JP3129929U - Lamina plate opener - Google Patents

Abstract

The present invention provides a medical instrument for expanding a lamina for inserting a spacer in laminoplasty.
A lamina vertebral expander (1) includes a main body part (2), a pistol grip (8) attached to the main body part, a movable gripping part (7) that rotates around a rotation axis fixed to the main body part, A fixed shaft 3 fixed to the main body, and a movable shaft that is connected to the main body by a connecting member A5 and connected to the movable gripping part and a connecting member B6, and is movable relative to the fixed shaft in conjunction with the movable gripping part. 4 and the movable gripper is operated to move the distal end of the movable shaft away from the fixed shaft while moving backward, and the gap between the distal end of the movable shaft and the distal end of the fixed shaft is widened. It is characterized by.
[Selection] Figure 2

Description

  The present invention relates to a medical instrument for expanding a lamina to insert a spacer composed of an artificial bone or the like in laminoplasty.

Cervical spinal stenosis (hereinafter referred to as cervical spondylosis) is a condition in which the opening for the spinal cord that extends through the spine of the spinal column is not wide enough to accept the spinal cord, and is associated with ligament hypertrophy and cervical stenosis. Persons with some kind of bulging of the intervertebral disc feel pressure on the spinal cord, causing symptoms such as head and neck pain, weakness, and sluggish arms and legs.
Among cervical spondylosis surgery, laminoplasty is a technique in which the posterior part of the spine is exposed and changes its shape instead of removing bone tissue. This opens the vertebral fora to form a wider space for the spinal cord.

For example, a part of the lamina is cut and a spacer made of an artificial bone made of hydroxyapatite is inserted between the cut ends of the lamina to open the lamina more widely. There is a method of maintaining the new shape as well as the new shape.
In this method, only a minimal skin incision of about 2 to 3 cm is required, and the physical burden on the patient is small, and the mental burden on the patient is reduced after the operation, thereby enabling a minimally invasive treatment.
An object of the present invention is to provide a medical instrument capable of expanding a lamina to insert a spacer composed of an artificial bone or the like in laminoplasty.

  Here, a spinal disc space distracter that expands a cutting portion of a lamina by grasping a grasping portion is conventionally known as a lamina dilator (Patent Document 1). This is a distractor for separating adjacent elements, such as vertebrae, and has a distraction mechanism in the form of a double-acting scissor.

  Further, as an opener, one in which a part of the tip slides in the front-rear direction by grasping a gripping part is known (Patent Document 2). This is a multiple bite bone forceps with an ultra-thin footplate with a monolithic storage chamber and a cutting element that can be replaced, etc., slidable with respect to the shaft terminating in the footplate A carrier member having a near end and a far end opposite to the near end and an open interior, and an opening communicating with the open interior of the near end, and a foot plate and a bone or cartilage cut piece in contact with each other A hollow member having an open end having a cutting edge to perform, a storage region for collecting and storing bone or cartilage cut pieces, and wherein the shaft is slidable relative to the carrier member without passing through the hollow member; And a drive mechanism that provides reciprocal motion of the member and shaft relative to each other.

  Also known as openers are rod pushers for biasing orthopedic or spinal rods into recesses or seats in orthopedic devices such as implants, connecting elements, pedicle screw devices, etc. (Patent Document 3). The device includes a body that is removably attachable to the orthopedic device, a pusher member, and a trigger that slidably couples the pusher member to the body.

  Further, as a member to be inserted in order to enlarge the cutting portion of the lamina and maintain the interval, the spacing means configured to be engaged between the cut ends of the lamina, and the interval A device for dynamically stabilizing a laminoplasty after laminoplasty comprising a holding means attached to the take-off means and shaped to hold the spacing means in an operative position is known. (Patent Document 4).

JP-T-2002-526147 JP 2004-321832 A JP-T-2005-523069 Japanese National Patent Publication No. 11-512314

The conventional opener has a problem in that it is not suitable for expanding the cutting portion of the lamino disc in order to insert the spacer in laminoplasty.
That is, in order to aim at a minimally invasive treatment, in order to perform a minimum skin incision, the insertion angle and operating range of the dilator with respect to the lamina are limited, and it is necessary to cope with it.
This will be described in more detail with reference to FIG. FIG. 1 shows, as an example, a method for inserting a spacer in laminoplasty.

