JP3370300B2 - Transplant ligament fixation device - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an anterior / posterior cruciate ligament reconstruction operation, which is typified by a knee joint anterior / posterior cruciate ligament reconstruction operation, and which consists of a tendon or fascia in an operation of anchoring a transplanted ligament composed of a tendon or fascia, etc. The present invention relates to a fixing device for easily and reliably fixing a transplant ligament.

[0002]

2. Description of the Related Art In recent years, when a ligament is ruptured or damaged beyond repair, a surgery for replacing the ligament with a ligament composed of tendons or fascia is widely performed. The method of fixing the graft ligament differs depending on whether the graft ligament is short and the end of the graft ligament does not extend from the bone hole and when the graft ligament is long and the end of the graft ligament extends from the bone hole. (1) When the graft ligament is short and the end of the graft ligament does not come out of the bone hole, the thread sewn to the end of the graft ligament is sewn to a screw screwed into the adjacent bone or fixed on the button. It (2) When the graft ligament is long and the end of the graft ligament extends from the bone hole, it is fixed by a washer with a staple or spike and a screw.

[0003]

However, in the case of (1),
It is difficult to adjust the tension applied to the graft ligament, and when the thread is sutured or ligated on the screw or button under high tension, the thread is torn or loosened. In the case of (2), the thickness of the ligament graft and the fixing device overlap, the protrusion to the skin is remarkable, which often causes pain. Also, since the ligament graft is damaged due to the use of the above-mentioned device, the fixing strength varies. It was easy.

Therefore, an object of the present invention is to solve the above problems and to more easily and firmly fix the end of the graft ligament to the bone while applying an arbitrary tension regardless of the length of the graft ligament. It is intended to provide a device that can be used.

[0005]

[Means for Solving the Problems] What achieves the above object is an instrument for fixing a graft ligament for fixing a graft ligament having a length not protruding from one end of a bone tunnel formed at a site to be grafted to bone. The fixing device is formed on the main body, one end of the main body, a ligation hole for ligating a thread sewn to the end of the graft ligament, and the other end of the main body. A through hole for fixing the tensioning thread, a spike for temporarily fixing the fixing device protruding from one surface of the main body part to a bone, and the fixing device formed on the main body part Is a device for fixing a graft ligament, which has a screw fixing hole for fixing a bone to a bone. Further, it is preferable that two spikes are provided at positions on both sides of the main body. Further, it is preferable that the two spikes are formed on the other end side of the main body, are parallel to each other, and are substantially perpendicular to the main body. Further, it is preferable that the through hole for fixing the tension applying thread is arranged at or near the center of the two spikes. The screw fixing hole is preferably provided between the ligation hole and the through hole. Furthermore, it is preferable that the screw fixing hole includes a screw head housing portion of the screw.

Further, what achieves the above-mentioned object is an instrument for fixing a graft ligament, which has a length protruding from one end of a bone tunnel formed in a site to be transplanted, which can penetrate a thread sewn to the end of the graft ligament. And a screw fixing hole forming portion having a screw fixing hole for fixing the fixing device to bone, and a flat plate portion formed so as to be closer to the bone tunnel than the screw fixing hole forming portion. A plurality of ligament penetrating spikes that project substantially perpendicularly from the flat plate portion, and the fixing device that is formed on the peripheral portion of the flat plate portion and that projects substantially parallel and in the same direction as the ligament penetrating spikes. A device for fixing a graft ligament, comprising: a temporary fixing spike for temporarily fixing the same. Further, the screw fixing hole forming portion and the flat plate portion may be bent at an arbitrary angle.
Further, the screw fixing hole forming portion and the flat plate portion may be on substantially the same plane. Further, the temporary fixing spikes are provided at positions on both side edges of the flat plate portion.
It is preferable that a book is provided. Further, the temporary fixing spike is preferably longer than the ligament penetrating spike. Furthermore, it is preferable that the screw fixing hole includes a screw head housing portion of the screw.

[0007]

BEST MODE FOR CARRYING OUT THE INVENTION An instrument for fixing a ligament graft according to the present invention will be described with reference to an embodiment shown in the drawings. FIG. 1 is a surface view of a device for fixing a graft ligament according to an embodiment of the present invention, FIG. 2 is a side view of the device for fixing a transplant ligament in FIG. 1, and FIG. 3 is A- of a device for fixing a transplant ligament in FIG. It is an A line sectional view.

