JP6199609B2 - Bone surgery guide instrument and bone surgery instrument set - Google Patents

Description

  The present invention mainly relates to a bone surgery guide device and a bone fixation device used for bone shortening surgery.

  Forearm fractures of the forearm are often shortened by axial tension exerted by the soft tissue as the fracture heals. Therefore, the other bone of the forearm, that is, the ulna is longer than the radius. As a result, the ulna may hit the wrist carpal bone, causing inflammation and pain. As a general treatment for this symptom, a method is known in which the ulna is shortened by a bone shortening operation and the appropriate relative lengths of the ulna and the rib are restored.

  Further, conventionally, in a bone plate for fixing two bone parts that have been cut after a bone shortening operation, an instrument having a guide portion that guides a saw blade to a bone during bone shortening surgery is known (for example, Patent Document 1).

Special table 2009-535129 gazette

  When performing a bone shortening operation (osteotomy) of a bone, it is necessary to cut two portions in the long axis direction of the bone, and after excising a part of the bone, it is necessary to unite the separated bone. Accordingly, the cut surfaces are required to be parallel to each other.

  For example, in the case of ulna, it consists of an upper proximal end (or upper end) and a lower distal end (or lower end) and a diaphysis (ulna body), and the upper and lower ends expand relative to the diaphysis of tubular bone. It has a (thickened) shape. In addition, although the diaphyseal portion is lightly curved in an S shape as a whole, there is a region that can be regarded as a substantially cylindrical shape partially (in the range of the length to be excised). For this reason, in conventional bone shortening surgery, a method of cutting two portions of the diaphysis in parallel with a plane perpendicular to the long axis has been adopted.

  However, it is difficult to secure the area of the cut surface by cutting at two locations of the diaphysis, and sufficient bone healing may not be obtained. For this reason, the method of cut | disconnecting so that a cut surface may incline with respect to the major axis of a diaphysis part is also employ | adopted (for example, refer patent document 1). However, if the inclination angle with respect to the long axis is too small, a large cross-sectional area can be secured, but it is not preferable because it is necessary to fix the bone over a long distance after the operation. Therefore, the inclination angle is limited to a predetermined range, and there is a limit to the expansion of the area of the cut surface.

  On the other hand, the upper end or lower end of the ulna expands compared to the diaphysis, and it is easy to ensure the area of the cut surface, but both are distorted shapes (for example, the shape that bulges obtusely at the lower end (ulna head)) ), It was difficult to form two parallel cut surfaces.

  In addition, as an aid for bone healing and bone after surgery, the separated bone after cutting is generally fixed with a plate (bone plate) straddling both. However, since this plate remains in the body semipermanently, it is desirable that its shape be as simple and narrow as possible and that there be sufficient fixation, but the conventional bone plate is not sufficient for both. There was a problem.

  In view of such circumstances, the present invention is capable of easily forming two parallel cut surfaces while ensuring the area of the cut surface, and a bone surgery guide instrument, and a sufficient amount of separated bone while having a simple and narrow shape. An object of the present invention is to provide a bone anchoring device that can be securely fixed.

(1) The present invention provides a bone operation for cutting a bone into a first bone portion and a second bone portion in the long axis direction and guiding the blade during a bone shortening operation in which a part is excised in the long axis direction. A guide instrument for bone, the guide instrument for bone surgery having a guide body, the guide body positioning a first guide surface defining a cutting surface, and positioning the first guide surface on the first bone portion A first guide portion having a first guide hole, a second guide surface that is spaced apart from and opposed to the first guide surface by the amount of bone resection, and the second guide surface is defined by the first guide hole. A second guide portion having a second guide hole for positioning in the second bone portion, and the first guide portion and the second guide portion while maintaining parallelism of the first guide surface and the second guide surface. and a guide shaft for supporting relatively movably in the axial direction, the bone The distance between the first guide hole and the second guide hole before excision is displaced according to the amount of bone excised, the distance from the first guide hole to the first guide surface, and the The distance from the second guide hole to the second guide surface is constant regardless of the amount of bone resection, and the portion corresponding to the separation distance between the first guide surface and the second guide surface is excised. When the first bone portion and the second bone portion of the bone are joined, the first positioning hole and the first positioning hole formed in the bone are aligned with the first guide hole and the second guide hole . 2. A bone surgery guide device characterized in that a bone fixing device having a predetermined length can be used by maintaining the distance of the positioning hole constant irrespective of the amount of bone resection .

  According to the present invention, a bone fixing device having a predetermined length can be used in a plurality of osteotomy operations.

  In addition, the positioning of the two guide surfaces (the first guide surface and the second guide surface) parallel to each other before cutting is completed by one positioning of the guide body (in a positioned state). Positioning, guiding the saw blade at the guide surface, cutting the bone, positioning the guide surface easily and accurately compared to a conventional guide device that needs to position the second guide surface again Can do.

  (2) In the present invention, the bone cutting surface defined by the first guide portion and the second guide portion so as to include the first guide surface and the second guide surface is a long axis of the bone. The bone surgery guide instrument according to (1) above, which includes a portion that is displaced in a direction.

  According to the above invention, a cutting surface that is displaced in the long axis direction of the bone can be formed. A large surface area can be secured. In addition, it is possible to secure a large area of the cut surface as compared with the case where a cut surface inclined with respect to the long axis direction of the bone is formed in a preferable range in the bone shortening operation. This enables early and reliable bone healing.

  (3) In the present invention, the first guide surface and the second guide surface are surfaces substantially parallel to the short axis direction of the bone, and at least one of the first guide portion and the second guide portion. The guide device for bone surgery according to (1) or (2), wherein the guide device has another guide surface substantially parallel to the long axis direction.

  According to the above-described invention, it is possible to secure a large area of the cut surface as compared with the case of forming a cut surface substantially parallel to the short axis direction of the bone (substantially perpendicular to the long axis direction). Can be fused.

(4) The present invention is also characterized in that a plurality of the first guide holes are arranged along the minor axis direction, and a plurality of the second guide holes are arranged along the major axis direction. It is a guide instrument for bone surgery as described in 3).
According to the above invention, since the first guide portion can be positioned at the end of the bone (for example, the ulna head of the ulna), two parallel cut surfaces can be accurately formed even if the shape is distorted. And a large area of the cut surface can be secured.
( 5) The present invention is also characterized in that the first guide surface and the second guide surface are surfaces inclined at a predetermined angle from the major axis direction, respectively (1) to ( 4 ) The bone surgery guide device according to any one of the above.

  According to the above-described invention, it is possible to secure a large area of the cut surface as compared with the case of forming a cut surface substantially parallel to the short axis direction of the bone (substantially perpendicular to the long axis direction). Can be fused.

( 6 ) In the present invention, the first guide portion and the first guide surface are positioned at the end of the bone before cutting, and the second guide portion is positioned at the diaphysis of the bone before cutting. The guide device for bone surgery according to any one of (1) to ( 5 ), characterized in that:

  According to the above invention, since at least the first guide surface can be positioned at the end of the bone (for example, the ulna head of the ulna), the cutting surface can be compared with the case where the two guide surfaces are positioned at the diaphysis. A large area can be secured, and early and reliable bone fusion is possible.

  (7) The present invention also provides the bone surgery guide device according to any one of (1) to (6), wherein the guide shaft includes a scale portion.

  According to the above invention, since the sliding distance of the second guide portion can be visually confirmed by the scale portion, the separation distance between the first guide portion and the second guide portion can be easily and accurately determined.

(8) The present invention further includes a positioning guide that is configured separately from the guide main body and opens the first positioning hole in the first bone portion at a constant angle with respect to the long axis of the bone. The bone surgery guide instrument according to any one of (1) to (7), wherein the bone surgery guide instrument is provided.

