JP5397801B2 - Ligament binder - Google Patents

Description

  The present invention relates to an artificial ligament or a ligament bonding material connected to an end of a tendon taken out from the body.

  The ligament is a fibrous tissue band, and serves to connect bones to bones. For example, the anterior cruciate ligament connects the femur and tibia forming the joint. When an excessive load is applied to the ligaments including the anterior cruciate ligament and the posterior cruciate ligament, the ligament may be damaged.

  When a ligament running outside the joint, such as the medial collateral ligament, is torn, the function of the ligament is often reacquired if the joint is kept at rest, but the joint ligament such as the anterior cruciate ligament When the ligament running inside is torn, the function of the ligament is not obtained again even if the joint is kept calm. For this reason, ligament reconstruction surgery is performed as a treatment for early regeneration of the ligament and enabling normal exercise at an early stage.

  As disclosed in Patent Documents 1 to 3 and the like, ligament reconstruction surgery includes a technique of connecting an artificial ligament made of polyester or the like to a joint.

  Further, as disclosed in Non-Patent Document 1, there is a technique in which a tendon is excised from a thigh of a patient and taken out, and the tendon is transplanted and used. A method of aligning the ends of the tendons with a plain weave tape made of biocompatible material such as polyester, etc., pressing and fixing with a forceps or other instrument, connecting them together, and attaching the plain weave tape to the bone It is.

JP 7-505326 A Japanese translation of National Publication No. 7-506995 Japanese National Patent Publication No. 8-510927 “Joint strength against anterior cruciate ligament (ACL) injury (authors: Ikuo Nakamae, Mitsuo Ochi, Masataka Deya, Nobuo Adachi, Joint Surgery Vol.27, April Special Issue, published April 19, 2008, Medical View)

  When a tendon is taken out from the patient's body and used, the operator sews the plain weave tape and the tendon while pressing them, which is very troublesome for the operator and takes a long time.

  The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a ligament binder that can easily connect an artificial ligament or a tendon extracted from the body and a bone forming a joint. .

In order to achieve the above object, the present invention is a ligament bonding material connected to the end of an artificial ligament or the end of a tendon taken out from the body, and the ligament bonding material is formed in a cylindrical shape that can be expanded and contracted, And at least one end having an opening that is annularly opened, and the ligament binder is formed such that a diameter on the opening side is larger than a diameter of the artificial ligament or the tendon, or the end of the artificial ligament or the An insertion portion into which an end portion of a tendon is inserted, and a stopper on the end portion of the artificial ligament or the end portion of the tendon, the diameter of the other end side of the opening being smaller than the diameter of the artificial ligament or the tendon has a fixing section connected to the bone, the functions as the end portions of or the tendons of the ligament in the opening is inserted, the end of the end portion or the tendons of the ligament the contact with more inserted into the fixing portion is suppressed, before Reduced in diameter at the other end of the ligament binding material is pulled, and fixed to compress the end of the end portion or the tendons of the ligament, characterized in that.

  Further, the ligament binder is formed in a mesh shape.

  Furthermore, one or a plurality of filaments are knitted and formed.

  Furthermore, the said filament is comprised from polyester, It is characterized by the above-mentioned.

  Furthermore, an annular body made of an elastic material is provided along the opening.

  According to the ligament bonding material of the present invention, after inserting the end of the tendon or artificial ligament taken out from the body into the opening of the ligament bonding material, pulling the other end of the ligament bonding material, The diameter of the covering part becomes small, and the tendon is pressed and fixed. Since there is no need to always hold it with forceps or the like, there is an advantage that the ligament binder and the tendon can be easily sutured.

(Embodiment 1)
A ligament bonding material according to Embodiment 1 of the present invention will be described with reference to the drawings. The ligament binder 1 is connected to the end of a tendon or an artificial ligament (hereinafter referred to as a tendon) taken out from the body and used to bond the tendon to a bone forming a joint. As shown in FIG. 1, the ligament bonding material 1 includes an insertion portion 13 into which a tendon or the like is inserted and a fixing portion 14. And, it is formed in a cylindrical shape and a net shape over the entire area.

