JP5877508B2 - Ligament reconstruction tool, cone and reamer - Google Patents

Description

  The present invention relates to a ligament reconstruction tool, a cone and a reamer.

  A ligament is a tissue that joins multiple bones together to form a joint. The ligament has, for example, a function of maintaining the mechanical strength of the joint and a function of stabilizing the joint by limiting the range of motion of the joint.

  When a ligament is torn due to an accident or the like, the ligament may heal spontaneously depending on the type of ligament, but the anterior cruciate ligament of the knee hardly heals spontaneously. If the ligament is left torn, the joint is unstable, and there is a risk that the bones may be detached and the cartilage may be damaged. In such a case, it is necessary to perform an operation for transplanting a new ligament in place of the torn ligament at or near the place where the torn ligament was originally located. The operation for reconstructing the ligament in this way is called ligament reconstruction.

  15 and 16 schematically show an example of reconstruction of the anterior cruciate ligament of the knee. FIG. 15 is a plan view showing a new graft ligament created in place of the torn anterior cruciate ligament. As shown in the figure, the graft ligament 140 includes a graft tendon 141 and an artificial ligament 142 connected to both ends thereof. In place of the artificial ligament 142, a suture or the like can be used. As the graft tendon 141, for example, a tendon obtained by bundling tendons collected from the patient himself is used. FIG. 16 is a front view showing a state in which the ligament for transplantation 140 is implanted into the knee joint. As shown in the figure, the knee joint has a hole 155 that passes through the femur 121 and a hole 156 that passes through the tibia 122. The hole 155 and the hole 156 are disposed concentrically through the inside of the joint (the gap between the femur 121 and the tibia 122) between them. One end of the graft tendon 141 is inserted into the hole 155 of the femur 121 and the other end is inserted into the hole 156 of the tibia 122 to connect the femur 121 and the tibia 122. The end of the artificial ligament 142 on the femur 121 side is fixed to the femoral outer opening of the hole 155 by a button 143 connected thereto. Similarly, the end of the artificial ligament 142 on the tibia 122 side is fixed to the outer tibial opening of the hole 156 by a button 143 connected thereto. In FIG. 16, illustration of skin, muscle, cartilage, etc. is omitted for simplification of illustration. In addition, the graft tendon 141 and the artificial ligament 142 (the graft ligament 140) are not actually visible because they are hidden by the femur 121 and the tibia 122, but are shown by solid lines for clarity of illustration.

  As shown in FIG. 16, as a method of drilling holes in the femur and tibia, for example, a hole is drilled with a cone (drill) from the outside to the inside (inside the joint) of the femur or tibia and the bone on the opposite side is directly A method of penetrating a cone (drill) to the outside is used. Hereinafter, this method may be simply referred to as “conventional method”. In the following, going from the outside of the bone to the inside of the joint may be referred to as “antegrade”, and conversely, going from the inside of the joint to the outside of the bone may be called “retrograde”. For example, drilling a hole from the outside of the bone toward the inside of the joint is called anterograde drilling, and advancing a drill from the outside of the bone to the inside of the joint is antegrade. It is said to advance the drill. In addition, drilling a hole from the inside of the joint toward the outside of the bone is referred to as piercing the hole retrogradely, and advancing a drill (drill) from the inside of the joint to the outside of the bone is a retrograde cone ( It is said to advance the drill.

  In recent years, methods other than the conventional method have been developed in the reconstruction of the anterior cruciate ligament of the knee. For example, after a hole is drilled antegradely with a drill from the outside of the tibia or femur to the inside of the joint (the gap between the tibia and the femur), a part of the hole is retrogradely spread with a reamer There exists an instrument and a method (nonpatent literature 1-2). Non-Patent Document 1 describes a method of drilling holes from the tibia side, and Non-Patent Document 2 describes a method of drilling holes from the femur side.

The Journal of Arthroscopic and Related Surgery, Vol 22, No 8 (August), 2006: pp 900.e1-900.e11 “Latest Surgery-Related News Challenge to the Latest Anterior Cruciate Ligament (ACL) Procedure”, [online], September 10, 2011, Alex Medical Group, [November 10, 2011 search] Internet <URL: http://ar-ex.jp/operation/info/t_info_0-12.htm>

  In the reconstruction of a ligament such as an anterior cruciate ligament, a hole made in a bone requires a thick hole corresponding to the graft tendon 141 in FIGS. 15 and 16, for example, on the inner side of the joint, but may be a thin hole outside the joint. . However, in the conventional method, the thickness of the holes cannot be made differently in this way, and the entire hole must be made the same thickness. For this reason, outside the joint, a bone that is unnecessarily thicker is drilled (that is, the surgical invasion is large). As a result, the stability of the ligament for transplantation may be reduced, and the rehabilitation period may be prolonged.

  According to the instruments and methods of Non-Patent Documents 1 and 2, in order to create a hole in the tibia or femur as described above, the thickness of the hole is thick on the inside of the tibia or femur (inside the joint). The outside is thin and can be made separately. However, in the other bone, it is impossible or very difficult to make the same hole thickness in the same manner with the devices of Non-Patent Documents 1 and 2.

  That is, first, in the instrument of Non-Patent Document 1, after a hole is drilled antegradely with a cone (drill) in the tibia, a reamer is attached to almost the tip of the cone (drill) in the gap between the tibia and the femur. . Thereafter, the reamer is retracted together with the drill, and the diameter of the hole is expanded retrogradely. However, at this time, since the reamer is attached to almost the tip of the cone (drill), a thin hole cannot be made in the femur. In the instrument of Non-Patent Document 2, a reamer blade is stored at the tip of the drill. In this document, after a hole is drilled antegradely with a cone (drill) in the femur, a reamer blade stored at the tip of the cone (drill) is projected in the gap between the femur and the tibia. Thereafter, similar to Non-Patent Document 1, the reamer is retracted together with the cone (drill), and the diameter of the hole is expanded in a retrograde manner. That is, even in Non-Patent Document 2, since the reamer is attached to the tip of the cone (drill), a thin hole cannot be made in the tibia. Further, the instrument of Non-Patent Document 2 is structurally fragile and may be damaged.

  Therefore, an object of the present invention is to provide a ligament reconstruction tool that can easily perform a minimally invasive ligament reconstruction. Furthermore, this invention provides the cone and reamer used for the said ligament reconstruction tool.

In order to solve the above problems, the ligament reconstruction tool of the present invention is:
A ligament reconstruction tool for use in an operation of reconstructing a ligament of a joint in which a plurality of bones are connected to each other by a ligament,
Including cones and reamers,
The cone can pierce holes through the plurality of bones and the joint;
The cone includes a front end portion, a rear end portion, and a reamer mounting portion provided between the front end portion and the rear end portion and capable of mounting the reamer.
The reamer can expand the diameter of the hole drilled by the cone from the inside of the joint in a state of being mounted on the reamer mounting portion.
In a state in which the reamer is mounted on the reamer mounting portion, a length from the reamer tip to the tip of the cone is a length capable of penetrating the hole in at least one of the plurality of bones. And

  The cone of the present invention is a cone used for the ligament reconstruction tool of the present invention.

  The reamer of the present invention is a reamer used for the ligament reconstruction tool of the present invention.

  According to the ligament reconstruction tool, cone and reamer of the present invention, minimally invasive ligament reconstruction can be performed easily.

