JP4810698B1 - Pedicle insertion instrument guide device - Google Patents

Abstract

[PROBLEMS] To stabilize a guide device without damaging bone tissue of a pedicle and to insert a pedicle insertion device such as a pedicle screw into a pedicle, and to accurately insert the insertion position and the insertion angle. There is provided a pedicle insertion instrument guide device that can be guided to a pedicle.
A fixed indicator needle, a movable indicator needle that sets and adjusts a separation distance of 2W between the fixed indicator needle, and a separation distance of 2W between the movable indicator needle and the fixed indicator needle are positioned at an intermediate point. The insertion angle of the pedicle insertion instrument is maintained by sliding while maintaining the circular arc state with respect to the insertion position of the pedicle indicated by the reference pointing pin 30 and the fixation indicating needle 10 in which the link mechanism 40 is assembled. an insertion guide portion 60 for setting and adjusting θ, and by aligning the reference line positioning pin 30 with the position of the spinous process, the insertion position and the insertion angle θ of the pedicle insertion instrument with respect to the spinous process are guided. It is the pedicle insertion instrument guide device 1 made as described above.
[Selection] Figure 1

Description

The present invention relates to a pedicle insertion instrument guide device that guides insertion of a pedicle insertion instrument such as a pedicle screw into a pedicle.
Such a device is, for example, a guide device that plays a role of guiding an insertion position and an insertion angle of a pedicle screw when the pedicle screw is inserted into the pedicle in a lumbar posterior approach interbody fusion (PLIF). Can be used as

  As a technique for guiding a drilling instrument for drilling a pilot hole in surgery or the like for inserting a pedicle screw into a pedicle, JP 2009-261485 A (Patent Document 1) conventionally discloses a drilling instrument guide device and a drilling tool. An apparatus is disclosed. Japanese Patent Application Laid-Open No. 5-123335 (Patent Document 2) discloses a technique capable of setting the direction, position, and depth of excavation of a hemispherical reamer as a surgical device for artificial joint replacement.

  Japanese Patent Laid-Open No. 11-290337 (Patent Document 3) describes guide wire insertion assistance for the purpose of reliably directing the insertion of a guide wire for embedment of a screw into a vertebra in spinal fusion. A guide wire stab comprising a stereotaxic part for placing the implement on the pedicle and a lead part for guiding the puncture direction of the guidewire, which is disposed in a predetermined relative positional relationship with the stereotactic part. An entry aid is disclosed.

JP 2009-261485 A JP-A-5-123335 JP-A-11-290337 Japanese Patent No. 4231540

  In the apparatus disclosed in Patent Document 1, the caliper pin 18 is provided in addition to the reference pin 3 in the apparatus shown in FIG. It is possible to set to a predetermined dimension. However, between the pins 3 and 8, there is no reference line indicating section that can indicate the intermediate point between the pins 3 and 8. For this reason, the task of matching the midpoint between the reference pin 3 and the caliper pin 18 with the spinous process is due to the amount of scale, and there is a problem of lack of accuracy. In other words, there is a problem that the midpoint of the pair of pins 3 and 18 cannot be accurately matched with the position of the spinous process.

  On the other hand, the surgical device for artificial joint replacement disclosed in Patent Document 2 is an apparatus for excavating a hemispherical hole at a predetermined position of the acetabulum, and the excavation center position of the excavation hemispherical reamer and the excavation axis ( The excavation angle) can be set. However, it is not intended to align the reference line with the spinous process, nor is it a guide device for inserting a pedicle insertion instrument such as a pedicle screw into the pedicle.

  In addition, the guide wire insertion aid disclosed in Patent Document 3 cannot be visually observed in the guide wire entry path, and the entry direction cannot be specified, so that it is difficult to reliably pass through the atlantoaxial joint. In view of this, the guide wire penetrates the vertebral joint and is inserted in the appropriate direction of the vertebra, and the spinal fixation by embedding the screw can be performed easily and quickly without depending on the skill level and intuition of the operator. Is.

  However, in the case of the guide wire insertion aid of Patent Document 3, as shown in FIG. 1 of Patent Document 3, since the lead portion 4 connected to the connecting portion 3 is fixed, it is guided by the lead portion 4. The adjustment of the insertion position of the guide wire and the adjustment of the insertion angle cannot be easily performed. Further, in the guide wire insertion assisting device of Patent Document 3, the distal end of the stereotaxic part is placed on the pedicle and shallowly inserted to avoid slipping on the bone, so that the bone tissue of the pedicle is somewhat reduced. There was a possibility of damage.

  Further, the perforating instrument guide device disclosed in Patent Document 4 is a device for guiding a perforating instrument that forms a prepared hole for embedding a pedicle screw in a pedicle, and the front of the vertebra is viewed from the posterior side of the spine. A reference pin that is stabbed in the direction and an arm body that extends laterally from the base end side of the reference pin. The arm body has a guide hole that opens toward the tip end position of the reference pin and guides the drilling device. A plurality of guide holes are formed in a radial pattern around the tip position of the reference pin.

