JP6578528B1 - Guide to use in osteotomy correction - Google Patents

Abstract

To provide a guide that is easy to design, and that can perform osteotomy correction safely and accurately. An osteotomy guide 1 comprises a guide wire inserted into a deformed bone, and a correction guide. The osteotomy guide includes first and second cylindrical legs 6 and 8 through which a guide wire can be inserted, and can be separated into first and second portions 1a and 1b with a separation surface 11 as a boundary. When the osteotomy guide is disposed at a predetermined position on the deformed bone, the separation surface is located on the same plane as the cutting line on the bone. After insertion of the guide wire into the deformed bone, the second portion is separated and removed before cutting the deformed bone. The correction guide includes a first portion and a third portion connected to the first portion via a connecting wire. The first and third portions are fitted into the guide wire, connected by the connecting wire, and connected in a state of being aligned in a predetermined arrangement, thereby correcting the positional relationship between the divided deformed bones. Is done. [Selection] Figure 1

Description

  The present invention relates to a guide used in osteotomy correction, which is one of the methods in orthopedic treatment.

In orthopedic treatment, it may be necessary to correct deformed bones (such as fracture deformity healing) caused by congenital diseases, trauma, aging, etc., and osteotomy correction is performed in such cases.
According to osteotomy correction, deformed bone is cut and divided along a predetermined cutting line crossing the deformed bone using a bone saw, and the divided deformed bone is corrected for mutual positional relationship, They are connected to each other by an internal fixation material (plate, screw, graft for bone defect, etc.) and fixed in a normal position.

By the way, although bone deformation is three-dimensional, conventional osteotomy correction mainly follows a preoperative plan created based on a two-dimensional simulation using two-dimensional projection data (image). Surgery has been performed, and an accurate three-dimensional simulation of the surgery has not been performed before surgery.
And, the operation according to the preoperative plan based on this two-dimensional simulation is very complicated technically, and there are problems such as bone cutting at an inappropriate site and insufficient correction by the operation. It was happening.

Therefore, guides used in the osteotomy correction have been developed as support means for accurately and simply performing osteotomy correction (see, for example, Patent Document 1 and Non-Patent Document 1).
This guide cuts the deformed bone along a predetermined cutting line and splits the osteotomy guide, the guide wire inserted into the deformed bone through the osteotomy guide, and the split deformed bone. It is comprised from the correction guide used in order to correct | amend the positional relationship of this through a guide wire.

  The osteotomy guide and the correction guide are based on a three-dimensional additive manufacturing technique based on a three-dimensional simulation of surgery (osteotomy correction) using three-dimensional projection data acquired from deformed bone by X-ray CT and MRI. It is formed using.

The osteotomy guide has a block body shape, and a plurality of guide holes through which guide wires can pass respectively are formed at both ends in the length direction, and at least one guide slit for guiding the bone saw is formed in the intermediate portion. ing.
In addition, the osteotomy guide is pressed and fixed on the deformed bone in a state of being fitted to the feature portion including the cutting line on the deformed bone surface, and the back surface of the osteotomy guide matches the undulation of the feature portion. Has the shape.

  In the osteotomy guide, the guide hole on one end in the length direction is located on one side with respect to the cutting line of the deformed bone, and the guide hole on the other end in the length direction is located on the other side with respect to the cutting line of the deformed bone. Is pressed and fixed on the deformed bone in an arrangement corresponding to the cutting line of the deformed bone.

Then, the guide wire is inserted into the deformed bone through the guide hole of the osteotomy guide, and then the bone saw is moved along the guide slit to perform osteotomy.
By osteotomy, the osteotomy guide is cut and split together with the deformed bone, and the osteotomy guide is removed from the split bone while the guide wire remains inserted.

The correction guide has a block shape, and the correction guide is formed with a plurality of guide holes extending in parallel with each other and through which guidewires inserted through the osteotomy guides can be inserted.
In this conventional guide, the positional relationship between the two divided bones is corrected in a state where the guide wires inserted into both divided bones are parallel to each other, so that the two divided bones are in normal positions. The back of the orthodontic guide is fitted to the surface of two split bones placed in the normal position with the guide wire corresponding to the guide hole of the orthodontic guide inserted. It has a shape to

  Then, in a state in which the mutual positional relationship between the two divided bones is corrected by the correction guide and the guide wire, the two divided bones are connected to each other by the internal fixing material and fixed at the normal position.

  By the way, according to this conventional guide, when the osteotomy guide is removed from the deformed bone, the portion on the extension line of the guide slit of the osteotomy guide is cut by the bone saw, and the generated chips are completely removed. If it remains at the treatment site without being removed, it may interfere with the subsequent treatment using the correction guide, and may adversely affect the patient after the operation.

  In addition, the alignment of the osteotomy guide on the deformed bone and the alignment of the divided bone to the correction guide are performed by fitting the back surface (fitting surface) of the osteotomy guide and the correction guide with the corresponding bone surface. However, in this case, it is difficult to accurately read the undulations on the bone surface from the three-dimensional projection data obtained from the deformed bone by X-ray CT and MRI. Therefore, the bone surface is compared based on the projection data. However, it is not easy to design the back surface of the guide that matches the undulations in a wide area (characteristic portion), and there is a problem that the guide cannot be manufactured efficiently.