  The distal end portion of the insertion portion 13 has an opening portion 12 that is opened annularly. The insertion portion 13 is a place where a tendon or the like is inserted from the opening 12 and the tendon or the like is fixed. For this reason, the diameter of the insertion portion 13 is configured to be slightly larger than the diameter of a tendon or the like. Here, the diameter of the tendon is the diameter of the tendon when attached to the joint. For example, when the tendon is attached to the joint in a double or quadruple state, the double or quadruple state is used. This refers to the diameter of tendons.

  The case where a tendon or the like to which the ligament bonding material 1 is bonded is attached to a joint will be described in detail later. When attaching to a joint, a bone hole is provided in each bone. A tendon or the like coupled with the ligament bonding material 1 is inserted into and fixed to both or one of the bone holes. Since the insertion portion 13 of the ligament bonding material 1 is disposed just in the bone hole when attached, it is formed in a length that does not protrude from the bone hole. Generally, since the length of the bone hole is about 2 cm, the length of the insertion portion 13 is formed to be about 2 cm.

  On the other hand, the fixing portion 14 is a portion where the staple is driven into the bone to be connected, and is formed to have a diameter that does not exceed the width of the staple when pulled and collapsed. Moreover, since it uses a tool such as a spring for attachment and is pulled and fixed with a predetermined tension, it has a length that can be pulled from the outside.

  Moreover, the fixing | fixed part 14 has a role as stoppers, such as a tendon inserted. The diameter of the fixing portion 14 is smaller than the diameter of the insertion portion 13 and the diameter of a tendon or the like. For this reason, the end portion of the tendon or the like that has passed through the insertion portion 13 does not enter further when contacting the fixing portion 14. Thereby, it is not necessary to align how much a tendon or the like is inserted.

  The ligament binder 1 is formed in a mesh shape, and FIG. 2A shows a partially enlarged view of the insertion portion 13. This network structure is configured using the filaments 11. It may be formed in a mesh shape from a single filament 11 or may be formed in a mesh pattern by weaving a plurality of filaments 11.

  The filament 11 is knitted with an inclination with respect to the longitudinal direction of the ligament binder 1. When the fixing portion 14 is pulled, that is, when pulled in the longitudinal direction of the ligament bonding material 1, as shown in FIG. 2B, the mesh extends in the longitudinal direction, while the mesh shrinks in the circumferential direction. For this reason, the insertion portion 13 is reduced in diameter.

  Since the ligament binder 1 is attached to a joint that assumes the shape and role of the ligament, the filament 11 used is made of a material having biocompatibility. In addition, the ligament binder 1 is attached in a state where tension is constantly applied as in the case of the ligament in the joint, and a certain strength is required because the joint must be given biomechanical stability. For example, the breaking load of a normal anterior cruciate ligament is 2160 N, and the ligament binder 1 needs to be able to withstand at least this tension. From such a viewpoint, it is preferable to use a polyester having biocompatibility and high tensile strength as the filament 11.

  Then, the usage method of the ligament binder 1 is demonstrated with reference to FIGS.

  First, a tendon 21 is prepared by excising from the thigh and the like in the body. The prepared tendon 21 is folded back, and a string 22 made of polyester or the like is passed through the looped portion and connected to the locking tool 23. The tip position of the tendon 21 opposite to the side to which the locking tool 23 is connected is matched with the opening 12 of the ligament bonding material 1 as shown in FIG.

  As shown in FIG. 4, the tendon 21 is inserted into the insertion portion 13 from the opening 12 of the ligament bonding material 1. Insert until the tip of the tendon 21 comes into contact with the fixed portion 14.

  After the end portion of the tendon 21 is inserted into the insertion portion 13, the portion indicated by the broken line in FIG. 5, that is, the vicinity of the opening 12 side tip of the insertion portion 13 and the tendon 21 are sutured. If only one thread is sewn, the insertion portion 13 will not come off the tendon 21 when the fixing portion 14 described later is pulled. A plurality of places may be sewn.

  And the fixing | fixed part 14 is pulled as shown by the arrow of FIG. As described with reference to FIG. 2, the mesh is contracted in the vertical direction, and the insertion portion 13 is reduced in diameter. The tendon 21 is compressed by reducing the diameter of the insertion portion 13. Since the surface of the inserted tendon 21 is pressed by the inner peripheral surface of the insertion portion 13 over the entire area, the insertion portion 13 and the tendon 21 are fixed. Even when only one thread is sutured as described above, the tendon 21 is fixed over the entire inner peripheral surface of the insertion portion 13, so that stress does not concentrate on the sutured portion. For this reason, a firm fixed state can be maintained.

