JP2022127646A - Reposition forceps - Google Patents

Abstract

To provide reposition forceps comparatively easy to insert into a target site even in a smaller incision region.SOLUTION: The reposition forceps, which is for temporarily fixing a bone, comprises (1) (a) a first handle, (b) a second handle, (c) a first grip to operate corresponding to the first handle, (d) a second grip to operate corresponding to the second handle, and (e) a cross joint. At least one of the first handle, the second handle, the first grip, and the second grip are detachable from the cross joint with fingers.SELECTED DRAWING: Figure 1

Description

The present invention relates to novel reduction forceps.

For example, in surgery to treat orthopedic trauma such as fractures of the clavicle, femur, humerus, etc., there is a reduction procedure that corrects the misalignment of the bones at the fracture site and restores them to their original positions. done. The reduced fracture site is temporarily fixed with bone grasping forceps (reduction forceps) while maintaining the reduced position. After that, the plate is brought into contact with the temporarily fixed fracture site to perform final fixation.

Various types of forceps have been proposed as such forceps for reduction. For example, a bone fixation forceps for temporarily fixing a broken bone in a reduced state, comprising first and second gripping members that are combined to grip the bone so that they can move toward and away from each other, and both of the gripping members. and a holding mechanism for holding the two gripping members together while gripping the bone, wherein at least one of the two gripping members contacts the bone. There is a forceps for bone fixation characterized in that a groove for receiving a filament to be wound around the bone is provided on the contacting side of the corresponding gripping member from the base end side to the free end side (Patent Reference 1).

In addition, for example, in order to fix a fractured finger bone by percutaneously inserting a steel wire, a pair of arm tips are provided with repositioning fixation needles facing each other, and a steel wire is inserted from the outside of each arm. In the reduction forceps provided with a guide tube through which the steel wire is inserted and guided to pass between the reduction and fixation needles, the arm forms a long hole with a curved surface chamfered in the vicinity of the reduction and fixation needles, and the guide tube is a tubular body that passes through the long hole and guides the steel wire, a sphere that abuts on the peripheral surface of the long hole and movably inserts the tubular body into the center, and a sphere that abuts on the upper surface of the sphere and is at the center It is characterized by having a bolt movably inserted through the tubular body, and a positioning member that suspends leg portions that movably hold both side surfaces of the arm and locks the arm by screwing the bolt onto the arm. Reduction forceps are known (Patent Document 2).

JP 2016-67847 JP 2007-75429

Recently, as with other laparotomy surgeries, it has become popular to minimize the incision in surgery to treat fractures, etc., from the standpoint of minimally invasive surgery and early discharge of patients. requested.

In this regard, there is room for further improvement in conventional fixing forceps. That is, when inserting the fixation forceps into the fracture site, it is necessary to make a relatively large incision due to its essential shape (scissors shape).

SUMMARY OF THE INVENTION Accordingly, it is a primary object of the present invention to provide a reduction forceps that can be relatively easily inserted into a target site even in a smaller incision area.

As a result of earnest research in view of the problems of the prior art, the inventors of the present invention have found that a forceps having a specific structure can achieve the above objects, and have completed the present invention.

That is, the present invention relates to the following reduction forceps.
1. Reduction forceps for temporarily fixing a bone,
(1) (a) a first handle portion, (b) a second handle portion, (c) a first grip portion that operates in correspondence with the first handle portion, and (d) operates in correspondence with the second handle portion. a second gripping portion and (e) a cross-connecting portion;
(2) the cross-connecting portion includes a shaft portion and a first connecting member and a second connecting member that are rotatable with respect to the shaft portion;
(3) the first handle portion and the first grip portion are connected to the first connecting member;
(4) the second handle portion and the second grip portion are connected to the second connecting member;
(5) At least one of the first handle portion, the second handle portion, the first gripping portion, and the second gripping portion can be attached and detached from the cross-connecting portion by fingers,
(6) By separating or approaching the first handle and the second handle, the tip region of the first gripping portion and the tip region of the second gripping portion approach or separate, and the tip regions approach each other. can grasp the bone with
Reduction forceps characterized by:
2. Item 2. The reduction forceps according to Item 1, further comprising fixing means for fixing the first gripping portion and the second gripping portion in a state in which the first gripping portion and the second gripping portion are close to each other.
3. Item 3. Reduction forceps according to item 1 or 2, wherein at least one of the first gripping portion and the second gripping portion is detachably connected between the side surface thereof and the side surface of the cross-connecting portion. .
4. When the first gripping portion and the second gripping portion are viewed from above, the longitudinal center line of the first gripping portion and the longitudinal center line of the second gripping portion are aligned with the first gripping portion or the second gripping portion. 4. The reduction forceps according to any one of items 1 to 3, wherein the first gripping portion and the second gripping portion are connected to a cross-connecting portion so that the tip regions of the two gripping portions intersect.