  According to the said invention, the 1st positioning hole for fixing a guide part main body to a predetermined position (positioning) can be previously formed by the positioning guide tool. That is, by forming the first positioning hole at an accurate position (on the approximate axis center line of the bone in the major axis direction and on a line orthogonal to the approximately axis center line), the guide portion main body (the first guide surface and the first guide surface) is formed. 2 guide surfaces) can be positioned at an appropriate position with respect to the axial center line of the bone (for example, a position where a cut surface perpendicular to the axial center line is formed).

(9) The present invention also provides the bone surgery guide device according to any one of (1) to (8), the first bone portion cut by the bone surgery guide device , and the second bone device . A bone surgical instrument set having a bone fixation instrument for fixing a bone part, wherein the bone fixation instrument extends in the longitudinal direction across the first bone part and the second bone part. A fixed shaft extending in a direction substantially perpendicular to the main surface of the plate portion at an end portion in the longitudinal direction of the plate portion and inserted through the first positioning hole, and a fixing provided in the plate portion And a fixing member that is inserted through the fixing hole in a state in which the fixing hole is aligned with the second positioning hole, and a fixing member that fixes the bone and the bone. Can be shared when the length is the first length and the second length It is a bone surgical instrument set to be characterized.

  According to the above-described invention, it is possible to provide a bone fixation device that is simple and narrow and can sufficiently fix separated bones.

  According to the bone surgery guide instrument described in claims 1 to 8 of the present invention, it is possible to use a bone fixation instrument having a predetermined length in a plurality of osteotomy operations, while securing the area of the cut surface. Two parallel cut surfaces can be easily formed.

  In addition, according to the bone fixation device according to claim 9 of the present invention, it is possible to sufficiently fix the separated bone while having a simple and narrow shape.

It is a figure which shows the bone surgery guide instrument concerning 1st Embodiment of this invention, (a) It is a top view of a guide main body, (b) It is an external appearance perspective view of a positioning guide tool. It is a figure which shows the guide main body concerning 1st Embodiment of this invention, (a) It is a disassembled perspective view, (b) It is a top view, (c) (d) The top view of a 1st guide part and a scale part It is. It is a figure which shows the positioning guide tool concerning 1st Embodiment of this invention, (a) It is an external perspective view, (b) It is a top view, (c) It is a front view. 1 is an external perspective view showing a bone fixation device according to a first embodiment of the present invention. It is a figure which shows the mode of the prior preparation of the guide main body and bone fixation instrument concerning 1st Embodiment of this invention, (a) It is an external appearance perspective view of a guide main body, (b) It is the elements on larger scale of a guide main body, (C) It is an external appearance perspective view of a bone fixing device, (d) It is an external perspective view of a bone fixing device. BRIEF DESCRIPTION OF THE DRAWINGS It is a schematic diagram explaining the usage method of the positioning guide tool concerning 1st Embodiment of this invention, (a) It is an external perspective view, (b) It is an external perspective view, (c) It is a top view, d) It is an external perspective view, (e) It is an external perspective view. It is a figure explaining the usage method of the guide main body concerning 1st Embodiment of this invention, (a)-(c) It is an external perspective view, (d) It is a top view. It is an external appearance perspective view explaining the usage method of the guide main body concerning 1st Embodiment of this invention. It is a figure which shows the bone cut | disconnected using the guide instrument for bone surgery concerning 1st Embodiment of this invention, (a) It is an external perspective view, (b) It is an upper surface schematic diagram, (c) In upper surface figure is there. It is a figure which shows the joining method of the bone cut | disconnected using the bone surgery guide instrument concerning 1st Embodiment of this invention, (a) Top view of bone, (b) It is a top view of a guide main body. It is an external appearance perspective view which shows the method to join bone using the bone fixing device concerning 1st Embodiment of this invention. It is the upper surface schematic diagram which shows (a) guide main body concerning 2nd Embodiment of this invention, (b) It is the upper surface schematic diagram of the cut | disconnected bone. It is an upper surface schematic diagram which shows the guide main body concerning 3rd Embodiment of this invention.

  Hereinafter, embodiments of the present invention will be described in detail with reference to FIGS. First, a first embodiment will be described with reference to FIGS.

[First Embodiment]
<Guide instrument for bone surgery>
The bone surgery guide instrument 1 will be described with reference to FIGS. 1 to 3. FIG. 1 is a view showing a bone surgery guide instrument 1, FIG. 1 (a) is a top view of a guide body 2, and FIG. 1 (b) is an external perspective view of a positioning guide tool 3. 2A and 2B are views showing the guide main body 2, FIG. 2A is an exploded perspective view, FIG. 2B is a top view, and FIG. 2C is the first guide portion 4 and the guide shaft. 10 is a top plan view of FIG. 10, and FIG. 2D is an enlarged top plan view of a broken-line circled portion of FIG. 3 is a view showing the positioning guide 3, wherein FIG. 3 (a) is an external perspective view, FIG. 3 (b) is a top view, and FIG. 3 (c) is a front view.

  Referring to FIG. 1, a bone surgery guide device 1 of the present embodiment cuts a bone into a first bone portion and a second bone portion in the long axis direction and excises a part in the long axis direction. During bone shortening surgery, it guides a blade (for example, a blade, a saw blade or a chisel) of a bone cutting instrument (for example, a bone saw, a micro reciprocating saw, etc.), and a guide body 2 ((a) in the figure). And the positioning guide tool 3 (the figure (b)) comprised separately from the guide main body 2 is comprised. The guide body 2 is fixed to the bone and guides a blade for cutting the bone to a predetermined position. The positioning guide 3 forms a positioning hole when the guide body 2 is fixed to the bone. Here, the “bone” in the description of this embodiment is a human bone, and this embodiment is particularly suitable for a tubular bone. In the following, as an example, cutting (resection) of the ulna using a bone cutting instrument is performed. The case where it performs is demonstrated to an example.

<Guide body>
With reference to FIG. 2, the guide main body 2 of this embodiment is demonstrated in detail. As shown in FIG. 2A, the guide body 2 has a first guide part 4, a second guide part 5, and a guide shaft 10. The guide shaft 10 is a prismatic member (or columnar member), and the first guide portion 4 and the second guide portion 5 are fixed to both ends in the major axis direction. The first guide portion 4 is fixed to the guide shaft 10 so as not to slide, and the second guide portion 5 is attached to the guide shaft 10 so as to be slidable in the long axis direction of the guide shaft 10. Is fixed in place.

  As shown in FIGS. 2 (a) and 2 (b), the first guide portion 4 and the second guide portion 5 are disposed to face each other, and when both are disposed closest to each other, the outer shape of both is substantially elliptical when viewed from above. Presents. The opposing surfaces of the first guide portion 4 and the second guide portion 5 in the separated portion are flat surfaces, and the flat surfaces serve as guide surfaces for guiding the blade of the bone cutting instrument. More specifically, the first guide portion 4 has a first guide surface 61 that defines a cutting surface, and the second guide portion 5 is cut away from and opposed to the first guide surface 61 by the amount of resection of the ulna. It has the 2nd guide surface 62 which defines a surface. The first guide surface 61 includes a first surface 61A perpendicular to the long axis of the guide shaft 10, and a first surface 61A perpendicular to the long axis of the guide shaft 10 and in the long axis direction. The second surface 61B is provided at a different position. The first guide portion 4 further has a third guide surface 63 parallel to the long axis of the guide shaft 10. The third guide surface 63 extends in the long axis direction so as to connect the first surface 61A and the second surface 61B.

  Similarly, the second guide surface 62 includes a first surface 62A perpendicular to the long axis of the guide shaft 10 and a first surface 62A perpendicular to the long axis of the guide shaft 10 and in the long axis direction. And the second surface 62B provided at a different position. The second guide portion 5 further has a fourth guide surface 64 parallel to the long axis of the guide shaft 10. The fourth guide surface 64 extends in the long axis direction so as to connect the first surface 62A and the second surface 62B. That is, the first guide surface 61 and the third guide surface 63 of the first guide portion 4 and the second guide surface 62 and the fourth guide surface 64 of the second guide portion 5 are complementary shapes that mesh with each other. It has become.