However, in the case of the perforating instrument guide device of Patent Document 4, the tip of the reference pin has a length that reaches the pedicle base, and the guide hole opens toward the tip of the reference pin. Therefore, in use, first, the tip position of the reference pin is inserted to the target point in the bone, and then inserted into the guide hole through the drilling device until it contacts the tip position of the reference pin. Although the puncture angle and puncture depth of the piercing device can be accurately guided and the accuracy and safety are greatly improved, there is a problem that the bone tissue of the pedicle is damaged by the reference pin.
Further, in the case of the perforating instrument guide device of Patent Document 4, since a plurality of guide holes are formed radially around the tip position of the reference pin, the insertion angle of the perforating instrument is adjusted only in stages due to the structure. There is a problem that it is difficult to finely adjust the insertion angle of the drilling device.

  Therefore, the present invention solves the above-mentioned conventional problems, and guides a device without damaging the bone tissue of the pedicle in the operation of inserting a pedicle insertion instrument such as a pedicle screw into the pedicle. It is an object of the present invention to provide a pedicle insertion instrument guide device that can stabilize the insertion position and more accurately guide the insertion position and the insertion angle, and can easily and reliably adjust the position and the angle of the insertion position and the insertion angle.

  A pedicle insertion instrument guide device according to the present invention for solving the above-mentioned problems is a pedicle insertion instrument guide apparatus for guiding insertion of an instrument to be inserted into a pedicle, comprising: a fixation indicator needle; and the fixation indicator needle; A movable indicator needle that sets and adjusts the separation distance of the movable reference needle, a reference line positioning pin that is assembled with a link mechanism so as to be positioned at an intermediate point of the separation distance between the movable indicator needle and the fixed indicator needle, and the fixed indicator needle An insertion guide for setting and adjusting the insertion angle of the pedicle insertion instrument by maintaining an arc state with respect to the insertion position of the pedicle indicated by A guide device that does not damage the bone tissue by placing the reference line positioning pin on the point, aligning the reference pin with the position of the spinous process, and bringing the distal ends of both the fixed indicator needle and the movable indicator needle into contact with the bone tissue of the pedicle Stabilize itself, relative to the spinous process It is the first feature that was to guide the insertion position and insertion angle of the pedicle insertion instrument.

  Further, in the pedicle insertion instrument guide device of the present invention, in addition to the first feature described above, the link mechanism of the reference line positioning pin is provided with a pair of link arms having the same dimensions, and the pair of link arms is common. The second feature is that the reference line positioning pin is attached to one node, and the remaining one node of each link arm is linked to the fixed indicating needle side and the movable indicating needle side.

  In addition to the first or second feature, the pedicle insertion instrument guide device of the present invention is a plane in which the reference line positioning pin is formed by a pair of a fixed indicating needle and a movable indicating needle. The third characteristic is that the direction is perpendicular to the direction.

  Further, in the pedicle insertion instrument guide device of the present invention, in addition to any of the first to third features, the fixation indicating needle is fixed to the origin position of a distance ruler having a scale indicating a separation distance. The fourth feature is that the movable indicating needle is fixed to a movable block that is slidable along the distance ruler.

  Further, in the pedicle insertion instrument guide device of the present invention, in addition to the fourth feature, the fixation indicator needle is fixed to a distance ruler via a fixation block, and the side of the fixation block on which the fixation indication needle is located. The fifth feature is that an operating grip is provided on the opposite side to the above.

  Further, in the pedicle insertion instrument guide device of the present invention, in addition to any of the first to fifth features, the insertion guide portion is along the scale of the angle ruler provided with a scale indicating an insertion angle. A sixth feature is that it is slidably attached to the provided arcuate attachment hole.

  Further, in the pedicle insertion instrument guide device according to the present invention, in addition to the sixth feature, the angle ruler is in a state where the axial direction of the guide groove of the insertion guide portion is always directed to the distal end of the fixation indicating needle. A seventh feature is that an arcuate mounting hole is formed so as to be slidable.

  In addition to the above sixth feature, the pedicle insertion instrument guide device of the present invention has an arcuate mounting so that the center of the arc is the tip of the fixed indicator needle in the arcuate mounting hole of the angle ruler. The eighth feature is that a hole is formed.

  In addition to the sixth feature, the pedicle insertion instrument guide device of the present invention is configured such that the angle ruler and the distance ruler are integrally formed, and the fixation block of the fixation indicator needle has a scale of the distance ruler zero. A ninth feature is that the angle ruler is fixed at a position and the scale of the angle ruler indicates the angle between the fixing indicator needle and the insertion guide portion.

  In addition to the sixth feature, the pedicle insertion instrument guide device of the present invention has a tenth feature in that the scale of the angle ruler is provided on both sides.

  Further, in the pedicle insertion instrument guide device according to the present invention, in addition to any of the first to fifth features, the insertion guide portion is removably attached to one having a different guide groove size or shape. This is the eleventh feature.

  The pedicle insertion instrument guide device according to the present invention has a fixed indicating needle and a movable indicating needle that are tapered in a tapered shape in addition to any of the first to fifth features described above. A twelfth feature is that the portion that comes into contact with the tissue is formed as a line.