The device 1 for fixing a graft ligament of the present invention is a device for fixing a graft ligament for fixing a graft ligament having a length not protruding from one end of a bone tunnel formed at a site to be transplanted to bone. The fixing device 1 is formed on the main body 2, a ligation hole 5 formed on one end side of the main body 2, for ligating a thread sewn to the end of the graft ligament, and the other end side of the main body 2. A through hole 7 for fixing the tensioning thread, spikes 8a, 8b for temporarily fixing a fixing device protruding from one surface of the main body 2 to the bone, and formed and fixed in the main body 2 Instrument 1
Has a screw fixing hole 6 for fixing to the bone.

The main body 2 is formed in a substantially flat plate shape, and has a ligation hole 5 on one end side (which becomes the bone tunnel side when in use).
Is formed, and the through holes 7 for fixing the spikes 8a and 8b and the tension applying thread are formed on the other end side.
A screw fixing hole 6 is formed between the ligation hole 5 and the through hole 7. As the size of the graft ligament fixing device 1, the thickness is 1 to 3 mm, the total length is 18 to 30 mm, the width at one end side (ligation hole forming portion) is 6 to 8 mm, the length is 6 to 8 mm, and the screw fixing hole is used. The width of the forming portion and the end portion of the through hole forming portion is 8 to 15
It is about mm.

The shape of the device 1 for fixing the graft ligament may be any shape as long as it does not damage the skin tissue, the muscle tissue, the inner wall of the bone hole, etc. when passing through the living body.
It is preferable that it has a rounded shape as shown in FIG.
For the same reason as described above, the shape of the edge of the device 1 for fixing the graft ligament is preferably a rounded shape so as not to damage the inside of the bone hole and the like.

Any material can be used as the material for the device 1 for fixing the graft ligament, as long as it has a certain level of strength and biocompatibility. For example, stainless steel (specifically, JISG43
04 SUS304, SUS316, etc.), pure titanium (specifically JISH4670), titanium alloy (specifically JISH4657 Ti-6Al-4V, AS).
TM F-136 Ti-6Al-4V ELI) or the like is used.

The ligation hole 5 is a portion for ligating the suture thread attached to the end of the graft ligament. Therefore, the shape of the ligation hole 5 is preferably such that the suture thread is not easily damaged when a high tension is applied by applying the suture thread to the ligation hole 5. For example, a circular shape, an elliptical shape, etc. may be mentioned, but a circular shape as shown in FIG. 1 is particularly preferable. Further, the edge of the ligation hole 5 is also preferably shaped so as not to easily damage the suture thread, and is preferably rounded as shown in FIG. Regarding the size of the ligation hole 5, when the shape of the ligation hole 5 is circular, the diameter is about 2 to 4 mm, more preferably 3 m.
It is preferably m.

The spikes 8a and 8b are provided so that the two spikes 8a and 8b are parallel to each other at both ends of the main body 2 and substantially perpendicular to the main body 2. By arranging the spikes in this way, the graft ligament fixation device 1 is stably fixed to the bone. The spikes 8a and 8b are for temporarily fixing the graft ligament fixing device 1 in a state in which an arbitrary tension is applied to the graft ligament, and as shown in FIGS. It is configured. Spike 8
The length of a and 8b is preferably about 5 to 10 mm. Note that the number of spikes may be two or more, or conversely, one, as long as the device 1 for fixing the graft ligament can be easily fixed.

The tip portion 81 preferably has a pointed tip so that it can be easily pierced into a bone. For example, a cone, a triangular pyramid, a quadrangular pyramid and the like can be mentioned, and a cone is particularly preferable. In the case of a cone, the tip angle of the cone is preferably 45 to 75 °. The tip 81 has a diameter of 2 to 3
mm, preferably 2.5 mm, length 2-4 m
m, preferably 3 mm.

The shape of the base end portion 82 is, for example, a cylinder,
Trigonal prisms, square prisms, etc. are preferable, and in particular, the ligation hole side of the base end portion 82 is preferably flat as shown in FIG. 1 so as not to be easily removed from the bone by the force from the pulling side. As for the size of the base end portion 82, in the case of a column, the diameter is preferably 2 to 4 mm and the length is preferably about 5 to 10 mm.

The shape of the spike does not have to be composed of the distal end portion and the proximal end portion as described above,
The diameter may be continuously reduced from the base end to the tip of the spike.

The spikes 8a and 8b may be made of any material as long as they have a certain degree of strength and biocompatibility. For example, stainless steel (specifically, stainless steel)
JISG4304 SUS304, SUS316, etc.), pure titanium (specifically JISH4670), titanium alloy (specifically JISH4657 Ti-6A).
1-4V, ASTM F-136 Ti-6Al-4V
ELI) and the like are used. Also spikes 8a, 8b
As long as a certain degree of strength can be maintained at the connecting portion of the implant ligament fixation device 1 main body portion, they may be made integrally or separately. As a method of connection when they are manufactured separately, soldering and fitting can be mentioned.

