JP2543460B2 - Fracture-percutaneous steel wire insertion guide - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a fracture-percutaneous steel wire puncture guide used for fracture-percutaneous steel wire puncture fixation in orthopedic surgery.

[0002]

2. Description of the Related Art Recently, when an X-ray apparatus for operation has been introduced and a human fractures, an orthopedic operation for joining the fractures is performed by a fracture-percutaneous steel wire puncture (PCP) technique. Became popular. This PCP
First, reduce the fractured area while observing the affected area with a surgical X-ray fluoroscope, and in order to maintain this state, use one or more Kirschner steel wires (steel wires with the tip of a flat drill) to make a fracture line. While rotating, pierce and pierce and fix. Usually, since only Kirschner steel wire has a weak post-operative fixing force, the affected part is fixed by a cast or splint. Then, the fractured part is naturally fused.

Prior to the Kirschner steel wire puncturing work, first, an X-ray fluoroscope is used to confirm the puncture site of the Kirschner steel wire and then to determine the puncture point, a probe needle (usually) is used. Use Denupo's black cathelan needle) to pierce the soft tissue of the skin to check the resistance of the bone hitting the needle tip. At this time, when piercing the soft tissue of the skin, the blood vessel is pierced in the middle to check for blood regurgitation, and the nerve is pierced for observing traces of radiation or reflexive muscle contraction. This operation is repeated around it to check the allowable range of the bone piercing point, and finally determine the best skin piercing point, direction, and bone piercing point. Then, make a small incision on the skin and fascia at the puncture point with a sharp knife, push the Kirschner steel wire through the small incision hole, and check the relative position of the bone and Kirschner steel wire and the piercing direction with an X-ray fluoroscope. To do.

The Kirschner steel wire is inserted into the bone, and two methods have been conventionally adopted as the method. One of them is the direct method shown in FIG. 12, in which the tip of the Kirschner steel wire 100 penetrates the skin and pierces the bone substance 101 through the periosteum, and the drill driver attached to the proximal end side is driven, Kirschner steel wire 100
Is rotated to penetrate the bone marrow cavity 102. The bone marrow cavity 102 is filled with cancellous bone such as bone marrow, so that the Kirschner steel wire 100 reaching the bone marrow cavity 102 can be easily advanced. Then, the tip of the Kirschner steel wire 100 is stopped in the bone marrow cavity 102 or the bone material on the opposite side is penetrated depending on the state of fracture. In addition, two of them are the indirect method shown in FIG. 13, in which a part of the surface (bone cortex) of the bone substance 101 is vertically cut beforehand to form a shallow recess 103, from which the Kirschner steel wire 100 is inserted as described above. To do.

However, in the direct method, it is difficult to insert the Kirschner steel wire into an accurate insertion point in the intended direction, and in the actual operation, the tip of the Kirschner steel wire does not slip on the bone surface. The limit tilt angle (minimum angle of Kirschner steel wire with respect to the bone surface) that can be used was about 40 °. Therefore, the selection range of the insertion point is narrow, and in many cases, PCP cannot be applied depending on the fracture state.
Further, in the indirect method, the limit inclination angle is smaller than that in the direct method, but prior to the Kirschner steel wire puncture, a labor-intensive work is required to form a recess serving as the puncture point in the bone cortex. Furthermore, both methods may cause blood vessels and nerves to be caught and damaged when the Kirschner wire turns,
There are also reports that it actually caused damage.

[0006]

SUMMARY OF THE INVENTION In view of the above-mentioned situation, the present invention aims to solve the problem that the Kirschner steel wire can be easily held at the insertion point and its direction and protects blood vessels and nerves. The point is to provide a guide for bone fracture-percutaneous steel wire insertion capable of preventing the damage.

[0007]

In order to solve the above-mentioned problems, the present invention is a hard metal pipe having an inner diameter through which a Kirschner steel wire can penetrate and having a required length. In the fracture-percutaneous steel wire insertion guide, an acute-angled cutting surface is formed, and both ends of the cutting surface are sharpened to form an acute-angled tapered edge in a plan view.