  In addition, you may sew the insertion part 13 and the tendon 21 of the ligament binder 1 further as reinforcement. Since it is not necessary to hold down the insertion portion 13 with forceps or the like, the surface of the insertion portion 13 is completely exposed. For this reason, there is nothing that obstructs the suturing operation. And since the insertion part 13 and the tendon 21 are being fixed, the position of the insertion part 13 and the tendon 21 does not shift. Therefore, the operator can easily suture.

  Further, in the above, the suturing is performed before the fixing portion 14 is pulled. However, if the inserting portion 13 is not detached from the tendon 21 even if the fixing portion 14 is pulled, the inserting portion 13 and the tendon 21 are not sewn. May be. It is also possible to pull the fixing portion 14 after pressing the distal end portion of the insertion portion 13 without sewing before the fixing portion 14 is pulled.

  FIG. 7 shows a state where the tendon 21 to which the ligament bonding material 1 is connected as described above is attached to the bone forming the knee joint as an example. With reference to FIG. 7, a method of connecting the tendon 21 to which the ligament bonding material 1 is connected to the joint will be described.

  In order to connect the tendon 21 to the knee joint, first, a femoral bone hole 32 and a tibial bone hole 34 are respectively provided in the femur 31 and the tibia 33 by drilling. The tendon 21 is passed through the tibial bone hole 34 and the femur bone hole 32 in this order from the fixed portion 14 side of the ligament bonding material 1. The tendon 21 is inserted until the entire locking tool 23 comes into contact with the surface of the femur 31. Since the locking tool 23 is formed in a disc shape having a larger diameter than the femoral bone hole 32, the tendon 21 remains at a predetermined position of the joint.

  An instrument capable of measuring tension, such as a spring, is connected to and pulled from the tibial bone hole 34 to the fixing portion 14 that has come out of the bone. The fixing portion 14 is inserted into the concave portion of the staple 35 a and the staple 35 b is driven into the tibia 33 while maintaining the state of being pulled with a predetermined tension. Further, the distal end of the fixing portion 14 is folded back toward the femur 31 by the staple 35b, the double fixing portion 14 is inserted into the concave portion of the staple 35a, and the staple 35a is driven into the tibia 33. The remaining fixing part 14 is put in the tibial bone hole 34. In this way, the tendon 21 connected with the ligament bonding material 1 can be attached.

  You may comprise the cyclic | annular opening part 12 smaller diameter than the tendon etc. to insert. If the diameter of the opening 12 is smaller than that of a tendon or the like, the tendon or the like into which the opening 12 is inserted is pressed, so that it is difficult to come off when the fixing portion 14 is pulled. Since the ligament bonding material 1 is configured so as to be able to be expanded and contracted, when the tendon or the like is inserted into the opening 12, the tendon or the like may be inserted while expanding the opening 12.

  When the opening 12 is configured to have a smaller diameter than a tendon or the like, for example, as illustrated in FIG. 8, an annular body 15 made of an elastic material may be installed along the opening 12. Since the inserted tendon or the like is tightened more strongly, it is difficult to come off when the fixing portion 14 is pulled.

  Further, as shown in FIG. 9, the string 16 may be passed along the opening 12. After the tendon or the like is inserted from the opening 12, the tendon or the like is tightened more firmly by tying the string 16. Thereby, when pulling the fixing | fixed part 14, the ligament bonding material 1 does not remove | deviate from a tendon.

(Embodiment 2)
The ligament bonding material 1 according to the first embodiment is formed by making the diameter of the insertion portion 13 and the diameter of the fixing portion 14 different from each other. However, as shown in FIG. . The ligament bonding material 2 is also formed in a mesh shape and a cylindrical shape as described above, and the tip has an annular opening 12. If both ends are openings 12, tendons or the like may be inserted from any opening 12.

  In the ligament bonding material 2, since there is no portion that can serve as a stopper when inserting a tendon or the like, it is preferable to mark or the like at a predetermined position of the ligament bonding material 2 so that the tip of the tendon or the like stays at a predetermined position. As in Embodiment 1, when the ligament binder 2 is pulled in the longitudinal direction, the mesh spreads in the longitudinal direction and shrinks in the circumferential direction. Thereby, the inserted tendon or the like is pressed and fixed. Since other configurations and operations are the same as those of the first embodiment, description thereof is omitted.