FIG. 1 is a diagram showing an example of a cone used in the ligament reconstruction tool of the present invention. FIG. 2 is a view showing an example of a reamer used in the ligament reconstruction tool of the present invention. FIG. 3 is a view showing another example of a reamer used in the ligament reconstruction tool of the present invention. FIG. 4 is a view showing still another example of a reamer used in the ligament reconstruction tool of the present invention. FIG. 5 is a view showing still another example of a reamer used in the ligament reconstruction tool of the present invention. FIG. 6 is a diagram showing another example of a cone used in the ligament reconstruction tool of the present invention. FIGS. 7A to 7C are views showing still another example of the cone used in the ligament reconstruction tool of the present invention. FIG.7 (d) is a figure which shows the ligament reconstruction tool of this invention which attached the reamer to the cone shown to Fig.7 (a)-(c). FIG. 8 is a view showing still another example of a cone used in the ligament reconstruction tool of the present invention. FIG. 9 is a diagram showing an example of a depth gauge used in the ligament reconstruction tool of the present invention. FIG. 10 is a diagram illustrating a state in which the tip of the cone is inserted into the depth gauge of FIG. FIG. 11 is a view showing an example of a grasping forceps used in the ligament reconstruction tool of the present invention. FIG. 12 is a diagram illustrating a state in which the reamer is gripped by the gripping forceps of FIG. 11. FIG. 13A is a diagram illustrating a part of a ligament reconstruction procedure using the ligament reconstruction tool of the present invention. FIG. 13B is a diagram illustrating a part of the process of ligament reconstruction using the ligament reconstruction tool of the present invention, and shows a process following the process of FIG. 13A. FIG. 14 is a schematic view illustrating the state of a knee transplanted with a ligament for transplantation following FIG. 13B. FIG. 15 is a diagram illustrating the structure of a transplant ligament. FIG. 16 is a schematic diagram showing an example of reconstruction of the anterior cruciate ligament of the knee by a conventional method. FIG. 17 is a photograph of a drill (drill pin) used in the example. FIG. 18 is a photograph showing a state in which a suture thread is passed through the reamer used in the example and is gripped with gripping forceps. FIG. 19 is a photograph of the entire grasping forceps used in the example. 20 is a photograph of the tip (gripping part) of the grasping forceps of FIG. FIG. 21 is a photograph showing a state in which the remaining anterior cruciate ligament is dissected (removed) by a transpiration device in order to fix the attached portion of the reconstructed (transplant) anterior cruciate ligament within the right knee joint. FIG. 22 is a photograph showing a state in which a laser beam is irradiated inside the knee joint in order to position a hole (bone hole) drilled in the bone in the example. FIG. 23 is a photograph showing a state in which a reamer is being attached to a cone (drill pin) inside the knee joint in the example. FIG. 24 is a photograph showing a state in which the length (depth) of a bone hole is being measured using a depth gauge in the example. FIG. 25 is a photograph showing a state in which the length (depth) of the femoral bone hole is being measured in the example. FIG. 26 is a photograph of the anterior cruciate ligament (by double bundle reconstruction) reconstructed in the example. FIG. 27 is an X-ray photograph of the knee after anterior cruciate ligament reconstruction in the example.

  Hereinafter, the present invention will be described in more detail. However, the present invention is not limited by the following description.

  In the ligament reconstruction tool of the present invention, it is preferable that the reamer mounting portion is located at substantially the center of the cone.

  In the ligament reconstruction tool of the present invention, it is preferable that a scale is attached to the cone tip, and the projection length of the cone tip from the bone can be measured by the scale.

  In the ligament reconstruction tool of the present invention, at least one of the cone tip portion and the rear end portion may be provided with a marker indicating a distance from the reamer tip or the rear end at a position close to the reamer mounting portion. preferable.

  In the ligament reconstruction tool of the present invention, it is preferable that the reamer has a hole for threading.

  The ligament reconstruction tool of the present invention is preferably used for knee joint ligament reconstruction, and the ligament is more preferably an anterior cruciate ligament.

  The ligament reconstruction tool of the present invention further includes a grasping forceps for grasping the reamer inside the joint, and a grasping portion of the grasping forceps is formed so as to be able to grasp the reamer in accordance with the shape of the reamer. Is preferred. The grasping forceps of the present invention is a grasping forceps used for such a ligament reconstruction tool of the present invention.

  The gripping forceps according to the present invention are preferably capable of gripping the reamer in a state where the cone on which the reamer is mounted penetrates the plurality of bones and the joint, and the reamer is located inside the joint.

  The ligament reconstruction tool of the present invention further includes a depth gauge, and the depth gauge includes a cylinder through which the cone tip can penetrate, and a scale portion connected to the tip of the cylinder and into which the cone tip can be inserted. The length of the portion inserted into the depth gauge at the tip of the cone is preferably measurable by the scale provided at the scale. Moreover, the depth gauge of this invention is a depth gauge used for such a ligament reconstruction tool of this invention.

[Cone]
Next, the cone used for the ligament reconstruction tool of the present invention will be described. In the present invention, the cone used in the ligament reconstruction tool of the present invention may be referred to as “drill”, “drill pin”, “drill guide pin”, or the like. “Drill” sometimes refers to a kind of cone (for example, a twisted groove is carved into a steel round bar, a blade is attached to the tip, and this is rotated to make a hole). In the present invention, “drill” Is not particularly limited and is synonymous with “cone”. “Drill pin” and “drill guide pin” are also synonymous with “drill” or “cone”.

  FIG. 1 shows an example of a cone (or a drill, a drill pin, or a drill guide pin) used in the ligament reconstruction tool of the present invention. FIG. 1A is a left side view, FIG. 1B is a front view, FIG. 1C is a right side view, and FIG. 1D is a plan view. For clarity of illustration, the scales of FIGS. 1A and 1C are shown larger than those of FIGS. 1B and 1D. Further, in FIG. 1A, illustration is omitted except for the tip 11a of the tip portion 11, and in FIG. 1C, illustration is omitted except for the connection portion 13a of the rear end portion 13. FIGS. 6A and 6C, FIGS. 7A and 7C, and FIGS. 8A and 8C described later are the same as FIGS. 1A and 1C.

  As shown in FIG. 1, the cone 10 includes a front end portion 11, a rear end portion 13, and a reamer mounting portion 12 provided between the front end portion 11 and the rear end portion 13 and capable of mounting a reamer. Further, as shown in the figure, the cone 10 has a straight bar shape from the rear end to the front end. The cross-sectional shape is substantially circular at portions other than the tip 11a of the tip end portion 11 and the connection portion 13a of the rear end portion 13. As shown in FIGS. 1B to 1D, the distal end 11a of the distal end portion 11 has a sharp three-eyed pyramid shape, so that a hole can be made in the bone. Further, the tip 11 is provided with a scale 14, and the scale 14 can measure the protruding length of the cone tip 11 from the bone. A connecting portion 13 a is provided at the rear end of the rear end portion 13. As shown in FIG. 1A, the connecting portion 13a has a hexagonal prism shape in which long sides and short sides are alternately arranged. The rear end of the connecting portion 13a is flat and has a minute hole through which a pin or a screw can be passed. With such a connection portion 13a, the cone 10 can be connected to a handle (not shown). The pattern is not particularly limited. For example, the handle may be further connected to a motor for rotating the handle together with the cone 10. The reamer mounting part 12 has a thread groove so that a reamer described later can be mounted and fixed.

  Further, the reamer mounting portion 12 and the rear end portion 13 are hollow inside, and the inner diameter thereof is the same as or slightly larger than the outer diameter of the front end portion 11, and a part of the front end portion 11 is included in the rear end portion 13. Or all can be stored. FIG. 1 shows a state in which a part of the front end portion 11 is stored in the reamer mounting portion 12 and the rear end portion 13. In the vicinity of the reamer mounting portion 12 or the rear end portion 13, unevenness is provided on the inner wall thereof. On the other hand, at the rear end of the front end portion 11, the outer wall is provided with irregularities. By fitting the unevenness of the inner wall and the unevenness of the outer wall, most of the front end portion 11 can be fixed in a state of being pulled out from the reamer mounting portion 12 and the rear end portion 13. In that state, for example, as shown in FIG. 7B or FIG. 8B, the lengths of the front end portion 11 and the rear end portion 13 are substantially equal. In other words, the reamer mounting part 12 is located substantially at the center of the cone 10. In this state, the cone 10 can pierce the plurality of bones and holes penetrating the joints in a joint in which the plurality of bones are connected to each other by a ligament.

