JP6525842B2 - Surgical grasper - Google Patents

Description

  The present invention relates to a surgical grasper for grasping a surgical member used by being fixed to a joint in a surgery in which a part or all of a joint is replaced with an artificial joint.

  The conventional art of a surgical grasping tool for grasping a surgical member fixed to a joint in a surgery for replacing a part or all of a joint with an artificial joint is described, for example, in Patent Document 1 as a surgical hip joint surgical instrument. It is done. This prior art surgical grasper comprises a broach driven into the femur to form a stem hole for the stem into which the stem of the artificial hip joint fixed to the proximal end of the femur is inserted. And a broach handle having a handle main body portion formed with an engagement convex portion which engages with an engagement hole portion as a fitting concave portion formed in the above.

  The outer wall of the engaging convex portion is formed with a pair of convex portion side tapered surfaces which are inclined so as to approach each other from one side to the other side in a direction intersecting with the direction in which the engaging convex portion protrudes. Ru. A pair of hole-side tapered surfaces corresponding to the pair of convex-portion-side tapered surfaces is formed on the inner wall of the engagement hole. The broach handle has a pair of convex portion side tapers by the engagement convex portion being pressed in the pressing direction from the one side to the other side in a state where the engagement convex portion is inserted into the engagement hole portion. A pressing mechanism is provided to press the surface against the pair of hole side tapered surfaces. The pressing mechanism is configured such that the engagement convex portion inserted in the engagement hole portion is pressed against the engagement hole portion by the operation portion displaced with respect to the handle main body portion and the displacement by the operation of the operation portion And a pressing portion for pressing the joint convex portion.

  The engagement protrusion of the broach handle is engaged with the engagement hole of the broach to fix the broach to the broach handle. The broach is driven into the femur by striking the broach handle with a hammer while the broach tip is in contact with the proximal end of the femur, and the stem hole for inserting the stem is the femur. Formed in the bones.

  In a state where the engaging convex portion is inserted into the engaging hole portion, each of the pair of convex portion side tapered surfaces of the engaging convex portion is engaged by the pressing of the engaging convex portion by the pressing portion of the pressing mechanism. The engaging convex portion and the engaging hole are fixed by being pressed against each of the pair of hole side tapered surfaces of the hole, and the broach is gripped by the broach handle with a large gripping force.

Unexamined-Japanese-Patent No. 2015-123092

  In the above-mentioned prior art, when the stem fixed in the femur is a modular necked stem in which the two members of the long stem and the neck are longitudinally split, the stem stem is the marrow cavity of the femur. And the stem neck axis intersects at an acute angle with the stem stem axis so as to conform to the three-dimensional shape to fit the A broach forming a stem bore into which such a stem is inserted also has an inclined axis corresponding to the stem neck axis and the stem stem axis.

  When the broach handle, which is a surgical grasper, is operated approximately parallel along the stem stem axis in order to perform broaching straight along the longitudinal axis of the stem stem using a broach, engagement with the axis of the handle body is achieved. Since it is substantially parallel to the axis of the joint convex portion, the engagement convex portion of the broach handle engages with the engagement hole portion of the broach in an inclined state at an acute angle.

  Therefore, the broach is gripped in a state in which the pressing force of the engagement convex portion with respect to the engaging hole portion is biased, and the bias of the broach against the bone is also biased by such bias. There is a problem that it is not preferable to securely hold a surgical member such as a broach or the like. Further, the present invention is not limited to the above-mentioned stem for artificial hip joint such as the above-mentioned modular neck type stem, but also for surgery for grasping surgical members such as stem for artificial joint to be embedded in various parts such as knee joint and elbow joint. The holding tool also has the same problem as described above.

  An object of the present invention is to provide a surgical gripping tool capable of reliably gripping a surgical member by applying an unbiased pressing force to a fitting recess of the surgical member.

