JP6522562B2 - Surgical jig and surgical bone fixing unit - Google Patents

Description

  The present invention relates to a surgical jig and a surgical bone fixing unit, and more particularly, to a surgical jig for removing a fixing tool from bone after healing of bone in pin and cable internal fixation surgery and the surgery The present invention relates to a surgical bone fixing unit provided with a jig.

  As a fixation method of bone in osteosynthesis for joining fractured bones, a fixing device having a penetration portion and a head provided at one end of the penetration portion, and a surgical cable (internal fixation cable) Insert the punctured parts of a plurality of fasteners into each part of the bone, pass the surgical cable through the through hole formed in the head of the fastener, and tie the fractured part with the surgical cable. There is known a pin cable type bone fixation method (internal fixation method) for fixing bones. As a fixing tool used for such a pin cable type bone fixation method, there exist some which were described in patent document 1 by this applicant, for example. Patent Document 1 describes a sleeve having a head in which a cable fixing hole for fixing a surgical cable is formed, and an insertion portion to be inserted into a bone.

  Fasteners inserted into bones are often foreign bodies for the body and are often removed from the bones after healing. Conventionally, the tip of an elongated rod-like jig (pick) is inserted into the through hole of the head of the fixture, and the edge of the through hole is used as a fulcrum to lift the head from the bone surface and hold the head After facilitating operation, the fixing tool was removed from the bone by holding and pulling the head with a holding tool such as forceps or pliers.

International Publication No. 99/42050

  When the head of the fixing device projects from the bone, when soft tissue such as skin or muscle covering the head comes in contact with the outside of the body, the soft tissue may be rubbed against the head to cause pain in the patient. Therefore, it is preferable that the head of the fixture be buried in a bone. However, when the head is buried in bone, it becomes difficult to pierce the tip of a jig (pick) into the through hole of the head. In addition, since the corners of the head are chamfered to avoid stimulation to living tissue, there is a problem that the head is difficult to grip even if the head is lifted using a jig.

  An object of the present invention is, in view of the above problems, to provide a surgical jig capable of easily removing a fixing tool from bone after healing of the bone in pin and cable type internal fixation surgery.

  In order to solve the above-mentioned problems, the present invention is a surgical jig (10) for grasping a surgical cable, which is disposed crossing each other and provided at the intersection (12) A handle (14) is rotatably coupled about a moving shaft (13), extends from the intersection to the rear end, and a head extends from the intersection to the tip and is opened and closed by operation of the handle 15) a pair of arms (11) respectively, a cable gripping surface (17) respectively provided at the tip end portion of each of the head portions and abutted against each other in the closed state of the head portions; A recess (18) is recessed in an intermediate portion in the width direction (W) parallel to the axial direction of the rotation shaft, and opens at the tip end side of the head portion and extends from the tip end side to the rear end side of the head portion Characterized in that it comprises and.

  According to this configuration, the surgical cables respectively extending from both ends of the through holes formed in the head of the fixing tool can be gripped by the cable gripping surface across the head. At this time, since the head portion of the fixing tool is accommodated in the recess, the head portion is obstructed and the gripping of the surgical cable by the cable gripping surface is not hindered.

  Preferably, the cable gripping surface is formed with a groove (17A) or irregularities.

  According to this configuration, when the surgical cable is gripped by the cable gripping surface, the frictional force between the cable gripping surface and the outer peripheral surface of the surgical cable can be increased to prevent the sliding displacement of the surgical cable. .

  A surgical bone fixing unit according to the present invention comprises a surgical jig (10) according to the above-described invention, a surgical cable (20), and a head (36) having a through hole (34) through which the surgical cable can be inserted. 32) A surgical bone fixing unit comprising: a fixture (30) having a piercing portion (36) projecting from a bottom surface (32A) of the head, wherein the recess is formed of the head portion It is characterized by having a shape which can accommodate the said head in a closed state.

  According to this configuration, in the pin and cable type internal fixation surgery using the surgical cable and the fixation device, the insertion portion is respectively extended from both ends of the through hole of the head of the fixation device pierced into the bone. The surgical cable can be gripped by the cable gripping surface across the head. At this time, since the head portion of the fixing tool is accommodated in the recess, the head portion is obstructed and the gripping of the surgical cable by the cable gripping surface is not hindered. Therefore, after healing of the bone, it is possible to easily withdraw the fixing device from the bone using a surgical jig.