  In addition to the first to twelfth features, the pedicle insertion instrument guide device of the present invention has a thirteenth feature that the instrument inserted into the pedicle is a pedicle screw. It is said.

  Further, the pedicle insertion instrument guide device of the present invention, in addition to any of the first to twelfth features described above, in the case of preparing a pilot hole in the pedicle in advance in the instrument to be inserted into the pedicle. Is characterized by including a pilot hole drilling tool for opening the pilot hole.

  According to the pedicle insertion instrument guide device of the first feature, for example, an insertion position and an insertion angle for inserting the pedicle insertion instrument into the pedicle are determined in advance using a CT image or the like. At this time, the insertion position is a horizontal distance from the spinous process. Then, the movable indicating needle is moved and set at a position where the distance from the fixed indicating needle is twice the horizontal distance. As a result, the reference line positioning pin is moved to the position of the intermediate point between the fixed indicating needle and the movable indicating needle by the link mechanism, and the distance from the fixed indicating needle becomes the horizontal distance.

On the other hand, the insertion guide part is slid to adjust the angle of the insertion guide part to the determined insertion angle. When the setting of the insertion position and the insertion angle is completed in this way, the reference line positioning pin is aligned with the position directly above the spinous process as the reference line. At this time, the distal end of the fixation indicating needle points to the insertion position on the pedicle, and the insertion guide portion is held at the insertion angle.
By performing the operation while guiding the insertion of the pedicle insertion instrument with the insertion guide portion, the pedicle insertion instrument can be inserted at a predetermined insertion position and a predetermined insertion angle.

  Therefore, according to the pedicle insertion instrument guide device of the first feature, the distal end portion of the fixation indicating needle is applied to the insertion point, and the insertion position and the insertion angle of the pedicle insertion instrument with respect to the spinous process are determined. By aligning the guiding reference line positioning pin with the position of the spinous process and bringing the distal ends of both the fixed indicator needle and the movable indicator needle into contact with the bone tissue of the pedicle, the guide device itself is not damaged. When the pedicle insertion device is inserted into the pedicle, the insertion position and the insertion angle are more accurately guided, and the insertion position and the insertion angle can be easily and reliably adjusted. It is.

  According to the pedicle insertion instrument guide device of the second feature, in addition to the operational effects of the configuration of the first feature, the link mechanism of the reference line positioning pin is provided with a pair of link arms having the same dimensions. The reference line positioning pin is attached to one common node of the pair of link arms, and the remaining one node of each link arm is linked to the fixed indicator needle side and the movable indicator needle side. When the movable indicator needle is moved, the common node of the pair of link arms moves to an exactly middle position of the separation distance between the fixed indicator needle and the movable indicator needle, and the reference line positioning pin is always just in the middle. Can be positioned at a point.

Therefore, the fixed indicating needle is moved by moving the movable indicating needle so that the distance between the fixed indicating needle and the movable indicating needle is twice the horizontal distance from the position of the spinous process to the insertion position of the pedicle insertion instrument. And the reference line positioning pin can be automatically set to the horizontal distance from the position of the spinous process to the insertion position of the pedicle insertion instrument.
Therefore, by aligning the reference line positioning pin with the position of the spinous process, the insertion position of the pedicle insertion instrument can be accurately, easily and reliably pointed to by the fixation indicator needle.

  According to the pedicle insertion instrument guide device of the third feature, in addition to the operational effect of the configuration of the first feature or the second feature, the reference line positioning pin fixes the direction of the pin. Since the direction is perpendicular to the plane formed by the pair of movable indicator needles, the reference line positioning pin is attached to the fixed indicator needle and the movable indicator needle that are arranged standing on the back surface of the vertebra. It can be easily and reliably aligned with the ridgeline of the spinous process.

  According to the pedicle insertion instrument guide device of the fourth feature, in addition to the operational effect of the configuration of any of the first feature to the third feature, the fixation indicating needle has a scale indicating a separation distance. Since the movable indicator needle is fixed to a movable block that is slidable along the distance ruler, it is fixed at the origin position of the distance ruler provided. By simply moving the movable indicator needle to the predetermined scale position with respect to the fixed indicator needle at the origin position, the distance between the fixed indicator needle and the movable indicator needle and the distance between the fixed indicator needle and the reference line positioning pin can be set easily. can do.

  According to the pedicle insertion instrument guide device of the fifth feature, in addition to the operational effect of the configuration of the fourth feature, the fixation indicator needle is fixed to the distance ruler via the fixation block. Since the operating grip is provided on the side opposite to the side where the fixing indicating needle is located, when operating this guide device, the operating block attached to the fixing block is operated with the hand in the fixing block. The fixed indicator needle on the opposite side can be directly operated on the distal end side of the hand, and accurate operation can be ensured by easy handling.