  Furthermore, from the state of the deformed bone actually viewed by the operator through the incision, the position where the guide wires inserted into the divided bones are parallel to each other (that is, the position where the guide wire corresponding to the guide hole of the correction guide is inserted) ), It may be determined that the positional relationship between the divided bones is not sufficiently corrected and it is necessary to further adjust the positional relationship between the divided bones. However, this correction guide cannot cope with such cases. It was.

Japanese Patent No. 5332385

"Corrective osteotomy for hyperextended elbow with limited flexion due to supracondylar fracture malunion" Keiichiro Oura et al. J Shoulder Elbow Surg, 2018, Aug; 27 (8); 1357-1365

  Therefore, an object of the present invention is to provide a guide that is easy to manufacture and that can perform osteotomy correction safely and accurately.

  In order to solve the above-mentioned problems, according to the present invention, a guide used in osteotomy correction is used to cut and divide a deformed bone along a predetermined cutting line across the deformed bone. An osteotomy guide, a guide wire inserted into the deformed bone through the osteotomy guide, and a correction guide used to correct the mutual positional relationship of the divided deformed bone via the guide wire; The osteotomy guide is connected to the main body portion via the first connecting means and arranged in parallel with each other, and a plurality of first cylindrical shapes through which the guide wire can penetrate each are provided. A plurality of second cylindrical legs that are connected to the main body via a second connecting means and are arranged in parallel to each other, each of which can be penetrated by a guide wire. The guide book Since the part is separable along a predetermined separation surface, the first part on the first connecting means side and the second part on the second connecting means side can be separated. And extending in parallel with each other through the part belonging to the first part in the direction intersecting the first cylindrical leg part from the separation surface to the part belonging to the first part in the main body part A plurality of first wire insertion holes are formed, an alignment recess is formed on the separation surface of the portion belonging to the first portion, and the osteotomy guide is in the state where the separation is not performed, It is configured to be pressed and fixed at a predetermined position on the deformed bone, and the lower end surfaces of the first and second cylindrical leg portions are at the predetermined position on the deformed bone without being separated. It has a shape that contacts without gap, and the osteotomy guide is When pressed and fixed at the predetermined position on the scapula, the first and second cylindrical legs are positioned on opposite sides of the cutting line on the deformed bone, and the guide wires are respectively inserted. The separation surface is located on the same plane as the cutting line, and the guide wire is inserted into the deformed bone through the first and second cylindrical legs. After entering, before the cutting of the deformed bone, the osteotomy guide is separated and the second portion is removed, and the correction guide is connected to the first portion of the osteotomy guide. A third portion connected to the first portion via a connecting wire having a certain degree of rigidity, and the third portions are connected to each other via third connecting means, respectively. The osteotomy is arranged on the divided deformed bones arranged in parallel. A plurality of third cylindrical leg portions through which a corresponding guide wire inserted through the second portion of the guide can penetrate, and a lower end surface of the third cylindrical leg portion is the divided deformation. The third connecting means extends in parallel with each other in a direction passing through the third connecting means and intersecting the third cylindrical leg portion. , A plurality of second wire insertion holes corresponding to the plurality of wire insertion holes of the first part, respectively, projecting from the third connecting means, and the tips thereof coincide with the alignment recesses of the first part And a guide wire corresponding to each of the first and third cylindrical legs, and the first and third portions abut against the deformed bone. In the crimped state, the first wire paired with each other. And the tip of the alignment rod of the third part is fitted into the alignment recess of the first part without slippage, and the first and second wires are inserted into the second wire insertion hole. A guide is provided in which the three portions are connected to each other, thereby correcting the positional relationship between the divided deformed bones.

  According to a preferred embodiment of the present invention, the portion belonging to the second portion of the main body portion of the osteotomy guide has a second cross section extending from the separation surface in a direction intersecting the second cylindrical leg portion. A third wire insertion hole corresponding to the first wire insertion hole of the portion belonging to the first portion and extending in parallel with each other through the portion belonging to the portion is formed, and the main body portion includes the first wire insertion hole. The first and second portions may be separated from the first portion in the axial direction of the second cylindrical leg, but the second portion may be separated from the first portion. Engaging means for engaging so as to prevent separation along the third wire insertion hole is provided, and the first and second portions are moved by the engaging means in a state where the osteotomy guide is not separated. The first and second connecting wires are engaged and the connecting wires are paired with each other. The first and second portions are joined by being inserted through the third wire insertion hole, and the second portion can be separated from the first portion by extracting the connecting wire. Become.

  According to the present invention, the osteotomy guide and the correction guide are aligned on the deformed bone by bringing the lower end surfaces of the first to third cylindrical legs into contact with the deformed bone surface without any gaps. Therefore, if the undulations of a plurality of narrow regions on the deformed bone surface can be grasped, the shape of the contact surface of the osteotomy guide with the deformed bone can be designed. The osteotomy guide and correction guide can be designed quickly and accurately using only the information that can be grasped from the projection data.