  FIG. 1 (a) shows a range in which the skin at the back of the cervical vertebra is incised in order to insert a spacer in laminoplasty. FIGS. 1B to 1E show views of the cross section of the cervical lamina from the overhead. FIG. 1B schematically shows a state in which a part of the lamina is cut by approaching from an incision in the skin. In FIG.1 (b), the broken line part has shown the cutting location. In FIG. 1 (c), the bone 12 forming the posterior part of the vertebral foramen is curved outward to open the vertebral foramen, and the gap (between 12 and 13) of the cut portion of the lamina 1 is widened. . Then, as shown in FIG. 1 (d), the spacer 15 is inserted so as to engage between the cut ends of the lamina, and the lamina is opened more widely as shown in FIG. 1 (e). And the new shape is retained to form a wider space for the spinal cord.

However, what is disclosed in the above-mentioned patent document 1 is that the blade part can be attached to and detached from the tip part so that different blades can be used depending on the patient and the situation. It operates. For this reason, a dilator inserted through the opening is not suitable for spreading the cut portion of the lamina.
Moreover, what is indicated by the said patent document 2 is a thing for which a shaft moves back and forth, and is not suitable for expanding the cutting part of a lamina.
Furthermore, what is disclosed in the above-mentioned Patent Document 3 is that the distal end portion biases the rod, and is not appropriate for expanding the cut portion of the lamina.
As described above, in the conventional opener, in order to insert the spacer in the laminoplasty as described above, it is difficult to perform an action of widening the gap between the cut portions of the larch.

  In view of the above-described problems, an object of the present invention is to provide a medical instrument for expanding a lamina safely and surely without damaging nerves because a spacer is inserted in laminoplasty.

  In order to achieve the above-mentioned object, a laminoplasty device of the present invention includes a main body, a pistol grip attached to the main body, and a movable gripping portion that rotates around a rotation shaft fixed to the main body. And a fixed shaft fixed to the main body, and connected to the main body by the connecting member A and connected by the movable gripping part and the connecting member B, and movable relative to the fixed shaft in conjunction with the movable gripping part. The tip of the movable shaft moves away from the fixed shaft while moving backward by operating the movable gripper, and the gap between the tip of the movable shaft and the tip of the fixed shaft is widened. It is characterized by that.

With the above configuration, the tip of the movable shaft is moved away from the fixed shaft while moving backward by operating the movable gripping portion (the tip of the movable shaft is raised), and fixed to the tip of the movable shaft. The gap at the tip of the shaft is widened. Therefore, when the movable gripping portion is operated by inserting the distal end portion of the movable shaft or the distal end portion of the fixed shaft into the cutting portion of the lamina, the following operation is performed.
First, the distal end portion of the movable shaft moves backward to engage with the bone inside the cut portion of the lamina. Next, the movable shaft is detached from the fixed shaft, and the gap between the distal end portion of the movable shaft and the distal end portion of the fixed shaft is widened, thereby widening the gap between the cut portions of the lamina. By maintaining the position of the movable gripping portion, the gap state of the cut portion of the lamina is maintained.
By the operation as described above, the gap state of the cut portion of the lamino disc for inserting the spacer in laminoplasty is created.
The pistol grip is used effectively with one hand.

Here, it is preferable that the tip of the movable shaft is formed in a hook shape or a spatula shape. Moreover, it is preferable that the front-end | tip part of the said fixed shaft is formed in the hook shape or the spatula shape. The saddle shape as used in the present invention refers to a state in which the tip of the shaft is bent and expanded in order to hook the end of the cut portion of the lamina. The spatula shape refers to a state in which the tip of the shaft is long and flat, and the tip is shaped like a blade.
The reason why the distal end portion of the shaft is formed in a hook shape or a spatula shape is to ensure that it can be locked to the bone inside the cut portion of the lamina. Another reason is to obtain an effect of preventing slipping when the shaft moves backward.

Further, it is more preferable that the shape of the movable gripping portion is formed in an annular shape or an inverted U shape.
This is because, in combination with the pistol grip, it can be used effectively with one hand. That is, by forming the shape of the movable gripping portion in an annular shape or an inverted U shape, it can be operated by hooking an index finger. In particular, by forming the shape of the movable gripping portion in an inverted U shape, it is possible to smoothly attach and detach the finger even when wearing surgical gloves.