The present invention relates to a surgical grasping tool for grasping a surgical member used by being fixed to a joint in the operation of replacing a part or all of a joint with an artificial joint,
A longitudinal gripper body having a hollow fitting portion that can be fitted into a fitting recess formed in the surgical member;
In the fitting portion, the longitudinal direction of the gripping tool main body is from the projecting position where the tip end protrudes from the fitting portion and abuts against the inner surface of the fitting recess, and the retracted position where the tip portion is retracted into the fitting portion An engagement member angularly displaceable about a first axis intersecting the longitudinal axis extending at a predetermined angle of less than 90 °;
The holding member body is movably held in the longitudinal direction, and is rotatable about a second axis orthogonal to the longitudinal axis at a portion of the engaging member opposite to the tip with respect to the first axis. An actuation member having a coupling portion coupled to the
And a drive means held by the grip tool body for moving the actuating member in the longitudinal direction of the grip tool body.

Further, in the present invention, the connecting portion is formed of a cylindrical body centered on the second axis,
A portion of the engaging member opposite to the tip end has a small diameter portion for contacting at least a part of the outer peripheral surface of the cylindrical body to support the cylindrical body, and from the small diameter portion to the second axis It is characterized in that a through hole whose inner diameter increases as it deviates in the direction is formed.

  Further, the invention is characterized in that the through hole is formed so that the inner diameter becomes larger from the small diameter portion toward both sides in the second axial direction.

  Further, the present invention is characterized in that an angle θ1 formed by an inner circumferential surface facing the through hole of the connecting portion and the second axis is selected to be an angle θ2 or more formed by the first axis and the second axis. I assume.

  According to the present invention, the surgical grasping tool is used for grasping a surgical member used by being attached to the joint in the operation of replacing a part or all of the joint with an artificial joint. Such a surgical grasper includes a grasper main body, an engagement member, an actuating member, and a drive means. The holding tool main body has a hollow fitting portion that can be fitted into a fitting recess formed in the surgical member, and the engaging member is such that the tip end projects from the fitting portion to the fitting portion. A first axis intersecting the longitudinal axis extending in the longitudinal direction of the gripping tool main body at a predetermined angle of less than 90 ° between the projecting position in contact with the inner surface of the fitting recess and the retracted position in which the tip is retracted in the fitting It is angularly displaceable around it. The actuating member has a coupling portion rotatably coupled about a second axis orthogonal to the longitudinal axis at a portion of the engaging member opposite to the tip with respect to the first axis.

  When the actuating member is moved in the longitudinal direction of the gripping tool body by the driving means in a state in which the fitting portion is fitted in the fitting recess of the surgical member, the engaging member retracts in the direction corresponding to the moving direction , Or from the protruding position to the retracted position. When the engaging member is displaced from the retracted position to the projecting position, the engaging member extends between the projecting position and the retracted position even if the fitting recess is inclined with respect to the longitudinal direction of the grip body. Since it is provided so as to be angularly displaceable around the axis, even if the direction of the driving force of the driving means and the moving direction of the engaging member are different, the tip of the engaging member is not biased on the inner surface of the fitting recess. With the large pressing force, the fitting portion can be pressed against the fitting recess with a large pressing force, and the surgical member can be reliably gripped by the surgical gripping tool.

  Further, according to the present invention, the connecting portion is formed of a cylindrical body centered on the second axis, and at least a part of the outer peripheral surface of the cylindrical body is in contact with a portion of the engaging member opposite to the distal end portion. A through-hole is formed which has a small diameter portion for supporting the cylindrical body and the inner diameter increases as it departs from the small diameter portion in the second axial direction. In the supported state, the engaging member can be angularly displaced, and in a state where the engaging member is angularly displaced in different directions with respect to the actuating member, the fitting portion is pressed against the fitting concave with a large pressing force to engage And the surgical member can be gripped securely.