As the hard metal pipe, it is preferable to use a hard metal pipe made of stainless steel or a bioinert metal.

The side view angle of the cut surface is about 30 °.
More preferably, it is set to ± 7 °, the planar view angle of the tapered edge is set to about 78 ° ± 7 °, and the side view angle of the tapered edge is set to about 38 ° ± 7 °.

[0010]

The guide for bone fracture-percutaneous steel wire insertion of the present invention having the above-mentioned contents pierces and holds the sharp tip of the guide made of a hard metal pipe into the bone and holds it inside the drill driver. By inserting and rotating the attached Kirschner steel wire, the insertion point is positioned and the insertion direction is maintained, and since the Kirschner steel wire does not directly contact the soft tissue of the skin, when the Kirschner steel wire is rotated,
It does not involve blood vessels or nerves at all.

Further, the guide cuts the tip of the hard metal pipe to form a cutting surface having an acute angle in a side view, and sharpens both ends of the cutting surface to form a tapered edge having a sharp angle in a plan view. And the side view angle of the cut surface is set to about 30 ° ± 7 °, the plane view angle of the tapered edge is set to about 78 ° ± 7 °, and the side view angle of the tapered edge is set to About 38 ° ± 7
By setting it to °, it is possible to suppress slippage when piercing the bone material and to insert at a small inclination angle equal to or less than the indirect method, especially for the Kirschner steel wire insertion guide to the bone surface. When the cut end of the cut surface formed at the tip is set upward, the inclination angle becomes the smallest.

[0012]

The present invention will be described in more detail with reference to the embodiments shown in the accompanying drawings. FIG. 1 shows a main part of a guide 1 made of a hard metal pipe having a sharp tip formed according to the present invention.
FIG. 2 shows the structure of a drill for cutting the bone material of the tip of the Kirschner steel wire 2 which is inserted into and held in the guide 1 and is rotated to be inserted into the bone.

The guide 1 of the present invention is manufactured by cutting a small-diameter hard metal pipe to a length of about 10 cm, cutting the base end side at a right angle, and cutting the tip end at an acute angle. As a material of the hard metal pipe, a stainless steel which is a bio-inert metal and which is not easily broken and which is hard to generate metal dust due to the rotation of the Kirschner steel wire 2 is used.
305 cold-rolled stainless steel is most preferable in terms of cost, and this stainless steel that is semi-seamless processed into a pipe shape is used. The tip of the guide 1 forms a sharp cutting surface 3 by cutting the hard metal pipe at a tip angle θ ₁ in a side view, and both sides of substantially half of the cutting surface 3 at the tip side are tapered with a taper angle θ ₂ in a plan view. A sharpened tapered edge 4 is formed by sharpening. Here, since the stainless steel is not a so-called "scattering", it does not break even if it pierces the bone, but when the guide 1 pierces the bone, the sharpness of the tip is lost and it cannot be used repeatedly. Must be a disposable product.

Here, the tip angle θ ₁ is about 30 ° ± 7 °.
And the taper angle θ ₂ is about 78 ° ±
It is preferably set at 7 °. When the tip angle θ ₁ is larger than the above-mentioned set range, the tip 5 becomes dull and it is difficult to pierce the bone, and when it is smaller than the set range, the tip 5 bends and is easily broken. Also, the taper angle θ ₂
The same applies to the case where is out of the set range described above.

The tip angle θ ₁ is about 30 ° ± 7
If the taper angle θ ₂ is set to about 78 ° ± 7 °, the second tip angle θ ₃ of the tapered edge 4 is necessarily set to about 38 ° ± 7 ° in side view. Here, although the tapered edge 4 is a slightly concave curved line in a side view, the taper angle θ is based on the string connecting the bending point 6 and the tip 5 of the boundary between the cutting surface 3 and the tapered edge 4 with a straight line.
₂ is prescribed.

