JP4233462B2 - Guide pin positioning device - Google Patents

Description

  The present invention relates to a guide pin positioning device that is pre-used to guide insertion of an implant into bone.

In the treatment of fractures, a method for fixing a fracture part by inserting an osteosynthesis material such as a screw into the bone is an important fracture treatment technique.
For example, as a treatment method when the circumference of the neck of the femur is broken or cracked, an operation is generally performed in which the bone head and neck of the femur are fixed with an implant such as a compression hip screw. Yes. Prior to this operation, a guide pin for guiding the insertion of the implant into the bone is inserted from below the greater trochanter of the femur into the center of the head. Whether or not the guide pin is correctly inserted into the bone, and the insertion direction and position of the guide pin affect the fixing effect of the implant.

  Conventionally, as shown in FIG. 10, the guide pin 12 is inserted into the bone by a guide pin 17 between the handle portion 17 that applies the base 16 to the neck portion 33 of the femur 30, and the base portion 16 and the handle 17. This is done using a temporary fixing member 15 having a guide portion 18 provided at a predetermined angle to insert 12. That is, the base portion 16 of the temporary fixing member 15 is applied to the neck portion 33 below the greater trochanter 31 of the femur 30, the handle portion 17 is operated to determine the direction of the guide portion 18, and the guide pin 12 is moved to the guide portion 18. When the guide pin 12 is inserted into the femur 30 to a certain length, the insertion direction is confirmed by the front and rear images and side images of the X-ray fluoroscopic image, and when the appropriate direction is obtained, the guide pin 12 is inserted. It was finally inserted. Then, an osteosynthesis material is put in the direction determined by the guide pin to fix the fracture portion. That is, it is important to insert the guide pin into an appropriate position.

However, since the insertion portion of the guide pin has a distance from the bone head, there are many portions that depend on experience to determine from which position the guide pin can be inserted at an appropriate position. As a tool that can know in advance the insertion direction of this guide pin regardless of experience, a guide pin mounting portion to be mounted on a guide pin temporarily fixed in the direction of implant insertion, and two index pins in parallel with the guide pin The inventor of the present application has proposed a guide pin positioning tool having two index pin holding portions that hold the guide pin at a predetermined angle interval around the guide pin (see Patent Document 1).
JP 2003-339727 A

  The guide pin positioning device described in Patent Document 1 can know the insertion direction and position of the guide pin before actually inserting the guide pin into the bone, but the guide pin is inserted at an appropriate position. For this purpose, it is necessary to hold the guide pin positioning tool so that the index pin is maintained in the X-ray fluoroscopic image photographing direction around the guide pin. For this reason, it is difficult for a surgeon to operate a guide pin and a guide pin positioning tool alone to insert the guide pin, and it is troublesome because an assistant is required.

  Therefore, in order to solve the above problems, the present invention is a guide pin positioning device used in advance to guide insertion of an implant into a bone, and the guide is temporarily fixed in the direction of implant insertion. A guide pin mounting portion to be mounted on the pin; an index pin provided at a predetermined distance in a plane including the guide pin at the guide pin mounting portion; and a setting position of the index pin around the guide pin in the guide pin mounting portion A positioning device for a guide pin comprising a position setting member provided so as to be maintained constant is provided.

  According to the present invention, in the guide pin positioning device according to claim 1, the guide pin mounting portion is provided to be rotatable about the guide pin, and the position setting member includes a balance weight that balances the index pin. A guide pin positioning device is provided.

  According to a second aspect of the present invention, there is provided the guide pin positioning device according to claim 2, wherein the balance weight is provided so that the position of the balance weight can be adjusted with respect to the guide pin mounting portion.

  Further, the present invention provides the guide pin positioning device according to claim 3, wherein the balance weight includes a balance weight screwed to a balance weight support member provided in the guide pin mounting portion. A device is provided.

  The present invention also provides a guide pin positioning device according to any one of claims 1 to 4, wherein the index pin is positioned in a direction substantially perpendicular to the guide pin. is there.

  The present invention also provides a guide pin positioning device according to any one of claims 1 to 4, wherein the index pin is positioned in a substantially horizontal direction with respect to the guide pin. is there.