According to the present invention, it is possible to provide a forceps for reduction that can be relatively easily inserted into a target site even in a smaller incision area.

In particular, in the reduction forceps of the present invention, at least one of the first handle portion, the second handle portion, the first gripping portion, and the second gripping portion can be attached and detached from the cross-connecting portion by fingers. When inserted into the body, it can be introduced and placed in a small size, including cross-connections. After that, each member is connected to the cross-connecting portion while the forceps are installed in the body, so that the forceps can function as a normal bone forceps.

For this reason, in surgery for treatment of bone fractures, etc., even when the incision area is narrow, or when normal bone rongeurs cannot be introduced depending on the position of the bone fracture, the forceps of the present invention can be used relatively easily and reliably in a predetermined position. can be arranged. In addition, it is also possible to appropriately exchange gripping portions having different shapes, sizes, etc., during the operation, if necessary.

Further, by using the forceps of the present invention, the incision area can be made smaller, so that the burden on the patient can be reduced. This can contribute to the shortening of the patient's hospitalization period.

The forceps of the present invention having such characteristics are particularly suitable for use as forceps for reducing fractured parts in surgery for treating orthopedic trauma such as fractures of the clavicle, femur, humerus, etc. be able to.

1 is a perspective view of a reduction forceps of the present invention; FIG. FIG. 2A is a side view of the closed reduction forceps of the present invention. FIG. 2B is a side view of the reduction forceps of the present invention in an open position. FIG. 3A is a side view of the cross-link of the reduction forceps of the present invention; FIG. 3B is a view seen from direction b in FIG. 3A. FIG. 3C is a view seen from direction c in FIG. 3A. FIG. 3D is a view seen from direction d in FIG. 3A. FIG. 4A is a top view of the reduction forceps of the present invention. 4B is an enlarged view of the first gripping portion and the second gripping portion of FIG. 4A.

REFERENCE SIGNS LIST 10 reduction forceps of the present invention 11 first handle portion 12 first grip portion 13 second handle portion 14 second grip portion 15 cross connection portion 15a first connection portion 15b second connection portion 15c shaft portion (rotating shaft)
15d, 15e, 15f, 15g projection 16 fixing means 16a bolt 16b nut C1 center line C2 center line

1. Reduction Forceps The reduction forceps of the present invention (the forceps of the present invention) are for temporarily fixing a bone,
(1) (a) a first handle portion, (b) a second handle portion, (c) a first grip portion that operates in correspondence with the first handle portion, and (d) operates in correspondence with the second handle portion. a second gripping portion and (e) a cross-connecting portion;
(2) the cross-connecting portion includes a shaft portion and a first connecting member and a second connecting member that are rotatable with respect to the shaft portion;
(3) the first handle portion and the first grip portion are connected to the first connecting member;
(4) the second handle portion and the second grip portion are connected to the second connecting member;
(5) At least one of the first handle portion, the second handle portion, the first gripping portion, and the second gripping portion can be attached and detached from the cross-connecting portion by fingers,
(6) By separating or approaching the first handle and the second handle, the tip region of the first gripping portion and the tip region of the second gripping portion approach or separate from each other, and the tip regions approach each other. The bone can be grasped by
It is characterized by

FIG. 1 shows a perspective view of an embodiment of the forceps of the present invention. The forceps 10 of the present invention includes a first handle portion 11, a second handle portion 13, a first gripping portion 12, a second gripping portion 14, and a cross connecting portion 15 as main constituent members.