  The concave portion is centered on an imaginary axis (A) extending from the tip end side to the rear end side of the head portion with respect to the direction when the surgical cable is gripped by the cable gripping surface. When the head is accommodated in the recess in a state rotated 90 degrees, at least a part of the side surface (32C) in a direction orthogonal to the axial direction of the through hole in the head can be locked. It has a formed locking portion (18A) and a penetrating portion (18B) which penetrates from the cable gripping surface to the opposite surface and has a size capable of inserting the surgical cable. preferable.

  According to this configuration, after the head of the fastener is lifted from the surface of the bone, the side surface of the head of the fastener can be locked by the locking portion of the recess. At this time, the surgical cables extending from both ends of the through hole of the head of the fixing device are inserted into the through portions of the recess, so the surgical cable becomes an obstacle and the locking of the head by the locking portion is prevented. There is nothing to do. The fixing tool can be removed from the bone by moving the surgical jig away from the bone in a state in which the side surface of the head is locked by the locking portion.

  The locking portion is preferably formed to have a shape complementary to the head when the head is in a closed state.

  According to this configuration, the head portion of the fixing tool can be easily and reliably gripped by the locking portion of the recess.

  The side surface of the head portion is inclined so as to spread from the bottom surface toward the opposite upper surface (32B), and the locking portion has a cross-sectional shape orthogonal to the direction in which the virtual axis extends However, it is preferable to be formed so as to spread from the front end side toward the rear end side.

  According to this configuration, when the side surface of the head of the fastener is inclined so as to extend from the bottom to the top, the side surface can be locked by the locking portion of the recess.

  It is preferable that the locking portion is formed such that the length in the direction in which the virtual axis extends is larger than the length between the bottom surface and the top surface of the head.

  According to this configuration, since the working space can be spared in the direction in which the virtual axis A extends, it is possible to more easily perform the operation of locking the side surface of the head by the locking portion of the recess.

  According to the surgical jig according to the present invention, the fixing tool can be easily removed from the bone after fixing the bone in pin and cable type internal fixation surgery.

BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a perspective view showing a surgical jig according to an embodiment of the present invention. FIG. 2 is a side view of the surgical jig as viewed along arrow II of FIG. 1; FIG. 2 is a top view of the surgical jig as viewed along arrow III of FIG. 1; (A) IV-IV sectional drawing of FIG. 2, (B) The enlarged view of a periphery of the holding part in FIG. BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a perspective view showing an embodiment of a fixing device used for a surgical bone fixing unit according to the present invention. The figure which shows the example which performed internal fixation surgery of the human knee joint part fractured using the surgical bone fixation unit which concerns on this invention. It is a figure for demonstrating the procedure which withdraws a fixing tool from bone using the surgical jig which concerns on this invention, (A) shows the state which gripped the surgical cable by the cable grip surface, (B) The head of the fastener is shown lifted from the surface of the bone. It is a figure for demonstrating the procedure which withdraws a fixing tool from a bone using a surgical jig concerning the present invention, and (A) shows the state where the head of a fixing tool was locked by a locking part, (B) shows a state in which the fixing tool is completely removed from the bone. (A) is a figure corresponding to FIG. 4 (A), and shows a state in which the head of the fixing tool is locked by the locking portion of the recess, and (B) is a figure corresponding to FIG. 4 (B) 11 shows a state in which a surgical cable is inserted through the through portion of the recess.

  Hereinafter, embodiments of a surgical jig and a surgical bone fixing unit including the same according to the present invention will be described with reference to the drawings.

  As shown in FIGS. 1 to 3, the surgical jig 10 according to the present invention is disposed so as to cross each other, and is rotatably coupled about a rivet (pivot shaft) 13 provided at the intersection 12 And a pair of arms 11, 11. The rivets 13 are inserted into through holes (not shown) formed at the intersections 12 of the arms 11 and fixed by caulking or the like. Each arm 11 has a handle portion 14 extending from the intersection 12 toward the rear end, and a head 15 extending from the intersection 12 toward the tip. At the distal end portion of each head portion 15, a gripping portion 16 for gripping the surgical cable 20 (see FIGS. 7A and 7B) is provided.