  Moreover, another example of the cone used for FIGS. 6-8 in the ligament reconstruction tool of this invention is shown. 6A is a left side view of an example of the cone, FIG. 6B is a front view thereof, and FIG. 6C is a right side view thereof. Fig.7 (a) is the left view of another example of the said cone, (b) is the front view, (c) is the right view. FIG. 8A is a left side view of still another example of the cone, FIG. 8B is a front view thereof, and FIG. 8C is a right side view thereof.

  As shown in the figure, the cone 10 in FIG. 6 is the same as the cone in FIG. 1 except that the position of the scale 14 is closer to the tip and that the dimensions and the like of each part are slightly different. FIG. 6 shows a state in which the front end portion 11 is stored in the reamer mounting portion 12 and the rear end portion 13 as in FIG.

  As shown in FIG. 7, the cone 10 is provided with a marker 15 indicating the distance from the front end or the rear end of the reamer mounting portion at a position close to the reamer mounting portion 12 at the front end portion 11 and the rear end portion 13. Yes. Except for this and the slightly different dimensions of each part, the cone 10 in FIG. 7 is similar to the cone in FIG. FIG. 7 shows a state in which most of the front end portion 11 is pulled out from the reamer mounting portion 12 and the rear end portion 13 and fixed as described above. FIG. 7D shows a state in which the reamer 20 is mounted on the reamer mounting portion 12. The reamer will be described later.

  As in FIG. 7, the cone 10 in FIG. 8 is provided with a marker 15 indicating the distance from the front end or the rear end of the reamer mounting portion at a position close to the reamer mounting portion 12 in the front end portion 11 and the rear end portion 13. ing. The cone 10 in FIG. 8 is the same as the cone in FIG. 7 except that the dimensions of each part are slightly different. FIG. 8 shows a state in which most of the front end portion 11 is pulled out from the reamer mounting portion 12 and the rear end portion 13 and fixed as described above.

  In the present invention, the scale 14 at the tip of the cone is not necessary, but it is preferable that the length of projection of the cone tip 11 from the bone can be measured by the scale 14. In addition, the marker 15 may be omitted, but if it is present, for example, during surgery, the length (depth) of the reamer's position or the portion whose diameter has been enlarged by the reamer at the bone hole by endoscopic observation or the like. It is preferable because it is easy to confirm the above. The marker 15 may be provided only on one of the front end portion 11 and the rear end portion 13, but it is more preferable that the marker 15 is provided on both as shown in FIG. 8B. In addition, one or a plurality of markers 15 may be provided at the front end portion 11 or the rear end portion 13, but a plurality of markers 15 are more preferably provided.

  1 and 6-8, the dimension of each part is not specifically limited, For example, it is as follows. That is, first, the total length of the cone 10 (the length from the rearmost end to the most distal end) is the state in which the front end portion 11 is stored in the reamer mounting portion 12 and the rear end portion 13 (FIG. 1B or FIG. 6B). )), For example, 100 to 300 mm, preferably 150 to 250 mm, more preferably 160 to 180 mm, and specifically, for example, 173 mm as shown in FIG. 1 or 165 mm as shown in FIG. . The total length of the cone 10 is, for example, 150 to 500 mm, preferably 250 to 450 mm in a state where the front end portion 11 is pulled out from the reamer mounting portion 12 and the rear end portion 13 and fixed (FIG. 7B or FIG. 8B). More preferably, it is 300 to 400 mm, and specifically, for example, 300 mm, 350 mm, 400 mm, and the like. The diameter (outer diameter) of the distal end portion 11 is, for example, 1.0 to 3.0 mm, preferably 1.5 to 2.7 mm, more preferably 2.0 to 2.7 mm. It is 2.0 mm as shown in FIG. 1, 6 or 7, 2.4 mm or 2.7 mm as shown in FIG. The outer diameter of the reamer mounting part 12 and the rear end part 13 is, for example, 2.0 to 5.0 mm, preferably 2.5 to 4.5 mm, more preferably 3.0 to 4.0 mm. For example, 3.0 mm as shown in FIG. 1, 6 or 7, 3.5 mm, 4.0 mm as shown in FIG. The inner diameters of the reamer mounting part 12 and the rear end part 13 are equal to or slightly larger than the diameter (outer diameter) of the tip part 11 as described above. The outer diameters of the reamer mounting part 12 and the rear end part 13 may be the same or different, but are preferably not so different from the viewpoint of ease of drilling into the bone. The length of the reamer mounting part 12 is, for example, 2.0 to 10.0 mm, preferably 2.0 to 5.0 mm, and more preferably 2.5 to 3.5 mm. As shown in Fig. 2, it is 2.5 mm or 3.0 mm. Moreover, the thread groove provided in the reamer mounting part 12 is, for example, M1.5 to 5.0, preferably M2.0 to 4.0, more preferably M2.5 to 3.5 according to JIS standards. Specifically, for example, as shown in FIG. 7, it is M2.5, M3.0, M3.5, or the like. The distance from the scale 14 to the tip of the cone 10 (that is, the tip of 11a) is, for example, 1 to 70 mm, preferably 5 to 50 mm, and more preferably 10 to 50 mm. The distance from the marker 15 provided at the front end portion 11 to the rear end of the reamer is, for example, 5 to 50 mm, preferably 10 to 40 mm, more preferably 20 to 30 mm. Specifically, for example, in FIGS. As shown, they are 20 mm, 25 mm, 30 mm, and the like. The distance from the marker 15 provided at the rear end portion 13 to the tip of the reamer is, for example, 5 to 50 mm, preferably 10 to 40 mm, more preferably 20 to 30 mm. As shown, they are 20 mm, 25 mm, 30 mm, and the like. The diameter of a minute hole provided in the connecting portion 13a through which a pin or a screw can be passed is, for example, 0.5 to 4.0 mm, preferably 1.0 to 3.0 mm, more preferably 1.0. Specifically, for example, 1.2 mm as shown in FIGS. 1 and 7, 1.5 mm as shown in FIGS. 6 and 8, 2.0 mm, or the like.

  In addition, the structure of the cone used for the ligament reconstruction tool of this invention is not limited to FIG. 1 and 6-8. For example, the tip of the cone is not limited to a three-eyed pyramid, and may be a fourth pyramid or the like, or a shape in which a twisted groove is formed. Further, the front end portion may not be retractable in the reamer mounting portion and the rear end portion.

[reamer]
Next, the reamer used for the ligament reconstruction tool of the present invention will be described.

  FIG. 2 shows an example of a reamer used for the ligament reconstruction tool of the present invention. 2A is a left side view, FIG. 2B is a front view, and FIG. 2C is a right side view. 2A and 2C, a part of the illustration is omitted for easy understanding. The same applies to FIGS. 3A and 3C described later, FIGS. 4A and 4C, and FIGS. 5A and 5C.

  As illustrated, the reamer 20 has a short cylindrical shape. A hole 21 is provided at the center of the cylinder. The inner wall of the hole 21 is provided with a thread groove, and the reamer 20 can be fixed to the reamer mounting part 12 by fitting the thread groove with the thread groove of the reamer mounting part 12 in the cone 10. Three blades 22 are provided on the outer periphery of the cylinder, and a twisted groove-like gap is formed between the blades 22. Slopes 23 are provided at the front and rear ends (both ends of the cylinder) of the blade 22. The slope 23 forms part of a side surface of a semi-cone that tapers toward the end of the cylinder. FIG. 7D shows a state in which the reamer 20 is mounted on the reamer mounting portion 12 of the cone 10. As shown in the figure, the outer diameter of the reamer is larger than the outer diameter of the cone, and the outer diameter is enlarged by the slope from the reamer tip and rear ends toward the center of the reamer. With this structure, the reamer 20 can expand the diameter of the hole drilled in the bone by the cone 10 from the inside of the joint while being mounted on the reamer mounting portion 12.