In the forceps 10 of the present invention, the distal end region of the first gripping portion 12 can be moved by separating or approaching the first handle portion 11 and the second handle portion 13 like pliers or the like, similar to the operating mode of general bone forceps. and the tip region of the second gripping part 14 approach or separate from each other, and the tip regions approach each other, so that the bone can be clamped.

As shown in FIG. 2A , when bringing the first handle portion 11 and the second handle portion 13 closer to each other (for example, when clenching the first handle portion 11 and the second handle portion 13 with fingers), the first grip portion 12 and the distal end region of the second gripper 14 can be closed to clamp the bone. On the other hand, as shown in FIG. 2B, when the first handle portion 11 and the second handle portion 13 are separated from each other, the first grip portion 12 and the second grip portion 14 are opened, and the tip regions thereof are separated from each other. , can release the bone that was gripped. In addition, FIG. 2B shows the state (side surface) when FIG. 1 is viewed from the direction A. As shown in FIG.

The forceps of the present invention have cross-connections. It includes a shank and first and second connecting members that are cross-connected so as to form an X-shape that can rotate about the shank.

Moreover, the first handle portion and the first grip portion are connected to the first connecting portion. A second handle portion and a second grip portion are connected to the second connecting portion. For example, the first handle is connected to the end of the first connecting portion, and the first grip is connected to the other end. Similarly, the second handle is connected to the end of the second connecting portion, and the second grip is connected to the other end.

In the present invention, at least one of the first handle portion, the second handle portion, the first gripping portion, and the second gripping portion can be attached and detached from the cross connecting portion by fingers. As a result, even in a narrow incision area, the forceps of the present invention can be relatively easily inserted and placed in the affected area. That is, when the forceps of the present invention is inserted into the body, the whole forceps of the present invention can be made to have a minimum necessary "bulk". Desired temporary fixation can be achieved by

FIG. 3 shows the cross connecting portion 15 and peripheral members thereof in the forceps 10 of the present invention shown in FIG. FIG. 3A shows a side view of cross-connect 15 . FIG. 3B is a view seen from direction b in FIG. 3A. FIG. 3C is a view seen from direction c in FIG. 3A. FIG. 3D is a view seen from direction d in FIG. 3A.

The cross connecting portion 15 has a substantially cylindrical shaft portion 15c, and the first connecting portion 15a and the second connecting portion 15b are arranged so as to form an X shape in a state in which they can be turned (revolved) about this axis. crossed and connected.

In the forceps shown in FIG. 3A, the first handle portion 11 is connected to one end of the first connecting portion 15a, and the first grip portion 12 is connected to the other end. The second handle portion 13 is connected to one end of the second connecting portion 15b, and the second grip portion 14 is joined to the other end in an integrated state (non-separable state) with the second connecting portion. . As described above, the forceps of the present invention need only be in a state where it can be easily inserted into the body at least for the first time. It does not need to be separable from the connecting part and may be partially integrated as described above.

In the forceps of the present invention, at least one of the first handle portion, the second handle portion, the first gripping portion, and the second gripping portion may be detachable from the cross-connecting portion by fingers. The parts other than the members may be in a non-detachable (fixed) state in the cross-connecting portion. Therefore, for example, as shown in FIG. 3A, the second grip portion 14 and the second connecting portion 15b are integrated (integrally molded), and such a form is also included in the present invention. When the second gripping portion and the second connecting portion are integrated, or when the first gripping portion and the first connecting portion are integrated, the grip force by the first gripping portion and the second gripping portion etc. can be increased.

A detachable connection method is not particularly limited, and known means can be adopted. For example, a method such as a one-touch joint may be used in addition to a screw type, a fitting type, or the like. Integrating means at least putting it in a state that cannot be separated during the treatment (a state that cannot be easily disassembled so as not to interfere with the treatment), for example, integration by molding, welding, adhesive, screwing, etc. but not limited to.