  More specifically, the third guide surface 63 and the second surface 61B of the first guide surface 61 are continuously continuous in an L shape when viewed from above, but the third guide surface 63 and the first surface 61A is partially discontinuous due to the presence of the guide shaft 10 between them. The second guide surface 62 is the same as the first guide surface 61, and the first surface 62A, the first guide surface 61A parallel to the first guide surface 61A, the third guide surface 63, and the second surface 61B of the first guide surface 61, respectively. It has four guide surfaces 64 and a second surface 62B.

  The guide shaft 10 supports the first guide portion 4 and the second guide portion 5 so as to be relatively movable in the major axis direction while maintaining the parallelism of the first guide surface 61 and the second guide surface 62. That is, the first guide surface 61 and the second guide surface 62 are maintained in a parallel state, and the separation distance G (see FIG. 5B) can be extended and shortened.

  The first guide portion 4 also has a first guide hole 7 for positioning the first guide surface 61 in the first bone portion of the bone. The second guide portion 5 has a second guide hole 9 for positioning the second guide surface 62 in the second bone portion of the bone. More specifically, the end portion of the first guide portion 4 opposite to the first guide surface 61 has an arc shape when viewed from above, and the first guide hole 7 (7A, 7B) is provided near the end portion. It is done. A positioning shaft (not shown here) is inserted into the first guide hole 7 (7A, 7B), whereby the first guide portion 4 and the first guide surface 61 are positioned on the first bone portion of the bone. Fixed. The first guide holes 7 (7A, 7B) are holes that penetrate the first guide portion 4 in the thickness direction, and a plurality (two in this case) are arranged along the direction perpendicular to the long axis of the guide shaft 10. . The first guide holes 7A and 7B have the same opening diameter, and are arranged symmetrically with respect to the center line C0 as the guide main body 2. The center line C0 (see FIG. 2B) as the guide body 2 and the center line of the guide shaft 10 do not match in this example, but they may match. An auxiliary guide hole 19 is provided in the vicinity of the first guide holes 7A and 7B. The auxiliary guide hole 19 will be described later.

  The end portion of the second guide portion 5 opposite to the second guide surface 62 has a sharper shape than the end portion of the first guide portion 4 when viewed from above, and the second guide portion 5 is located near the center of the second guide portion 5. Holes 9 (9A, 9B) are provided. Another positioning shaft (not shown here) is inserted into the second guide hole 9 (9A, 9B), whereby the second guide portion 5 and the second guide surface 62 are positioned on the second bone portion of the bone. Fixed. A plurality (two in this case) of the second guide holes 9 (9A, 9B) are arranged at positions translated from the center line C0 of the guide body 2 along the direction parallel to the long axis of the guide shaft 10. The second guide holes 9A and 9B have the same opening diameter, but are larger than the first guide holes 7A and 7B.

  As shown in FIGS. 2C and 2D, a scale portion 10 </ b> A that is visible in a top view is provided at the end portion of the guide shaft 10 on the first guide portion 4 side. The scale portion 10A is provided with a gauge (scale) of, for example, 2 to 7 in units of 1 mm, and the separation distance G between the first guide portion 4 and the second guide portion 5 (that is, the length of the bone to be excised) is easily visually recognized. It can be done.

  As will be described in detail later, in the present embodiment, the guide shaft 10 is arranged along the long axis direction of the bone, and the first guide surface 61, the second guide surface 62, the third guide surface 63, and the fourth guide surface 64 are used. Guide (guide) the blade of the bone cutting instrument. That is, a cut surface is formed along the first guide surface 61, the second guide surface 62, the third guide surface 63, and the fourth guide surface 64. Thus, in the present embodiment, the bone cutting surface defined by the first guide portion 4 and the second guide portion 5 so as to include the first guide surface 61 and the second guide surface 62 is in the long axis direction of the bone. It includes a part that is displaced. As a result, the total length (the length of the cutting path) L in the cutting direction of the cutting plane (see (c) in the same figure) becomes larger than the length in the short axis direction of the bone. The separation distance between the third guide surface 63 and the fourth guide surface 64 is a minimum necessary distance (a distance slightly larger than the thickness of the blade) that can be cut by inserting a blade of a bone cutting instrument between them. is there.

  Note that the notation “R” in the first guide portion 4 indicates the direction used when cutting (resecting) the ulna of the right hand (the doctor should use “R” in a direction that can be visually recognized). ing. And on the back side (not shown), “L” is written (see FIG. 7), that is, the direction used for cutting (removing) the ulna of the left hand. That is, when cutting the ulna of the left hand, the ulna is rotated 180 degrees around the guide shaft 10 from the state shown in FIG. Thereby, the shape of the 1st guide surface 61 and the 2nd guide surface 62 becomes a line symmetrical shape centering on the guide shaft 10 in the case of right-hand use and left-hand use.

<Positioning guide>
The positioning guide (alignment guide) 3 will be described with reference to FIG. As described above, the positioning guide 3 is separate from the guide main body 2, and prior to the use of the guide main body 2, a plurality of positioning holes are formed at a fixed angle with respect to the long axis of the bone. It is an instrument that opens in a part.

  The positioning guide 3 is a T-shaped (or substantially I-shaped) in a top view, and has a thicker head 3H and a longer base portion 3B having a smaller thickness than the head 3H. The head 3H is provided with first positioning guide portions 12A and 12B at both ends of the base portion 3B in the short direction. The first positioning guide portions 12A and 12B are cylindrical holes having the same opening diameter, which are arranged in a line-symmetrical position around the center line C1 in the longitudinal direction of the base portion 3B. The head 3H is provided with a guideline 3L for aligning with the bone cutting position. Here, the distance LG (distance parallel to the center line C1) LG from the guideline 3L to the straight line connecting the center points of the first positioning guide portions 12A and 12B is the first distance closest to the first guide hole 7A of the guide body 2. This is the same as the shortest distance (distance perpendicular to the second surface 61B) LG to the guide surface 61 (second surface 61B).

  The base portion 3B is provided with a second positioning guide portion 13 and a third positioning guide portion 14 arranged in the longitudinal direction of the base portion 3B. The second positioning guide portion 13 and the third positioning guide portion 14 are arranged on the center line C1 in the longitudinal direction of the base portion 3B, and the second positioning guide portion 13 is an ellipse that is long in the longitudinal direction of the base portion 3B in a top view. The third positioning guide portion 14 has a circular shape. The second positioning guide portion 13 is provided at substantially the center in the longitudinal direction of the positioning guide tool 3, and the third positioning guide portion 14 is provided at the rear end portion. All of the first positioning guide portions 12 </ b> A and 12 </ b> B, the second positioning guide portion 13, and the third positioning guide portion 14 pass through in the thickness direction of the positioning guide tool 3.

  Further, the positioning guide tool 3 has four spikes 8 embedded on the back surface side, and is placed with the center line C1 of the positioning guide tool 3 aligned with the center line of the ulna to be cut. The spike 8 prevents the positioning guide 3 from slipping on the ulna. As will be described later, the head 3H is arranged at the end (ulna head) of the ulna that bulges in an obtuse circle, and the base 3B is arranged at the diaphysis of the ulna.

  The first positioning guide portions 12A and 12B are guide portions for forming a first positioning hole in the ulna head. The first positioning hole positions the first guide portion 4 of the guide body 2 at a predetermined position, and the fixing shaft 17 of the bone fixing device 15 is inserted through the first positioning hole. The second positioning guide portion 13 and the third positioning guide portion 14 are used when positioning the positioning guide 3 on the ulna (these will be described later).

<Bone fixation device>
With reference to FIG. 4, the bone fixation device 15 will be described. The bone fixation device 15 includes a first bone portion (for example, a portion including the ulna head) and a second bone portion (bone) of the bone (ulna) cut using the bone surgery guide device 1 of the present embodiment described above. The portion including the trunk) is fixed.