  Moreover, another example of the reamer used for FIGS. 3-5 to the ligament reconstruction tool of this invention is shown. 3A is a left side view of a reamer 20a different from FIG. 2, FIG. 3B is a front view thereof, and FIG. 3C is a right side view thereof. 3, the hole 21a is the same as the hole 21 of FIG. 2, the blade 22a is the same as the blade 22 of FIG. 2, and the slope 23a is the same as the slope 23 of FIG. FIG. 4 (a) is a left side view of still another reamer 20b, FIG. 4 (b) is a front view thereof, and FIG. 4 (c) is a right side view thereof. 4, the hole 21b is the same as the hole 21 of FIG. 2, the blade 22b is the same as the blade 22 of FIG. 2, and the slope 23b is the same as the slope 23 of FIG. FIG. 5 (a) is a left side view of still another reamer 20c, FIG. 5 (b) is a front view thereof, and FIG. 5 (c) is a right side view thereof. 5, the hole 21c is the same as the hole 21 of FIG. 2, the blade 22c is the same as the blade 22 of FIG. 2, and the slope 23c is the same as the slope 23 of FIG. As shown, the reamer of FIGS. 3-5 is similar to the reamer of FIG. 2 except that the outer diameter is different.

  Although the dimension of each part of a reamer used for the ligament reconstruction tool of this invention is not specifically limited, For example, it is as follows. That is, first, the total length (length from the front end to the rear end) of the reamer is, for example, 3.0 to 15 mm, preferably 4.0 to 12 mm, more preferably 5.0 to 10 mm. For example, 7 mm, 8 mm, 9 mm, 10 mm, etc. 2 to 5 and 7 all show examples in which the total length of the reamer is 8 mm. Moreover, although the cone of FIG. 8 has shown the state which is not mounting | wearing with the reamer, mounting | wearing of the reamer with a full length of 7 mm is assumed. The outer diameter of the reamer is, for example, 3 to 15 mm, preferably 4 to 12 mm, more preferably 5 to 11 mm, and specifically 5 mm, 6 mm, 7 mm, 8 mm, 9 mm, and the like. 2 to 5 show examples in which the diameter of the reamer is 8 mm, 9 mm, 5 mm, and 7 mm, respectively, as illustrated. The depth of the gap (groove) between the reamer blade and the blade (“A” in FIG. 2A) is, for example, 0.5 to 6.0 mm, preferably 1.0 to 5.0 mm, more preferably 1. 5 to 4.0 mm, specifically, for example, 2.0 mm, 2.5 mm, and 3.0 mm. 2 to 5 all show examples in which the depth of the groove is 2 mm (2.0 mm). The inclination angle of the inclined surface (23 in FIG. 2B) is, for example, 30 to 80 °, preferably 45 to 70 °, more preferably 50 to 70 ° with respect to the axial direction of the reamer cylinder. Specifically, for example, they are 50 °, 60 °, 70 °, and the like. In all of the reamers shown in FIGS. 2 to 5, the inclination angle of the slope is 60 ° with respect to the axial direction of the cylinder of the reamer. The inner diameter of the hole (21 in FIG. 2) for mounting to the reamer mounting portion is the same as or slightly larger than the outer diameter of the reamer mounting portion. For example, when the outer diameter of the reamer mounting portion is 2 mm, 2. 1 mm or the like.

  In addition, it is preferable that the reamer used for the ligament reconstruction tool of the present invention has a hole for threading as described above. Thereby, for example, by passing a suture thread through the hole of the reamer and leaving the thread out of the surgical wound, the reamer can be prevented from falling off inside the joint. The hole for passing the thread can be provided at an arbitrary position of the reamer. For example, it may be provided in at least one of the blades.

[Depth gauge]
Next, the depth gauge used in the ligament reconstruction tool of the present invention will be described.

  In FIG. 9, an example of the depth gauge used for the ligament reconstruction tool of this invention is shown. FIG. 9A is a left side view, and FIG. 9B is a front view. As shown in the figure, the depth gauge 90 includes a cylinder 92 through which the cone tip portion can penetrate, and a scale portion 93 that is connected to the tip of the tube 92 and into which the cone tip portion can be inserted, and is provided on the scale portion 93. With the scale, the length of the portion inserted into the depth gauge 90 at the tip of the cone can be measured. The cylinder 92 can penetrate the tip of the cone through the hole 91 inside. In addition, in FIG. 9A, illustration of parts other than the cylinder 92 is omitted for simplification.

  FIG. 10 illustrates a state in which the cone tip is inserted into the depth gauge of FIG. As shown in the figure, the tip 11 of the cone 10 is passed through the tube 92 and inserted into the scale 93, and the scale 94 provided on the scale 93 is read at the position of the scale 14 provided on the tip 11. Thus, the length of the portion inserted into the depth gauge 90 at the cone tip portion 11 can be measured. In the case where the scale 14 is not provided at the cone tip 11 (or even when the scale 14 is provided), for example, the scale provided at the scale 93 at the forefront of the cone tip 11. By reading 94, the length of the portion inserted into the depth gauge 90 in the cone tip 11 may be measured. For example, as described in the description of the ligament reconstruction described below, as shown in the step (d) of FIG. 13A, the rear end (rear end) of the reamer 20 is aligned with the rear end (opening) of the hole 125. The tip of the cone 10 protruding from the femur 121 is inserted into the depth gauge 90 and the scale is read to measure the length of the protruding portion. By subtracting this length from the length from the rear end of the reamer 20 to the tip of the tip of the cone 10, the total length of the hole drilled in the femur (that is, the total length of the holes 124 and 125) can be calculated. . The alignment of the rear end of the reamer 20 and the rear end (opening) of the hole 125 can be performed, for example, while observing with an endoscope.

  Note that the length of the portion of the cone tip 11 inserted into the depth gauge 90 need only be measurable even if the absolute value is not measurable. Thereby, for example, the length (depth) of the portion whose diameter is expanded by the reamer in the hole drilled in the bone by the cone can be measured. This measurement can be performed by moving the reamer and the cone back and forth to read the difference in the relative value of the length of the portion inserted into the depth gauge 90 at the cone tip 11. More details will be described later.

  In the depth gauge of FIG. 9, the dimensions and the like of each part are not particularly limited, but are as follows, for example. The length of the cylinder 92 is, for example, 30 to 70 mm, preferably 35 to 60 mm, more preferably 40 to 60 mm, and specifically, for example, 40 mm, 50 mm, and 60 mm. The inner diameter of the hole 91 in the cylinder 92 is the same as or slightly larger than the outer diameter of the cone tip 11. For example, when the outer diameter of the cone tip 11 is 2.0 mm, as shown in FIG. .3 mm or the like. Although the outer diameter of the cylinder 92 is not particularly limited, for example, as shown in FIG. 9A, the inner diameter of the cylinder 92 is 2.3 mm and the outer diameter is 3.2 mm. The length of the scale 94 is, for example, 10 to 100 mm, preferably 15 to 80 mm, more preferably 20 to 70 mm, and specifically, for example, 40 mm, 60 mm, and 70 mm. The length of the scale part 93 is, for example, 10 to 120 mm, preferably 20 to 100 mm, more preferably 30 to 90 mm, and specifically, for example, 70 mm, 80 mm, and 90 mm. The total length of the depth gauge 90 (the length from the tip of the cylinder 92 to the rear end of the scale portion 93) is, for example, 40 to 200 mm, preferably 50 to 190 mm, more preferably 100 to 180 mm. As shown in FIG. 9, it is 150 mm, 160 mm, 170 mm, or the like.