  Further, the present invention provides the guide pin positioning device according to any one of claims 1 to 4, wherein the index pin is provided in the guide pin mounting portion at a predetermined angle interval around the guide pin. A guide pin positioning device comprising a plurality of index pins is provided.

  According to the present invention, in the guide pin positioning device according to claim 7, one index pin is set in a substantially vertical direction with respect to the guide pin, and the other index pin is set in a substantially horizontal direction with respect to the guide pin. A guide pin positioning device positioned at the position is provided.

  Further, the present invention provides the guide pin positioning device according to any one of claims 1 to 8, wherein the guide pin mounting portion is provided with a fitting hole in which the guide pin is removably inserted and fitted from the longitudinal direction. A guide pin positioning device is provided.

  According to the present invention, in the guide pin positioning device according to any one of claims 1 to 8, the guide pin mounting portion is provided with a mounting portion that can be mounted from a side direction that intersects the guide pin in the longitudinal direction. A guide pin positioning device is provided.

  Further, the present invention provides a guide pin positioning device according to any one of claims 1 to 10, wherein the guide pin positioning device is provided so as to be movable in a plane including the index pin and the guide pin. To do.

  The guide pin positioning device according to any one of claims 1 to 11, wherein the guide pin mounting portion is provided with a temporary fixing member for temporarily fixing the guide pin. Is to provide.

  The guide pin positioning device according to the present invention is a guide pin positioning device used in advance to guide insertion of an implant into a bone, and the guide pin is temporarily fixed in the implant insertion direction. A guide pin mounting portion to be mounted on the guide pin, an index pin provided at a predetermined distance in a plane including the guide pin in the guide pin mounting portion, and a setting position of the index pin with the guide pin mounting portion centered on the guide pin. By having a configuration consisting of a position setting member provided so as to be maintained constant, the setting position of the index pin can be maintained constant around the guide pin without troublesome operations and assistance from an assistant. By observing with the X-ray fluoroscopic image from the set position direction of the index pin, the guide is provided by the index pin provided in the plane including the guide pin. It is possible to accurately indicate the insertion direction and position of the guide pin into the bone from the insertion direction and insertion position indicated by the index pin image that overlaps with each other, and appropriate and accurate surgery regardless of doctor's experience There is an effect that can be performed in a short time.

  According to the present invention, in the guide pin positioning device according to claim 1, the guide pin mounting portion is provided to be rotatable about the guide pin, and the position setting member includes a balance weight that balances the index pin. By having the configuration, the entire instrument can be rotated around the guide pin to balance the index pin and the balance weight, so that the index pin can be maintained by its own weight in the X-ray fluoroscopic image capturing direction.

  Further, the present invention provides a guide pin positioning device according to claim 2, wherein the balance weight is provided so that the position of the balance weight can be adjusted with respect to the guide pin mounting portion. There is an effect that the position of the weight can be adjusted to match the photographing direction of the X-ray fluoroscopic image.

  Further, the present invention provides the guide pin positioning device according to claim 3, wherein the balance weight includes a balance weight screwed to a balance weight support member provided at the guide pin mounting portion. Thus, by slightly rotating the balance weight with respect to the balance weight support member, the balance weight can be accurately positioned with respect to the guide pin mounting portion, and the setting position of the index pin is set in the X-ray fluoroscopic image shooting direction. There is an effect that can be surely matched.

  In the guide pin positioning device according to any one of claims 1 to 4, the present invention has a configuration in which the index pin is positioned in a substantially vertical direction with respect to the guide pin by a balance weight or the like. There is an effect that an X-ray fluoroscopic image can be taken from a substantially vertical direction with respect to the guide pin to know the insertion direction of the guide pin from the substantially vertical direction.

  In the guide pin positioning device according to any one of claims 1 to 4, the present invention has a configuration in which the index pin is positioned in a substantially horizontal direction with respect to the guide pin by a balance weight or the like. There is an effect that an X-ray fluoroscopic image can be taken from the substantially horizontal direction with respect to the guide pin, and the insertion direction of the guide pin from the substantially horizontal direction can be known.