The through hole 7 is a portion for fixing a suture thread for applying and maintaining arbitrary tension to the end of the ligament graft. The through hole is
It is located at or near the center of the two spikes. The shape of the through hole 7 is preferably rounded for the same reason as described for the ligation hole 5, and particularly preferably circular as shown in FIG. The edge of the through hole 7 is also preferably rounded for the same reason as the edge of the ligation hole 5. When the shape of the through hole 7 is circular, the diameter thereof is preferably 2 to 4 mm, more preferably 3 mm.

The screw fixing hole 6 is a portion for finally fixing the graft ligament fixing device 1. Screw fixing hole 6
Is provided between the ligation hole 5 and the through hole 7. The screw fixing hole 6 includes a screw head housing portion that houses the screw head without the screw head of the screw 90 protruding from the main body of the fixing device 1. The shape of the screw fixing hole 6 is a screw 9
Since it is fixed using 0, it is preferably circular. Further, as shown in FIG. 3, it is preferable to process the screw fixing hole 6 into a screw head shape. By doing so, when fixing the graft ligament fixation device 1 with the screw 90, the screw head does not protrude from the main body of the fixation device 1, and therefore the skin tissue or the like due to the protrusion of the screw head Damage can be prevented. The size of the screw fixing hole 6 is preferably 3 to 8 mm in diameter, more preferably 4 to 7 mm, and the size of the shape of the screw head is preferably 5 to 9 mm, particularly 7 mm.

The ligation hole 5 of the device 1 for fixing the ligament graft,
The screw fixing hole 6, the through hole 7, and the spikes 8a and 8b are shown in FIG.
It is preferable that they are arranged on the same plane as shown in FIG. Since the present invention is to be fixed on the surface of bone, it is preferable that the structure does not protrude into the skin. Further, it is preferable that the ligation hole 5 and the through hole 7 are arranged in a straight line so that an arbitrary force can be accurately applied to the graft ligament.

Next, an instrument for fixing a graft ligament according to another embodiment of the present invention will be described with reference to the embodiment shown in the drawings. Figure 4
6 is a front view of the device for fixing a ligament graft according to another embodiment of the present invention, FIG. 5 is a side view of the device for fixing a ligament graft according to FIG. 4, and FIG.
[Fig. 5] is a cross-sectional view taken along line BB of the device for fixing the ligament graft in Fig. 4.

The graft ligament fixing device 10 is a fixing device for fixing a graft ligament having a length sufficient to project from one end of a bone tunnel formed at a site to be grafted. This fixing device 10 is capable of penetrating a thread sewn to the end of a ligament for transplantation, and a screw fixing hole forming portion 12 having a screw fixing hole 15 for fixing the fixing device to bone, and a screw fixing The flat plate portion 11 formed so as to be closer to the bone tunnel than the use hole forming portion, a plurality of ligament penetrating spikes 13 protruding substantially vertically from the flat plate portion 11, and formed on the peripheral portion of the flat plate portion 11, It is provided with temporary fixing spikes 14a and 14b for temporarily fixing the fixing device protruding substantially in the same direction as the ligament penetrating spike in the same direction to the bone.

The instrument 1 for fixing the graft ligament according to this embodiment.
At 0, the portion between the screw fixing hole forming portion 12 and the flat plate portion 11 is bent at an arbitrary angle along the shape of the bone. In particular,
Angle between the screw fixing hole forming portion 12 and the flat plate portion 11 (θ1)
Is about 45 °. The angle (θ1) between the screw fixing hole forming portion 12 and the flat plate portion 11 is 0 to 60 °, for example, 30 to 30, though it varies depending on the shape of the portion of the bone to be fixed.
60 ° is preferred. Also, when expressed by the interior angle (θ2), 1
About 00 to 180 °, preferably 110 to 160 °,
Particularly preferably, it is 110 to 150 °. By doing so, the end of the graft ligament can be fixed by the spikes 13, 14a, 14b inside the bone hole.
Therefore, when fixing the end of the graft ligament to the surface of the bone, it is possible to prevent pain caused by the overlapping thickness of the graft ligament and the fixing device.