[Grip forceps]
Next, the grasping forceps used in the ligament reconstruction tool of the present invention will be described.

  FIG. 11 shows an example of a grasping forceps used in the ligament reconstruction tool of the present invention. FIG. 4A is a plan view, and FIG. 4B is a front view of the grip portion. As illustrated, the grasping forceps 110 includes a handle 111 and a grasping portion 112. The tip 113 of the grip portion 112 has a shape that fits into the blade of the reamer, whereby the reamer can be gripped, for example, as shown in FIG. Further, the tip 113 of the grasping portion 112 is formed with an angle as shown in the figure, so that it is easy to grasp the reamer during ligament reconstruction described later. Other than the shape of the tip 113, for example, it may be the same as a normal forceps.

  The material of the cone, reamer, depth gauge, grasping forceps and the like used for the ligament reconstruction tool of the present invention is not particularly limited and can be appropriately selected in consideration of strength, safety to the human body, and the like. The material may be similar to, for example, a general ligament reconstruction tool or other surgical tool.

[Ligament reconstruction]
Next, an example of ligament reconstruction using the ligament reconstruction tool of the present invention will be described.

13A and 13B schematically show an example of ligament reconstruction using the ligament reconstruction tool of the present invention. The both figures are diagrams illustrating a part of the process of reconstruction of the anterior cruciate ligament of the knee. Figure 1 3A, shows the steps (a) ~ (d), in FIG. 13B, showing a step subsequent (e) ~ (h). In both figures, the skin, muscle, cartilage and the like are not shown for simplification. In addition, the ligament reconstruction tool and other surgical instruments of the present invention are shown with solid lines for clarity of illustration even when they are hidden behind the femur 121 and the tibia 122.

  First, as shown in the step (a), by rotating and advancing the cone 10, the hole 123 is formed in the tibia 122 from the outside of the joint to the inside (gap between the femur 121 and the tibia 122) (in an antegrade manner). And pierce the tibia 122. A method for positioning the hole 123 is not particularly limited. For example, a laser beam (not shown) is used to irradiate a laser beam in a direction in which the hole 123 is to be drilled, and the hole 123 is formed along the direction of the laser beam. You may wear it.

  Further, in the step (a), in the state where the tip of the cone 10 has just reached the surface of the femur 121, the scale of the tip of the cone 10 is read by reading the scale where the tip of the cone 10 and the surface of the tibia 122 intersect. The protrusion length from the tibia 122 (that is, the distance between the tibia 122 and the femur 121) can be measured. This length can be regarded as equal to the length of the ligament to be reconstructed inside the joint (gap between the femur and the tibia).

  Next, as shown in step (b), the reamer 20 grasped by the grasping forceps 110 is inserted into the gap (inside the joint) between the femur 121 and the tibia 122 through the hole 1001 created by incision of the skin. And the front-end | tip part of the cone 10 is inserted in the hole (21 in FIG. 2) of the center of the reamer 20. As shown in FIG. At this time, prior to putting the reamer 20 into the joint, the suture thread 130 is passed in advance through a hole for threading provided separately in the reamer 20. When the suture thread 130 is put inside the joint, the reamer 20 is prevented from falling off inside the joint by leaving the suture thread 130 out of the skin hole 1001. These operations are performed, for example, while observing the gap (inside the joint) between the femur 121 and the tibia 122 with an endoscope (arthroscope) 1100 opened in the skin through a hole 1002 different from 1001. be able to. Although not limited to the step (b), all the steps in FIG. 13A and FIG. 13B can be performed while observing with the endoscope 1100. However, for the sake of simplification of illustration, except for the step (b) The illustration of the endoscope 1100 is omitted. 13A and 13B can be performed without using the endoscope 1100, but it is preferable to use the endoscope 1100 for accurate and rapid operation. In particular, an endoscope is usually required when reading the scale attached to the cone 10 inside the joint.

  Next, as shown in step (c), the cone 10 is further rotated and advanced, and a hole 124 penetrating the femur 121 is formed. At this time, the reamer 20 may be gripped by the gripping forceps 110. Further, the suture thread 130 is preferably left passing through the reamer 20. When the reamer mounting part (12 in FIGS. 1 and 6 to 8) reaches the gap between the femur 121 and the tibia 122, the reamer 20 is fixed to the reamer mounting part. Prior to the next step, the grasping forceps 110 and the suture thread 130 are removed from the reamer 20 and taken out from the skin hole 1001. The suture thread 130 is preferably removed from the reamer 20 and fixed out of the skin hole 1001 before the reamer 20 is fixed to the reamer mounting portion so as not to be entangled with other instruments. The grasping forceps 110 may be removed from the reamer 20 after the reamer 20 is fixed to the reamer mounting portion, but may be before the reamer 20 is fixed if the reamer 20 does not fall off from the cone 10.

  Next, as shown in step (d), the cone 10 is further advanced while rotating together with the reamer 20, and the diameter on the inner side of the joint is enlarged by the reamer 20 in the hole 124 formed in the femur 121. To do. At this time, the absolute value or the relative value of the length of the protruding portion can be measured by inserting the distal end portion of the cone 10 protruding from the femur 121 into the depth gauge 90 as illustrated. For example, as shown in the figure, with the rear end (rear end) of the reamer 20 aligned with the rear end (opening) of the hole 125, the tip of the cone 10 protruding from the femur 121 is inserted into the depth gauge 90, and the scale , The length of the protruding portion is measured. By subtracting this length from the length from the rear end of the reamer 20 to the tip of the tip of the cone 10, the total length of the hole drilled in the femur (that is, the total length of the holes 124 and 125) can be calculated. . The alignment of the rear end of the reamer 20 and the rear end (opening) of the hole 125 can be performed while observing with the endoscope 1100, for example.

  Further, as shown in step (e), the cone 10 and the reamer 20 are further advanced while rotating, and the hole 125 is drilled to an appropriate depth. The accurate or approximate length (depth) of the hole 125 can be measured, for example, by reading the position of the marker attached in the vicinity of the reamer 20 at the rear end of the cone 10 with the endoscope 1100. It is. Specifically, for example, in a state where the reamer 20 front end and the hole 125 front end (the backmost) coincide with each other, the relationship between the position of the marker and the position of the rear end (opening) of the hole 125, By reading with the endoscope 1100, the exact or approximate length (depth) of the hole 125 can be confirmed. As for the length (depth) of the hole 125, for example, the length of the tip of the protruding cone 10 when the tip of the reamer 20 is positioned at the forefront (most back) of the hole 125. It is also possible to calculate by subtracting the length when located at the rearmost end (opening) from.

  Next, as shown in step (f), the cone 10 is retreated while being rotated together with the reamer 20, and the diameter inside the joint is enlarged by the reamer 20 in the hole 123 formed in the tibia 122 to form a hole 126. At this time, similarly to the step (d), the length of the hole 126 is read by using the depth gauge 90 or by reading the position of the marker attached in the vicinity of the reamer 20 at the tip of the cone 10 with the endoscope 1100. (Depth) can be measured. Specifically, for example, an accurate or approximate length (depth) of the hole 126 is measured by reading the position of the marker attached to the vicinity of the reamer 20 at the tip of the cone 10 with the endoscope 1100. Is possible. More specifically, for example, in a state where the rear end of the reamer 20 is aligned with the rear end (the deepest) of the hole 126, the relationship between the position of the marker and the position of the tip (opening) of the hole 126 is as follows. By reading with the endoscope 1100, the accurate or approximate length (depth) of the hole 126 can be confirmed. Further, for example, in the length of the tip portion of the protruding cone 10, when the rearmost end of the reamer 20 is located at the rearmost end (the deepest) from the length when the rearmost end of the hole 126 is located at the foremost end (opening). The length (depth) of the hole 126 can also be calculated by subtracting the length of.