  Further, the present invention provides the guide pin positioning device according to any one of claims 1 to 4, wherein the index pin is provided in the guide pin mounting portion at a predetermined angle interval around the guide pin. By using the X-ray fluoroscopic image from the two directions where the two index pins overlap the guide pins, the guide pins are overlapped with the guide pins from the insertion direction and the insertion position indicated by the image of the index pins. The insertion direction and position can be easily grasped in three dimensions in a state where the two index pins are inserted into the bone to an appropriate length before the guide pin is inserted into the bone.

  According to the present invention, in the guide pin positioning device according to claim 7, one index pin is set in a substantially vertical direction with respect to the guide pin, and the other index pin is set in a substantially horizontal direction with respect to the guide pin. By having a configuration set at the position, the X-ray fluoroscopic image is used to observe the guide pin from two directions, substantially vertical and horizontal, and the guide pin is inserted into the bone. There is an effect that the two index pins can be easily grasped in three dimensions in an image state in which the two index pins are inserted into bones at an appropriate length.

  Further, the present invention provides the guide pin positioning device according to any one of claims 1 to 8, wherein the guide pin mounting portion is provided with a fitting hole in which the guide pin is removably inserted and fitted from the longitudinal direction. By having the configuration as described above, there is an effect that the guide pin mounting portion can be fitted to the guide pin and the positioning device can be securely mounted on the guide pin.

  According to the present invention, in the guide pin positioning device according to any one of claims 1 to 8, the guide pin mounting portion is provided with a mounting portion that can be mounted from a side direction that intersects the guide pin in the longitudinal direction. By having the configuration, it is possible to attach and detach the guide pin mounting portion from the side direction of the guide pin. Therefore, there is an effect that the positioning device can be quickly attached to and detached from the guide pin.

  Further, the present invention provides a guide pin positioning device according to any one of claims 1 to 10, wherein the guide pin positioning tool is configured to be movable in a plane including the guide pin and the guide pin. There is an effect that the index pin can be moved to an appropriate position in accordance with the part where the pin is inserted or the body shape of the patient.

  The guide pin positioning device according to any one of claims 1 to 8, wherein the guide pin mounting portion is provided with a temporary fixing member for temporarily fixing the guide pin. Since the insertion angle of the guide pin mounted on the guide pin mounting portion can be determined and temporarily fixed by the temporary fixing member, the insertion angle of the guide pin can be easily corrected by the temporary fixing member to quickly determine the insertion direction. There is an effect that can.

Embodiments of the present invention will be described based on examples shown in the drawings.
In the embodiment shown in FIGS. 1 to 4, reference numeral 10 denotes an instrument body of a guide pin positioning device according to the present invention, a guide pin mounting portion 1 that is mounted on a guide pin 12 temporarily fixed toward an implant insertion direction, The indicator pins 2 and 3 provided at a predetermined distance in a plane including the guide pins 12 on the guide pin attaching portion 1 and the setting of the indicator pins 2 and 3 around the guide pins 12 on the guide pin attaching portion 1 The position setting member 11 is provided so as to keep the position constant.

A first embodiment shown in FIGS. 1 to 4 will be described.
As shown in FIGS. 7 to 9, the guide pin 12 guides insertion of the compression hip screw 19, which is an implant for fixing the fracture portion of the femur 30, into the bone.
In the embodiment of the present invention, as shown in FIG. 3 or FIG. 4, the guide pin 12 is inserted into the guide portion 18 of the temporary fixing member 15 so that the tip portion does not enter the bone, and the neck portion by the handle portion 17. The instrument main body 10 according to the present invention is used after being temporarily fixed to 33.

  1 to 4, the guide pin mounting portion 1 has a fitting hole 4 into which the guide pin 12 can be detachably fitted, and is rotatable around the guide pin 12. The instrument body 10 is configured to be rotatably mounted on the temporary fixing member 15 by mounting the guide pin mounting portion 1 on the guide pin 12 through the fitting hole 4.

