JP5778720B2 - Puncture tool - Google Patents

Description

The present invention relates to a puncture device for use in surgery when implanting one or more screw-type fasteners in a portion of a patient's spinal column for fixation and stabilization of the spinal column.

Conventionally, in spondylolisthesis and the like, a surgical operation may be required, and a spinal fusion operation is usually performed after the surgical procedure to hold the spinal column until fusion is achieved.
In spinal fusion surgery, the midline of the back is incised for a predetermined length, the incisions are opened on both sides, the muscle tissue is incised to expose the surface of the facet joint, and a radiation measurement device (for example, C-arm fluorescence test) Device) etc. to form an insertion hole with a puncture tool at a depth and angle determined at a plurality of locations in the pedicle or sacrum of the spine, and insert a fixing screw of the coupling unit into the insertion hole. This is done in such a way that the injured spine is held by connecting and connecting with a rod.
The puncture device used in this operation is described in the following patent document.

JP 2010-22838 A

The puncture device of the above-mentioned known example is not used for spinal fixation surgery, but a protrusion (probe portion) that forms a hole in the pedicle is formed at the tip of one rod, and a spherical handle is formed at the base of the rod. The insertion hole is formed in the vertebra.
If this puncture device is used for spinal fixation surgery, the insertion hole formed in the vertebra is hidden by the tissue near the spinal column when the puncture device is pulled out, and there is a problem that it is not easy to insert a fixation screw.
In this application, the configuration of the pedicle probe, which is a puncture device, has been devised to facilitate the discovery of the insertion hole formed by the pedicle probe concealed by the tissue near the spinal column and to shorten the operation time. .

According to the first aspect of the present invention, the base of the affected part can be drilled into the predetermined bone body H in a state where the distal end reaches a predetermined position of the pedicle or sacrum of the spine by a biocompatible material. Has a predetermined length that protrudes rearward from the rear surface of the spine, has a plurality of scales 3 that can be visually recognized by the naked eye and a radiation measuring device provided at predetermined intervals in the length direction, and has a predetermined length of the affected area A probe 2 having a tip shape that can be drilled in the bone body H is formed, a shaft member 4 having an insertion hole 5 into which a base portion of the probe 2 can be inserted, and an outer portion that is slidably attached to the outer periphery of the shaft member 4 A pedicle probe body 1 having a cylinder 15 is configured such that the probe 2 can be detachably attached by an attachment / detachment mechanism, and the probe 2 is configured to have a length shorter than the length of the shaft member 4. Separately leave the probe 2 in H Bed 2 perforated insert configured to be capable of attachment and detachment mechanism includes a engaging groove 6 formed in the base of the probe 2 moves in the transverse direction to the axis of the shaft member 4 to the engagement groove 6 The engagement protrusion 9 has an engagement protrusion 9 that engages and disengages. The engagement protrusion 9 moves the outer cylinder 15 in the axial direction of the shaft member 4 with respect to the shaft member 4. The puncture device is configured to be engaged with and disengaged from the groove 6.
According to a second aspect of the present invention, a flange portion 16 is provided at the base of the outer cylinder 15, the outer cylinder 15 is formed shorter than the shaft member 4, and the tip of the outer cylinder 15 is disposed so as to overlap the engaging body 10. When the outer cylinder 15 is moved to the base side of the shaft member 4, the distal end of the outer cylinder 15 is retracted from the distal end of the engagement body 10 to the base side, and the engagement body 10 is engaged from the engagement groove 6 of the probe 2. When the projection 9 is detached and the outer cylinder 15 is moved to the distal end side of the shaft member 4, the distal end of the outer cylinder 15 overlaps the distal end of the engagement body 10 from the outside and pushes the engagement projection 9 of the engagement body 10 inward. The engaging protrusion 9 is configured to engage with the engaging groove 6 of the probe 2, and the outer cylinder 15 is attached between the shaft member 4 and the outer cylinder 15 so as to move to the distal end side of the shaft member 4. This is a puncture device provided with a spring 18 to be energized.