  As shown in FIG. 4A, the bone fixation device 15 includes a plate portion 16, a fixing shaft 17 (17A, 17B), fixing holes 18 (18A to 18D), and a fixing member (not shown here). Have. The plate portion 16 has a substantially rectangular shape extending in the long axis direction of the bone, and integrally covers the first bone portion and the second bone portion of the bone. Further, the plate portion 16 is provided with two extension portions 16A in which only a substantially rectangular long side end portion is further extended in the longitudinal direction on one end side in the longitudinal direction, and at the tip of the extension portion 16A, Two fixed shafts 17A and 17B are provided. The fixed shafts 17 </ b> A and 17 </ b> B are bent in a hook shape from the extension portion 16 </ b> A, respectively, and extend in a direction substantially perpendicular to the main surface of the plate portion 16. The fixed shafts 17A and 17B respectively correspond to two first positioning holes (not shown here) provided in the first bone portion (ulna head) by the positioning guide 3 and are respectively inserted through these. .

  The plate portion 16 is provided with a plurality (four in this case) of fixing holes 18 (18A to 18D). A fixing member (for example, a bone screw) (not shown) is communicated with the fixing hole 18 to fix the plate portion 16 and the second bone portion (diaphysis).

  As a material of the bone fixation device 15, any suitable biocompatible material and / or bioresorbable (bioabsorbable) material can be adopted. For example, suitable biocompatible materials include metals / metal alloys (e.g., titanium or titanium alloys, cobalt chromium alloys, stainless steel, etc.), plastics (e.g., ultra high molecular weight polyethylene (UHMWPE), polymethyl methacrylate (PMMA), Polytetrafluoroethylene (PTFE), polyetheretherketone (PEEK) and / or PMMA / polyhydroxyethyl methacrylate (PHEMA)), ceramics (e.g. alumina, beryllia, calcium phosphate and / or zirconia, among others), composites (e.g. Carbon fiber composites), bioresorbable materials or polymers (e.g., alpha-hydroxy carboxylic acids (e.g., polylactic acid, (e.g., PLLA, PDLLA and / or PDLA), polyglycolic acid, lactide / glycolide copolymers, etc.), polydioxano , Polycaprolactone, polytrimethylene carbonate, polyethylene oxide, poly β-hydroxybutyrate, poly β-hydroxypropionate, polyδ valerolactone, PHB-PHV grade poly (hydroxyalkanoate), other bioresorbable Polyesters and / or natural polymers (collagen or other polypeptides, polysaccharides (eg, starch, cellulose and / or chitosan), any copolymers thereof, etc.) and one or more of these materials are It may be coated on and / or on the bone fixation device 15 body.

  The number of fixing holes 18 is not limited to four, but may be three (or less) or five or more as shown in FIG. Furthermore, you may prepare multiple types of the bone fixing instrument 15 from which the length of fixing shaft 17A, 17B differs.

  The bone surgery guide device 1 and the bone fixation device 15 of the present embodiment are the first bone of the ulna B obtained by excising a portion corresponding to the separation distance G between the first guide surface 61 and the second guide surface 62 of the guide body 2. When the part B1 and the second bone part B2 are joined, the first positioning hole and the second positioning hole formed in the ulna B are aligned with the first guide hole 7 and the second guide hole 9, respectively. The distance can be kept constant. Thereby, the bone fixing device 15 having a predetermined length can be used in a plurality of osteotomy operations, which will be described later.

<Usage of bone surgery guide device and bone fixation device>
With reference to FIG. 5 to FIG. 11, a method of using the bone surgery guide device 1 and the bone fixation device 15 of the first embodiment will be described by taking an example of cutting the ulna of the left hand.

  5A and 5B are diagrams showing a state of preparation of the bone surgery guide instrument 1, in which FIG. 5A is an external perspective view of the guide body 2, and FIG. 5B is an enlarged top view of the scale portion 10A. FIGS. 5C and 5D are external perspective views showing a state of preliminary preparation of the bone fixation device 15.

  First, referring to FIG. 5A, after confirming the left and right sides of the guide body 2 (the figure shows a case where the ulna of the left hand is cut), the wire guide is inserted into the second guide hole 9 (9A, 9B). 29 (29A, 29B) is attached. Then, as shown in FIG. 5B, the scale of the scale portion 10A is fixed with the fixing screw 11 in accordance with the amount of bone cutting (length to be cut).

  Further, as shown in FIG. 5C, in the bone fixation device 15, the drill guide 39 (39A, 39B) is attached to each of the two inner fixing holes 18B, 18C among the four fixing holes 18. Keep it. The drill guide 39 is attached by being screwed into the fixing hole 18. Further, as shown in FIG. 5D, wire guide sleeves 49 are respectively attached to the drill guides 39A and 39B.

  FIG. 6 is a diagram illustrating an example of use of the positioning guide tool 3, and FIGS. 6 (a), (b), (d), and (e) are external perspective views in a state in which the positioning guide tool 3 is attached to the ulna B. FIG. 6C is a top view of the state where the positioning guide 3 is attached to the ulna B. FIG.

  As shown in FIG. 6 (a), the ulna B is an ulnar head BH whose lower end (distal end) is bluntly expanded (thickened), and from there toward the upper end (proximal end), a substantially cylindrical shape ( The (substantially prismatic) shaped diaphysis extends. And as shown in the figure, the positioning guide 3 arrange | positions the head 3H on the 1st bone part B1 (part containing ulna head BH) of the ulna B, and the base | substrate part 3B is the 2nd of the ulna B. It arrange | positions on the bone part B2 (part containing the diaphysis part BT). At this time, the center line C2 and the longitudinal direction of the positioning guide 3 are continuously viewed while monitoring the X-ray irradiation monitor image showing the center line C2 in the long axis direction (X direction) of the ulna B to be cut. Centering is performed with the center line C1. Similarly, while observing the monitor image or the like, the vertical line P passing through the centers of the first positioning guide portions 12A and 12B of the positioning guide tool 3 is aligned so as to be orthogonal to the center lines C1 and C2, and the vertical determination with respect to the ulna B I do.

  Next, as shown in FIG. 6B, for example, a plurality of wires Y1 and Y2 are inserted into the oval second positioning guide portion 13 and inserted into the second bone portion B2, and the positioning guide 3 is temporarily fixed. To do. The wires Y1 and Y2 are, for example, Kirschner copper wires (K-wires) having a diameter of 1.2 mm.

  Then, as shown in FIG. 6C, the cut site (indicated by a thick broken line) is confirmed while viewing the monitor image or the like. Specifically, the positioning guide 3 is finely adjusted so that the guideline 3L is aligned with the assumed distal osteotomy position P1 of the ulna head BH. Since the plurality of wires Y1 and Y2 are inserted through the oval second positioning guide portion 13, the positioning guide tool 3 can be slightly moved (finely adjusted) in the major axis direction of the ulna B as indicated by an arrow. is there.

  Next, as shown in FIG. 6 (d), for example, a wire Y 3 is inserted into the third positioning guide portion 14 and is inserted into the second bone portion B 2, and the positioning guide 3 is fixed to the ulna. The wire Y3 is, for example, a Kirschner copper wire having a diameter of 1.2 mm.

  Then, as shown in FIG. 6E, the first guide portion positioning shafts 30A and 30B are inserted into the first positioning guide portions 12A and 12B. The first guide portion positioning shafts 30A and 30B are, for example, Kirschner copper wires having a diameter (for example, 1.8 mm) thicker than the wires Y1 to Y3.

  7A and 7B are views showing how the guide main body 2 is attached to the ulna B. FIGS. 7A to 7C are external perspective views, and FIG. 7D is a top view.