  Further, according to the present invention, the through hole is formed such that the inner diameter increases from the small diameter portion toward both sides in the second axial direction, so that the reaction force acting on the small diameter portion of the engaging member from the connecting portion is engaged. It is possible to disperse on both sides in the second axial direction of the joint member, to allow a large reaction force acting on the small diameter portion of the engagement member from the connection portion, and to suppress damage or deformation of the engagement member.

  Further, according to the present invention, the angle θ1 formed by the inner circumferential surface facing the through hole of the connecting portion and the second axis is selected to be not less than the angle θ2 formed by the first axis and the second axis. Even when the angular displacement occurs beyond the angle θ2 formed by the first axis and the second axis, the connecting portion interferes with the small diameter portion of the engaging member and a large reaction force acts on the small diameter portion from the connecting portion. It can be prevented.

It is a front view showing grasping tool 1 for surgery of one embodiment of the present invention. It is a top view of the holding | gripping tool 1 for surgery seen from the upper direction of FIG. It is the perspective view which notched the front side of the holding | gripping tool 1 for surgery. FIG. 6 is an enlarged plan view of the vicinity of the engagement member 4 of the surgical grasper 1; FIG. 5 is an enlarged cross-sectional view of section V of FIG. 4; FIG. 5 is an enlarged front view of the engagement member 4; FIG. 5 is an enlarged plan view of the engagement member 4; FIG. 6 is an enlarged rear view of the engagement member 4; FIG. 9 (1) is a view for explaining the operation of the surgical grasper 1, and FIG. 9 (1) shows a state in which the tip end 4a of the engagement member 4 is disposed at the contact position projecting from the fitting portion 8; 9 (2) shows a state in which the leading end 4a of the engaging member 4 is disposed at an intermediate position displaced from the contact position to the retracted position, and FIG. 9 (3) shows that the leading end 4a of the engaging member 4 is fitted The state arrange | positioned in the evacuation position retracted | saved in the joint part 8 is shown.

  FIG. 1 is a front view showing a surgical grasper 1 according to an embodiment of the present invention, FIG. 2 is a plan view of the surgical grasper 1 seen from the upper side of FIG. 1, and FIG. 3 is a surgical grasper It is the perspective view which notched the near side of 1. FIG. The surgical grasper 1 of the present embodiment is used to grasp a surgical member used by being fixed to a joint in a surgery in which a part or all of a joint is replaced with an artificial joint. In this embodiment, the broach, which is a surgical member for forming a stem hole for inserting a stem from the proximal end side of the femur, into the marrow cavity of the femur from which the great trochanter of the hip joint has been removed A surgical grasper 1 used to hold 2 and drill a femur (hereinafter referred to as "broaching") will be described. In the femur, a pilot hole of the stem for inserting the broach 2 is formed.

  The broach 2 is formed to be tapered from the proximal end 2a to the distal end 2b, and a large number of blades are formed on the outer peripheral surface. After the broach 2 is driven in through the opening of the pilot hole, the stem hole is formed by pulling out the broach 2 which has been driven in. The stem is a modular necked stem, and two members of a long stem and a neck are configured to be split in the longitudinal direction.

  The surgical grasper 1 includes a grasper main body 3, an engagement member 4, an actuating member 5 and a drive means 6. The gripper body 3 is an elongated member having a hollow fitting portion 8 that can be fitted into the fitting recess 7 formed in the broach 2. The engaging member 4 is a projecting position at which the distal end portion 4a protrudes from the fitting portion 8 and abuts against the inner surface of the fitting recess 7 in the fitting portion 8 and a retraction where the distal end portion 4a is retracted in the fitting portion 8 Over the position, it is angularly displaceable about a first axis L1 which intersects the longitudinal axis L0 extending in the longitudinal direction of the gripper body 3 at a predetermined angle α of less than 90 °.