  According to the pedicle insertion instrument guide device of the sixth feature, in addition to the operational effect of any one of the first to fifth features, the insertion guide portion has a scale indicating the insertion angle. Since it is slidably attached to the arcuate mounting hole provided along the scale of the angle ruler provided, the insertion angle can be easily set to a predetermined angle by sliding the insertion guide part into the arcuate mounting hole. Can be set. Therefore, the insertion at the predetermined angle can be easily performed by guiding the insertion of the pedicle insertion instrument by the insertion guide portion in which the insertion angle is set.

  According to the pedicle insertion instrument guide device of the seventh feature, in addition to the function and effect of the configuration of the sixth feature, the angle ruler is configured so that the axial direction of the guide groove of the insertion guide portion is always fixed. An arcuate mounting hole is formed so that it can slide in a state where it is pointed toward the tip, so that when the tip of the fixation indicator needle is in contact with the pedicle, the instrument to be inserted into the pedicle is fixed. Can be reliably inserted at the tip position.

  According to the pedicle insertion instrument guide device of the eighth feature, in addition to the operational effects of the configuration of the sixth feature, the center of the arc at the arcuate mounting hole of the angle ruler is at the tip of the fixation indicator needle. Since the arc-shaped mounting hole is formed, the instrument to be inserted into the pedicle is surely inserted into the distal position of the fixed indicator needle while the distal end of the fixation indicator needle is in contact with the pedicle. be able to.

  According to the pedicle insertion instrument guide device of the ninth feature, in addition to the operational effect of the configuration of the sixth feature, the angle ruler and the distance ruler are integrally formed, and the fixation block of the fixation indicator needle Is fixed at the position of the scale of the distance ruler, the scale of the angle ruler just indicates the angle between the fixing indicator needle and the insertion guide part.

  According to the pedicle insertion instrument guide device of the tenth feature, in addition to the operational effect of the configuration of the sixth feature, the scale of the angle ruler is provided on both sides. The angle can be confirmed from the front side and the back side, and human errors such as angle adjustment errors can be reduced.

  According to the pedicle insertion instrument guide device of the eleventh feature, in addition to the operational effect of the configuration of any one of the first to fifth features, the insertion guide portion includes the size and shape of the guide groove. Since the guide grooves are detachably attached, a plurality of types having different guide groove dimensions and shapes can be prepared and replaced according to the type of pedicle insertion device.

  According to the pedicle insertion instrument guide device of the twelfth feature, in addition to the operational effect of the configuration of any of the first feature to the fifth feature, the fixed indicator needle and the movable indicator needle have their tips Is tapered and is formed so that the portion that contacts the bone tissue becomes a line, so that the bone tissue can be prevented from being damaged.

  According to the pedicle insertion instrument guide device of the thirteenth feature, in addition to the operational effect of any one of the first to twelfth features, the instrument to be inserted into the pedicle is a vertebra Since it is a root screw, the insertion position and insertion angle of the pedicle screw can be accurately guided.

  According to the pedicle insertion instrument guide device described in the fourteenth feature, in addition to the operational effect of any one of the first to twelfth features, the instrument to be inserted into the pedicle includes When the pilot hole is previously drilled in the pedicle, the insertion position and the insertion angle of the pilot hole drilling tool can be accurately guided by including the pilot hole drilling tool that opens the pilot hole.

It is a whole perspective view which shows the front side of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention. It is a whole perspective view which shows the back side of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention. It is a front view of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention. It is a top view of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention. It is A arrow directional view of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention. It is B arrow directional view of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention. It is C arrow line view of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention. It is sectional drawing of the pedicle vicinity vicinity explaining the usage of the pedicle insertion instrument guide apparatus which concerns on embodiment of this invention.

  With reference to the following drawings, a pedicle insertion instrument guide device according to the present invention will be described for understanding of the present invention. However, the following description does not limit the invention described in the claims of the utility model registration of the present invention.

First, referring to FIG. 8, a pedicle insertion instrument guide device according to the present invention is a pedicle which is a pedicle insertion instrument K at a predetermined insertion position X at a predetermined insertion position X of the pedicle. A guide device for inserting a screw. Usually, since the pedicle insertion device K is inserted in a pair on both sides of the spinous process, the insertion position X is a pair of insertion positions X1 and X2, and the insertion angle θ is also a pair of insertion angles θ1 and θ2. The pair of insertion positions X1 and X2 and the insertion angles θ1 and θ2 are usually mirror-symmetric positions and angles around the spinous process. Of course, the insertion position X1, the insertion angle θ1 and the insertion position X2, and the insertion angle θ2 may not be mirror-symmetrical depending on the condition of the skeleton.
The pedicle insertion instrument K is guided by the pedicle insertion instrument guide device, and is inserted into the pedicle at a predetermined insertion angle X1 (θ2) at a predetermined insertion position X1 (X2).

1 to 7, the pedicle insertion instrument guide device 1 according to the present embodiment includes a fixed indicating needle 10, a movable indicating needle 20 provided as a pair thereto, and a reference line positioning pin 30. The link mechanism 40 is combined with the reference line positioning pin 30. The pedicle insertion instrument guide device 1 has a distance ruler 50 that fixes the fixation indicator needle 10 and slides the movable indicator needle 20, and further slides the insertion guide portion 60 and the insertion guide portion 60. An angle ruler 70 is provided.
The pedicle insertion instrument guide device 1 can be operated by holding the operation grip 80 by hand.