The shape of the device 10 for fixing the graft ligament is as follows.
Any material may be used as long as it does not damage the skin tissue, the muscle tissue, the inner wall of the bone hole, etc. when passing through and fixing in the living body, for example, it has a rounded shape as shown in FIGS. It is preferable. As described above, the shape of the edge of the device 10 for fixing the ligament graft is preferably a rounded shape so as not to damage the inside of the bone hole and the like.

Regarding the size of the device 10 for fixing the ligament graft, the thickness is 1 to 3 mm and the width of the flat plate portion 11 is 6 to 10 m.
m, the length is 6 to 10 mm, the width of the screw fixing hole forming portion 12 is preferably 9 to 13 mm, and the length is preferably about 8 to 12 mm.

As the material of the device 10 for fixing the ligament graft,
Any material that has a certain level of strength and biocompatibility, such as stainless steel (specifically, JISG4
304 SUS304, SUS316, etc.), pure titanium (specifically JISH4670), titanium alloy (specifically JISH4657 Ti-6Al-4V, AS)
TM F-136 Ti-6Al-4V ELI) or the like is used. In particular, a titanium alloy such as Ti-6Al-4V is preferable.

The plurality of ligament penetrating spikes 13 are provided so as to project substantially vertically from the flat plate portion 11. Further, as described above, in the graft ligament fixing device 10, since the screw fixing hole forming portion 12 and the flat plate portion 11 are bent at an arbitrary angle along the shape of the bone, the ligament penetrating spikes 13 and Temporary fixing spikes 14a, 14b described later
Is also inclined at the same angle with respect to the surface of the screw fixing hole forming portion 12.

The ligament penetrating spike 13 penetrates the end of the graft ligament and serves to fix the graft ligament to the bone in cooperation with the flat plate portion 11. As shown in FIGS. It is composed of a base end portion 132. Further, the ligament penetrating spike 13 has a diameter smaller than that of temporary fixing spikes 14a and 14b which will be described later so as to easily penetrate the graft ligament.

The tip portion 131 preferably has a sharp tip so that it can be easily pierced into a ligament and a bone. For example, a cone, a triangular pyramid and the like can be mentioned, and a cone is particularly preferable. Tip 1
As the size of 31, an outer diameter of 1 to 2 mm, preferably,
It is 1.1 to 1.4 mm, and the length is 6 to 10 mm, preferably 7 to 9 mm. Further, the shape of the base end portion 132 is preferably, for example, a cylinder, a quadrangular prism, a triangular prism or the like. As for the size of the base end portion 132, in the case of a cylinder, the diameter is 1 to
2 mm and a length of about 8 to 15 mm are suitable. Also,
Many of the spikes 13 for penetrating the ligaments have a relatively small diameter, and in this embodiment, seven are provided, and the number of the spikes 13 is small, and the number of the spikes 13 is small to make the fixation of the graft ligament more reliable. The number of the ligament penetrating spikes 13 is preferably about 5 to 15, more preferably about 7 to 11. Further, as the arrangement of the plurality of ligament penetrating spikes 13, it is preferable that the plurality of ligament penetrating spikes 13 are arranged radially so that the force is uniformly applied to the end of the transplanted ligament.

The temporary fixing spikes 14a and 14b are for temporarily fixing the fixing device 10 to the bone.
As shown in FIG. 6, it is composed of a front end portion 141 and a base end portion 142, respectively. The tip portion 141 preferably has a pointed tip so that it can be easily pierced into a bone. For example, a cone, a triangular pyramid and the like can be mentioned, and a cone is particularly preferable. In the case of a cone, the tip angle of the cone is preferably 45 to 75 °. As the size of the tip portion 141, the diameter is 1 to 3
mm, and a length of about 1 to 3 mm are suitable. Proximal end 14
The shape of 2 is preferably, for example, a cylinder, a quadrangular prism, a triangular prism, or the like. As the size of the base end portion 142, in the case of a cylinder,
The diameter is preferably 1 to 3 mm and the length is preferably 8 to 15 mm. Further, similarly to the spikes 8a and 8b of the ligament fixation instrument 1 described above, the portion on the bone tunnel side may be flat. Temporary fixing spikes 14a, 14b
Is longer than the ligament penetrating spike 13, and is preferably about 1 to 5 mm, and particularly 1 to 3 mm.
It is preferable that the length is about mm. Further, the temporary fixing spikes 14a and 14b are provided near the center in the longitudinal direction of the graft ligament fixing device 10, and the ligament penetrating spike 13 is on one end side (tip side) of the graft ligament fixing device 10. It is provided so as to be located on one end side (tip side) with respect to the temporary fixing spikes 14a and 14b.