  The actuating member 5 is movably held in the longitudinal direction by the grasping tool main body 3, and a second axis perpendicular to the longitudinal axis L0 at a portion of the engaging member 4 opposite to the tip 4a with respect to the first axis L1. It has a connecting portion 9 rotatably connected around L2. The driving means 6 is held by the gripper body 3 and moves the actuating member 5 in the longitudinal direction of the gripper body 3. The engaging member 4 and the actuating member 5 are made of, for example, stainless steel.

  The driving means 6 includes the operation lever 20, the first link member 21, the second link member 22, the first pin 24, the second pin 25, the third pin 26, the fourth pin 27, and the fifth. The pin 28 and the sixth pin 29 are configured. The control lever 20, the first and second link members 21 and 22, and the first to sixth pins 24 to 29 are made of, for example, stainless steel.

  The operation lever 20 is formed of a flat rod-like body, and is continuous with an operation portion 20a held by an operator such as an operator and one longitudinal end of the operation portion 20a in the thickness direction (direction perpendicular to the sheet of FIG. 1) And a substantially elliptical base portion 20b when viewed in the vertical direction. The base portion 20b has a pair of plate-like portions 20b1 and 20b2 and a thick portion 20b3 integrally formed integrally with the plate-like portions 20b1 and 20b2. Between the plate-like portions 20b1 and 20b2, a recess 20b4 is formed in which one end of the first link member 21 is movably fitted in the surface direction.

  The gripping tool main body 3 is a substantially U-shaped hollow member whose cross section perpendicular to the longitudinal direction is open in one direction (upward in FIG. 1), and the first gripping portion 3a extending in a straight line and the first gripping portion A second grip 3b bent and connected to one longitudinal end of 3a, a third grip 3c bent and connected parallel to the first grip 3a to one end of the second grip, and a vertically long It has a plate-like body, and has an impact plate 3d which is struck by a hammer when the broach 2 is driven. Such a holder body 3 is made of, for example, stainless steel.

  In the internal space of the gripping tool main body 3, one end in the longitudinal direction of the operating portion 20a of the operating lever 20 described above, the base 20b, the first and second link members 21 and 22, the actuating member 5, and the second pin 25, the third pin 26, the fourth pin 27 and the sixth pin 29 are accommodated. One end of the first pin 24 is fixed to one side wall of the holder main body 3, and the other end of the first pin 24 is fixed to the other side wall of the holder main body 3. An intermediate portion between the side walls of the first pin 24 rotatably penetrates the thick portion 20b3 of the base portion 20b of the control lever 20, and the arrow direction of arrow A1 and the arrow around the axis of the first pin 24 It is angularly displaceable in the direction of mark A2.

  One end of the second pin 25 is fixed to one plate-like portion 20b1 of the base 20b, and the other end of the second pin 25 is fixed to the other plate-like portion 20b2 of the base 20b. An intermediate portion between the plate-like portions 20b1 and 20b2 of the second pin 25 penetrates one end of the first link member 21, and one end of the first link member 21 is rotatable around the axis of the second pin 25. Pinned to.

  The other end of the first link member 21 is pin-coupled to one end of the second link member 22 by a third pin 26. The other end of the second link member 22 is pin-coupled to one end of the actuating member 5 by a fourth pin 27. The middle portion of the second link member 22 is pin-coupled to the fifth pin 28, one end of the fifth pin 28 is fixed to one side wall of the grip body 3, and the other end of the fifth pin 28 is It is fixed to the other side wall of the grip tool body 3.

  The other end of the actuating member 5 is pin-coupled to the engaging member 4 by the connecting portion 9 so as to be rotatable about the second axis L2. The middle portion of the engagement member 4 is pin-coupled to the fitting portion 8 by the sixth pin 29 so as to be rotatable about the first axis L1. One end of the engagement member 4 constitutes the above-described tapered tip 4a.