In addition, in the forceps of the present invention, it is particularly desirable that at least one of the first handle portion and the second handle portion can be detached from the cross-connecting portion by fingers. That is, it is desirable that at least one of the first handle portion and the second handle portion can be manually removed from or manually attached to the cross-connection portion. With such a configuration, for example, the first handle portion and the second handle portion can be attached to the cross connecting portion after the first handle portion and the second handle portion are attached to the body in a detached state. As a result, the forceps of the present invention can be more reliably and easily inserted into a relatively small incision area for bone fixation. In addition, since the forceps can be inserted into the body without the first handle portion and the second handle portion, the forceps of the present invention can be easily placed in the body at virtually any incision site.

In the present invention, if necessary, at least one of the first gripping portion and the second gripping portion may be detachable from the cross connecting portion with fingers. Accordingly, there is an advantage that the first gripping portion or the second gripping portion can be appropriately replaced with gripping portions having various sizes, shapes, and the like.

Further, in the forceps of the present invention, at least one of the first gripping portion and the second gripping portion may be detachable by fingers between the side surface thereof and the side surface of the cross-connecting portion. By adopting such a structure, the first gripping part or the second gripping part can be attached or removed from the side with fingers, making it easier and easier to operate even in a limited operation space. It is possible to reliably attach and detach.

In particular, in the present invention, it is desirable that the first gripping portion 12 is attached to the side surface of the cross connecting portion 15, as shown in FIG. 4A. As shown in FIG. 3B, protrusions 15d and 15e are provided on one side surface of the cross connecting portion 15, and protrusions 15f and 15g are provided on the other side surface. Two holes (recesses) that can be fitted with the protrusions 15d and 15e or the protrusions 15f and 15g are formed on both side surfaces. By fitting the corresponding two projections and two holes together, the first gripping part can be connected to either the right side or the left side of the cross connecting part.

In FIG. 4A, the right side surface of the cross connecting portion 15 toward the tip is connected to the left side surface of the first grip portion 12 toward the tip. A state in which the left side toward the tip of the first grip portion 15 and the right side toward the tip of the first grip portion 12 are connected can also be configured. That is, the first gripping portion 12 can be attached to either the left side or the right side of the cross connecting portion 15 . Also, in FIG. 4A, there are two protrusions on each of the left and right side surfaces, but three or more protrusions may be provided. Moreover, the number of protrusions on the left and right side surfaces may be the same as each other, or may be different from each other. As a result, the first gripping portion can be freely removed and attached to either the left or the right during treatment.

As shown in FIG. 4B, by connecting the first gripping portion to either the right side or the left side of the cross-connecting portion, when viewed from the direction (above) in which the first gripping portion and the second gripping portion overlap, , the longitudinal center line C1 of the first gripping part and the longitudinal center line C2 of the second gripping part are not parallel to each other and intersect at the tip region of the first gripping part or the second gripping part. , the first gripping portion and the second gripping portion are connected to the cross-connecting portion. As a result, the first gripping portion 12 whose center line C1 is a straight line and the second gripping portion 14 whose center line C2 is a straight line are used, and the first gripping portion or the second gripping portion intersects at the tip region, and the It is possible to grip the bone in the area centered on the intersection point C.

Moreover, the forceps of the present invention may further include fixing means for fixing the first gripping portion and the second gripping portion in a close state. In this case, the form, method, installation location, etc. of the fixing means are not particularly limited. For example, as shown in FIG. 3A, threaded fixing means 16 may be provided spanning the first and second links 15a, 15b of the cross link. This includes a bolt portion 16a fixed to the second connecting portion 15b and installed so as to pass through a through hole 17 formed in the first connecting portion 15a as shown in FIG. 3C; It includes a nut portion (handle knob) 16b that can be tightened in a closed state with the connecting portion 15b. The cross-section of the through-hole 17 is larger than the cross-sectional size of the bolt portion and is formed with a certain clearance so that the first gripping portion 12 and the second gripping portion 14 can be freely opened and closed.