  In FIG. 13B, the rotation directions of the cone 10 and the reamer 20 are the same in the steps (e) and (f), because the shape of the reamer blade is set in this way. Thus, it is preferable from a viewpoint of stability of the reamer 20 fixed to the reamer mounting part of the cone 10 to make the rotation direction the same in the steps (e) and (f). In addition, the direction of the thread groove cut in the outer wall of the reamer mounting portion and the hole of the reamer is preferably set appropriately from the same viewpoint.

  Once the hole 126 has been drilled to an appropriate length (depth), as shown in step (g), the grasping forceps 110 is inserted through the hole 1001 in the skin and the reamer 20 is gripped and fixed. (E) and (f) are rotated in the opposite direction, and the reamer 20 is removed from the reamer mounting part. Then, the cone 10 is pulled out from the femur 121, the reamer 20 and the tibia 122 and taken out from the body, and then the reamer 20 is taken out from the body together with the grasping forceps 110.

  In this manner, holes 123, 124, 125 and 126 of appropriate length (depth) and thickness can be drilled in the femur 121 and tibia 122 as shown in step (h). Thereafter, as shown in FIG. 14, the implantation ligament is inserted and fixed in the holes 123, 124, 125, and 126 in the same manner as in FIG. 16, and this process is performed by, for example, general ligament reconstruction. Can be done as well. For example, a loop thread may be tied to the end of each artificial ligament 142, and after inserting the graft ligament 140 into the joint, the end of the artificial ligament 142 may be pulled out from the hole 123 or 124 together with the loop thread. Thereafter, a button 143 having a diameter larger than the diameter of the hole 123 or 124 can be attached to the end of each artificial ligament 142 to secure the graft ligament 140 in the holes 123, 124, 125 and 126. In addition, the ligament for transplantation can also be produced in the same manner as general ligament reconstruction.

  As described above, the ligament reconstruction using the ligament reconstruction tool of the present invention can be performed, but the present invention is not limited to this. For example, in FIGS. 13A and 13B, only one hole 123, 124, 125, and 126 for ligament implantation is drilled, but another similar hole is drilled, one for each hole (ie, a total of 2 The present ligament for transplantation may be transplanted. The positions of the holes drilled in the femur and tibia can be determined as appropriate, for example, in the same manner as in general ligament reconstruction. In the case of reconstruction of the anterior cruciate ligament, two ligaments for transplantation are more preferable than one from the viewpoint of postoperative knee joint stability (for example, rotational stability).

  The diameters and lengths (depths) of the holes 123, 124, 125, and 126 are not particularly limited, but are as follows, for example. That is, in anterior cruciate ligament reconstruction, when the number of ligaments for transplantation is one (that is, one hole is made), the diameter of the hole 123 outside the tibia is, for example, 2.0 to 7.0 mm, preferably 2.2. It is -5.0 mm, More preferably, it is 2.4-4.5 mm, Specifically, it is 2.4 mm, 3 mm, 4.5 mm etc., for example. The diameter of the hole 124 outside the femur is, for example, 2.0 to 7.0 mm, preferably 2.2 to 5.0 mm, more preferably 2.4 to 4.5 mm. 4 mm, 3 mm, 4.5 mm, etc. The diameter of the hole 125 inside the femur is, for example, 4.0 to 12.0 mm, preferably 5.0 to 10.0 mm, more preferably 6.0 to 10.0 mm, and specifically, for example, 5 mm. , 6 mm, 7 mm, 8 mm, 9 mm, 10 mm and the like. The diameter of the hole 126 inside the tibia is, for example, 4.0 to 12.0 mm, preferably 5.0 to 10.0 mm, more preferably 6.0 to 10.0 mm, and specifically, for example, 5 mm, 6 mm, 7 mm, 8 mm, 9 mm, 10 mm, etc. The length (depth) of the hole 125 inside the femur is, for example, 10 to 40 mm, preferably 15 to 30 mm, more preferably 20 to 25 mm, and specifically, for example, 20 mm and 25 mm. Further, the total length of the holes drilled in the femur (that is, the total length of the holes 124 and 125) is, for example, 25 to 80 mm, preferably 30 to 60 mm, more preferably 30 to 50 mm. For example, 30 mm, 40 mm, etc. The length (depth) of the hole 126 inside the tibia is, for example, 10 to 40 mm, preferably 15 to 30 mm, more preferably 20 to 25 mm, and specifically, for example, 20 mm and 25 mm. Further, the total length of the holes drilled in the tibia (that is, the total length of the holes 123 and 126) is, for example, 25 to 80 mm, preferably 30 to 60 mm, more preferably 30 to 50 mm. 30 mm, 40 mm, etc.

  In the anterior cruciate ligament reconstruction, when there are two ligaments for transplantation (that is, two holes to be drilled), the diameter of the hole 123 outside the tibia is, for example, 2.0 to 6.0 mm, preferably 2.4. It is -5.0 mm, More preferably, it is 2.4-4.5 mm, Specifically, it is 2.4 mm, 3 mm, 4.5 mm etc., for example. The diameter of the hole 124 on the outer side of the femur is, for example, 2.0 to 6.0 mm, preferably 2.4 to 5.0 mm, and more preferably 2.4 to 4.5 mm. 4 mm, 3 mm, 4.5 mm, etc. The diameter of the hole 125 inside the femur is, for example, 3 to 8 mm, preferably 4 to 7 mm, more preferably 5 to 6 mm, and specifically, for example, 5 mm, 6 mm, 7 mm, and 8 mm. The diameter of the hole 126 inside the tibia is, for example, 3 to 8 mm, preferably 4 to 7 mm, more preferably 5 to 6 mm, and specifically, for example, 5 mm, 6 mm, 7 mm, and 8 mm. The length (depth) of the hole 125 inside the femur is, for example, 10 to 40 mm, preferably 15 to 30 mm, more preferably 20 to 25 mm, and specifically, for example, 20 mm and 25 mm. Further, the total length of the holes drilled in the femur (that is, the total length of the holes 124 and 125) is, for example, 25 to 80 mm, preferably 30 to 60 mm, more preferably 30 to 50 mm. For example, 30 mm, 40 mm, etc. The length (depth) of the hole 126 inside the tibia is, for example, 10 to 40 mm, preferably 15 to 30 mm, more preferably 20 to 25 mm, and specifically, for example, 20 mm and 25 mm. Further, the total length of the holes drilled in the tibia (that is, the total length of the holes 123 and 126) is, for example, 25 to 80 mm, preferably 30 to 60 mm, more preferably 30 to 50 mm. 30 mm, 40 mm, etc. When the number of ligaments for transplantation is two, the diameter of the holes 125 and 126 may be slightly smaller correspondingly because the graft tendon may be slightly thinner as compared with the case of one ligament for transplantation.

  The ligament reconstruction tool of the present invention, in particular, the cone and the reamer can be reused a plurality of times, but from the viewpoint of hygiene and the like, it is preferably disposable only once.

  Further, as described above, the ligament reconstruction tool of the present invention is preferably used for knee ligament reconstruction, and preferably used for reconstruction of the anterior cruciate ligament, but is not limited thereto, and in any joint, It can be used for any ligament reconstruction.