  The handle portion 14 is a portion gripped and operated by one hand of the user of the surgical jig 10, and is rotatable in directions approaching or separating from each other with the rivet 13 as a fulcrum. The head portion 15 pivots in directions approaching or separating from each other with the rivet 13 as a fulcrum in response to the approach and separation of the handle portion 14. The grip portion 16 provided at the tip end portion of the head portion 15 opens and closes in response to the approach and separation of the head portion 15. That is, the grip portion 16 is opened and closed by the operation of the handle portion 14. The portions of the head portion 15 located between the gripping portion 16 and the crossing portion 12 are separated from each other in the closed state of the gripping portion 16 and a gap is formed between them.

  A cable gripping surface 17 is formed on the surfaces of the gripping portion 16 facing each other in the closed state. A plurality of grooves 17 </ b> A extending in the width direction W parallel to the axial direction of the rivet 13 are formed in the cable holding surface 17. Thus, when the groove 17A is formed in the cable gripping surface 17, when the surgical cable 20 is gripped by the cable gripping surface 17, the frictional force between the cable gripping surface 17 and the outer peripheral surface of the surgical cable 20 is increased. The sliding displacement of the surgical cable 20 can be prevented. The shape, direction, and number of the grooves 17A can be changed as appropriate. Moreover, you may form an unevenness | corrugation instead of the groove | channel 17A. Even when the unevenness is formed, the sliding displacement of the surgical cable 20 can be prevented as in the case where the groove 17A is formed.

  The cable gripping surface 17 is provided with a recess 18 at an intermediate portion in the width direction W thereof. The recess 18 is formed so as to open at the tip end side of the grip portion 16 and to extend from the tip end side of the grip portion 16 (cable grip surface 17) toward the rear end side. The recess 18 extends beyond the rear end of the cable grip surface 17 to the rear end of the grip 16. That is, the recess 18 divides the cable gripping surface 17 into two in the width direction W (see FIG. 4A). The recess 18 is the cable gripping surface 17, and when the surgical cable 20 extending from both ends of the through holes 34 formed in the head 32 of the fixture 30 is gripped across the head 32, the head 32 It is formed in the shape which can accommodate (refer FIG. 7 (A)).

  As shown in FIG. 4A, in the recess 18, the shape of the cross section orthogonal to an imaginary axis A extending from the front end side to the rear end side of the head portion 15 is expanded from the front end side to the rear end side. Is formed. Although details will be described later, the side surface 32C in the direction orthogonal to the axial direction of the through hole 34 in the head portion 32 of the fixture 30 is formed to be inclined so as to extend from the bottom surface 32A to the upper surface 32B. (See Figure 5). Therefore, the locking portion 18A is formed to have a shape complementary to the head 32 of the fixing tool 30 in the closed state of the grip portion 16 (see FIG. 9A). In addition, the locking portion 18A is formed such that the length in the direction of the imaginary axis A is larger than the length between the bottom surface 32A and the top surface 32B (see FIG. 5) of the head 32 of the fixture 30 (see FIG. 5) 9 (A)).

  As shown in FIG. 4B, the recess 18 has a through portion 18B formed to penetrate from the cable gripping surface 17 to the outer surface 19 on the opposite side. The penetration part 18B is formed in the magnitude | size which can penetrate the surgical cable 20. As shown in FIG. Although the details will be described later, when the side surface 32C of the head portion 32 of the fixture 30 is locked by the locking portion 18A of the recess 18, the surgical cable 20 is inserted into the penetrating portion 18B (FIG. 9B) reference).

  The surgical jig 10 is made of, for example, a highly rigid material such as stainless steel or titanium alloy. The surgical jig 10, together with the surgical cable 20 and the fixture 30 shown in FIG. 5 and FIG. 6, is used as a surgical bone fixing unit for pin and cable type internal fixation surgery. It is used to remove the fixture 30.

  As the surgical cable 20, for example, a flexible cable formed by twisting a plurality of strands of a highly biocompatible material such as stainless steel or a polymer material is used. The surgical cable 20 is not limited to a stranded wire, but may be a single wire such as a piano wire or a mild steel wire.