The arrangement of the spikes 14a and 14b is as follows.
Any arrangement is possible as long as the device 10 for fixing the graft ligament is stably fixed and does not obstruct the course of the screw when the device 10 for fixing the transplant ligament is fixed by the screw fixing hole 15. Well, for example, as shown in FIG. 4, it is preferable that the flat plate portion 11 is arranged near both ends in the longitudinal direction.

The spikes 13, 14a, 14b may be made of any material as long as they have a certain level of strength and biocompatibility. For example, stainless steel (specifically, JI
SG4304 SUS304, SUS316, etc.), pure titanium (specifically JISH4670), titanium alloy (specifically JISH4657 Ti-6Al-4).
V, ASTM F-136 Ti-6Al-4V EL
I) or the like is used. In particular, a titanium alloy such as Ti-6Al-4V is preferable.

The spikes 13, 14a and 14b are
It may be manufactured integrally with the flat plate portion 11 or separately. As a connecting method in the case where they are manufactured separately, soldering, fitting, etc. may be mentioned.

The screw fixing hole 15 is sewn to the end of the graft ligament and penetrates a thread for maintaining an arbitrary tension on the graft ligament, and finally fixes the fixing device 10 after temporary fixing. It is for fixing the screw 91 for.
The screw fixing hole 15 preferably has a circular shape so that the screw 91 can be passed therethrough. Further, as shown in FIG. 6, the screw fixing hole 15 preferably has a shape capable of accommodating the screw head. By doing so, when the fixing device 10 is fixed with the screw 91, the screw head does not project from the fixing device main body. Therefore, damage to the inside of the skin due to the protrusion of the screw head can be prevented. Further, as shown in FIG. 4, the edge of the screw fixing hole 15 is preferably rounded so that the suture thread sewn to the end of the graft ligament is not easily damaged. The size of the screw fixing hole 15 is 3 to 8 mm in diameter, more preferably 4 to 7 mm,
The size of the screw head is 5 to 9 mm in diameter, especially 7 m
m is preferred.

Next, a device for fixing a ligament graft according to another embodiment of the present invention will be described with reference to the drawings. FIG. 7 is a surface view of a device for fixing a graft ligament according to another embodiment of the present invention, FIG. 8 is a side view of the device for fixing a graft ligament in FIG. 7, and FIG. 9 is C of a device for fixing a graft ligament in FIG. It is a -C line sectional view. This graft ligament fixing device 20 is also similar to the graft ligament fixing device 10 described above.
It is a fixing instrument for fixing a graft ligament having a length protruding from one end of a bone tunnel formed in a transplant target site.

The fixing device 20 is capable of penetrating the thread sewn to the end of the ligament for transplantation and has a screw fixing hole forming portion 22 having a screw fixing hole 15 for fixing the fixing device to bone. A flat plate portion 21 formed to be closer to the bone tunnel than the screw fixing hole forming portion, a plurality of ligament penetrating spikes 13 protruding substantially perpendicularly from the flat plate portion 21, and formed on the peripheral portion of the flat plate portion 21. In addition, it is provided with temporary fixing spikes 14a and 14b for temporarily fixing the fixing device protruding in the same direction and substantially parallel to the ligament penetrating spike to the bone.

This fixing device 20 and the fixing device 1 described above
The difference from 0 is that in the device 20 for fixing the graft ligament of this embodiment, the space between the screw fixing hole forming portion 22 and the flat plate portion 21 is substantially linear, and the screw is used like the fixing device 10 described above. It is only that the fixing hole forming portion 22 and the flat plate portion 21 are not bent, and the same portions are denoted by the same reference numerals and the description thereof will be omitted. Since the screw fixing hole forming portion 22 and the flat plate portion 21 are not bent, the ligament penetrating spike 13 and the temporary fixing spikes 14a and 14b are also substantially perpendicular to the surface of the screw fixing hole forming portion 22. Has become.

The devices 1 and 10 for fixing the graft ligament of the present invention are mainly used for anterior / posterior cruciate ligament reconstruction of the knee joint. The patient is placed in a supine position under general anesthesia, and the knee joint is bent at 75-80 ° using a lower limb holding device to hang the lower leg or lower part. The skin incision is a vertical incision of 3-4 cm inside the tibial rough surface. A graft ligament composed of four hamstring tendons is prepared by any of the following methods. The semitendinosus tendon is attached to the tibia and the semitendinosus tendon is collected with a tendon exfoliator. The collected semitendinosus tendon is folded into four to prepare a graft ligament 30 having a diameter of 7 to 9 mm and a length of 6 cm or more, and sutures are sewn to both ends (short graft ligament). Moreover, the semitendinosus tendon and the tibial tendon attachment part of the tendon are cut off together, and the semitendinosus tendon and sarcomatoma are respectively collected by a tendon peeler, and both tendons are folded in two and the diameter is 7 to 9 mm, and the length is 9 mm. A graft ligament 50 of 8 cm or more is prepared, and sutures are sewn to both ends (long graft ligament).