The fixing instruction needle 10 is fixed to the distance ruler 50 via a fixing block 11. The fixed position of the fixing indicator needle 10 is the position of the origin of the distance scale 51 of the distance ruler 50 (scale = 0), that is, the position of the scale line that is scaled with distance = 0.
The fixed indicating needle 10 is composed of a straight extending needle perpendicular to the rectangular distance ruler 50 (parallel to the scale line of the distance scale 51). The distal end of the fixation indicating needle 10 is configured with a certain width and length so that it does not pierce the pedicle, and is configured to coincide with the scale line indicating the origin position of the distance scale 51. ing.
The distance scale 51 appears in FIG. 1 but does not appear in FIG. However, the present invention is not limited to this, and a distance scale may be provided at the portion 54 in FIG. Thus, by providing the distance scales 51 on both sides of the distance ruler 50, the distance can be confirmed from the front side and the back side of the distance ruler 50 during actual operation, and human errors such as misalignment adjustment errors are reduced. be able to.

The fixation indicating needle 10 can be made of stainless steel, for example.
The fixing instruction needle 10 is fixed by fixing means such as a screw (not shown) while being passed through an attachment hole 11 a provided in a part of the fixing block 11.
The fixed block 11 is fixed to the distance ruler 50 by a fixing means such as a screw (not shown) in a state of being externally fitted to the distance ruler 50.
You may enable it to adjust the amount of advancement of the fixed indicating needle 10 with respect to the fixed block 11.

The movable indicating needle 20 is fixed to a movable block 21 slidable along the distance ruler 50.
Similar to the case of the fixed indicating needle 10, the movable indicating needle 20 is fixed by fixing means such as a screw (not shown) while being passed through an attachment hole 21 a provided in a part of the movable block 21.
The movable block 21 is configured to be able to slide forward and backward in the direction of a distance scale 51 which is the longitudinal direction of the distance ruler 50 in a state where the movable block 21 is externally fitted to the rectangular distance ruler 50.

The movable block 21 is provided with a set screw 22. The movable block 21 can be freely fixed by the set screw 22 in a state where the movable block 21 is slid to a predetermined position (a predetermined scale position of the distance scale 51). Thereby, the separation distance 2W between the fixed indicating needle 10 and the movable indicating needle 20 can be freely set and adjusted.
As in the case of the fixed indicator needle 10, the movable indicator needle 20 is configured by a straight extension needle perpendicular to the direction of the distance scale 51 of the rectangular distance ruler 50 (parallel to the scale line of the distance scale 51). The distal end of the movable indicator needle 20 is configured with a certain width and length so that it does not pierce the pedicle, and is parallel to the graduation line of the distance scale 51 (including coincidence). It is configured.

The movable indicator needle 20 can be made of the same material as the fixed indicator needle 10, for example, stainless steel.
The movable indicator needle 20 is set so that the amount of advancement relative to the movable block 21 is the same as the amount of advancement of the fixed indicator needle 10.
Of course, the movable indicator needle 20 may be adjusted in its advance amount with respect to the movable block 21 as in the case of the fixed indicator needle 10.

By configuring the fixed indicating needle 10 and the movable indicating needle 20 as described above, the fixed indicating needle 10 and the movable indicating needle 20 are parallel and have a pair of indicating needles 10 and 20 having the same advance length. Become. As a result, the fixed indicator needle 10 and the movable indicator needle 20 that are paired with the pedicles on the left and right sides of the vertebra can be brought into contact with each other with a good balance in a vertical posture or can be held in an approaching state.
The fixed indicator needle 10 and the movable indicator needle 20 are formed so that the respective distal end portions (14, 24) are tapered and tapered so that the portion in contact with the bone tissue becomes a line. No bone tissue damage without puncture. For example, as shown in FIG. 6, the distal end portion 24 of the movable indicating needle 20 is tapered and cut in a tapered shape (25b), and the portion that contacts the bone tissue is a line (24a).

The reference line positioning pin 30 is a pin for aligning the reference line indicated by the reference line positioning pin 30 with the position of the ridgeline of the spinous process T (see FIG. 8). The reference line positioning pin 30 is oriented in a direction perpendicular to a plane formed by a pair of the fixed indicating needle 10 and the movable indicating needle 20.
The reference line positioning pin 30 is formed of an elongated straight round bar.
The link mechanism 40 is assembled so that the position of the reference line positioning pin 30 is located at the midpoint of the distance between the fixed indicating needle 10 and the movable indicating needle 20, that is, the separation distance 2W.

  The link mechanism 40 includes a pair of link arms 41 and 42 having the same dimensions. The pair of link arms 41 and 42 are arranged in a V-shape, and a reference line positioning pin 30 is attached as a pivot to the common node 41a and 42a where the link arms 41 and 42 overlap. Yes.