  First, as shown in FIGS. 7A and 7B, the wires Y1 to Y3 are extracted from the ulna B, and the first guide positioning shafts 30A and 30B are inserted through the first positioning holes h11 and h12, and then the positioning is performed. The guide tool 3 is removed from the ulna B. Next, the guide body 2 is arranged on the ulna B so that the first guide portion positioning shafts 30A and 30B are inserted through the first guide holes 7B and 7A, respectively.

  As shown in FIG. 7 (c), the first guide portion 4 (that is, the first guide portion 4) (ie, the first guide portion 4) (that is, the first guide portion 4 (that is, the first guide portion 4) is communicated with the first guide portion positioning shafts 30A and 30B. 1 guide surface 61) is positioned at a predetermined position of the ulna head BH. The shortest distance from the first guide hole 7A (or the first guide hole 7B) to the first guide surface 61 (second surface 61B) (distance parallel to the guide shaft 10 (distance perpendicular to the second surface 61B)) ) LG is the same as the distance LG from the first positioning guide portions 12A, 12B to the guideline 3L of the positioning guide 3, and in this state, the first guide surface 61 coincides with the assumed distal osteotomy position P1. Fixed to the ulna head BH.

  Further, the second guide portion positioning shafts 32A and 32B are inserted through the wire guides 29A and 29B inserted through the second guide hole 9 of the guide body 2. The second guide portion positioning shafts 32A and 32B are, for example, Kirschner copper wires having a diameter of 1.2 mm. The two first positioning holes h11 and h12 are arranged along the short axis direction (Z direction) of the ulna B, and the two second positioning holes (here, the positions of the second guide portion positioning axes) are formed on the ulna B. They are arranged along the long axis direction (X direction).

  Further, as shown in FIG. 7D, a wire (for example, a Kirschner copper wire having a diameter of 1.2 mm) Y4 is inserted into the auxiliary guide hole 19. The first positioning holes h11, h12 and the second positioning hole are formed in the direction (perforation direction) parallel to each other, but the auxiliary guide hole is formed in the direction (extending direction in the wire Y4) is the first positioning hole h11, It is provided so as to be inclined with respect to the forming direction of h12 (the extending direction of the first guide portion positioning shafts 30A and 30B). Thereby, the 1st guide part 4 can be more fixed to the ulna head BH, and the blurring by the vibration of the bone cutting instrument at the time of cutting | disconnection of the ulna B can be prevented.

  FIG. 8 is an external perspective view showing a state in which the ulna B is cut with a bone cutting instrument. 9 is a view showing the ulna B in a state in which the cutting of the ulna B in the short axis direction is completed and the guide main body 2 is removed from the ulna B, and FIG. 9A is an external perspective view. FIG. 9B is a schematic top view, and FIG. 9C is a top view.

  As shown in FIG. 8 (a), first, a micro bone saw blade (blade) S is brought into contact with the third guide surface 63 of the first guide portion 4 (or the fourth guide surface 64 of the second guide portion 5). Then, cut along the long axis direction (X direction) of the ulna B. As already described, the separation distance between the third guide surface 63 and the fourth guide surface 64 is the minimum necessary distance that can be cut by inserting the blade S therebetween (a distance slightly larger than the thickness of the blade S). It is.

  Next, as shown in FIG. 8 (b), the microreciprocating saw blade S is sequentially brought into contact with the first guide surface 61 (first surface 61A and second surface 61B) of the first guide portion 4, Cut along the short axis direction (Z direction) of the ulna B. Similarly, the microreciprocating saw blade S is sequentially brought into contact with the second guide surface 62 (first surface 62A and second surface 62B) of the second guide portion 5 and cut along the short axis direction of the ulna B. To do.

  9A, the wire Y4 is inserted into the auxiliary guide hole (not shown), the first guide portion positioning shafts 30A and 30B are respectively inserted into the first positioning holes h11 and h12, and the second guide portion. The guide body 2 is removed from the ulna B while the positioning shafts 32A and 32B are inserted into the second positioning holes h21 and h22, respectively.

  In the ulna B, a first cut surface Sf1 is formed along the first guide surface 61 at the ulna head BH, and along the second guide surface 62 at the diaphysis BT, that is, parallel to the first cut surface Sf1. A second cut surface Sf2 is formed. In addition, a third cut surface Sf3 and a fourth cut surface Sf4 are formed along the long axis direction of the ulna B.

  However, in the state immediately after the guide body 2 is removed from the ulna B, the first bone portion B1 and the second bone portion B2 are not completely separated.

  That is, as shown in FIG. 9B, the ulna B is completely separated from the first cut surface Sf1 and the second cut surface Sf2 in the portions indicated by solid lines. On the other hand, in the portion indicated by the broken line, a part of the ulna B is not cut.

  This is because the movement of the blade S is restricted in the broken line area by the guide shaft 10 connecting the first guide part 4 and the second guide part 5 of the guide body 2 when the guide body 2 is attached. . That is, the guide shaft 10 is thinner in thickness (Y-direction thickness) than the first guide portion 4 and the second guide portion 5 (see FIG. 2A). Then, the ulna B is completely divided into the first bone portion B1 and the second bone portion B2, but is in an uncut state in a region corresponding to the thickness of the guide shaft 10 on the lower surface side. In addition, although illustration is abbreviate | omitted, in the state shown in FIG.9 (b), wire Y4, 1st guide part positioning shaft 30A, 30B, and 2nd guide part positioning shaft 32A, 32B remain inserted in the ulna B.

  Then, as shown in FIG. 9C, the broken line region (uncut region R) is cut with a microbone saw or a reciprocating saw. Since the uncut region R is a very narrow region, it can be cut without causing distortion or deformation without using a guide device such as the guide body 2.

  Thereafter, the wire Y4 and the first guide portion positioning shafts 30A and 30B are removed from the ulna B. The second guide portion positioning shafts 32A and 32B remain inserted into the ulna B.

  Thus, in the guide main body 2 of the present embodiment, the first guide portion 4 is fixed to one end of the guide shaft 10 extending in the long axis direction (X direction) of the ulna B, and the second guide portion 5 is guided to the other end. It is fixed so as to be movable along the axis 10. Therefore, even in a state where the bone cutting length is determined at the preliminary preparation stage (see FIG. 5), it is a state immediately after the guide body 2 is fixed to the ulna B (see FIG. 8D). However, the first guide surface 61 and the second guide surface 62 are always kept parallel.

  Then, the positioning guide tool 3 is used to accurately determine the center and vertical with respect to the ulna B to form the first positioning holes h11 and h12, and the guide body 2 (first guide portion 4) based on this. Positioning. Therefore, the first guide surface 61 can be accurately positioned even in a distorted portion such as the ulna head BH. In addition, since the 2nd guide surface 62 is maintaining the parallel with the 1st guide surface 61 by the guide shaft 10, the 2nd guide surface 62 can also be positioned correctly inevitably.

  The ulna head BH is thicker than the diaphysis BT and can secure a large area of the cut surface, but positioning is difficult due to its distorted shape. However, according to the present embodiment, the first guide surface 61 can be accurately positioned in the ulna head BH, so that a large cut surface can be secured.

  In addition, the first guide portion 4 includes a first surface 61A and a second surface 61B that extend in the short axis direction (Z direction) of the ulna B and have different positions in the long axis direction (X direction). It has a guide surface 61 and a third guide surface 63 extending in the long axis direction, and the second guide portion 5 extends in the short axis direction of the ulna B and has a first surface 62A having a different position in the long axis direction. The second guide surface 62 includes the second surface 62B, and the fourth guide surface 64 extends in the long axis direction. Therefore, when cut along this, the length L of the cutting path of the first cut surface Sf1 and the third cut surface Sf3 (second cut surface Sf2 and fourth cut surface Sf3) (FIG. 9B) Compared with the case of cutting parallel to the short axis direction of the ulna B, the third cut surface Sf3 (fourth cut surface Sf4) is long, and a large cut surface can be secured. For this reason, early and reliable fusion of bones becomes possible.