As shown in FIGS. 10 and 11, from the medial side of the tibial rough surface 31, 51 to the central portion 32, 52 of the tibial attachment of the anterior cruciate ligament.
Using a guide, the tibia bone holes 33, 53 with a diameter of 7-9 mm
Through the tibial holes 33, 53 to the anterior cruciate ligament femoral attachment parts 34, 54 to the lateral femoral cortex 35, 55 of the femur.
The femoral bone holes 36 and 56 having a diameter of 7 to 9 mm are made toward the. Sutures 39, 5 sewn to the graft ligament ends 37, 57
9 is guided from the tibial bone holes 33 and 53 into the joint and then to the femoral outer bone cortex 35 via the femoral bone holes 36 and 56. After drawing the graft ligament ends 37, 57 into the femoral bone holes 36, 56 by at least 1.5 cm or more, the femoral lateral bone cortex 3
Ligament 3 for transplant using buttons 42, 62, etc. on 5, 55
Fixation on the femur side of 0 and 50 is performed by the pull-out method.

When the graft ligament is the short graft ligament described above, the graft ligament fixing device 1 is used. 1 and FIG.
0, a suture 40 sewn to the end 38 of the graft ligament
Is sutured to the ligation hole 5. Next, a suture thread is applied to the through hole 7 to apply an arbitrary tension, and the spike 8 is held while maintaining this tension.
Drive a and 8b. Finally, screw 90 into the screw fixing hole 6.
Screw in and fix it finally. When the graft ligament is the long graft ligament described above, as shown in FIGS. 4 and 11, the suture thread sewn to the graft ligament end 58 is divided into two parts and an arbitrary tension is applied. While maintaining this tension, spikes 13 and 14
Drive a and 14b in a direction perpendicular to the ligament graft. After that, the screw 91 is screwed into the screw fixing hole 15 and finally fixed.

Next, the medial collateral ligament reconstruction method using the graft ligament fixing device 20 will be described. Place the patient in the supine position under general anesthesia and use the lower limb holding device to move the knee joint to 75-
Bend 80 ° and hang down below the lower leg. The skin incision is a vertical incision of 9 to 11 cm inside the knee joint. The semitendinosus tendon is collected with a tendon peeler and folded in half to have a diameter of 5 to 7 mm and a length of 1
A graft ligament 70 of 2 cm or more is prepared, and sutures are sewn on both ends. From the medial side collateral ligament attachment part 71 of the femur, a drill hole 73 having a diameter of 5 to 7 mm is drilled toward the lateral femoral cortex 72, and the tip 74 of the transplanted ligament is drawn into the drill hole 73 by 1.5 to 2.5 cm, and sutured. The thread 75 is withdrawn over the lateral femoral cortex 72 and pull-out secured using the button 76.

Then, as shown in FIGS. 7 and 12,
Arbitrary tension is applied to the suture thread sewn to the end 77 of the graft ligament. While maintaining this tension, spikes 13, 14a, 1
4b is driven in a direction perpendicular to the graft ligament. After that, the screw 91 is screwed into the screw fixing hole 15 and finally fixed. The device 20 for fixing the graft ligament is used by appropriately bending it according to the shape of the bone. In addition, this operation method uses pull-out on the tibia side.
The method may use the device 20 for fixing the ligament graft on the femur side.

Next, the ligament graft fixation device 100 of the embodiment shown in FIGS. 13 to 15 will be described. The basic configuration is the same as that shown and described in FIGS.
The only difference is the size and the peripheral shape of the screw fixing hole 6. The peripheral edge of the screw fixing hole 6 is tapered so that the diameter thereof decreases in the tip direction of the spike. Two of the graft ligament fixation devices 100 are driven in the vicinity of the open end of the tibial bone hole 33, and thus are smaller than the above-described graft ligament fixation device 1. Regarding the size of the ligament graft fixation device 100, the thickness is 1 to 3 mm, the total length is 8 to 18 mm, preferably 9 to 13 mm, and the width on one end side (ligation hole forming portion) is 3 to.
The length is 7 mm, the length is 3 to 6 mm, and the widths of the screw fixing hole forming portion and the through hole forming portion end portions are about 6 to 10 mm.