Since the Kirschner steel wire 2 has a standard, the guide 1 has an optimum diameter according to the standard. Usually, the Kirschner steel wire 2 has a diameter of 1.0 to 3.0.
Often used in mm, the corresponding guide 1
Is 8G (outer diameter 4.2mm, inner diameter 3.64mm (3.0
mm)), 11G (outer diameter 3.06 mm, inner diameter 2.64)
mm (for 2.4 mm), 12G (outer diameter 2.76 mm,
Inner diameter 2.4 mm (for 2.0 mm)), 16 G (outer diameter 1.
61 mm, inner diameter 1.25 mm (for 1.0 mm)). The guide 1 corresponding to the thinner Kirschner steel wire 2 is 17G (outer diameter 1.48 mm, inner diameter 1.12 m).
m) and 18G (outer diameter 1.26 mm, inner diameter 0.9 mm) are also prepared.

As shown in FIG. 2, the Kirschner steel wire 2 has a flat drilled tip, and in this embodiment, it is manufactured by Mizuho Medical Industry Co., Ltd., and the material thereof is defined by JIS-SUS316L. Manufactured with a stainless steel wire. The tip angle α of the rake face 7 is
60 for outer diameters of 2.0 mm, 2.4 mm and 3.0 mm
90 ° for 1.0 ° and 1.0 mm, and the flank 8 with a clearance angle of 20 ° cuts the bone material with the cutting edge 9 only when turning right, and the cut piece is removed to the outside by the rake face 7. It has a structure that

Next, the effectiveness of the present invention will be described by comparing the method of inserting the Kirschner steel wire 2 using the guide 1 of the present invention with the conventional direct method and indirect method based on specific examples. As a perforation target, the periosteal ribs of bovine that were cryopreserved were used because they are close to clinical cases and are easily available.
This rib is fixed with a vise, and the Kirschner steel wire 2 is brought into contact with the periosteum as tilted as possible with an air drill driver made by Stryker, which is grasped with both hands, and the minimum inclination angle that allows perforation to be inserted without slipping (relative to the bone surface The minimum angle of Kirschner steel wire) was defined as the limit angle, and the measurement was performed by the following three methods. That is, the direct method of directly inserting into bone (see FIG. 1
2), a part of the bone cortex is cut vertically to form a shallow recess, and an indirect method of inserting from there (the method of FIG. 13), a guide method of inserting using the guide 1 of the present invention. Further, in the guide method, the cut end of the cut surface 3 of the guide 1 is subdivided into three directions of upward (see FIG. 3), sideward (see FIG. 4) and downward (see FIG. 5) with respect to the bone surface.

With respect to each of the above methods and subdivisions, the Kirschner steel wire 2 was pierced by the same tester three times until the bone material 10 penetrated the bone marrow cavity 11, and the limit angle was measured. Furthermore, the outer diameter of the Kirschner steel wire 2 is 1.0 m.
The same measurement was performed for four types of m, 2.0 mm, 2.4 mm, and 3.0 mm. In the guide method, the above-mentioned corresponding guide 1 was used according to the outer diameter of the Kirschner steel wire 2. The results are shown in Table 1 below.

[0020] * 1 The guide method is a puncture method using the guide of the present invention. * 2 The orientation in the guide method is the orientation of the cut end of the guide. * 3 The angle in the table is the average value of the limit angle with respect to the bone surface.

As shown in Table 1, the indirect method can obtain a significantly smaller marginal angle than the direct method, and the guide method also has a smaller marginal angle than the direct method. It was the smallest in the case of doing, and it is rather small value compared with the indirect method. Regarding the difference in the limit angle depending on the thickness, 1.0 mm Kirschner steel wire 2
The smallest value is obtained by using.