  As shown in FIG. 5, the fixture 30 is vertically protruded from the head 32 formed with the through hole 34 through which the surgical cable 20 (see FIG. 6) can be inserted, and the bottom surface 32A of the head 32. A pin-like insertion portion 36 and a rod-like grip portion 38 vertically protruding from the upper surface 32 B of the head 32 are provided. The insertion portion 36 and the grip portion 38 are provided to extend on the same straight line across the head 32. The fixture 30 is made of, for example, a highly biocompatible material such as stainless steel or titanium alloy.

  The head 32 is formed in a frustum shape whose cross-sectional shape is larger than that of the insertion part 36. In addition, the corners of the head 32 are appropriately chamfered in order to avoid stimulation on living tissue. The side surface 32C in the direction orthogonal to the axial direction of the through hole 34 in the head portion 32 is formed to be inclined so as to extend from the bottom surface 32A to the top surface 32B. The side surface 32C is formed flat so as to be easily grasped by forceps or the like at the time of internal fixation surgery.

  The through hole 34 extends in a direction orthogonal to the axial direction of the insertion portion 36. The through holes 34 are formed in a straight line and have a circular cross-sectional shape. The inner diameter of the through hole 34 is slightly larger than the outer diameter of the surgical cable 20. For example, if the outer diameter of the surgical cable 20 is 1.2 mm, the inner diameter of the through hole 34 is 1. It is formed in about 3 mm.

  The insertion part 36 is a part to be inserted into the bone of the fractured part. The insertion portion 36 is formed in a pin shape having a circular cross section, and has a diameter of about 2 mm. The insertion portion 36 is integrally formed with the head 32, and the proximal end of the insertion portion 36 vertically extends from the bottom surface 32 A of the head 32. The tip end of the insertion portion 36 is a pointed tip portion 36A sharpened by two-chamfering processing and V-shaped processing so as to be easily inserted into a bone.

  The grip 38 is a forceps for performing various operations in internal fixation surgery, for example, inserting the insertion portion 36 into a bone or inserting the surgical cable 20 through the through hole 34 of the head 32. And other parts that can be held by the hand of the operator or the operator. For this reason, the grip portion 38 has a chamfered portion 38A on its side surface so as to be easily grasped with a forceps or the like. In addition, the grip 38 is configured so that it can be separated and removed from the head 32 because the grip 36 pierces the bone and becomes unnecessary after fixing the surgical cable 20 to the head 32. It is done. Specifically, the connecting portion 38 B of the grip portion 38 with the head 32 is tapered in a tapered shape so as to be easily separated from the head 32. By thus reducing the diameter of the connecting portion 38B, the grip portion 38 can be easily separated from the head 32 and removed by being broken at the connecting portion 38B without using a cutting tool.

  Next, an example in which a human fractured knee joint is internally fixed using the fixture 30 with the surgical cable 20 will be described with reference to FIG.

  To describe the procedure of the internal fixation surgery, first, the fixtures 30A to 30G are fixed to predetermined places of the bone 100 of the fractured part. In the example of FIG. 6, the fixtures 30A to G are fixed to seven points of the bone 100. The fixing devices 30A to 30G are fixed by inserting the insertion portion 36 into the bone 100. As shown, the piercing portion 36 is inserted into the bone 100 substantially entirely. The number of fasteners 30, the insertion position of the insertion part 36, and the like are appropriately selected so that the fixation of the fractured part is optimal. The head portions 32 of the fixtures 30A and 30B are configured to be crimpable and deformable so that the surgical cable 20 can be passed twice.

  Next, the surgical cable 20 is passed through the through hole 34 of the head 32 of the fixture 30 fixed to the bone 100. In this operation, one end of the surgical cable 20 is grasped with tweezers or forceps, and a thread is passed through the needle hole. This operation is performed in order of the fixture 30A, 30B, 30C, 30D, 30E, 30F, and 30G. Then, the distal end of the surgical cable 20 passing through the through hole 34 of the fixture 30G is passed through the through hole 34 of the head 32 of the fixture 30A, 30B. Thus, the surgical cable 20 can be made annular by passing the surgical cable 20 twice through the head 32 of the fixture 30A, 30B. Thus, the surgical cable 20 is wound around the fracture.