  FIG. 4 is an enlarged plan view of the vicinity of the engagement member 4 of the surgical grasper 1, and FIG. 5 is an enlarged sectional view of the section V of FIG. 6 is an enlarged front view of the engagement member 4, FIG. 7 is an enlarged plan view of the engagement member 4, and FIG. 8 is an enlarged rear view of the engagement member 4. As shown in FIG. The connection part 9 consists of a cylindrical body centering on the 2nd axis line L2. A portion of the engaging member 4 on the side opposite to the tip end 4a has a small diameter portion 10 for contacting at least a part of the cylindrical outer peripheral surface of the connecting portion 9 to support the connecting portion 9, A through hole 11 is formed whose inner diameter increases as it departs from the portion 10 in the direction of the second axis L2.

  An angle θ1 formed by the inner circumferential surface 12 facing the through hole 11 of the connecting portion 9 and the second axis L2 is selected to be equal to or larger than an angle θ2 formed by the first axis L1 and the second axis L2.

  FIG. 9 is a view for explaining the operation of the surgical grasping tool 1. FIG. 9 (1) shows a state in which the distal end portion 4a of the engagement member 4 is disposed at the contact position projecting from the fitting portion 8. 9 (2) shows a state in which the tip 4a of the engaging member 4 is disposed at an intermediate position displaced from the contact position to the retracted position, and FIG. 9 (3) shows the tip of the engaging member 4 The state where 4a is arrange | positioned in the retracted position which retracted | saved in the fitting part 8 is shown.

  As shown in FIG. 9 (1), in a state where the operation lever 20 is disposed substantially parallel to the grasping tool main body 3, the tip end portion of the engaging member 4 is disposed and fitted at a projecting position projecting from the fitting portion 8 With the portion 8 fitted in the fitting recess 7 of the broach 2, the tip 4a of the engagement member 4 presses the inner surface of the fitting recess 7, and the fitting portion 8 is large on the inner surface of the fitting recess 7. It can be pressed by the pressing force and the broach 2 can be gripped by the high gripping force.

  As shown in FIG. 9 (1) described above, when the control lever 20 is operated in the direction of the arrow mark A1 from the state in which the control lever 20 is tilted substantially parallel to the grip tool body 3, it is shown in FIG. Thus, when the distal end 4a of the engaging member 4 is displaced toward the inside of the fitting portion 8 and the operating lever 20 is further operated in the direction of the arrow mark A1, as shown in FIG. 4 is buried in the fitting portion 8 and disposed at the retracted position.

  When the actuating member 5 is moved in the longitudinal direction of the grasping tool body by the driving means 6 in a state where the fitting portion 8 is fitted to the fitting recess 7 of the surgical member by the surgical grasping tool 1 as described above. The engaging member 4 can be displaced from the retracted position to the projecting position, or from the projecting position to the retracted position in the direction corresponding to the movement direction. When the engaging member 4 is displaced from the retracted position to the projecting position, even if the fitting recess 7 is inclined to the longitudinal direction of the grip portion main body, the engaging member 4 is in the projecting position and the retracted position. Since it is provided so as to be angularly displaceable around the first axis L1, the driving force of the driving means 6, that is, in the case where the direction of the actuating member 5 is different from the moving direction of the engaging member 4 by the operation lever 20 by the operator Even if it is, the tip 4a of the engaging member 4 is brought into contact with the inner surface of the fitting recess 7 with a large pressing force without any bias, and the fitting unit 8 is pressed against the fitting recess 7 with a large pressing force. Can be reliably gripped by the surgical gripping tool 1.

  The connecting portion 9 is formed of a cylindrical body centered on the second axis L2, and at least a part of the outer peripheral surface of the cylindrical body is brought into contact with the portion of the engaging member 4 opposite to the tip 4a. A through hole 11 is formed which has a small diameter portion 10 for supporting the cylindrical body, and the inner diameter increases as it departs from the small diameter portion 10 in the direction of the second axis L2. The engaging member 4 can be angularly displaced in a state supported by the connecting portion 9 of the second embodiment, and a large pressing force is applied to the fitting recess 77 in a state where the engaging member 4 is angularly displaced in different directions with respect to the actuating member 5 The fitting portion 8 is pressed and engaged by force, and the broach 2 can be gripped reliably.