In the laminoplasty device according to the present invention, in order to insert a spacer in laminoplasty, the tip of the inserted shaft is expanded while moving backward, so that the laryngeal plate can be removed without damaging the nerve. It has the effect that it can be surely opened.
In addition, the structure has an effect that the lamina can be safely and reliably expanded without damaging the nerve even under the minimum skin incision.
Furthermore, even when a surgical glove is worn, the lamina can be reliably opened with one hand.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

The larch plate opening device of Example 1 shows one embodiment of the larch plate opening device of the present invention, and a schematic configuration diagram thereof is shown in FIG.
As shown in FIG. 2, the lamino-disc dilator 1 according to the first embodiment includes a main body 2, a pistol grip 8 attached to the main body 2, and a rotation shaft 2 a fixed to the main body 2. The movable gripping portion 7 that rotates about the center, the fixed shaft 3 fixed to the main body portion 2, the main body portion 2 and the connecting member A (5) are connected, and the movable gripping portion 7 and the connecting member B (6) are connected. The movable shaft 4 is connected and movable relative to the fixed shaft 3 in conjunction with the movable gripping portion 7.
By operating the movable gripping portion 7, the distal end portion 4 a of the movable shaft 4 moves away from the fixed shaft 3 while moving backward, and the gap between the distal end portion 4 a of the movable shaft 4 and the distal end portion 3 a of the fixed shaft 3 is widened.

  This will be described in more detail. The movable gripping portion 7 is configured to rotate around a rotating shaft 2 a fixed to the main body portion 2. Moreover, the movable holding part 7 is connected with the movable shaft 4 by the connection member B (6). More specifically, the columnar protrusions 7c of the movable gripping portion 7 are connected by being locked in holes provided in the connecting member B (6).

In FIG. 2, when the pistol grip 8 is gripped and a finger is placed on the movable gripper 7 and pulled forward (when the movable gripper 7 is moved to the right when viewed from the front of FIG. 2), the movable gripper 7 Rotates counterclockwise about the rotating shaft 2a. At the same time, the connecting member B (6) receives a force on the right side as seen from the drawing by the action of the protrusion 7c of the movable gripping portion 7, and shifts the movable shaft 4 to the right. The distal end portion 4a of the movable shaft 4 moves backward.
Moreover, the movable shaft 4 is connected with the main-body part 2 by the connection member A (5). More specifically, the columnar protrusions 5a provided on the connecting member A (5) are connected by being engaged with holes 4d provided on the plate-like body 4b existing at the center of the movable shaft 4. .
Therefore, when the movable shaft 4 is shifted to the right as viewed from the drawing, the connecting member A (5) rotates clockwise around the rotation shaft 5b fixed to the main body 2. As a result, the movable shaft 4 is detached from the fixed shaft 3.

  FIG. 3 is a diagram for explaining the operation of the movable shaft. FIGS. 3A to 3C show a state in which the distal end portion 4a of the movable shaft 4 expands while moving backward. As shown in FIG. 3A, the fixed shaft 3 and the movable shaft 4 are initially in contact with each other. The position of the front end portion 4a is located at the leftmost end when viewed from the front of the figure. Further, the columnar protrusion 5 a provided on the connecting member A (5) is located on the rightmost side of the hole 4 d provided on the plate-like body 4 b of the movable shaft 4. As described above, by operating the movable gripping portion 7 (moving to the right when viewed from the front in FIG. 2), the variable shaft 4 shifts to the right.

As a result, as shown in FIG. 3B, the columnar protrusion 5 a provided on the connecting member A (5) is located on the leftmost side of the hole 4 d provided on the plate-like body 4 b of the movable shaft 4. 3 (c), the connecting member A (5) rotates clockwise around the rotation shaft 5b fixed to the main body (not shown) as shown in FIG. .
As a result, the movable shaft 4 is detached from the fixed shaft 3 as shown in FIG.

  Further, the torsion springs (9a, 9b) serve as a brake for preventing the return when the movable shaft moves backward.

  As can be seen from the above description, by the operation of the movable gripping portion 7, the distal end portion 4a of the movable shaft 4 is detached from the fixed shaft 3 while moving backward, and the distal end portion 4a of the movable shaft 4 and the distal end portion 3a of the fixed shaft 3 are removed. This gap is widened.