Considering this result, the limit angle in the direct method is theoretically determined by the tip angle α of the Kirschner steel wire 2, that is, the tip angle α is 60 ° of 2.0 mm, 2.4 mm,
The limit angle should be 30 ° for the 3.0 mm Kirschner steel wire 2 and 45 ° for the 1.0 mm Kirschner steel wire 2 with the tip angle α of 90 °. Actually, the Kirschner steel wire 2 having a tip angle α of 60 ° of 2.0 mm, 2.4 mm and 3.0 mm all showed a limit angle of 30 ° or more, but the Kirschner steel wire of 1.0 mm which should be the largest On the contrary, the smallest value in 2 is probably because the tip part is fixed by the strong periosteum, and it becomes slightly convex due to its thinness, so that the horizontal force is absorbed. Regarding the indirect method, the side wall of the shallow recess made by cutting in advance has an angle regardless of the tip of any needle, so a small limit angle could be obtained as expected. In the guide method,
When the cut face is directed downward, the taper edge 4 and the cut surface 3 adhere to the bone surface, which naturally causes the limit. However, in the other directions, all are below the theoretical limit, and good results are obtained. Results were obtained. This is because the Kirschner steel wire 2 is sufficiently held by the guide 1, so that the tip of the Kirschner steel wire 2 does not slip on the bone surface, and the bone material 10 is first shaved by the shoulder portion of the tip to form a shallow recess. Therefore, it is speculated that this brought about an indirect legal effect.

In the present embodiment, the Kirschner steel wire 2 was inserted by three kinds of methods including the conventional method, and the stability of the stability was compared by measuring the respective limit angles. As a result, the indirect method had a small limit. It can be said that it is a relatively stable puncture method with its corners removed and not slipping, but clinically, when the bone surface is deep or the soft tissue is hard, the Kirschner steel wire 2 bends,
There is a drawback that the operation of tilting the insertion angle becomes difficult. On the other hand, in the guide method, the Kirschner steel wire 2 does not bend, and the limit angle is small, so it can be said that it is the most stable insertion method. In particular, the smallest limit angle can be obtained by firmly fixing the tip of the guide 1 with the fingertip such that the cut end of the cut surface 3 faces upward and is inserted into the periosteum.

Finally, a more detailed description will be given based on clinical cases. The actual procedure of PCP using the guide 1 of the present invention is shown below. In the operating room, lay the affected area of the fracture on an X-ray fluoroscopy operating table. Confirm the Kirschner steel wire insertion site using an X-ray fluoroscope (image). First, a probe needle (usually a Denupo black cathelan needle is used)
Check the resistance of the bone hitting the needle tip by piercing the soft tissue of the skin with. When piercing the soft tissue, observe the blood vessels by piercing the blood vessels for regurgitation, and by piercing the nerves for radiation traces and reflexive muscle contraction. Repeat this operation around it and check the allowable range of the bone piercing point. Finally, determine the best skin penetration point, direction, and bone penetration point. Make a small incision in the skin and fascia at the point of insertion with a sharp knife. Push the Kirschner steel wire from the base end (the end without the tip) through the small incision hole and hit the target bone puncture part, and confirm the relative position of the bone and Kirschner steel wire in the image. A guide is externally inserted into the Kirschner steel wire from the tip, and the Kirschner steel wire is used as a guide to push the guide into contact with the bone. Then, the guide is pressed against the bone, and the tip of the guide is pierced into the bone and fixed, and the Kirschner steel wire inside is pulled out. A Kirschner steel wire that penetrates the bone is attached to a drill driver, and the tip of the wire is slid through the guide in the above-described fixed state, and the bone is pierced to perform rotational perforation.

6 to 9 show four types of treatment examples according to the state of the fractured part, and different examples of the insertion of the Kirschner steel wire are shown. In FIG. 6, the fracture line 12 runs obliquely with respect to the bone surface, and the two Kirschner steel wires 2 and 2 are fixed substantially parallel to each other by penetrating the fracture line 12. In FIG. 7, the fracture line 12 runs substantially at right angles to the bone surface, and two Kirschner steel wires 2 and 2 are crossed and the fracture line 12 is penetrated and fixed. In FIG. 8, a part of the bone is broken and the fracture line 12 does not reach the opposite bone surface, and one Kirschner steel wire 2 is penetrated and inserted from a direction substantially orthogonal to the fracture line 12. .
9 has a fracture line 12 similar to that of FIG. 7, but one long Kirschner steel wire 2 is inserted along the inside of the bone so as to be substantially orthogonal to the fracture line 12, and the Kirschner steel wire 2 of FIG. The tip is embedded in the bone and stopped.