The remaining one node 41b of one link arm 41 is pivotally supported at a position corresponding to the fixing indicator needle 10 in the fixing block 11. The remaining one joint 42 b of the other link arm 42 is pivotally supported at a position corresponding to the movable indicating needle 20 in the movable block 21.
By making the distances to the common nodes 41a and 42a of the link arms 41 and 42 and the remaining nodes 41b and 42b the same, the fixed indicating needle 10, the movable indicating needle 20, and the pair of link arms 41 and 42 are M-shaped. The reference line positioning pin 30 is positioned at the nodes 41a and 42a at the center of the M-shape.
When the movable block 21 is slid along the distance ruler 50, the reference line positioning pin 30 moves by a distance that is half the sliding amount of the movable block 21, so that the fixed indicating needle 10 and the movable indicating needle 20 are always Is located at the midpoint of the separation distance 2W.

The distance ruler 50 is a ruler in which a distance scale 51 for displaying a separation distance 2W between the fixed indicating needle 10 and the movable indicating needle 20 is graduated in the longitudinal direction, and fixes the fixing block 11 of the fixing indicating needle 10. At the same time, it is a base for slidably fitting the movable block 21 of the movable indicating needle 20.
The distance ruler 50 is configured in a rectangular shape. The rectangular distance ruler 50 is externally fitted to the fixed block 11 in a state of penetrating the fixed block 11 and fixed in an immobile state. The distance ruler 50 is fitted outside the movable block 21 in a state of penetrating the movable block 21, and is slidable.
The distance scale 51 can be scaled in units of mm, for example. The scale can be from 0 to 10 cm as the origin. However, the present invention is not limited to this.

The insertion guide unit 60 is a member that guides a pedicle insertion instrument K that is an instrument to be inserted into the pedicle. The insertion guide unit 60 guides the pedicle insertion instrument K toward the insertion position on the pedicle surface so as to have a predetermined insertion angle.
The insertion guide part 60 is slidably fitted in and attached to an arcuate mounting hole 72 provided along an angle scale 71 of the angle ruler 70.
The insertion guide part 60 itself consists of a block body provided with a guide groove 61 in the longitudinal direction in which a groove having an arcuate cross section is formed in a linear shape. The guide groove 61 is configured to be slidable by being fitted into the arcuate mounting hole 72 at a part of the back side of the block body.
The guide groove 61 is always held in a state of being directed to the tip of the fixed indicating needle 10. This ensures that the guide groove 61 is directed to the insertion position X (see FIG. 8) in a state where the distal end of the fixation indicating needle 10 is in contact with the pedicle.
The angle scale 71 appears in FIG. 1 but does not appear in FIG. However, the present invention is not limited to this, and an angle scale may be provided at a portion 74 in FIG. Thus, by providing the angle scales 71 on both sides of the angle ruler 70, the angle can be confirmed from the front side and the back side of the angle ruler 70 during actual operation, and human errors such as angle adjustment errors can be reduced. it can.

The insertion guide portion 60 can be freely fixed in a fixed state while being slid to a predetermined slide position of the arcuate mounting hole 72 (a predetermined scale position of the angle scale 71) by the set screw 62. Thus, the angle of the guide groove 61 of the insertion guide portion 60, that is, the insertion angle θ of the pedicle insertion instrument K guided by the guide groove 61 can be freely set and adjusted.
For example, a plurality of types of insertion guide portions 60 having different sizes and shapes of the guide grooves 61 may be prepared so that they can be replaced according to the type of the pedicle insertion instrument K.

Referring to FIG. 8 as well, the pedicle insertion instrument K corresponds to, for example, a pedicle screw K1 used in lumbar posterior approach interbody fusion (PLIF). More precisely, this corresponds to the driver K2 of the pedicle screw K1.
The pedicle screw K1 is a device that is inserted into the pedicle in the lumbar posterior approach interbody fusion (PLIF), and it is necessary to insert it while avoiding the spinal cord, nerve root, blood vessel, etc. Usually, the position of the pair of pedicles is set as an insertion position X (X1, X2), and a predetermined insertion angle θ (θ1, θ2) is determined and inserted at the pair of insertion positions X1, X2. The insertion position X (X1, X2) and the insertion angle θ (θ1, θ2) are individually determined by taking an X-ray CT photograph for each patient.

  The driver K2 of the pedicle screw K1 is an instrument for screwing the pedicle screw K1 into the pedicle at the insertion position X (X1, X2). The driver K2 is guided by the guide groove 61 of the insertion guide portion 60 to a predetermined insertion position X at a predetermined insertion angle θ, so that the pedicle screw K1 is inserted from the predetermined insertion position X into the predetermined insertion position X. It will be inserted into the pedicle at an angle θ.

  Further, the pedicle insertion instrument K may be an unillustrated pilot hole drilling needle when a pilot hole for inserting the pedicle screw K1 is previously drilled. In this case, the pilot hole punch needle is guided by the guide groove 61 of the insertion guide part 60, and a pilot hole is opened from the predetermined insertion position X at a predetermined insertion angle θ. After that, the pedicle screw K1 is guided by the driver K2 and inserted in the same manner.