In the forceps shown in FIG. 1, the through-hole is substantially rectangular and elongated in the longitudinal direction of the first connecting portion 15a. By tightening the nut portion 16b while the bone is sandwiched between the first gripping portion and the second gripping portion, the bone can be strongly fixed. By loosening the nut portion 16b, the first connecting portion and the second connecting portion can be separated, and the forceps of the present invention can be removed from the bone. In the forceps shown in FIG. 1, a combination of bolts and nuts is used as a fixing means, but a rubber band or the like may be used instead of the nut, or any other known similar fixing means may be employed. can.

In FIG. 3A, as a method of connecting the bolt 16a to the second connecting portion, a through hole 16c (not shown) is provided at the end of the bolt portion 16a, and the bolt portion 16a of the second connecting portion 15b is fixed. A through-hole 18 is also provided at a point, and the end of the bolt portion 16a is inserted into the through-hole 18 so that the through-hole 18 and the through-hole 16c are linear, and the pin 18a that straddles the through-hole 18 and the through-hole 16c is inserted. By inserting, the bolt portion 16a can be fixed in such a state that it moves back and forth in the longitudinal direction of the second grip portion 14 around the pin 18a.

The material of each member constituting the forceps 10 of the present invention is not particularly limited, and examples thereof include materials such as metals/alloys (stainless steel, aluminum, etc.), carbon, synthetic resins, and composite materials thereof. . Further, each member may be made of the same material as each other, or may be made of different materials.

In addition, the size and shape of each member can be appropriately set depending on, for example, the size, shape, and position of the target bone. For example, as shown in FIG. 1, the first gripper and the second gripper can employ plate-shaped material. Temporary fixation can be easily performed by arranging the plates so that the bone is sandwiched between the flat surfaces of both plates. In this case, it is preferable to be processed into a spoon shape, a fork shape, or the like as shown in FIG. 1 in order to reliably grip the bone. In addition, when the second gripping part supports the bone from below and the first gripping part presses the bone from above, the supporting surface of the second gripping part can be enlarged to stably grip the bone. A high pressure can be obtained by reducing the pressing area of one gripping portion. In this way, the fractured portion can be temporarily fixed more strongly. Also, the handle portion can be appropriately set to a shape that is easy for the operator to grip.

2. Use of Reduction Forceps The forceps of the present invention can be used for temporary fixation of fractured parts. As a procedure, first, the skin is incised according to a conventional method to expose the fractured part. After the exposed fractured portion is returned to its original position (reduction position), temporary fixation is performed with the forceps of the present invention in that state.

A forceps as shown in FIG. 1 can be used as the forceps of the present invention. At the time of introduction into the body, as a minimum unit, for example, as shown in FIG. The first gripping portion is used in a state of being removed from the cross-connecting portion 15 . As shown in FIG. 1, the first gripping portion 12 and the second gripping portion 14 are curved toward the bone to be gripped so that the concave portions of the curved spoons face each other inward. positioned to stably clamp the bone. In particular, it is possible to temporarily fix the fractured portion by nipping the bone with the first gripping portion and the second gripping portion facing in a direction substantially perpendicular to the longitudinal direction of the bone.

In the forceps shown in FIG. 1, the tip of the second gripping portion 14 has a loop shape with a hollow (hollow) center portion, but the hollow does not necessarily have to be formed, and other shapes are also possible. . In particular, when it is loop-shaped, there is an advantage that a high pressure (clamping force) can be obtained locally. In particular, since the region corresponding to the loop-shaped portion (hollow portion) of the first gripping portion can be locally pressurized from the tip of the second gripping portion, it is possible to clamp the bone more strongly. In other words, the bone can be held more stably by supporting both ends of the bone with the first gripping portion and pressing the space between the both ends with the second gripping portion.

The sandwiching between the first gripping part and the second gripping part can be performed by fixing means 16 attached to the cross-connecting part 15, as shown in FIG. 3A. The bolt portion 16a of the fixing means 16 is attached to the second connecting portion 15b of the cross connecting portion at the end of the bolt portion 16a, and as shown in FIG. penetrates towards A nut portion 16b is attached to the penetrating bolt 16a. When the nut portion 16b is rotated and loosened, the first grip portion 12 and the second grip portion 14 are opened. When the nut portion 16b is rotated and tightened, the first gripping portion 12 and the second gripping portion 14 are fixed in a closed state.