  In the anterior cruciate ligament reconstruction according to the conventional method, as described above, the hole (bone hole) drilled in the bone is large. For this reason, in order to return to an athletic competition or the like, long-term rehabilitation such as 6 to 9 months is required, for example. In addition, the vertical and lateral movements of the reconstructed ligament (transplanted ligament transplanted to the knee) may cause the bone hole to expand and the knee joint to become unstable.

  On the other hand, according to the ligament reconstruction tool of the present invention, it is possible to perform a minimally invasive ligament reconstruction operation, and for example, it is possible to improve joint stability, shorten the rehabilitation period, and the like.

  Examples of the present invention will be described below. However, the present invention is not limited at all by the following examples.

  Thirteen cases were subjected to ligament reconstruction using the ligament reconstruction tool of the present invention. Eleven of these were reconstructions of the entire anterior cruciate ligament, with double bundle reconstruction (ie, two holes drilled and two graft ligaments). The 11 cases were 16 to 44 years old (average 31 years old), 5 males and 6 females. In addition, the two ligaments for transplantation in the double bundle reconstruction are referred to as an anterior medial fiber bundle (AM bundle) and a posterior lateral fiber bundle (PL bundle). Two cases other than the 11 cases were a 19-year-old man and a 16-year-old woman, and only ligament reinforcement of AM bundles was performed.

  The photograph of FIG. 17 shows a cone (hereinafter also referred to as “drill pin” or “drill guide pin”) used in the ligament reconstruction operation of this example. The drill guide pin (drill pin) in the figure (photograph) corresponds to the cone (drill pin) 10 shown in FIG. As shown in FIG. 7, the outer diameter of the rear end portion 13 is 3 mm, and the outer diameter of the tip end portion 11 is 2 mm. The right side of FIG. 17 is the front-end | tip part 11, the left side is the rear-end part 13, and the reamer mounting | wearing part 12 is provided among them. Moreover, the enlarged photograph shown with the arrow in the figure is an enlarged photograph of the front-end | tip part 11, the rear-end part 13, and the reamer mounting part 12 of this drill pin, respectively. With this drill pin, it is possible to drill a hole in the bone. Further, as described above, the thread groove is cut in the reamer mounting portion 12, and the bone hole can be enlarged by the reamer by mounting the reamer. 13A and 13B, the drilling of the tibial hole 123 or the femoral hole 124 may be referred to as “pre-drilling” or simply “drilling”. Further, to enlarge the diameter of the tibial hole 123 or the femoral hole 124 to produce the tibial hole 126 or the femoral hole 125 may be referred to as “drilling” as compared to “pre-drilling”. In this example, drilling and pre-drilling were performed by rotating the drill pin with a motor attached to the drill pin unless otherwise specified.

  The reamer is provided with a hole through which a thread passes to prevent the reamer from falling into the joint. As shown in the photograph of FIG. 18, the thread is passed through and held by gripping forceps. Can be inserted inside the joint. FIG. 19 shows a photograph of the entire grasping forceps used in this example, and FIG. 20 shows a photograph of the tip (gripping part) of the grasping forceps of FIG.

  Next, the method of ligament reconstruction according to this embodiment will be described. In this example, bone holes for anterior medial fiber bundle (AM bundle) and posterior lateral fiber bundle (PL bundle) were prepared according to the steps of FIGS. 13A and 13B, respectively. In the following, all the photographs in FIGS. 21 to 27 show the right knee technique. 21 to 23 and 25 to 26 are photographs obtained by photographing the inside of the joint (the gap between the femur and the tibia) using an endoscope.

  That is, first, a bone hole for an anterior medial fiber bundle (AM bundle) was prepared according to the steps of FIGS. 13A and 13B. First, prior to the preparation of the bone hole, a transpiration device was inserted into the joint through a hole formed in the skin of the knee joint as shown in the photograph of FIG. The remaining anterior cruciate ligament was dissected (removed) by the transpiration device in order to fix the attached portion of the anterior cruciate ligament to be reconstructed (for transplantation). Next, as shown in the photograph of FIG. 22, a laser was inserted into the joint, and a guide laser beam was irradiated in the direction in which the hole 123 should be formed. In FIG. 22, the light that can be seen at two locations indicated by the white arrows is the irradiated laser light. Next, as shown in step (a) of FIG. 13A, the drill pin 10 was penetrated from the outside of the tibia to the inside of the joint, and a hole 123 was made. At this time, by reading the scale at the intersection of the tip of the drill 10 and the surface of the tibia 122, the protruding length of the tip of the drill 10 from the tibia 122 (that is, the distance between the tibia 122 and the femur 121) is determined. It was measured. This length was considered equal to the length of the ligament to be reconstructed (also called the reconstructed ligament or graft ligament) inside the joint (the gap between the femur and the tibia).

  Next, as shown in the photograph of FIG. 23, the reamer grasped by the grasping forceps was put into the joint through the hole in the skin, and the tip of the drill pin was inserted into the hole at the center of the reamer. This step corresponds to step (b) in FIG. 13A. In this example, the diameter of the reamer was 6 mm.

  Further, as shown in step (c) of FIG. 13A, the drill pin 10 was further advanced while rotating (forward rotation), and a hole 124 penetrating the femur 121 and the skin of the thigh was made. At this time, when the drill pin 10 passes through the hole in the center of the reamer 20 and the tip of the drill pin 10 is inserted into the femur 121, the suture thread 130 and the grasping forceps 110 are removed from the reamer 20 and from the hole 1001 in the skin. I went out. Thereafter, the drill pin 10 was further advanced while rotating (forward rotation), and when the reamer mounting part reached the gap between the femur 121 and the tibia 122, the reamer 20 was fixed to the reamer mounting part. In this embodiment, the inner diameter of the tibial hole 123 was 3 mm or 4.5 mm, and the inner diameter of the femoral hole 124 was also 3 mm or 4.5 mm.

  Next, as shown in step (d) of FIG. 13A, the drill pin 10 is further advanced while rotating together with the reamer 20, and the diameter inside the joint is enlarged by the reamer 20 in the hole 124 formed in the femur 121. The hole 125 was used. Then, as shown in the drawing, with the rear end (rear end) of the reamer 20 aligned with the rear end (opening) of the hole 125, the front end of the drill pin 10 protruding from the femur 121 and the skin of the thigh (trans The length of the protruding portion was measured by inserting into the depth gauge 90 and reading the scale. By subtracting this length from the length from the rear end of the reamer 20 to the tip of the tip of the drill pin 10, the total length of the hole drilled in the femur (that is, the total length of the holes 124 and 125) was calculated. . The photograph of FIG. 24 shows a state in which the femur 121 and the tip of the drill pin 10 protruding from the skin of the thigh are (percutaneously) inserted into the depth gauge 90. The figure (photograph) also shows an endoscope protruding from the skin of the knee joint.

  Further, as shown in step (e) of FIG. 13B, the drill pin 10 and the reamer 20 were further advanced while rotating (forward rotation), and the hole 125 was drilled to a length (depth) of 25 mm. It should be noted that the length (depth) of the hole 125 being 25 mm means that the tip of the reamer 20 and the tip of the hole 125 (the deepest) coincide with each other in the vicinity of the reamer 20 at the rear end of the drill pin 10. The endoscope 1100 reads that the position of a 25 mm marker (that is, a marker indicating that the distance from the tip of the reamer 20 is 25 mm) coincides with the rear end (opening) of the hole 125. Confirmed by that. The state is shown in the photograph of FIG. FIG. 25 is a photograph during measurement of the length (depth) of the femoral bone hole 125 for the posterior lateral fiber bundle (PL bundle).