Next, a method of using the graft ligament fixation device 100 will be described. The device 100 for fixing the graft ligament is mainly used for reconstruction of the anterior and posterior cruciate ligaments of the knee joint. Place the patient in the supine position under general anesthesia and use the lower limb holding device to move the knee joint 75
Bend at -80 ° and hang below the lower leg. The skin incision is a vertical incision of 3-4 cm inside the tibial rough surface. A graft ligament composed of four hamstring tendons is prepared by any of the following methods. The semitendinosus tendon is attached to the tibia and the semitendinosus tendon is collected with a tendon exfoliator. The collected semitendinosus tendon is divided into two, each of which is folded into four to prepare two graft ligaments 30a and 30b having a diameter of 4 to 7 mm and a length of 6 cm or more, and sutures are sewn to both ends (short. Transplant ligament).

As shown in FIG. 16, a tibial hole 33 having a diameter of 7 to 9 mm is drilled from the medial side 31 of the tibia to the anterior cruciate ligament central portion 32 of the tibial attachment part, and the anterior cruciate ligament is passed through the tibial hole 33. Two femoral bone holes 36a and 36b having a diameter of 4 to 7 mm are formed from the femoral bone attachment portions 34a and 34b toward the outer femoral bone cortex 35a and 35b. The sutures 39a and 39b sewn to the graft ligament ends 37a and 37b are guided into the joint from the tibial bone hole 33 to introduce the femoral bone holes 36a and 36b.
It is guided to the femoral lateral bone cortex 35a, 35b via b.
After pulling the graft ligament ends 37a, 37b into the femoral bone holes 36a, 36b for at least 1.5 cm or more, the femurs of the graft ligaments 30a, 30b using the buttons 42a, 42b and the like on the lateral femoral cortex 35a, 35b. Side fixed pu
The ll-out method is used. As shown in FIG. 14, sutures 40a, 40b sewn to the ligament graft ends 38a, 38b.
Are sewn to the ligation holes 5a and 5b of the respective ligament fixation devices 100a and 100b. Then through holes 7a, 7b
Apply a tension to the suture and apply a desired tension, and drive the spike while maintaining this tension. Finally, screw fixing holes 6a, 6
The screw 93 is screwed into b and finally fixed.

[0046]

The instrument for fixing a graft ligament of the present invention is a device for fixing a graft ligament for fixing to a bone a graft ligament having a length not protruding from one end of a bone tunnel formed in a site to be transplanted, The fixing device includes a main body portion, a ligation hole formed on one end side of the main body portion for ligating a thread sewn to the end of the ligament graft, and a ligation hole formed on the other end side of the main body portion. A through hole for fixing the application thread, a spike for temporarily fixing the fixing device protruding from one surface of the main body portion to the bone, and a spike formed on the main body portion for fixing the fixing device to the bone. And a screw fixing hole for fixing to.

Therefore, when fixing a short graft ligament end whose end is not exposed from the bone hole, the suture thread sewn to the graft ligament end is ligated to the ligation hole, and the through hole is used for applying tension. By fixing the thread and pulling this tensioning thread, it is possible to apply arbitrary tension to the graft ligament, and
In this state, it can be easily temporarily fixed to the bone by hitting the fixing device, and then the final fixing can be performed using the screw. For this reason, the end of the transplanted ligament can be firmly fixed to the bone more easily and in a short period of time with any tension applied to the transplanted ligament.

Further, the device for fixing a graft ligament of the present invention is a device for fixing a graft ligament having a length protruding from one end of a bone tunnel formed in a site to be transplanted, and a thread sewn to the end of the graft ligament is used. A screw fixing hole forming portion having a screw fixing hole for fixing the fixing device to bone, and a flat plate formed so as to be closer to the bone tunnel than the screw fixing hole forming portion Section, a plurality of ligament penetrating spikes that project substantially vertically from the flat plate section, and the fixing device that is formed on the peripheral edge of the flat plate section and that projects substantially parallel to and in the same direction as the ligament penetrating spikes. And a temporary fixing spike for temporarily fixing the bone to the bone.

Therefore, when fixing a long graft ligament end whose end is exposed from the bone hole, an arbitrary tension is applied to the graft ligament by pulling the suture thread sewn to the graft ligament end. And, in this state, it can be easily temporarily fixed to the bone by hitting the fixing device,
After that, the final fixing can be done with screws. For this reason, the end of the transplanted ligament can be firmly fixed to the bone more easily and in a short period of time with any tension applied to the transplanted ligament. Furthermore, the graft ligament end can be fixed inside the bone hole, and when the graft ligament end is fixed on the surface of the bone, the thickness of the graft ligament end and the fixing device, that is, the pain caused by the significant protrusion Can be prevented.