In the embodiment shown in FIGS. 1 to 4, the vertical index pin 2 is formed of an elongated rod-like member that can be photographed by X-rays, and is separated from the body by a predetermined distance so as to be positioned substantially parallel to the guide pin 12 by the holding member 7. The guide pin mounting portion 1 is provided.
The horizontal index pin 3 is composed of an elongated rod-shaped member that can be photographed by X-rays, and is constituted by a holding member 8 provided in a direction opposite to the holding member 7 from the guide pin mounting portion 1 and a holding member 9 provided so as to cross the holding member 8. The guide pin mounting portion 1 is provided at a predetermined distance so as to be located outside the body substantially parallel to the guide pin 12. Further, when the vertical index pin 2 is positioned in the vertical plane with respect to the guide pin 12, the horizontal index pin 3 is provided so as to be positioned in the horizontal plane with respect to the guide pin 12.

  In the first embodiment, the guide pin mounting portion 1 mounted on the guide pin 12 is coaxial with the holding member 7 instead of the holding member in the arrow X direction orthogonal to the holding member 7 in the direction indicated by the arrow Y. By holding the horizontal indicator pin 3 by the holding member 8 and the holding member 9 intersecting with the holding member 8, the guide pin around the guide pin 12 inserted through the guide portion 18 of the temporary fixing member 15 in FIG. When the mounting portion 1 is rotated to set the vertical index pin 2 and the horizontal index pin 3 at predetermined positions, a handle portion 17 provided perpendicular to the base portion 16 of the temporary fixing member 15 is provided with the holding member 8. Therefore, it is possible to prevent the handle 17 and the holding members 8 and 9 from coming into contact with each other.

In the embodiment of FIGS. 1 to 4, the position setting member 11 includes a balance weight 13 provided on the balance weight support member 14 so as to be balanced with the vertical index pin 2 and the horizontal index pin 3.
The balance weight support member 14 is provided by extending the holding member 9 in the direction opposite to the horizontal index pin 3, and the balance weight 13 is centered around the guide pin mounting portion 1 mounted on the guide pin 12 and the vertical index pin 2 and the horizontal index pin 3. The indicator pin 3 is configured to be balanced. The balance weight 13 is screwed to the balance weight support member 14 so that the balance position can be adjusted by rotating the balance weight 13 with respect to the balance weight support member 14. For example, it can be adjusted so that it stops at a set position that matches the horizontal and vertical directions.
Of course, the balance weight 13 may be configured to be fixed to the balance weight support member 14 at a balanced position so that the vertical indicator pin 2 is positioned in the vertical direction with respect to the guide pin 12.

Further, as in the embodiment described in FIGS. 1 to 4, the guide pin mounting portion 1 is not limited to be detachably provided on the guide pin 12, and the guide portion 18 of the temporary fixing member 15 is, for example, shown in FIG. In FIG. 10, a pipe shaft is extended on the opposite side of the bone, and a guide pin mounting portion 1 is rotatably provided around the pipe, so that the main body 10 of the present invention and the temporary fixing member 15 are detachable or integrated. It can also be provided.
In the illustrated embodiment, the holding members 7 and 8 are not limited to being provided in a direction orthogonal to the guide pin 12, but can be provided in an oblique direction toward the insertion direction of the guide pin 12. .

Next, the operation of the guide pin positioning device according to the present invention will be described taking a femoral neck fracture as an example.
As shown in FIG. 3 or 4, the base portion 16 of the temporary fixing member 15 is applied to the bone neck portion 33 below the greater trochanter 31 of the femur 30, and the guide pin 12 is inserted into the guide portion 18 of the temporary fixing member 15. Then, the guide pin 12 is temporarily fixed by determining an insertion angle into the bone.

The guide pin positioning tool body 10 is mounted on the guide pin 12 by fitting the fitting hole 4 of the guide pin mounting portion 1 to the guide pin 12. The instrument body 10 is maintained at a position where the guide pin mounting portion 1 rotates around the guide pin 12 and the vertical index pin 2, the horizontal index pin 3, and the balance weight 13 are balanced. At this time, the balance weight 13 is rotated with respect to the balance weight support member 14 so that the vertical indicator pin 2 is positioned in a substantially vertical direction with respect to the guide pin 12 and the horizontal indicator pin 3 is substantially It can be adjusted to be positioned horizontally.
In this setting state, the guide pin 12 and the index pins 2 and 3 are set so as to overlap each other by photographing from the X-ray fluoroscopic direction in which the photographing angle is set in the substantially vertical direction and the substantially horizontal direction with respect to the guide pin 12. It is possible to shoot.
Of course, as shown in FIG. 3 or FIG. 4, the index pins 2 and 3 are mounted so as to appear in the X-ray fluoroscopic image together with the fracture portion of the femur 30.