  Further, as shown in step (f) of FIG. 13B, the drill pin 10 is retracted while rotating (forward rotation) together with the reamer 20, and the diameter inside the joint is enlarged by the reamer 20 in the hole 123 formed in the tibia 122. , Holes 126 were formed. At this time, in a state where the rear end of the reamer 20 and the rear end (the deepest) of the hole 126 are aligned, any position of the 10 to 40 mm marker attached in the vicinity of the reamer 20 at the tip of the drill pin 10 is set to the inside. By reading with the endoscope 1100, the length (depth) of the hole 126 was confirmed. Note that the length of the graft tendon (141 in FIGS. 14 and 15), which is a part of the reconstructed ligament (graft ligament, 140 in FIG. 15), is within the joint (the femur 121 and the tibia 122) of the graft tendon 141. It is equal to the sum of the length in the gap (the length measured in the step (a) of FIG. 13A), the length in the hole 125, and the length in the hole 126. In this embodiment, the length (depth) of the hole 125 is set to be equal to or slightly larger than the length of the graft tendon 141 in the hole 125. Similarly, the length (depth) of the hole 126 was made equal to or slightly larger than the length of the graft tendon 141 in the hole 126. In the present embodiment, the diameters of the holes 125 and 126 are 6 mm (equal to the diameter of the reamer).

  Further, as shown in the step (g) of FIG. 13B, after inserting the grasping forceps 110 from the skin hole 1001 and gripping and fixing the reamer 20, the drill pin 10 is manually moved to the steps (e) and (f). The reamer 20 was removed from the reamer mounting part. Then, the drill pin 10 was pulled out from the femur 121, the reamer 20 and the tibia 122 and taken out from the body, and then the reamer 20 was taken out from the body together with the grasping forceps 110. Then, as shown in the step (h), holes 123, 124, 125, and 126 having appropriate lengths (depths) and thicknesses were drilled in the femur 121 and the tibia 122.

  As described above, a bone hole for an anterior medial fiber bundle (AM bundle) was prepared. Similarly, bone holes for posterior lateral fiber bundles (PL bundles) were also produced. In this embodiment, the thickness of the holes 123, 124, 125 and 126 for the posterior outer fiber bundle (PL bundle) and the length of the holes 125 and 126 are the same as those for the anterior inner fiber bundle (AM bundle). It was the same as the bone hole, or was appropriately set according to the length, thickness, etc. of the graft tendon (141 in FIGS. 14 and 15) and the artificial ligament (142 in FIGS. 14 and 15).

  After drilling (creating) bone holes for the front inner fiber bundle (AM bundle) and the rear outer fiber bundle (PL bundle) in this way, as shown in FIG. 14, holes 123, 124, 125 and The ligament 140 for transplantation was inserted into 126 and fixed. That is, first, in the graft ligament 140 shown in FIG. 15, after tying a loop thread to the end of each artificial ligament 142 and inserting the graft ligament (reconstruction ligament) 140 inside the joint, the end of the artificial ligament 142 is The loop yarn was pulled out from the hole 123 or 124. Thereafter, a button (end button) 143 having a diameter larger than the diameter of the hole 123 or 124 was attached to the end of each artificial ligament 142, and the graft ligament 140 was fixed in the holes 123, 124, 125 and 126. Note that CL-BTB (bone-tendon-bone) was used as the artificial ligament 142 on the femur side, and the end of the CL-BTB was connected to a button (end button) 143 on the femur side. On the tibia side, a suture was used as the artificial ligament 142, and the end of the suture was tied to a button (end button) 143 on the tibia side.

  As described above, the anterior cruciate ligament reconstruction of this example was performed. The photograph of FIG. 26 shows the reconstructed two-root anterior cruciate ligament (that is, two of an anterior medial fiber bundle (AM bundle) and a posterior lateral fiber bundle (PL bundle)). FIG. 27 shows an X-ray photograph of the knee after the anterior cruciate ligament reconstruction. As shown in the figure, the reconstructed two-route anterior cruciate ligament could be stably fixed by the end buttons. All cases had good postoperative stability.

  As described above, according to the present example, it was possible to easily create a bone hole with an accurate length (depth) and diameter in the tibia and femur, and the postoperative stability was also good. . Thus, according to the present invention, a minimally invasive ligament reconstruction operation can be easily performed. For example, joint stability can be improved and a rehabilitation period can be shortened.

  As described above, according to the ligament reconstruction tool, cone, and reamer of the present invention, a minimally invasive ligament reconstruction operation can be easily performed. According to the present invention, for example, in the anterior cruciate ligament reconstruction of the knee, it is possible to further shorten the place where the rehabilitation period takes 6 to 9 months in the conventional method. The ligament reconstruction tool of the present invention is preferably used for knee ligament reconstruction, and preferably used for anterior cruciate ligament reconstruction, but is not limited thereto, and any ligament reconstruction in any joint. Can be used.

DESCRIPTION OF SYMBOLS 10 Cone 11 Tip part 11a Tip 12 Reamer mounting part 13 Rear end part 13a Connection part 14 Scale 15 Marker 20, 20a, 20b, 20c Reamer 21, 21a, 21b, 21c Reamer hole 22, 22a, 22b, 22c Reamer blade 23, 23a, 23b, 23c Slope 90 Depth gauge 91 Depth gauge hole 92 Cylinder 93 Scale part 94 Scale 110 Grasping forceps 111 Handle 112 Grasping part 113 Tip of grip part 121 Femur 122 Tibia 123 Tibia hole 124 Femur hole 125 Reamer Femoral hole 126 tibia hole 130 reamer enlarged diameter by reamer, suture 1001, 1002 skin hole 1100 endoscope 140 ligament for transplantation 141 graft tendon 142 artificial ligament 143 button 155 femoral bone Hole 156 Tibial hole

Claims (10)

A ligament reconstruction tool for use in an operation of reconstructing a ligament of a joint in which a plurality of bones are connected to each other by a ligament,
Including cones and reamers,
The cone can pierce holes through the plurality of bones and the joint;
The cone includes a front end portion, a rear end portion, and a reamer mounting portion provided between the front end portion and the rear end portion and capable of mounting the reamer.
The reamer can expand the diameter of the hole drilled by the cone from the inside of the joint in a state of being mounted on the reamer mounting portion.
In a state in which the reamer is mounted on the reamer mounting portion, a length from the reamer tip to the tip of the cone is a length capable of penetrating the hole in at least one of the plurality of bones. A ligament reconstruction tool.   The ligament reconstruction tool according to claim 1, wherein the reamer mounting portion is located substantially in the center of the cone. A scale is attached to the cone tip,
The ligament reconstruction tool according to claim 1 or 2, wherein the protruding length of the cone tip from the bone can be measured by the scale.   The marker which shows the distance from a reamer front-end | tip or a rear end in the position close | similar to the said reamer mounting part in at least one of the said cone front-end | tip part and a rear-end part is provided in any one of Claim 1 to 3 The ligament reconstruction tool as described.   The ligament reconstruction tool according to any one of claims 1 to 4, wherein the reamer has a hole for threading.   The ligament reconstruction tool according to any one of claims 1 to 5, wherein the joint is a knee joint.   The ligament reconstruction tool according to claim 6, wherein the ligament is an anterior cruciate ligament. Further comprising grasping forceps for grasping the reamer inside the joint;
The ligament reconstruction tool according to any one of claims 1 to 7, wherein a grasping portion of the grasping forceps is formed so as to be able to grasp the reamer in accordance with a shape of the reamer.   The ligament according to claim 8, wherein the grasping forceps can grasp the reamer in a state where the cone on which the reamer is mounted penetrates the plurality of bones and the joint, and the reamer is located inside the joint. Reconstruction tool. A depth gauge,
The depth gauge includes a cylinder through which the cone tip can pass, and a scale portion connected to the tip of the cylinder and into which the cone tip can be inserted,
The ligament reconstruction tool according to any one of claims 1 to 9, wherein a length of a portion of the cone tip portion inserted into the depth gauge can be measured by a scale provided on the scale portion.