According to the first aspect of the present invention, a predetermined bone body H of the spine can be drilled by the probe 2 to form an insertion hole, and the probe 2 is removed from the pedicle probe body 1 and inserted while leaving the probe 2 in each insertion hole. A hole can be formed, the probe 2 can be used as both an insertion hole forming tool and an insertion hole position confirmation tool, and further, the insertion hole can be quickly formed into the predetermined bone body H, The operation time can be shortened , the attachment / detachment mechanism of the probe 2 can be simply configured, and the attachment / detachment work of the probe 2 can be easily performed.
According to the second aspect of the present invention, the probe 2 can be attached and detached by simply sliding the outer cylinder 15 with respect to the shaft member 4 by the handle portion 26 and the flange portion 16, and the probe 2 can be easily attached and detached.

Exploded view of pedicle probe. Sectional drawing of the front-end | tip part of a pedicle probe. FIG. (A) The cross-sectional top view in the state where the probe at the tip of the pedicle probe is drilled in a predetermined bone body. (B) Side view. (C) The rear view. (A) The cross-sectional top view of the state which fixed the predetermined bone body with the fixing screw and the rod. (B) Side view. (C) The rear view.

An embodiment of the present invention will be described with reference to the drawings. Reference numeral 1 denotes a pedicle probe main body, and a probe 2 is detachably attached to the pedicle probe main body 1.
In a preferred embodiment, the members and parts of the pedicle probe main body 1 and the probe 2 are made of a rigid and durable biocompatible material, such as stainless steel, steel, titanium, or a titanium alloy. . As is well known to those skilled in the art, “biocompatible” material, as used herein, refers to a material that does not cause a harmful chemical or immunological reaction after being implanted in a patient's body. To do.

  The probe 2 is formed to have a predetermined length enough to reach the predetermined bone body H of the spine or the sacrum, and the tip of the probe 2 has a shape that can pierce a predetermined bone body such as the pedicle. The formed perforated part 2A is used.

  The probe 2 is provided with a scale 3 at a predetermined interval. For example, it is preferable to apply a paint that reacts with radiation to the scale 3 so that the scale 3 can be visually recognized by the naked eye and can be visually recognized by a radiation measuring apparatus (for example, a C-arm type fluorescence inspection apparatus).

  An example of the use of the pedicle probe composed of the pedicle probe body 1 and the probe 2 is shown. The probe 2 is attached to the pedicle probe body 1, and the patient is opened by incising the midline of the patient's back by a predetermined length. Then, muscles and tissues are incised to expose the surface of the facet joint, and a radiation measuring device (for example, C-arm type fluorescence examination device) or the like is used at a plurality of locations on a predetermined bone body H of the spine pedicle or sacrum The probe 2 attached to the pedicle probe body 1 is inserted at a determined depth and angle, an insertion hole is formed in a predetermined bone H portion, and the probe 2 is inserted and fitted to a predetermined depth in the patient's body. The pedicle probe main body 1 is removed from the probe 2 in the state of being left, and then another probe 2 is attached to the pedicle probe main body 1 to separately form an insertion hole in a predetermined bone body H portion. Insertion while Is allowed again, while leaving the probe 2 at a predetermined depth within the patient, remove the pedicle probe body 1 from the probe 2, repeating this work.

  Next, the rod B of the coupling unit is created in accordance with the position of the base portion of the probe 2 remaining in each insertion hole. This rod B connects a plurality of fixing screws A, and is not the gist of the present application, but is injured by connecting a plurality of rods B formed with a bendable bent portion C in the middle portion at the fixing screw A portion. Hold the vertebrae (Fig. 5).

The length of each probe 2 left in each insertion hole is grasped by the scale 3, and the fixing screw A of the coupling unit is selected, and the selected fixing screw A is replaced with the previously inserted probe 2 and inserted (screw) Then, the head of each fixing screw A is connected by the rod B prepared in advance to fix and hold the injured spine.
Thereafter, the retractor is removed and the minimum load incision is closed and sutured.

Thus, the configuration of an attachment / detachment mechanism that can attach / detach the probe 2 to / from the pedicle probe body 1 is arbitrary, but an example will be shown below.
An insertion hole 5 for inserting the probe 2 along the axis of the shaft member 4 (the length direction of the shaft member 4) is formed at the tip of the shaft member 4 constituting a part of the pedicle probe main body 1. .