Thereafter, the front and rear images taken from the vertical direction of the X-ray fluoroscopic image and the side images taken from the horizontal direction are confirmed, and adjustment is performed by the temporary fixing member 15 so that the insertion direction and position of the guide pins 12 are appropriate.
When the insertion direction and position of the guide pin 12 are appropriate, the insertion direction of the guide pin 12 is fixed by the temporary fixing member 15, and the guide pin positioning device body 10 is removed from the guide pin 12 as necessary, and is temporarily fixed. While being guided by the guide portion 18 of the member 15, the guide pin 12 can be inserted into the bone as much as necessary.

Thereafter, the temporary fixing member 15 is removed from the guide pin 12, and a hole is formed in the bone along the guide pin 12 using a drilling tool such as a drill or a reamer as shown in FIG. The lag screw 20 having a hole to be inserted is inserted into the bone from the greater trochanter 31 side toward the lesser trochanter 32 side while being screwed along the guide pin 12 by the screwing tool 21.
Furthermore, as shown in FIG. 8 or FIG. 9, the side plate 22 is attached to the rear end portion of the lag screw 20 with the connecting screw 24, and the side plate 22 is fixed to the femur 30 with the bolt 23, thereby Can be reinforced and fixed. Reference numeral 19 denotes a compression hip screw including a side plate 22 and a lag screw 20.
In the above embodiment, the guide pin 12 is inserted and positioned as an instrument for guiding the lag screw 20 of the compression hip screw 19 for the femoral neck fracture, but as is clear from the description, the femur Of course, it can be implemented as an insertion positioning device when inserting guide pins for guiding various implants to be used with respect to fractures at other sites, other bones, and other objects.

  As shown in FIG. 5A, the guide pin positioning device according to the present invention may be configured such that only the vertical indicator pin 2 and the position setting member 11 are provided on the guide pin mounting portion 1 via the holding member 7. Is possible. In the case of the embodiment shown in FIG. 5A, the position setting member 11 includes a balance weight support member 14 provided in the guide pin mounting portion 1 in a direction opposite to the holding member 7 and a balance weight fixed to the balance weight support member 14. 13

  Further, as shown in FIG. 5B, the guide pin positioning device according to the present invention may be configured without the vertical index pin 2 of the device body 10 shown in the first embodiment. In the illustrated embodiment, the configuration other than the vertical indicator pin 2 is the same as the configuration of the first embodiment. In the illustrated embodiment, the holding member 9 and the balance weight support member 14 can be directly provided on the guide pin mounting portion 1 without providing the holding member 8.

Further, the guide pin positioning device according to the present invention may be configured as shown in FIG.
The guide pin mounting portion 1 is formed in an inverted U-shaped cross section, and a mounting portion 5 that can be mounted on the guide pin 12 from the side direction intersecting the longitudinal direction is provided. The mounting portion 6 can rotate about the guide pin 12 as long as the guide pin mounting portion 1 does not fall off the guide pin 12. Of course, the guide pin mounting portion 1 may be provided with a drop-off prevention mechanism in which one of the opening ends extends downward and protrudes to the inside of the opening.

  As shown in FIG. 6, the holding member 7 is provided on the guide pin mounting portion 1 via the hinge connecting portion 6a, and the holding member 7 rotates in the YZ ′ plane around the hinge shaft 6d. It is. Further, the vertical indicator pin 2 is provided on the holding member 7 via the hinge connecting portion 6b, and the vertical indicator pin 2 rotates in the Y-Z ′ plane around the hinge shaft 6e. That is, the vertical index pin 2 is configured to be movable in a plane (Y-Z ′ plane) including the vertical index pin 2 and the guide pin 12.