  Next, in order to bring the surgical cable 20 wound around the fractured part into close contact with the fractured part with a predetermined pressure, the both ends of the surgical cable 20 are grasped and tensioned with forceps or the like, and the surgical cable 20 is tensioned. Add In this tension applied state, the left and right side surfaces of the head parts 32 of the fasteners 30A and 30B through which the surgical cable 20 is passed doubly are sandwiched by forceps or the like to be strongly pressed and caulked and deformed. As a result, the through hole 34 is crushed and deformed, and the surgical cable 20 is also plastically deformed, and the outer surface of the surgical cable 20 is in close contact with the inner surface of the through hole 34. The cable 20 is fixed by caulking. In this way, the fasteners 30 allow the ends of the surgical cable 20 to be fastened together with a predetermined tension. The surplus portion at the end of the surgical cable 20 is cut and removed.

  After fastening both ends of the surgical cable 20, the grip portion 38 of each fixing tool 30 is bent and separated at the connection portion 38B and removed from the head 32. Then, the head 32 of the fixture 30 is buried in the bone 100 by tapping with a hammer or the like so as not to protrude from the surface of the bone 100. Thereafter, the internal fixation surgery is completed by performing suturing or the like.

  Next, after healing of the bone 100, a procedure for removing the fixing tool 30 inserted into the bone 100 using the surgical jig 10 will be described. In the present embodiment, the head 32 of the fastener 30 is not completely buried in the bone 100 and a portion thereof protrudes from the surface of the bone 100.

  First, after the surgical site is incised, the appropriate position of the surgical cable 20 wound around the fracture portion is cut using a cutting jig such as pliers. The cutting point of the surgical cable 20 is appropriately selected so as to optimize removal and removal of the fixture 30 and the surgical cable 20.

  Next, as shown in FIG. 7A, the surgical cable 20 extending from each end of the through hole 34 of the head 32 of the fixture 30 by the grip portion 16 of the surgical jig 10 is It grips over the section 32. The gripping portion 16 grips the surgical cable 20 by pinching the cable gripping surface 17. At this time, the portion of the head portion 32 of the fixture 30 that protrudes from the surface of the bone 100 is accommodated in the recess 18 of the surgical jig 10, so that gripping of the surgical cable 20 by the cable gripping surface 17 is hindered. There is nothing to be done.

  Next, as shown in FIG. 7 (B), the surgical jig 10 is moved in a direction away from the bone 100 in a state where the surgical cable 20 is gripped by the grip portion 16. Thus, the surgical cable 20 located near the surface of the bone 100 moves in a direction away from the bone 100 with the surgical jig 10. Since the surgical cable 20 is inserted through the through hole 34 of the head 32 of the fixture 30, when the surgical cable 20 moves in a direction away from the bone 100, the head 32 of the fixture 30 is also surgical cable 20. And move in a direction away from the bone 100. As a result, the head 32 of the fixture 30 is lifted from the surface of the bone 100.

  After the head 32 of the fixture 30 is lifted from the surface of the bone 100, the handle portion 14 of the surgical jig 10 is operated to open the gripping portion 16 and the gripping of the surgical cable 20 by the gripping portion 16 is released. Then, the direction of the gripping portion 16 is rotated 90 degrees around the virtual axis A with respect to the direction when the surgical cable 20 is gripped by the cable gripping surface 17. Thereafter, the gripping portion 16 is opened, and the gripping portion 16 is closed so as to sandwich the head 32 of the fixing tool 30 between the cable gripping surfaces 17 (see FIG. 8A).

  Thereby, the head 32 of the fixture 30 is accommodated in the recess 18. At this time, as shown in FIG. 9A, the side surface 32C of the head 32 of the fixture 30 is locked by the locking portion 18A of the recess 18. At this time, as shown in FIG. 9B, the surgical cables 20 extending from both ends of the through hole 34 of the head 32 are inserted into the through portion 18B of the recess 18, so that the locking portion 18A is obtained. The locking of the side surface 32C of the head 32 due to

  As described above with reference to FIG. 4A, the locking portion 18A is formed so as to have a shape complementary to the head 32 of the fixing tool 30 when the grip portion 16 is in the closed state. The head of the fastener can be locked easily and reliably. Further, as shown in FIG. 9B, the locking portion 18A is formed such that the length in the direction in which the imaginary axis A extends is greater than the length between the bottom surface 32A and the top surface 32B of the head 32. Therefore, the working space can be spared in the direction in which the virtual axis A extends, whereby the work of locking the side surface 32C of the head 32 with the locking portion 18A can be performed more easily.