  In addition, for example, by making a cut surface made of two inclined surfaces that are inclined by a predetermined angle from the short axis direction of the ulna B and oppose each other, a larger cutting area is ensured than in the case of a cut surface parallel to the short axis direction. be able to. However, when the cutting surface has a large inclination angle from the short axis direction (Z direction) of the ulna B (small inclination angle from the long axis direction), a long cutting is required in the long axis direction (X direction) of the ulna B. The length of fixing with a fixing tool (such as a plate) becomes longer after cutting, which is not preferable.

  On the other hand, by making it a stepped shape (a shape in which two L shapes are reversed) in a top view as in the present embodiment, the cutting distance in the long axis direction of the ulna B is not extended so much. A large cutting area can be secured. Thereby, a small (short length) bone fixation device 15 can be used.

  In the present embodiment, the parallel positioning of the first guide surface 61 and the second guide surface 62 can be performed by one positioning of the guide body 2 to the ulna B.

  For example, in a conventional guide tool that has only one guide surface and can translate the guide surface, after guiding the first cut surface, the guide surface is translated in order to guide the second cut surface. Need to be fixed. That is, since the guide surface is moved in a state where the bone is cut, the treatment becomes complicated, and there is a possibility that the second positioning is insufficient, such as a slight deviation of the bone.

  However, according to the guide main body 2 of the present embodiment, the guide main body 2 is positioned on the bone before cutting the bone (by one positioning operation), so that two parallel guide surfaces (first guide surface 61, first guide 2 guide surfaces 62) can be positioned. After that, by cutting the bone along the first guide surface 61 and the second guide surface 62, the parallel two cut surfaces (the first cut surface) are simply and accurately in a state where the posture of the ulna B is stabilized. A cutting plane Sf1 and a second cutting plane Sf2) can be formed. Each of the first cut surface Sf1 and the second cut surface Sf2 has a surface substantially parallel to the major axis direction (X direction) of the ulna B and a surface substantially parallel to the minor axis direction (Y direction).

  In addition to this, according to the guide body 2 of the present embodiment, as shown in FIG. 9B, the cutting of the ulna B in the short axis direction by the microreciprocating saw is completed, and the guide body 2 is removed from the ulna B. Then, the ulna B is not completely separated into two. For this reason, it becomes possible to maintain the attitude | position of the ulna B stably until the guide main body 2 is removed.

  Next, a method for joining the first bone portion B1 and the second bone portion B2 of the ulna B cut into two will be described with reference to FIGS. FIG. 10A is a top view of a state in which the ulna B is shortened by contacting the cut surface. FIG. 10B is a top view of the guide body 2 for explaining the positional relationship of the second guide holes 9. FIG. 11 is an external perspective view of the ulna B for explaining a fixing method using the bone fixing device 15.

  First, after cutting the uncut region R to completely separate the first bone portion B1 and the second bone portion B2, as shown in FIG. 10A, the cut surfaces Sf3 and Sf4 are brought into contact with each other. The ulna B is moved in the long axis direction (X direction) (with these as slide surfaces) and brought into contact with the first cut surface Sf1 and the second cut surface Sf2. Thereby, the length of the long axis direction of the ulna B can be shortened. By using the cut surfaces Sf3 and Sf4 as slide surfaces, the first bone portion B1 and the second bone portion B2 can be joined without causing a shift in the long axis direction of the ulna B. Further, by bringing the cut surfaces Sf3 and Sf4 into contact with each other, the second bone portion B2 moves in the direction of the center line C2 of the long axis direction of the ulna B, and the second positioning holes h21 and h22 (second guide portion positioning). The shafts 32A and 32B) are located on the center line C2 of the ulna B in the long axis direction.

  As shown in FIG. 10B, the center lines C4 of the second guide holes 9A and 9B of the guide body 2 are arranged at positions translated from the center line C0 of the guide body 2 in the Z direction. In the present embodiment, the cutting along the long axis direction (X direction) of the ulna B is guided in order to ensure a large area of the cut surface (length L of the cutting path). For this reason, the third guide surface 63 of the first guide portion 4 and the fourth guide surface 64 of the second guide portion 5 are separated by a minimum necessary distance that allows the blade S to be disposed between them. ing. Therefore, when the ulna B is cut, the first bone portion B1 and the second bone portion B2 are brought into contact with each other after cutting the bone (cut planes Sf3 and Sf4 along the long axis direction of the ulna B (FIG. 10A). The second bone portion B2 moves in the direction of the center line C2 of the ulna B. For this reason, the distance (the length corresponding to the thickness of the blade S) ST of the third guide surface 63 and the fourth guide surface 64, which is the movement amount, is set to the center line C2 of the guide body 2 (the long axis direction of the ulna B). The second guide holes 9 (9A, 9B) are provided so that the center line C4 is located at a position offset from the center line C0).

  Thus, when the first bone portion B1 and the second bone portion B2 are joined after cutting the ulna B, the second positioning holes h21 and h22 (second guide portion positioning shafts 32A and 32B) are formed. It comes to be located on the centerline C2 of the long axis direction of the ulna B (refer Fig.10 (a)).

  Thereafter, as shown in FIG. 11A, the first bone portion B <b> 1 and the second bone portion B <b> 2 are fixed by the bone fixing device 15. In this case, the fixing shafts 17A and 17B provided at one end of the bone fixing device 15 are respectively inserted into the first positioning holes h11 and h12 of the ulna head BH. The fixed shafts 17A and 17B are slightly smaller in diameter than the first positioning holes h11 and h12, and the length from the plate portion 16 is, for example, about 12 mm to 15 mm.

  Drill guides 39A and 39B are attached in advance to the fixing holes 18B and 18C of the plate portion 16, and wire guide sleeves 49 are attached to the respective drill guides 39A and 39B. Then, the second guide portion positioning shafts (Kirschner copper wires) 32 </ b> A and 32 </ b> B are inserted into the wire guide sleeve 49. Thereby, the drill guides 39A and 39B and the second positioning holes h21 and h22 are centered. In the present embodiment, the distance between the first positioning holes h11 and h12 and the second positioning holes h21 and h22 is maintained at a constant distance after resection of a part of the ulna B. A first guide hole 7 and a second guide hole 9 are provided. They coincide with the distance between the fixing shafts 17A and 17B of the bone fixing device 15 and at least a part of the fixing hole 18 (here, the fixing holes 18B and 18C).

  That is, by using the bone surgery guide device 1 and the bone fixation device 15 of the present embodiment, after excision of a part of the ulna B, the drill guides 39A and 39B and the second positioning holes h21 and h22 are centered. The positions of the first positioning holes h11, h12 and the second positioning holes h21, h22, and the positions of the fixing shafts 17A, 17B of the bone fixing device 15 and at least a part of the fixing holes 18 (here, the fixing holes 18B, 18C) Match. Accordingly, the bone fixation device 15 having a predetermined length can be used in a plurality of bone resection operations. Specifically, as shown in FIG. 4, variations (length) of the bone fixation device 15 of the present embodiment are as small as one or two (large and small), and a plurality of ( Can be used universally for many patients).

  As shown in FIG. 4, the bone fixing device 15 has a plurality of (for example, two types) with different numbers of fixing holes 18 and different lengths of the fixing shafts 17A and 17B depending on the size of the ulna B. And more desirable. Even in such a case, the types of the bone fixation devices 15 to be aligned as compared with the conventional case can be greatly reduced (for example, two types of large size and small size).

  After that, as shown in FIG. 11B, for example, the wire guide sleeve 49 and the second guide portion positioning shaft 32B are extracted from the drill guide 39B, and the drill DR is inserted into the insertion hole of the drill guide 39B to drill the ulna B. To do. Similarly, although not shown, the wire guide sleeve 49 and the second guide portion positioning shaft 32A are extracted from the drill guide 39A, the drill DR is inserted into the insertion hole of the drill guide 39A, and the ulna B is drilled.