The holding member 8 is provided so as to hang downward from the side surface of the guide pin mounting portion 1, and the holding member 8 is provided with a rotary shaft joint 6g. The lower side of the holding member 8 is the XZ ′ plane. It is designed to rotate around a rotation axis provided perpendicular to the axis. The horizontal indicator pin 3 is provided on a holding member 9 provided so as to cross the holding member 8 via a hinge connecting portion 6c, and the horizontal indicator pin 3 is located in the XZ ′ plane with the hinge shaft 6f as the center. Rotate with. That is, the horizontal index pin 3 is configured to be movable in a plane (XZ ′ plane) including the horizontal index pin 3 and the guide pin 12.
In the embodiment shown in FIG. 6, the configuration other than the above is the same as the configuration of the first embodiment.

The schematic perspective view which shows one Example of this invention instrument. The schematic front view which shows one Example of this invention instrument. The schematic explanatory drawing which shows the one use aspect. Schematic explanatory drawing which shows another use aspect. The schematic perspective view which shows the other Example of this invention instrument. The schematic perspective view which shows the other Example of this invention instrument. The schematic perspective view which shows the other Example of this invention instrument. Schematic explanatory drawing explaining the conventional treatment method after use of this invention instrument. Schematic explanatory drawing explaining the conventional treatment method regarding this invention instrument. Schematic explanatory drawing explaining the conventional treatment method regarding this invention instrument. Schematic explanatory drawing explaining the conventional treatment method regarding this invention instrument.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Guide pin mounting part 2 Vertical index pin 3 Horizontal index pin 4 Fitting hole 5 Mounting part 6a, 6b, 6c Hinge connection part 6d, 6e, 6f Hinge shaft 6g Rotary shaft coupling 7, 8, 9 Holding member 10 Instrument body 11 Position setting member 12 Guide pin 13 Balance weight 14 Balance weight support member 15 Temporary fixing member 16 Base portion 17 Handle portion 18 Guide portion 19 Compression hip screw 20 Lag screw 21 Screwing tool 22 Side plate 23 Bolt 30 Femur 31 Greater trochanter 32 Little trochanter 33 Neck

Claims (11)

A guide pin positioning device for positioning a guide pin used in advance to guide insertion of an implant into a bone by an X-ray fluoroscopic image, the guide pin being mounted on a guide pin temporarily fixed toward an implant insertion direction A pin mounting portion, an index pin provided at a predetermined distance in a plane including the guide pin in the guide pin mounting portion, and a setting position of the index pin around the guide pin in the guide pin mounting portion . A position setting member provided so as to be maintained in the photographing direction, and the guide pin mounting portion is provided so as to be rotatable about the guide pin, and the position setting member includes a balance weight that balances the index pin. Positioning instrument. The guide pin positioning device according to claim 1 , wherein the balance weight is provided so that the position of the balance weight can be adjusted with respect to the guide pin mounting portion. 3. The guide pin positioning device according to claim 2 , wherein the balance weight is formed by a balance weight screwed to a balance weight support member provided at the guide pin mounting portion. 4. The guide pin positioning device according to claim 1 , wherein the index pin is positioned in a substantially vertical direction with respect to the guide pin. 4. The guide pin positioning device according to claim 1 , wherein the index pin is positioned in a substantially horizontal direction with respect to the guide pin. The guide pin positioning device according to any one of claims 1 to 3 , wherein the index pin is composed of two index pins provided at a predetermined angle interval around the guide pin on the guide pin mounting portion. Pin positioning tool. 7. The guide pin positioning device according to claim 6 , wherein one index pin is positioned in a substantially vertical direction with respect to the guide pin, and the other index pin is positioned in a substantially horizontal direction with respect to the guide pin. Positioning equipment. The guide pin positioning device according to any one of claims 1 to 7 , wherein the guide pin mounting portion is provided with a fitting hole in which the guide pin is removably inserted and fitted from the longitudinal direction. Instruments. The guide pin positioning device according to any one of claims 1 to 7 , wherein the guide pin mounting portion is provided with a mounting portion that can be mounted from a side direction intersecting the longitudinal direction of the guide pin. 10. A guide pin positioning device according to claim 1 , wherein the index pin is movably provided within a plane including the index pin and the guide pin. 11. The guide pin positioning device according to claim 1 , wherein a temporary fixing member for temporarily fixing the guide pin is provided on the guide pin mounting portion.

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