An engagement groove 6 is formed at the base of the probe 2 in the direction intersecting the axis of the probe 2.
The shaft member 4 is provided with an engaging body 10 having an engaging protrusion 9 that engages with and disengages from the engaging groove 6. The engaging body 10 is fitted into a recess 11 formed on the outer periphery of the shaft member 4. A communication hole 12 that communicates with the insertion hole 5 is formed in the concave portion 11 on the distal end side of the shaft member 4, and the engagement protrusion 9 moves in the crossing direction of the shaft member 4 through the communication hole 12 to engage and disengage with the engagement groove 6. To do.

The shaft member 4 has a predetermined length, and an outer cylinder 15 constituting a part of the pedicle probe body 1 is slidably attached to the outer periphery of the shaft member 4.
The outer cylinder 15 is provided with a flange portion 16 at the base, the outer cylinder 15 is formed shorter than the shaft member 4, and the distal end of the outer cylinder 15 is disposed so as to overlap the engaging body 10. The engaging body 10 is formed by an elastic body so as to protrude outward (outward in the crossing direction) toward the tip, and the engaging protrusion 9 is attached so as to be detached from the engaging groove 6 of the probe 2 by the elasticity of the engaging body 10 itself. The tip of the outer cylinder 15 overlaps with the engaging body 10 to engage the engaging protrusion 9 with the engaging groove 6.

That is, when the outer cylinder 15 is moved to the base side of the shaft member 4 by the flange portion 16 of the outer cylinder 15, the distal end of the outer cylinder 15 is retracted from the distal end of the engagement body 10 to the base side, The engaging protrusion 9 of the engaging body 10 is released from the mating groove 6.
On the contrary, when the outer cylinder 15 is moved to the distal end side of the shaft member 4, the distal end of the outer cylinder 15 overlaps the distal end of the engagement body 10 from the outside and pushes the engagement protrusion 9 of the engagement body 10 inward to engage. The protrusion 9 engages with the engagement groove 6 of the probe 2 and holds the probe 2 on the shaft member 4.

A spring 18 is provided between the shaft member 4 and the outer cylinder 15. The spring 18 is formed by a coil spring and is inserted into the outer periphery of the shaft member 4.
An inner flange portion 20 is provided on the outer peripheral surface of the shaft member 4, and an inner flange portion is provided on the inner peripheral surface of the outer cylinder 15. A spring 18 is provided between the inner flange portion 20 and the inner flange portion 21.

A stopper 25 that engages the tip of the outer cylinder 15 is provided outside the tip of the engaging body 10.
That is, the spring 18 constantly urges the outer cylinder 15 to move toward the distal end of the shaft member 4, and the stopper 25 is always engaged with the distal end of the outer cylinder 15. The shaft member 4 is prevented from coming off.

A sleeve portion 27 of the handle portion 26 is fitted to the base portion of the shaft member 4, and the sleeve portion 27 is fixed to the shaft member 4 by an engagement pin 28.
In this case, the entire length T of the engaging body 10 is formed longer than the slide stroke L of the outer cylinder 15 between the sleeve portion 27 of the shaft member 4 and the flange portion 16 of the outer cylinder 15, and the outer cylinder 15 is Even when the handle member 26 of the shaft member 4 is pulled to the maximum, the distal end of the outer cylinder 15 is overlapped with the engagement body 10 to prevent the engagement body 10 from coming off from the recess 11 of the shaft member 4 (FIG. 3). .

  In the pedicle probe main body 1, the engaging body 10 is mounted in the recess 11 of the shaft member 4, the spring 18 is inserted into the outer periphery of the shaft member 4, and then the outer cylinder 15 is inserted into the outer periphery of the shaft member 4. The sleeve portion 27 of the handle portion 26 is fitted to the base portion of the member 4, and the sleeve portion 27 is fixed to the shaft member 4 by the engaging pin engaging pin 28 and assembled.