Before inserting the Kirschner steel wire, it is necessary to reduce the fractured part. However, since a strong traction force is required for fractures of the extremities, a steel wire traction device for a bone extension for lower limbs as shown in FIG. Take advantage of 13. This steel wire traction device 13 for bone extension is made of aluminum through which an X-ray of an image can be transmitted, and a curved arch rod 15 is fixed to the tips of parallel supporting rods 14 and 14 having base ends connected to each other. At the same time, a steel wire 16 is stretched between the tips of the supporting rods 14, 14,
On the other hand, a screw shaft 18 is provided so as to be capable of advancing and retracting at the base end side connecting rod 17 of the supporting rods 14 and 14, and a horseshoe-shaped traction member 19 is provided at the tip thereof.
And a steel wire 20 is stretched between the ends of the pulling member 19. Then, the steel wires 16 and 20 are connected to the bone 21.
It is pulled through at a proper position, and is rotated by rotating the screw shaft 18 to be pulled and reduced.

Further, when the bone in the fractured state shown in FIG. 9 is reduced, even if it is pulled by using the above-mentioned pulling device 13,
The fracture part (fracture line 12) may be vertically displaced.
In that case, the reduction is performed by the method shown in FIG. That is, using the guide 1 for the bone 21 in the pulled state, for example, 3.0 mm
The Kirschner steel wire 2a is pierced until it penetrates the bone substance 10 (see (a)), and then the Kirschner steel wire 2a is pulled out leaving the guide 1 fixed, and then the tip of the Kirschner steel wire 2a is slightly bent to a 2.4 mm Kirschner. The steel wire 2b is inserted into the guide 1, and the tip of the Kirschner steel wire 2b is inserted into the bone marrow cavity 11 and stopped at the opposite side of the bone material 10 (see (b)). Then, the bent tip of the Kirschner steel wire 2b is pushed through the fractured portion into the bone marrow cavity 11 of the opposing bone fragment (see the solid line in (c)). Finally, the Kirschner steel wire 2b is slowly rotated to press the inner walls of the opposing bone fragments at the tip to reduce the fractures so that they are continuous (see the imaginary line in (c)). According to this method, the Kirschner steel wire 2 can not only fix the fractured part but also reduce the displacement.

[0028]

As described above, according to the guide for piercing a bone fracture-percutaneous steel wire of the present invention, a sharp metal tip of a guide made of a hard metal pipe is pierced and held in the bone substance, and a drill is drilled therein. By inserting and turning the Kirschner steel wire attached to the driver, the insertion point can be positioned accurately and the insertion direction can be fixed securely, and even if the Kirschner steel wire is thin, it does not bend, Moreover, since the Kirschner steel wire does not come into direct contact with the soft tissue of the skin, there is no risk of entraining blood vessels or nerves when the Kirschner steel wire rotates, which is safe and the application range of the percutaneous steel wire fixation method is expanded.

The guide cuts the tip of the hard metal pipe to form a cutting surface having an acute angle in a side view, and sharpens both sides of the cutting surface to sharpen a tapered edge in a plan view. Since it is a simple structure that is formed, it can be manufactured and provided at low cost, and the side view angle of the cut surface is set to about 30 ° ± 7 °, and the plan view angle of the tapered edge is set to about 78 °. ± 7
Set to °, the side view angle of the tapered edge is about 3
By setting the angle to 8 ° ± 7 °, it is possible to suppress slippage when piercing bone material and to insert with a small inclination angle equal to or less than that of the indirect method, especially Kirschner steel wire puncture for bone surface. By setting the cut end of the cutting surface formed at the tip of the insertion guide to be upward, the angle of inclination is minimized, the allowable penetration range of Kirschner steel wire is expanded, and Kirschner steel wire can be used even in fractures that could not be applied in the past. Can be fixed by.