  Then, as shown in FIG. 11 (c), the depth of drilling is measured with the depth gauge DG. Is inserted into the fixing hole 18, and the plate portion 16 is fixed to the diaphysis BT with a driver D or the like (FIG. 4D).

  As described above, in the state where the first bone portion B1 and the second bone portion B2 are joined, the positions of the second positioning holes h21 and h22 are the positions of the fixing holes 18 (here, the fixing holes 18B and 18C). It is positioned at the position (the same center point as the fixing holes 18B and 18C). Therefore, the fixing hole 18 can be fixed along the center line C2 of the ulna B in the major axis direction by screwing the fixing member 23 into the second positioning holes h21 and h22 (centering on these). Further, the fixing member 23 is screwed into the fixing hole 18D. For example, the fixing member 23 reaches a depth of about 10 mm from the plate portion 16. As a result, in the bone fixing device 15, the fixing shafts 17A and 17B are inserted into the first positioning holes h11 and h12, and the plate portion 16 integrally connects the first bone portion B1 and the second bone portion B1 of the ulna B. Cover and fix to ulna B and support them. (FIG. 11 (e)).

  According to the bone fixation device 15 of the present embodiment, a fixing member such as a screw is separately used at one end of the bone fixation device 15 by engaging the fixing shafts 17A and 17B with the first positioning holes h11 and h12. One end of the bone fixation device 15 can be fixed to the ulna head BH. Accordingly, since screwing is not necessary on the ulna head BH side, the bone fixing device 15 can be narrowed, and the number of parts and the number of mounting steps can be reduced.

  Further, by engaging a plurality (two in this case) of the fixed shafts 17A and 17B with the first positioning holes h11 and h12, the rotation of the plate portion 16 around the fixed shafts 17A and 17B can be suppressed. In addition, the plate portion 16 can be properly positioned.

  As described above, in this embodiment, since the cutting path is bent, the cutting path is perpendicular to the major axis of the diaphysis BT (parallel to the minor axis) and the cutting path forms a linear cut surface. Large areas of the first cut surface Sf1 and the third cut surface Sf3, and the second cut surface Sf2 and the fourth cut surface Sf4 can be secured. Further, since the first bone portion B1 and the second bone portion B2 mutually restrict movement toward the long axis direction center line of the ulna B, compared with the case where the cutting path forms a straight cut surface. Thus, a shift in the Z direction (particularly a shift toward the center line) between the first bone portion B1 and the second bone portion B2 can be suppressed. Thereby, bone fusion can be reliably performed at an early stage (at an appropriate position).

  As described above, the first positioning holes h11 and h12 position the first guide portion 4 of the guide main body 2 at a predetermined position and the fixing shaft 17 of the bone fixing device 15 is inserted therethrough. The first positioning holes h11 and h12 are formed by inserting the first guide portion positioning shafts 30A and 30B through the first positioning guide portions 12A and 12B of the positioning guide 3, as shown in FIG. . At this time, the head 3H of the positioning guide tool 3 provided with the first positioning guide portions 12A and 12B is disposed so that the first guide portion positioning shafts 30A and 30B are stably inserted into appropriate positions of the ulna head BH. It is thick. On the other hand, the 2nd positioning guide part 13 and the 3rd positioning guide part 14 are used in order to temporarily fix the positioning guide tool 3 with the wires Y1-Y3. The temporarily fixed wires Y1 to Y3 are to be removed later, and a slight inclination with respect to the ulna B is allowed at these insertion positions. Therefore, the base body on which the second positioning guide portion 13 and the third positioning guide portion 14 are received. The portion 3B has a thickness that is significantly smaller than that of the head 3H (for example, the thickness of the base portion 3B is equal to or less than one-third of the thickness of the head 3H), and the positioning guide 3 is made compact. ing.

[Second Embodiment]
A second embodiment of the present invention will be described with reference to FIG. 12A is a top view showing the guide body 20, and FIG. 12B shows a state of cut surfaces (first cut surface Sf1 and second cut surface Sf2) formed using the guide main body 20. FIG. 3 is a schematic top view of ulna B. FIG.

  In the second embodiment, the shape of the guide main body 20 is different from that of the first embodiment, and the other configuration is the same as that of the first embodiment, and thus the description thereof is omitted. Moreover, in the following description, the same code | symbol is attached | subjected to the same component as 1st Embodiment, and the description is also abbreviate | omitted.

  As shown in FIG. 12A, the first guide surface 26 and the second guide surface 28 of the guide body 20 of the second embodiment are respectively predetermined from the long axis direction of the guide shaft 10 (the long axis direction of the ulna B). It is a surface inclined at an angle of.

  The first guide portion 24 and the first guide surface 26 are positioned at predetermined positions of the ulna head BH before cutting, and the second guide portion 25 is positioned at the diaphysis BT of the ulna B before cutting.

  In this state, for example, the blade S is moved along the first guide surface 26 to cut the ulna B at the ulna head BH portion. Moreover, the blade S is moved along the 2nd guide surface 28 in the state as it is, and the ulna B is cut | disconnected in the diaphysis part BT part. In the ulna B, a first cut surface Sf1 is formed along the first guide surface 26 at the ulna head BH, and along the second guide surface 28 at the diaphysis BT, that is, parallel to the first cut surface Sf1. A second cut surface Sf2 is formed.

  Also in this case, the cut surface of the ulna B defined by the first guide portion 24 and the second guide portion 25 so as to include the first guide surface 26 and the second guide surface 28 is displaced in the major axis direction of the ulna B. The part to do is included. For this reason, compared with the case where it cut | disconnects substantially perpendicular | vertical with respect to the long axis of the ulna B, the area of a cut surface can be ensured large.

  In the present embodiment, the parallel positioning of the first guide surface 26 and the second guide surface 28 is possible by positioning the guide body 2 to the ulna B once.

  In the second embodiment, since cutting along the center line C2 of the ulna B is unnecessary, the centers of the second guide holes 9A and 9B may be provided on the center line C0 of the guide body 2.

  Also in the second embodiment, as shown in FIG. 12B, the ulna B is not completely separated into two by cutting with the blade S, and an uncut region R exists. Therefore, the posture of the ulna B can be stably maintained until the guide body 20 is removed.

  In FIG. 12, each of the first guide surface 26 and the second guide surface 28 is one plane (a surface inclined at a predetermined angle from the long axis direction of the guide shaft 10 (the long axis direction of the ulna B)). Although the case has been described as an example, the present invention is not limited to this, and the third guide surface 63 and the fourth guide surface 64 (plane in the direction along the guide shaft 10) of the first embodiment are provided in the middle of each plane. The cutting path may be bent when viewed from above.

[Third Embodiment]
A third embodiment will be described with reference to FIG. FIG. 13 is a top view showing another form of the bone surgery guide instrument 60.

  The guide instrument 60 for bone surgery according to the third embodiment is also configured such that the positioning guide tool 3 according to the first embodiment is not necessary and positioning is possible only by the guide main body 2. Moreover, in the following description, the same code | symbol is attached | subjected to the same component as 1st Embodiment, and the description is also abbreviate | omitted.

  A guide line GLL parallel to the longitudinal direction of the guide shaft 10 is provided in the first guide part 164 and / or the second guide part 165. The guide line GLL coincides with the center line C0 of the guide body 2. The first guide holes 7A and 7B are arranged at positions that are line-symmetric with respect to the guide line GLL. Since the other configuration is the same as that of the first embodiment, the description thereof is omitted.

  When positioning the bone surgery guide device 60 on the bone, first, the bone surgery guide device 60, which is previously fixed by the fixing screw 11 by sliding the second guide portion 165 for the length to be excised, is used. Positioned above, the guide line GLL is aligned with the long axis center line of the bone (not shown here). Then, first positioning holes h11 and h12 are formed in the first bone portion B1 via the first guide holes 7A and 7B, and the first guide holes 7A and 7B and the first positioning holes h11 and h12 are respectively first. A guide part positioning shaft (not shown) is inserted. In addition, after the second positioning holes h21 and h22 are drilled in the second bone portion B2 through the second guide holes 9A and 9B, the second guide portion positioning shaft (not shown) is inserted and used for bone surgery. The guide device 60 is fixed to the bone.