Next, the usage method of the lamina deployment apparatus of Example 1 is demonstrated using FIGS. 4-1 to 4-3.
FIG. 4-1 is a diagram for explaining a cut portion of a lamina. FIG. 4B and FIG. 4C are diagrams for explaining a method of using the lamina magnifying device of the first embodiment.
First, the lamina 1 is cut at two locations (31, 32). Although the part shown by the code | symbol 33 in a figure does not cut | disconnect, the hole is provided so that a bone may bend easily.
Next, as shown in FIG. 4B, the distal end portion 4a of the movable shaft 4 of the lamina plate expander 1 is inserted into the cut portion 31, and the spatula-like distal end portion 4a is engaged with the inner surface of the lamina 1. The distal end 3a of the fixed shaft 3 is locked to the outer surface of the lamina 1.
Then, as shown in FIG. 4C, after the distal end portion 4 a of the movable shaft 4 moves backward and engages with the bone inside the cutting portion 31 of the lamina 1, the movable shaft 4 is detached from the fixed shaft 3. The gap between the distal end portion 4a of the movable shaft and the distal end portion 3a of the fixed shaft is widened, so that the gap between the cut portions 31 of the lamina is widened. As a repetitive explanation, the spatula is formed so that it can be securely locked to the bone inside the cut portion of the lamina.

  Moreover, in Example 1, the shape of the movable holding part 7 is formed in reverse U shape (7a-7d). Combined with the pistol grip, it can be used effectively with one hand, and fingers can be attached and detached smoothly even when wearing surgical gloves.

The larch plate opener of the second embodiment shows another embodiment of the larch plate expander of the present invention, and a schematic configuration diagram thereof is shown in FIG.
As shown in FIG. 5, the lamina disc dilator 1 according to the second embodiment is movable around a main body, a grip 28 attached to the main body, and a rotation shaft fixed to the main body. The grip part 27, the fixed shaft 23 fixed to the main body part, the main body part 2 and the connecting member A (25) are connected, and the movable grip part 27 and the connecting member B (26) are connected to each other. The movable shaft 24 is movable with respect to the fixed shaft 23 in conjunction with the movement.
By operating the movable gripping portion 27, the distal end portion 24a of the movable shaft 24 moves away from the fixed shaft 23 while moving backward (or away from the distance), and the distal end portion 24a of the movable shaft 24 and the distal end portion 23a of the fixed shaft 23 are separated. The gap is enlarged.

  As another embodiment, the position of the rotary shaft 2a fixed to the main body 2 which is the rotation center of the movable gripping portion 7 is arranged above the movable shaft 4 in the first embodiment. Is to be placed. In this case, the movable shaft 4 can be moved backward and opened by pushing the movable gripping portion 7 not to the front but to the back.

  According to the laminoplasty device of the present invention, it can be used as a medical instrument in laminoplasty.

Illustration of a method for inserting a spacer in laminoplasty Schematic block diagram of the laminoplasty device of Example 1 Illustration of the operation of the movable shaft Explanatory drawing of the cut part of the lamina Use explanatory drawing (1) of the lamina deployment device of Example 1 Use explanatory drawing (2) of the lamina magnifying device of Example 1 Schematic configuration diagram of the laminoplasty device of Example 2

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Larch open device of this invention 2 Main-body part 3 Fixed shaft 4 Movable shaft 5 Connecting member A
6 Connecting member B
7 Movable gripping part 8 Pistol grip 10 Lamina 15 Spacer

Claims (4)

  A main body, a pistol grip attached to the main body, a movable gripping part that rotates about a rotation shaft fixed to the main body, a fixed shaft fixed to the main body, and the main body And a movable shaft connected to the movable gripper and connected to the movable gripper by a connecting member B, and movable relative to the fixed shaft in conjunction with the movable gripper. Accordingly, the distal end portion of the movable shaft moves away from the fixed shaft while moving backward, and the gap between the distal end portion of the movable shaft and the distal end portion of the fixed shaft is widened.   2. The laminoplasty expander according to claim 1, wherein a tip end portion of the movable shaft is formed in a hook shape or a spatula shape.   2. The laminoplasty expander according to claim 1, wherein the distal end portion of the fixed shaft is formed in a hook shape or a spatula shape.   4. The laminoplasty dilator according to claim 1, wherein the movable gripping portion is formed in an annular shape or an inverted U shape.