  Then, with the side surface 32C of the head 32 locked by the locking portion 18A, the surgical jig 10 is moved in a direction away from the bone 100 (see FIG. 8B) to fix the bone 100. The insertion portion 36 of the tool 30 can be pulled out. Thereby, the fixing tool 30 is removed from the bone 100.

  As mentioned above, although the suitable embodiment of the present invention was described, the present invention is not limited to the above-mentioned embodiment, and if it is a range which does not deviate from the meaning of the present invention, it can change suitably. Moreover, all the components shown in the above embodiment are not necessarily essential, and it is possible to select them as appropriate without departing from the spirit of the present invention.

  For example, in the above embodiment, the locking portion 18A of the recess 18 is formed to have a shape complementary to the side surface 32C of the head 32 of the fixture 30, but at least a portion of the side surface 32C of the head 32 The locking portion 18A of the recess 18 may not have a shape complementary to the side surface 32C of the head 32, as long as the locking can be performed.

  Moreover, in the said embodiment, although the head 32 of the fixing tool 30 is formed in frustum shape, the shape of the head 32 may be other shapes, such as a rectangular shape. Further, the shape and the number of the through holes 34 of the fixing tool 30 and the shape and the number of the insertion parts 36 can be appropriately changed.

10 Surgical jig 11 Arm 12 Crossed part 13 Rivet (rotational shaft)
14 handle portion 15 head portion 16 grip portion 17 cable gripping surface 17A groove 18 concave portion 18A locking portion 18B penetrating portion 19 outer surface 20 surgical cable 30 fixture 34 through hole 34 head 32A bottom surface 32B top surface 32C side surface 36 insertion portion 38 grip part 100 bone A virtual axis W width direction

Claims (6)

A surgical jig for grasping a fixing tool having a head having a through hole through which a surgical cable can be inserted and a piercing portion provided on the bottom of the head ,
The handle portion is disposed so as to intersect with each other and is pivotally coupled about a pivot axis provided at the intersection, and extends from the intersection to the tip side from the handle and extending from the intersection to the rear end, A pair of arms each having a head portion that opens and closes by operation of the handle portion;
A cable gripping surface provided respectively at the tip end of each of the head parts and abutted against each other in the closed state of the head parts;
A concave portion which is recessed in an intermediate portion in the width direction parallel to the axial direction of the rotation shaft in the cable gripping surface, and is opened at the tip end side of the head portion and extends from the tip end side of the head portion toward the rear end side viewing including the door,
The recess is
A locking portion formed to be able to lock a side surface in a direction orthogonal to the axial direction of the through hole in the head portion of the fixing device;
A surgical jig comprising: a penetrating portion extending from the cable gripping surface to the opposite surface and having a size capable of inserting the surgical cable .   The surgical jig according to claim 1, wherein a groove or an unevenness is formed on the cable gripping surface. The locking portion is in the closed state of the head portion, the surgical tool according to claim 1 or 2, characterized in that it is formed to be complementary shape to the head. The side of the head is inclined to extend from the bottom of the head to the opposite upper surface,
The locking portion is formed so that the shape of the cross section orthogonal to the direction in which the virtual axis extending from the tip end side to the rear end side of the head portion extends is from the front end side toward the rear end side. The surgical jig according to claim 3 , characterized in that The locking portion is formed such that a length in a direction in which an imaginary axis extending from the tip end side to the rear end side of the head portion extends is greater than a length between the bottom surface and the top surface of the head portion. The surgical jig according to any one of claims 1 to 4 , characterized in that: The surgical jig according to any one of claims 1 to 5 .
Surgical cables,
Surgical bone fixation unit, wherein the kite and a fixture having a penetration of the surgical cable is protruding from the bottom surface of the can be inserted the head through holes are formed, and the head portion.

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