  The bone is cut along the first guide surface 661, the second guide surface 662, and the third guide surface 663 (or the fourth guide surface 664). In the subsequent steps, the bone is cut in the same manner as in the first embodiment. Then, the bone surgery guide device 60 is removed, the bone fixing device 15 is attached, and the fixing member is screwed to fix the bone fixing device 15 and the bone.

  In both the second and third embodiments, for example, a spike (see the spike 8 of the positioning guide 3 in FIG. 3) may be provided on the guide shaft 10 or the like. Further, the guide line GLL of the third embodiment may be provided on the guide shaft 10.

  As described above, in the above embodiment, the first guide portion 4 is provided with the third guide surface 63, the second guide portion 5 is provided with the fourth guide surface 64, and these are separated and arranged in parallel. Explained in the example. However, the present invention is not limited to this, and the third guide surface 63 (or the fourth guide surface 64) may be provided on at least one of the first guide portion 4 or the second guide portion 5. That is, when cut by the third guide surface 63, the ulna is not shortened, and the third guide surface 63 separates the ulna into the first bone portion and the second bone portion, and the length of the cutting path. In order to ensure the thickness, a cut surface in the major axis direction of the ulna B is formed. Further, by forming a cut surface in the major axis direction of the ulna B, it is possible to move (shorten) the bone without causing a positional shift by sliding the ulna with the cut surface abutting. In other words, the first bone portion B1 and the second bone portion B2 of the ulna B are separated to form a cutting surface that can slide and secure the length of the cutting path in the long axis direction of the ulna B. Such a cut surface may be formed as long as at least one of the first guide portion 4 and the second guide portion 5 has the third guide surface 63 (or the fourth guide surface 64). Since it is necessary to insert the blade S between the third guide surface 63 and the fourth guide surface 64, in the present embodiment, the blades S are separated by about the thickness of the blade S, and both are provided in parallel. The surface 63 and the fourth guide surface 64 can also be separated greatly. In this case, for example, the first bone portion B1 and the second bone portion B1 are cut by cutting the ulna B along the third guide surface 63 (only). The bone part B2 can be separated.

  Further, in the above-described embodiment, the case where the bone is used for the bone shortening operation of the ulna B has been described as an example. However, the present invention is not limited to this.

  Further, the bone surgery guide device and bone fixation device of the present invention are not limited to the above-described embodiments, and it goes without saying that various changes can be made without departing from the scope of the present invention.

  The bone surgery guide device and bone fixation device of the present invention can be used in the field of guide devices and bone fixation devices used for bone shortening surgery.

1 Bone surgery guide instrument 2 Guide body 3 Positioning guide (alignment guide)
3B Base part 3H Head 3L Guideline 4 First guide part 5 Second guide part 61 First guide surface 61A First surface 61B Second surface 62 Second guide surface 62A First surface 62B Second surface 63 First 3 guide surface 64 4th guide surface 7, 7A, 7B 1st guide hole 8 Spike 9, 9A, 9B 2nd guide hole 10 Guide shaft 10A Scale part 11 Fixing screw 12A, 12B 1st positioning guide part 13 2nd positioning guide Part 14 Third positioning guide part 15 Bone fixing device 16 Plate part 16A Extension part 17, 17A, 17B Fixing shaft 18, 18A-18D Fixing hole 19 Auxiliary guide hole 20 Guide body 23 Fixing member 24 First guide part 25 First 2 guide part 26 1st guide surface 28 2nd guide surface 29, 29A, 29B Wire guide 30A, 30B 1st positioning guide shaft 32A 32B 2nd positioning guide shaft 39, 39A, 39B Drill guide 60 Bone surgery guide instrument 64 1st guide part 65 2nd guide part 661 1st guide surface 662 2nd guide surface 663 3rd guide surface 664 4th guide surface h11 , H12 First positioning holes h21, h22 Second positioning hole B Ulna B1 First bone part B2 Second bone part BH Ulna head BT Skeletal part D Driver G Separation distance S Saw blade Sf1 First cut surface Sf2 Second cut surface

Claims (9)

A bone surgery guide device for guiding a blade during a bone shortening operation in which a bone is cut into a first bone portion and a second bone portion in a long axis direction and a part thereof is excised in the long axis direction,
The bone surgery guide instrument has a guide body,
The guide body is
A first guide portion having a first guide surface defining a cutting surface, and a first guide hole for positioning the first guide surface in the first bone portion;
A second guide surface that defines a cut surface that is spaced apart from and opposed to the first guide surface by the amount of bone resection, and a second guide hole that positions the second guide surface in the second bone portion. A second guide part;
A guide shaft that maintains the parallelism between the first guide surface and the second guide surface and supports the first guide portion and the second guide portion so as to be relatively movable in the major axis direction;
With
The separation distance between the first guide hole and the second guide hole before resection of the bone is displaced according to the amount of resection of the bone,
The distance from the first guide hole to the first guide surface and the distance from the second guide hole to the second guide surface are each constant regardless of the amount of bone resection,
When the first bone portion and the second bone portion of the bone obtained by excising a portion corresponding to a separation distance between the first guide surface and the second guide surface are joined, the first guide hole and the second guide portion The distance between the first positioning hole and the second positioning hole, which are aligned with the second guide hole and formed in the bone, is kept constant regardless of the bone resection amount, thereby fixing the bone of a predetermined length. The instrument can be used,
A bone surgery guide device characterized by the above. The bone cutting surface defined by the first guide portion and the second guide portion so as to include the first guide surface and the second guide surface includes a portion that is displaced in the longitudinal direction of the bone. The bone surgery guide device according to claim 1. The first guide surface and the second guide surface are surfaces substantially parallel to the short axis direction of the bone, and at least one of the first guide portion and the second guide portion is substantially parallel to the long axis direction. Having other guide surfaces,
The bone surgery guide instrument according to claim 1 or 2, wherein the guide instrument is used for bone surgery. A plurality of the first guide holes are arranged along the minor axis direction, and a plurality of the second guide holes are arranged along the major axis direction,
The bone surgery guide device according to claim 3. Each of the first guide surface and the second guide surface is a surface inclined at a predetermined angle from the major axis direction.
The guide instrument for bone surgery according to any one of claims 1 to 4, wherein the guide instrument is used for bone surgery. The first guide part is positioned at the end of the bone before cutting, and the second guide part is positioned at the diaphysis of the bone before cutting;
The bone surgery guide instrument according to any one of claims 1 to 5, wherein the guide instrument is used for bone surgery. The guide shaft has a scale portion,
The bone surgery guide instrument according to any one of claims 1 to 6, wherein the guide instrument is used for bone surgery. Consists of a separate body from the guide body,
A positioning guide for opening the first positioning hole in the first bone portion at a constant angle with respect to the long axis of the bone;
The bone surgery guide instrument according to any one of claims 1 to 7, wherein the guide instrument is used for bone surgery. A bone surgery guide instrument according to any one of claims 1 to 8 ,
A bone surgery instrument set comprising the bone fixation device for fixing the first bone portion and the second bone portion cut by the bone surgery guide device ,
The bone fixation device is:
A plate portion extending in the longitudinal direction across the first bone portion and the second bone portion;
A fixed shaft extending in a direction substantially perpendicular to the main surface of the plate portion at an end portion in the longitudinal direction of the plate portion, and inserted through the first positioning hole;
A fixing hole provided in the plate portion;
A fixing member that is inserted through the fixing hole in a state in which the fixing hole is aligned with the second positioning hole and fixes the plate portion and the bone;
It can be shared when the amount of bone resection is the first length and the second length.

This is a bone surgery instrument set .

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