The angle ruler 70 is a ruler for setting the insertion angle θ by the insertion guide portion 60 and includes an angle scale 71 for setting the insertion angle.
The angle scale 71 is displayed on an arc concentric with the arc formed by the arcuate mounting hole 72. In other words, the angle scale 71 represents the angle formed by the fixing instructing needle 10 and the central axis of the guide groove 61 of the insertion guide portion 60, that is, the insertion angle θ.
The interval of the angle graduations 71 is graduated from 5 degrees to 40 degrees, for example, with one graduation having an angle of 2 degrees. However, it is not limited to these.
With the configuration described above, the insertion angle θ can be set and adjusted to a free angle by freely sliding the insertion guide portion 60 along the arcuate mounting hole 72.

The angle ruler 70 can be configured as an integral part of the distance ruler 50. In this case, by fixing the fixing block 11 of the fixing indicator needle 10 at the position where the distance scale 51 of the distance ruler 50 is zero, the angle ruler 70 is also fixed simultaneously, and the angle scale of the angle ruler 70 is also fixed. 71 indicates exactly the angle between the fixed indicating needle 10 and the insertion guide portion 60.
On the other hand, the angle ruler 70 may be configured separately from the distance ruler 50. In this case, the angle ruler 70 is fixed to the fixing block 11 of the fixing indicating needle 10 separately from the distance ruler 50.

  The operating grip 80 is a grip for operating the pedicle insertion instrument guide device 1 by hand. The operation grip 80 is vertically installed on the upper surface of the fixing block 11 on the side opposite to the side on which the fixing indicating needle 10 is attached. The operation grip 80 is provided in the vicinity of the fixing indicator needle 10 so that the instruction operation by the fixing indicator needle 10 is facilitated.

Next, an operation using the pedicle insertion instrument guide device 1 will be described.
Referring to FIG. 8, the insertion position X (X1) and the insertion angle of the pedicle screw K1 or the like that is the pedicle insertion device K using image data obtained by computer tomography (CT) or the like in the vicinity of the intervertebral disc. θ (θ1) is determined. Then, the horizontal distance W from the center line T1 to the insertion position X (X1) is measured with the ridge line passing through the apex of the spinous process T as the center line T1 from the CT image.

  When the horizontal distance W to the insertion position X (X1) and the insertion angle θ (θ1) are determined, the movable indicator needle 20 is moved on the distance ruler 50, and the position of the movable indicator needle 20 is the position of the distance scale 51. Set and adjust to a position that is twice the horizontal distance W. At that position, the movable indicating needle 20 is brought into an immobile state by the set screw 22. On the other hand, the insertion guide part 60 is moved on the angle ruler 70, and the insertion guide part 60 is set to the position of the insertion angle θ (θ1) of the angle scale 71.

  As described above, when the position of the movable indicating needle 20 on the distance scale 51 and the position of the insertion guide portion 60 on the angle scale 71 are set, the operator holds the operation grip 80. The reference line positioning pin 30 is made to coincide with a ridge line passing through the apex of the spinous process T, and the pair of fixed indicating needles 10 and the movable indicating needle 20 are vertically contacted with a pair of pedicles on both sides from above. At this time, since the fixed indicator needle 10 and the movable indicator needle 20 are parallel and have the same length, the fixed indicator needle 10 and the movable indicator needle 20 can be erected in a vertical state with good balance.

Since the point where the fixation indicating needle 10 contacts the pedicle is the insertion position X (X1) as described above, the operator applies the tip of the pedicle screw K1 to the insertion position X (X1), and While the driver K2 is guided by the guide groove 61 of the insertion guide portion 60 set at the insertion angle, the pedicle arch screw K1 is screwed and inserted with the driver K2.
When the pedicle screw K1 is inserted, it is inserted while simultaneously adjusting the inclination in a plane perpendicular to the plane formed by the insertion angle θ (θ1) while viewing the CT image.

After the insertion of the pedicle screw K1 at the insertion position X1, the pedicle screw K1 is inserted at the insertion position X2.
When the insertion position X2 and the insertion angle θ2 are mirror-symmetric with respect to the insertion position X1 and the insertion angle θ1 about the spinous process T, the position of the movable indicator needle 20 and the position of the insertion guide portion 60 are changed. There is no need. In this case, the pedicle insertion instrument guide device 1 may be reversed about the reference line positioning pin 30 so that the fixation indicating needle 10 points to the insertion position X2. Subsequent operations are the same as those described above.

  On the other hand, when the insertion position X2 and the insertion angle θ2 are different from the insertion position X1 and the insertion angle θ1, the insertion position X2 and the insertion angle θ2 are determined again from the image data, and the movable indicating needle 20 and the insertion guide portion 60 are moved. Adjust the settings. Subsequent operations are the same as those described above.

  Even when the pedicle insertion instrument K is a pilot hole perforation needle, the pedicle insertion instrument guide device 1 can be operated in the same manner as in the case of the pedicle screw K1. In this case, the elongated pilot hole perforating needle itself is guided by the insertion guide portion 60. When the pilot hole is opened, the pilot hole drilling needle is removed.