[Brief description of drawings]

FIG. 1 shows a main part of a Kirschner steel wire insertion guide of the present invention, (a) is a side view of a tip portion thereof, and (b) is a plan view of the tip portion.

FIG. 2 shows a main part of a Kirschner steel wire, (a) is a side view of a tip portion thereof, and (b) is an end view seen from a tip end direction.

FIG. 3 is a partial cross-sectional view of a main part showing a state in which a Kirschner steel wire is inserted by the guide method of the present invention and a cut end of the guide is set upward.

FIG. 4 is a partial cross-sectional view of a main part showing a state in which a Kirschner steel wire is inserted by the guide method of the present invention and in which a cut end of the guide is set to a side direction.

FIG. 5 is a partial cross-sectional view of a main part showing a state in which a Kirschner steel wire is inserted by the guide method of the present invention, with a cut end of the guide set downward.

FIG. 6 is a simplified explanatory view showing a state in which a fractured part where the fractured line runs obliquely is fixed with Kirschner steel wire.

FIG. 7 is a simplified explanatory view of a state in which a fractured portion whose fracture line is substantially orthogonal to the bone surface is fixed by Kirschner steel wire.

FIG. 8 is a simplified explanatory view showing a state in which a fractured part in which a part of the bone is cut off is fixed with a Kirschner steel wire.

FIG. 9 is a simplified explanatory view showing a state in which a fractured portion whose fracture line is substantially orthogonal to the bone surface is fixed by a Kirschner steel wire embedded along the bone marrow cavity.

FIG. 10 is a perspective view showing a usage state of the steel wire traction device for bone extension.

[Fig. 11] Fig. 11 shows an example of use in which a vertically displaced bone fracture part is reduced and fixed by a Kirschner steel wire, (a) is a partial cross-sectional view of the main part showing a state in which the first Kirschner steel wire is inserted, (b) )
Is a partial cross-sectional view of the main part showing the state of inserting the second Kirschner steel wire with the tip bent, and (c) is the fracture by rotating the second Kirschner steel wire with the tip pushed into the bone marrow cavity of the opposite bone fragment. FIG. 6 is a partial cross-sectional view of a main part showing a state in which the misalignment of parts is reduced.

FIG. 12 is a partial cross-sectional view of an essential part showing a direct method of directly inserting a conventional Kirschner steel wire.

FIG. 13 is a partial cross-sectional view of a main part showing a conventional indirect method in which a Kirschner steel wire is inserted after a recess is cut and formed in a bone cortex.

[Explanation of symbols] 1 guide 2 Kirschner steel wire 3 cutting surface 4 taper edge 5 sharp point 6 bending point 7 rake surface 8 flank surface 9 cutting edge 10 bone quality 11 bone marrow cavity 12 fracture line 13 bone extension traction device 14 Support rod 15 Arch rod 16 Steel wire 17 Connecting rod 18 Spiral shaft 19 Traction member 20 Steel wire 21 Bone

Claims (4)

(57) [Claims] 1. A hard metal pipe having an inner diameter through which a Kirschner steel wire can penetrate and having a required length, and cutting a tip portion to form a sharp cut surface in a side view, and both end portions of the cut surface. A guide for inserting a percutaneous steel wire into a bone fracture, characterized by being sharpened to form an acute-angled tapered edge in a plan view. 2. The fracture-percutaneous steel wire insertion guide according to claim 1, wherein a hard metal pipe made of stainless steel or a bio-inert metal is used as the hard metal pipe. 3. A side view angle of the cut surface is about 30 ° ± 7.
The fracture-percutaneous steel wire insertion guide according to claim 1 or 2, wherein the tapered edge has a plan view angle of about 78 ° ± 7 °. 4. The fracture-percutaneous steel wire puncture guide according to claim 1, 2 or 3, wherein a side view angle of the tapered edge is set to about 38 ° ± 7 °.