(Operation of the embodiment)
When the flange portion 16 is pulled with respect to the handle portion 26 of the shaft member 4 of the pedicle probe, the distal end of the outer cylinder 15 is retracted from the distal end of the engagement body 10, and the engagement body 10 has its own elasticity and the shaft of the shaft member 4. The engagement protrusion 9 of the engagement body 10 is retracted from the insertion hole 5.

  In this state, when the base portion of the probe 2 is inserted into the insertion hole 5 of the shaft member 4 and the flange portion 16 is separated from the handle portion 26 of the shaft member 4, the outer cylinder 15 is moved by the elasticity of the spring 18. The distal end of the outer cylinder 15 is overlapped with the distal end of the engaging body 10 from the outside to push the engaging protrusion 9 of the engaging body 10 inward, and the engaging protrusion 9 engages with the engaging groove 6 of the probe 2. Then, the probe 2 is held on the shaft member 4.

  In this state, the probe 2 attached to the pedicle probe main body 1 at a depth and angle determined at a plurality of locations on the spine pedicle or sacrum using a radiation measurement device (for example, a C-arm type fluorescence inspection device) or the like. The insertion hole is formed in the predetermined bone body H portion.

  Next, the flange portion 16 is pulled with respect to the handle portion 26 of the shaft member 4 of the pedicle probe, the distal end of the outer cylinder 15 is retracted from the distal end of the engaging body 10, and the engaging protrusion 9 and the probe 2 of the engaging body 10 are retracted. The pedicle probe main body 1 is removed from the probe 2 in a state where the engagement with the engagement groove 6 is disengaged and the probe 2 remains at a predetermined depth in the body of the patient.

  Next, another probe 2 is attached to the pedicle probe body 1, and an insertion hole is separately formed in a predetermined bone portion, and the probe 2 is again left at a predetermined depth in the patient's body, The pedicle probe body 1 is removed from 2 and this operation is repeated to create a connecting unit rod B in accordance with the base of the probe 2 remaining in the insertion hole of the predetermined bone H portion, and the selected fixing screw A Is replaced with the probe 2 and the head of each fixing screw A is connected by a plurality of rods B formed with bent portions C that can be bent in the middle portion to fix and hold the injured spine.

  In the spine fixing method, the vertebra part of the spine has a different shape depending on the position, and the affected part differs depending on the patient. Therefore, the insertion position and the depth of the fixing screw A are all different. Reducing the time required for selecting the screw A and the length of the rod B connecting the fixing screws A contributes to shortening of the operation time.

  In the present application, since the insertion hole is drilled in the predetermined bone body H by the probe 2 and is left there, the probe 2 left in each insertion hole allows the insertion location and depth of the fixing screw A and each fixing screw. The time required for selecting the length of the rod B connecting A can be shortened, which contributes to shortening of the operation time.

Since the engaging body 10 having the engaging protrusion 9 protruding inwardly on the inner surface of the tip end is fitted in the concave portion 11 of the shaft member 4, it is possible to engage only by moving the outer cylinder 15 in the axial direction of the shaft member 4. The mating protrusion 9 is engaged with and disengaged from the engaging groove 6.
Since the spring 18 is provided between the shaft member 4 and the outer cylinder 15, the outer cylinder 15 is always urged so as to move toward the distal end side of the shaft member 4.

  Since a stopper 25 that engages the tip of the outer cylinder 15 is provided outside the tip of the engaging body 10, the outer cylinder 15 is urged by a spring 18 so as to move toward the tip of the shaft member 4, and the outer cylinder 15 Since the stopper 25 is always engaged with the tip of the outer cylinder 15, the outer cylinder 15 is prevented from coming off from the shaft member 4 due to the elasticity of the spring 18, and the outer cylinder 15 and the shaft member 4 are held in an integrated state.

Since the outer cylinder 15 is urged by the spring 18 so as to move in the distal direction of the shaft member 4 by the spring 18, the outer cylinder 15 is attached to the shaft member 4 when the handle portion 26 and the flange portion 16 are gripped (picked). When the engagement protrusion 9 of the engagement body 10 is disengaged from the engagement groove 6 of the probe 2 and the flange portion 16 is released, the outer cylinder 15 returns to its original state.
Therefore, the probe 2 can be easily attached to and detached from the shaft member 4 simply by grasping the handle portion 26 and the flange portion 16.