(Embodiment 3)
In the ligament bonding material 1 and the ligament bonding material 2, an example in which one or a plurality of filaments are knitted has been described. However, as shown in FIG. It may be formed. Since the ligament bonding material 3 is also formed in a mesh shape, the insertion portion 13 is reduced in diameter when the fixing portion 14 is pulled as described above. Since other configurations and operations are the same as those in the first and second embodiments, description thereof is omitted.

  In each of the above embodiments, the example in which the ligament joining tool is formed in a mesh shape has been described. However, by pulling the fixing portion, the diameter of the insertion portion is reduced, and the tendon inserted into the insertion portion is compressed and fixed. If it is a structure, it does not need to be mesh-like.

  Moreover, although the example which formed the filament in mesh shape was demonstrated, if the diameter of an insertion part shrinks by pulling a fixing | fixed part and the tendon etc. which were inserted in the insertion part are compressed and fixed, what kind of thing? Lines may be knitted into. For example, any knitting method such as knit knitting or glance rubber knitting can be used.

  As described above, after inserting the end of the tendon taken out from the body or the end of the artificial ligament into the opening of the ligament bonding material, pulling the other end of the ligament bonding material, the tendon of the ligament bonding material, etc. The diameter of the covering part becomes small, and the tendon is pressed and fixed. Since it is not necessary to hold down with forceps or the like at all times, the ligament binder and the tendon can be easily sutured. Therefore, it can be used in the medical field in ligament injury.

It is a perspective view which shows the external appearance of the ligament bonding material which concerns on Embodiment 1 of this invention. (A) And (B) is the elements on larger scale of the ligament binder which concerns on Embodiment 1 of this invention. It is a figure which shows the usage method of the ligament bonding material which concerns on Embodiment 1 of this invention. It is a figure which shows the usage method of the ligament bonding material which concerns on Embodiment 1 of this invention. It is a figure which shows the usage method of the ligament bonding material which concerns on Embodiment 1 of this invention. It is a figure which shows the usage method of the ligament bonding material which concerns on Embodiment 1 of this invention. It is a figure which shows the state which attached the tendon which connected the ligament bonding material which concerns on Embodiment 1 of this invention to the bone which forms a joint. It is a perspective view which shows the opening end of the ligament bonding material which concerns on Embodiment 1 of this invention. It is a perspective view which shows the opening end of the ligament bonding material which concerns on Embodiment 1 of this invention. It is a side view of the ligament bonding material which concerns on Embodiment 2 of this invention. It is a side view of the ligament bonding material which concerns on Embodiment 3 of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Ligament bonding material 2 Ligament bonding material 3 Ligament bonding material 11 Line 12 Opening part 13 Insertion part 14 Fixing part 15 Annulus 16 String 21 Tendon 22 String 23 Locking tool 31 Femur 32 Femur bone hole 33 Tibia 34 Tibia bone Hole 35a Staple 35b Staple

Claims (5)

A ligament binding material connected to the end of an artificial ligament or the end of a tendon taken out from the body,
The ligament binding material is formed in a cylindrical shape that can freely expand and contract, and has an opening that is open at least at one end in an annular shape,
The ligament binding material has an insertion portion in which an end portion of the artificial ligament or an end portion of the tendon is inserted so that a diameter on the opening side is larger than a diameter of the artificial ligament or the tendon, and the opening portion A fixed portion connected to a bone and having a diameter on the other end side smaller than the diameter of the artificial ligament or the tendon and functioning as a stopper of the end of the artificial ligament or the end of the tendon. And
The end portion of the artificial ligament or the end portion of the tendon is inserted into the opening, the end portion of the artificial ligament or the end portion of the tendon abuts on the fixing portion, and further insertion is suppressed, and the ligament The other end of the binding material is reduced in diameter, and the end of the artificial ligament or the end of the tendon is pressed and fixed,
A ligament binder characterized by that.   The ligament bonding material according to claim 1, wherein the ligament bonding material is formed in a mesh shape.   The ligament binder according to claim 2, wherein one or a plurality of filaments are knitted.   The ligament binder according to claim 3, wherein the filament is made of polyester.   The ligament binder according to claim 1, wherein an annular body made of an elastic material is provided along the opening.

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