  Further, the angle θ1 formed by the inner circumferential surface 12 facing the through hole 11 of the connecting portion 9 and the second axis L2 is selected to be equal to or larger than the angle θ2 formed by the first axis L1 and the second axis L2. Even when the member 4 is angularly displaced beyond the angle θ2 formed by the first axis L1 and the second axis L2, the connecting portion 9 interferes with the small diameter portion 10 of the engaging member 4 and the small diameter portion 10 is connected to the connecting portion 9 Can prevent the action of a large reaction force.

  As another embodiment of the present invention, the through hole 11 may be formed such that the inner diameter increases from the small diameter portion 10 toward both sides in the direction of the second axis L2. Thereby, the reaction force acting on the small diameter portion 10 of the engaging member 4 from the connecting portion 9 is dispersed to both sides in the second axis L 2 direction of the engaging member 4, and the small diameter portion 10 of the engaging member 4 from the connecting portion 9 A large acting reaction force can be tolerated, and damage or deformation of the engagement member 4 can be suppressed.

  In the above-mentioned embodiment, although the case where the broach 2 is held as the operation member is described, in another embodiment of the present invention, even when the stem embedded in the human body is removed as the operation member, the stem The surgical gripper according to the invention can advantageously be implemented for gripping. Further, the present invention is not limited to the stem for artificial hip joint such as the above-mentioned modular neck type stem, and grasps a surgical member such as an artificial joint stem embedded in various parts such as a knee joint and an elbow joint. The present invention can also be suitably implemented in a surgical grasper for medical use.

DESCRIPTION OF SYMBOLS 1 surgical gripping tool 2 broach 3 gripping tool main body 4 engaging member 4a tip 5 operating member 6 driving means 7 fitting recess 8 fitting portion 9 connecting portion 10 small diameter portion 11 through hole 12 inner circumferential surface 20 operation lever 21 1 link member 22 second link member 24 first pin 25 second pin 26 third pin 27 fourth pin 28 fifth pin 29 sixth pin L0 longitudinal axis line L1 first axis line L2 second axis line

Claims (4)

What is claimed is: 1. A surgical grasping tool for grasping a surgical member used by being fixed to a joint in a surgery for replacing a part or all of a joint with an artificial joint, comprising:
A longitudinal gripper body having a hollow fitting portion that can be fitted into a fitting recess formed in the surgical member;
In the fitting portion, the longitudinal direction of the gripping tool main body is from the projecting position where the tip end protrudes from the fitting portion and abuts against the inner surface of the fitting recess, and the retracted position where the tip portion is retracted into the fitting portion An engagement member angularly displaceable about a first axis intersecting the longitudinal axis extending at a predetermined angle of less than 90 °;
The holding member body is movably held in the longitudinal direction, and is rotatable about a second axis orthogonal to the longitudinal axis at a portion of the engaging member opposite to the tip with respect to the first axis. An actuation member having a coupling portion coupled to the
A surgical grasper comprising: driving means held by a grasper main body to move the actuating member in a longitudinal direction of the grasper main body. The connecting portion comprises a cylindrical body centered on the second axis,
A portion of the engaging member opposite to the tip end has a small diameter portion for contacting at least a part of the outer peripheral surface of the cylindrical body to support the cylindrical body, and from the small diameter portion to the second axis The surgical grasper according to claim 1, characterized in that a through hole whose inner diameter increases as it deviates in the direction is formed.   The surgical grasper according to claim 1, wherein the through hole is formed such that an inner diameter increases from the small diameter portion toward both sides in the second axial direction.   An angle θ1 formed by an inner circumferential surface facing the through hole of the connecting portion and the second axis is selected to be an angle θ2 or more formed by the first axis and the second axis. Or the surgical grasper according to 3.

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