  The relationship between the shaft member 4 and the outer cylinder 15 is such that the total length T of the engaging body 10 with respect to the slide stroke L of the outer cylinder 15 between the sleeve portion 27 of the shaft member 4 and the flange portion 16 of the outer cylinder 15. Even if the outer cylinder 15 is pulled to the handle portion 26 of the shaft member 4 to the maximum, the distal end of the outer cylinder 15 overlaps with the engaging body 10, so that the engaging body 10 is recessed in the shaft member 4. To prevent it from coming off.

  In the pedicle probe main body 1, the engaging body 10 is mounted in the recess 11 of the shaft member 4, the spring 18 is inserted into the outer periphery of the shaft member 4, and then the outer cylinder 15 is inserted into the outer periphery of the shaft member 4. If the sleeve portion 27 of the handle portion 26 is fitted to the base portion of the member 4 and the sleeve portion 27 is fixed to the shaft member 4 by the engagement pin 28, even if the relationship between the shaft member 4 and the outer cylinder 15 is satisfied, The assembled shaft member 4 and the outer cylinder 15 are not disassembled unless the handle portion 26 is removed.

  DESCRIPTION OF SYMBOLS 1 ... Pedicle probe main body, 2 ... Probe, 3 ... Scale, 4 ... Shaft member, 5 ... Insertion hole, 6 ... Engagement groove | channel, 9 ... Engagement body, 11 ... Recessed part, 12 ... Communication hole 15 ... outer cylinder, 16 ... flange, 18 ... spring, 20 ... inner flange, 21 ... inner flange, 25 ... stopper, 26 ... handle, 27 ... sleeve, 28 ... engagement pin, A ... fixed Screw, B ... Rod, C ... Curved part, H ... Bone.

Claims (2)

The base is posterior to the rear surface of the spine, with a rigid and biocompatible material that can pierce the predetermined bone body H of the affected area, with the tip reaching a predetermined position of the spine pedicle and sacrum. And has a graduation 3 that can be visually recognized by the naked eye and a radiation measuring apparatus provided at a predetermined interval in the length direction, and can pierce a predetermined bone body H of the affected area. A pedicle having a shaft 2 having an insertion hole 5 into which a probe 2 having a distal end shape is formed and into which the base of the probe 2 can be inserted, and an outer cylinder 15 slidably attached to the outer periphery of the shaft 4 The probe 2 is configured to be detachably attachable to the probe main body 1 by an attaching / detaching mechanism, and the probe 2 is configured to be shorter than the length of the shaft member 4, thereby leaving the probe 2 in the predetermined bone body H. The probe 2 can be drilled and inserted separately Configured to, detaching mechanism includes a engaging groove 6 formed in the base of the probe 2, the engaging projection disengaging moved in the transverse direction to the axis of the shaft member 4 to the engagement groove 6 The engagement protrusion 9 is engaged with and disengaged from the engagement groove 6 when the outer cylinder 15 is moved in the axial direction of the shaft member 4 with respect to the shaft member 4. A puncture device configured to perform . In Claim 1, the flange part 16 is provided in the base part of the said outer cylinder 15, the said outer cylinder 15 is formed shorter than the shaft member 4, the front-end | tip of the outer cylinder 15 is arrange | positioned so that it may overlap with the engaging body 10, When the cylinder 15 is moved to the base side of the shaft member 4, the distal end of the outer cylinder 15 retracts from the distal end of the engagement body 10 to the base side, and the engagement protrusion 9 of the engagement body 10 from the engagement groove 6 of the probe 2. When the outer cylinder 15 is moved to the distal end side of the shaft member 4, the distal end of the outer cylinder 15 overlaps the distal end of the engagement body 10 from the outside and pushes the engagement protrusion 9 of the engagement body 10 inward. The mating protrusion 9 is configured to engage with the engaging groove 6 of the probe 2 and urges the outer cylinder 15 between the shaft member 4 and the outer cylinder 15 so as to move to the distal end side of the shaft member 4. A puncture device provided with a spring 18 .

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