[Brief description of drawings]

FIG. 1 is a front view of an instrument for fixing a graft ligament according to an embodiment of the present invention.

2 is a side view of the ligament fixation device of FIG. 1. FIG.

FIG. 3 is a cross-sectional view taken along the line AA of the device for fixing the ligament graft in FIG. 1.

FIG. 4 is a surface view of an implantable ligament fixation device according to another embodiment of the present invention.

5 is a side view of the ligament graft fixation device of FIG. 4. FIG.

FIG. 6 is a cross-sectional view taken along line BB of the device for fixing the graft ligament of FIG.

FIG. 7 is a surface view of an implantable ligament fixation device according to another embodiment of the present invention.

8 is a side view of the ligament graft fixation device of FIG. 7. FIG.

9 is a cross-sectional view taken along the line CC of the ligament graft fixation device of FIG. 7.

FIG. 10 is an explanatory view for explaining the action of the device for fixing a ligament graft according to the embodiment of the present invention.

FIG. 11 is an explanatory view for explaining the action of the device for fixing a graft ligament according to another embodiment of the present invention.

FIG. 12 is an explanatory view for explaining the action of the device for fixing a ligament graft according to another embodiment of the present invention.

FIG. 13 is a front view of a device for fixing a graft ligament according to another embodiment of the present invention.

FIG. 14 is a side view of the ligament fixation device of FIG.

FIG. 15 is a view of the device for fixing the ligament graft shown in FIG.
It is a -D line sectional view.

FIG. 16 is an explanatory view for explaining the action of the device for fixing a ligament graft according to the embodiment of the present invention.

[Explanation of symbols]

1,10,20,100 Implantation ligament fixation device 5 ligation holes 6,15 Screw fixing hole 7 through holes 8a, 8b, 13, 14a, 14b spikes

Claims (9)

(57) [Claims] 1. A ligament graft fixing device for fixing to a bone a graft ligament having a length that does not protrude from one end of a bone tunnel formed in a site to be grafted, the fixing device comprising a main body portion, A ligation hole formed on one end side of the main body portion for ligating a thread sewn to the end of the graft ligament, and a through hole formed on the other end side of the main body portion for fixing a tensioning thread. A spike for temporarily fixing the fixing device to the bone, which protrudes from one surface on the other end side of the main body portion, and between the ligation hole and the through hole, which is formed in the main body portion. Set up
The vignetting was the fixing device and a screw fixing hole for fixing to the bone, the spike, the both side ends of the main body portion position
2 are provided for fixing the tension applying thread.
The through hole is for the center of the two spikes or its
A device for fixing a graft ligament, which is characterized by being arranged in the vicinity . Wherein said two spikes are parallel to one another, and the claim has become almost perpendicular to the body portion 1
The device for fixing a transplanted ligament according to. 3. The device for fixing a ligament for transplantation according to claim 1, wherein the screw fixing hole is provided with a screw head accommodating portion for the screw. 4. The edge portion of the ligation hole is rounded.
The device for fixing a graft ligament according to claim 1. 5. The instrument for fixing a graft ligament according to claim 1, wherein an edge of the through hole is rounded . 6. A device for fixing a ligament graft, which has a length protruding from one end of a bone tunnel formed at a site to be transplanted,
A thread fixing hole forming part that is capable of penetrating a thread sewn to the end of the graft ligament and has a screw fixing hole for fixing the fixing device to bone, and a bone tunnel from the screw fixing hole forming part. A flat plate portion formed to be on the side, a plurality of ligament penetrating spikes that project substantially perpendicularly from the flat plate portion, and a peripheral portion of the flat plate portion that is substantially parallel to the ligament penetrating spike and A temporary fixing spike for temporarily fixing the fixing device protruding in the same direction to the bone, and further, the screw fixing hole forming portion and the flat plate portion
It is bent, and the screw fixing hole forming part and the flat part are
The internal angle between the plates is 110-160 °
Instrument for fixation of transplanted ligaments. 7. The device for fixing a ligament for transplantation according to claim 6 , wherein two temporary fixing spikes are provided at positions on both sides of the flat plate portion. Wherein said temporary fixing spikes claimed has become longer than the ligament penetrating spikes claim 6 or 7
The device for fixing a transplanted ligament according to. 9. The device for fixing a graft ligament according to claim 6 , wherein the screw fixing hole is provided with a screw head accommodating portion for the screw.