the blade 210 and the holding device 220. .

Claims (10)

A first separating member having a first inner surface and a first outer surface formed in a wedge shape gradually thicker with respect to the first inner surface from the distal end side to the rear end side and in contact with bone;
A second separating member having a second inner surface and a second outer surface that is formed in a wedge shape gradually thicker with respect to the second inner surface from the front end side to the rear end side and is in contact with the bone;
A first base portion provided on the rear end side of the first separating member and having a guide member for guiding an opening and closing operation of the first separating member and the second separating member;
A second base provided on the rear end side of the second separation member and having an opening into which the guide member is inserted;
A holding portion for holding the sliding of the guide member and the opening,
Osteotomy in which the first separating member and the second separating member are inserted into cuts formed in the bone, and the opening and closing state of the first separating member and the second separating member is held by the holding portion. Holding device.   The holding device for osteotomy according to claim 1, wherein the first outer surface and the second outer surface include a rough surface that prevents the bone from slipping on the bone.   The said holding | maintenance part is a screw provided in the said 2nd base part, and contacting the outer peripheral surface of the said guide member, and holding the sliding of the said guide member and the said opening part. Holding device for osteotomy of the stomach.   The osteotomy for osteotomy according to any one of claims 1 to 3, wherein the guide member of the first base has a stopper member so that the second base cannot be removed from an open end of the guide member. Holding equipment.   The osteotomy for osteotomy according to any one of claims 1 to 4, wherein the guide member is formed with an angle scale that allows a user to visually check an opening / closing angle of the first separation member and the second separation member. Holding equipment. A holding device for osteotomy according to any one of claims 1 to 5, and
A first opening / closing mechanism that is arranged on one of the first separating member and the second separating member and that adjusts an opening / closing angle of the first separating member and the second separating member with respect to the other;
Osteotomy for osteotomy.   7. The osteotomy dilator of claim 6, wherein one of the first and second spacing members is longer than the other. A osteotomy dilator comprising a blade for enlarging a cut in a bone, and a holding device detachably attached to the blade and holding a cut in the expanded bone,
The blade is
A pair of pivot members having an inner surface and an outer surface opposite to the inner surface, the pair of pivot members being relatively rotatably connected by a hinge portion disposed at a distal end,
The open device for osteotomy, wherein the holding device is the holding device according to any one of claims 1 to 5. The blade is
A second opening / closing mechanism that opens and closes the pair of rotating members about an axis of the hinge portion;
The outer surfaces of the pair of rotating members include an inclined outer surface that is gradually thicker with respect to the inner surface from the front end side to the rear end side, and a parallel outer surface that is parallel to the inner surface from the front end side to the rear end side,
The first inner surface of the holding device is disposed on the parallel outer surface of one of the pair of rotating members, and the first outer surface is flush with the inclined outer surface of one of the pair of rotating members. Become
The second inner surface of the holding device is disposed on the other parallel outer surface of the pair of rotating members, and the second outer surface is flush with the other inclined outer surface of the one rotating member. An osteotomy for osteotomy according to claim 8. The osteotomy dilator according to claim 9, wherein the blade has a connecting member that is connected to at least one of the first base or the second base of the holding device.