First, only the second grip part 14 is pre-bonded to the cross-connecting part 15, and is inserted from the incision toward the fractured part. More specifically, the second grasping part 14 is inserted so as to pass under the fractured part. In this way, the second grip portion 14 is stuck under the fractured portion and fixed.

Next, the first handle part 11 and the second handle part 13 are connected by fingers to the first connection part and the second connection part of the fixed cross connection part 15, respectively. The order of connection in this case is not particularly limited, and may be appropriately determined according to, for example, the site to be treated, the dominant hand of the practitioner, and the like. Further, the first gripping portion 12 is attached to the side surface of the cross connecting portion 15 . In this case, the order may be any, and the first gripping portion 12 may be attached to the side surface of the cross connecting portion 15 first. As shown in FIG. 4A, projections 15d and 15e on the right side of the cross connecting portion 15 from the hand to the tip are inserted into two corresponding holes (not shown) formed on the left side of the first grip portion 12. Fit and connect.

The first gripping part 12 is adjusted to a position where the second gripping part 14 and the bone can be sandwiched, and after the positioning is completed, the nut part 16b is tightened in the fixing means 16 having the bolt part 16a and the nut part 16b. Thus, the first gripping portion 12 can be brought as close to the second gripping portion 14 as possible, and the fractured portion can be firmly and temporarily fixed by the pressure of both gripping portions.

After the temporary fixation by the forceps of the present invention is completed, treatment may be performed according to a normal surgical procedure. After the prescribed treatment is completed, the grasping portion of the forceps of the present invention is released from the fixed portion, and the forceps of the present invention is removed. When removing the forceps of the present invention, in addition to the method of removing the first handle portion, the second handle portion, the first gripping portion, and the second gripping portion while they are joined to the cross-connecting portion, the forceps of the present invention can be assembled. It is also possible to adopt a method based on a procedure opposite to the procedure described above. For example, in the case of the forceps shown in FIG. 1, the first handle portion 11, the second handle portion 13, and the first grip portion 12 are pulled from the cross-connecting portion while the forceps 10 of the present invention is placed on the fractured portion (treated portion). It is removed (divided), and then loosened while rotating the nut portion 16b to release the first gripping portion and the second gripping portion, thereby removing it from the treated portion, and finally remaining the second gripping portion 14 and the cross connecting portion 15. should be removed together.

Claims (4)

Reduction forceps for temporarily fixing a bone,
(1) (a) a first handle portion, (b) a second handle portion, (c) a first grip portion that operates in correspondence with the first handle portion, and (d) operates in correspondence with the second handle portion. a second gripping portion and (e) a cross-connecting portion;
(2) the cross-connecting portion includes a shaft portion and a first connecting member and a second connecting member that are rotatable with respect to the shaft portion;
(3) the first handle portion and the first grip portion are connected to the first connecting member;
(4) the second handle portion and the second grip portion are connected to the second connecting member;
(5) At least one of the first handle portion, the second handle portion, the first gripping portion, and the second gripping portion can be attached and detached from the cross-connecting portion by fingers,
(6) By separating or approaching the first handle and the second handle, the tip region of the first grip part and the tip region of the second grip part are separated or approached, and the tip regions approach each other. can grasp the bone with
Reduction forceps characterized by: 2. The reduction forceps of claim 1, further comprising fixing means for fixing the first gripping portion and the second gripping portion while the first gripping portion and the second gripping portion are in close proximity. The reduction forceps according to claim 1 or 2, wherein at least one of the first gripping portion and the second gripping portion is detachably connected between the side surface thereof and the side surface of the cross-connecting portion. . When the first gripping portion and the second gripping portion are viewed from above, the longitudinal center line of the first gripping portion and the longitudinal center line of the second gripping portion are aligned with the first gripping portion or the second gripping portion. The reduction forceps according to any one of claims 1 to 3, wherein the first gripping portion and the second gripping portion are connected to the cross-connecting portion so that the two gripping portions intersect at their tip regions.

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