  The present invention relates to medical treatment such as lumbar posterior approach interbody fusion (PLIF) as a pedicle insertion instrument guide device for guiding insertion of a pedicle insertion instrument such as a pedicle screw into a pedicle. The applicability in the medical industry and medical equipment industry is great.

DESCRIPTION OF SYMBOLS 1 Pedicle insertion instrument guide apparatus 10 Fixed indicator needle 11 Fixed block 11a Attachment hole 14 Tip part 20 Movable indicator needle 21 Moveable block 21a Attachment hole 22 Set screw 24 Tip part 30 Reference line positioning pin 40 Link mechanism 41 Link arm 41a 1 Section 41b Section 1 42 Link arm 42a Section 1 42b Section 1 50 Distance ruler 51 Distance scale 60 Insertion guide part 61 Guide groove 62 Set screw 70 Angle ruler 71 Angle scale 72 Arc-shaped mounting hole 80 Grip for pedicle insertion K1 pedicle screw K2 driver X insertion position X1 insertion position X2 insertion position θ insertion angle θ1 insertion angle θ2 insertion angle T spinous process T1 spinous process center line W separation distance

Claims (14)

A pedicle insertion instrument guide device for guiding insertion of an instrument to be inserted into a pedicle,
A fixed indicator needle,
A movable indicator needle that sets and adjusts the distance from the fixed indicator needle;
A reference line positioning pin in which a link mechanism is assembled so as to be located at an exactly middle point of the separation distance between the movable indicating needle and the fixed indicating needle;
An insertion guide portion for setting and adjusting the insertion angle of the pedicle insertion instrument by sliding while maintaining an arc state with respect to the insertion position of the pedicle indicated by the fixation indicating needle;
Have
The distal end of the fixation indicator needle is brought into contact with the insertion point, the reference line positioning pin is aligned with the position of the spinous process, and the distal ends of both the fixation indicator needle and the movable indicator needle are brought into contact with the bone tissue of the pedicle. A pedicle characterized in that the guide device itself is stabilized without causing damage to the bone tissue by contact, and the insertion position and the insertion angle of the pedicle insertion instrument with respect to the spinous process are guided. Insertion instrument guide device.   The link mechanism of the reference line positioning pin is provided with a pair of link arms having the same dimensions, the reference line positioning pin is attached to one common node of the pair of link arms, The pedicle insertion instrument guide device according to claim 1, wherein the pedicle insertion instrument guide device is linked to the fixed indicating needle side and the movable indicating needle side.   The vertebra according to claim 1 or 2, wherein the reference line positioning pin is oriented in a direction perpendicular to a plane formed by a pair of the fixed indicating needle and the movable indicating needle. Bow insertion instrument guide device.   The fixed indicator needle is fixed to an origin position of a distance ruler having a scale indicating a separation distance, and the movable indicator needle is fixed to a movable block slidable along the distance ruler. The pedicle insertion instrument guide device according to any one of claims 1 to 3.   5. The fixing indicator needle is fixed to the distance ruler via a fixing block, and an operation grip is provided on a side of the fixing block opposite to the side where the fixing indicator needle is provided. The pedicle insertion instrument guide device described.   The said insertion guide part is slidably attached to the circular arc-shaped attachment hole provided along the said scale of the angle ruler provided with the scale which shows an insertion angle, Any one of Claims 1-5 characterized by the above-mentioned. A pedicle insertion instrument guide device according to claim 1.   The arc-shaped attachment hole is formed in the angle ruler so that the guide groove of the insertion guide portion can always slide in a state where the axial direction of the guide groove is always directed to the tip of the fixed indicator needle. Item 7. A pedicle insertion instrument guide device according to Item 6.   The pedicle according to claim 6, wherein the arcuate mounting hole is formed in the arcuate mounting hole of the angle ruler so that the center of the arc is the tip of the fixation indicator needle. Insertion instrument guide device.   The angle ruler and the distance ruler are integrally formed, the fixing block of the fixed indicator needle is fixed at a position of the scale of the distance ruler, and the scale of the angle ruler is fixed to the fixed indicator needle and the insertion guide portion. The pedicle insertion instrument guide device according to claim 6, wherein an angle with respect to the pedicle insertion instrument is indicated.   The pedicle insertion instrument guide device according to claim 6, wherein the scale of the angle ruler is provided on both sides.   The pedicle insertion instrument guide device according to any one of claims 1 to 5, wherein the insertion guide portion is removably attached to a guide groove having a different size or shape.   6. The fixed indicator needle and the movable indicator needle are formed so that tips of the fixed indicator needle and the movable indicator needle are tapered and tapered so that a portion that comes into contact with the bone tissue is a line. A pedicle insertion instrument guide device according to claim 1.   The pedicle insertion instrument guide device according to any one of claims 1 to 12, wherein the instrument inserted into the pedicle is a pedicle screw.   The instrument to be inserted into the pedicle includes a pilot hole drilling tool for opening the prepared hole when the prepared hole is previously opened in the pedicle. Pedicle insertion instrument guide device.