  In addition, the osteotomy guide and the correction guide share a portion (first portion) related to one of the deformed bones divided into two, while the osteotomy guide and the correction guide are divided into two (the osteotomy guide and the correction guide). ) Since the parts (second and third parts) related to the other of the deformed bones are individually formed, the osteotomy guide and the correction guide can be manufactured at a lower cost.

Further, according to the present invention, the osteotomy guide can be separated into the first part and the second part, and before the osteotomy by the bone saw, the second part of the osteotomy guide is removed from the deformed bone, The cutting line on the bone is visible on the extension of the separation surface on the first part side of the cutting guide, and the bone saw body is placed along the separation surface on the second part side while the cutting edge of the bone saw is applied to the bone. The bone was cut by moving it.
As a result, osteotomy can be performed more smoothly, and it is not necessary to cut the osteotomy guide by a bone saw during osteotomy, and chips are not scattered in the patient's body.

  Furthermore, according to the present invention, the correction guide is composed of a first portion, a third portion, and a connecting wire having a certain degree of rigidity that connects the first and third portions, and the operator Can finely adjust the positional relationship between the first and third portions by bending the connecting wire. As a result, if the positional relationship between the two divided deformed bones is corrected with the correction guide and further positional adjustment becomes necessary, the necessary fine adjustment can be made by bending the connecting wire appropriately. Can be done easily.

It is a perspective view of the osteotomy guide among the guides used in osteotomy correction operation by one Example of the present invention, (A) shows the state where the osteotomy guide is not separated, and (B) is the osteotomy guide. Indicates a separated state. (A) is a perspective view of the 1st part of the osteotomy guide of FIG. 1, (B) is a perspective view of the 2nd part of the osteotomy guide of FIG. It is a perspective view which shows the state before two parts of the correction guide of the guides used in the osteotomy correction operation by one Example of this invention are connected. FIG. 2 is a perspective view showing a state where a guide wire is inserted into a deformed bone through the osteotomy guide of FIG. 1. FIG. 2 is a perspective view showing a state where the osteotomy guide of FIG. 1 is separated after the guide wire is inserted into the deformed bone. It is a perspective view which shows the state by which the 3rd part of the correction guide of FIG. 3 was engage | inserted by the guide wire. FIG. 4 is a perspective view showing a state where two portions of the correction guide of FIG. 3 are connected by a connecting wire, and the positional relationship between the divided deformed bones is corrected by the correction guide and the guide wire. (A) is the perspective view which looked at the state shown in FIG. 4 in the axial direction of the guide wire, (B) is the perspective view which looked at the state shown in FIG. 7 in the axial direction of the guide wire.

Hereinafter, the configuration of the present invention will be described based on preferred embodiments with reference to the accompanying drawings.
FIG. 1 (A) is a perspective view showing a state in which the osteotomy guide among the guides used in osteotomy correction according to one embodiment of the present invention is not separated, and FIG. 1 (B) is the same bone. It is a perspective view which shows the state by which the cutting guide was isolate | separated. 2A is a perspective view of a first portion of the osteotomy guide of FIG. 1, and FIG. 2B is a perspective view of a second portion of the osteotomy guide.
FIG. 3 is a perspective view showing a state before two portions of the correction guide among the guides used in the osteotomy correction according to one embodiment of the present invention are connected.

4 is a perspective view showing a state in which a guide wire is inserted into the deformed bone through the osteotomy guide of FIG. 1, and FIG. 5 is a diagram illustrating how the osteotomy guide of FIG. 1 inserts the guide wire into the deformed bone. It is a perspective view which shows the state isolate | separated later.
FIG. 6 is a perspective view showing a state in which the third portion of the correction guide of FIG. 3 is fitted into the guide wire, and FIG. 7 is a diagram in which two portions of the correction guide of FIG. FIG. 5 is a perspective view showing a state in which the mutual positional relationship between divided deformed bones is corrected by a correction guide and a guide wire.

  1 to 7, the guide of the present invention includes a bone cutting guide 1 used for cutting and dividing a deformed bone W along a predetermined cutting line X across the deformed bone W, and a bone. In order to correct the positional relationship between the guide wire 2 (also referred to as “Kirschner steel wire”) 2 inserted into the deformed bone W through the cutting guide 1 and the divided deformed bones W1 and W2 through the guide wire 2. It is comprised from the correction guide 3 used for.

  The osteotomy guide 1 and the correction guide 3 are designed and acquired based on a three-dimensional simulation of osteotomy using three-dimensional projection data obtained from the deformed bone W by X-ray CT and MRI. Based on the original design data, it is formed using a three-dimensional additive manufacturing technique.

  As shown in FIGS. 1, 2, 4, and 5, the osteotomy guide 1 is connected to the main body portion 4 and the main body portion 4 via a first framework (first connecting means) 5. A plurality of (two in this embodiment) first cylindrical legs 6 which are arranged in parallel to each other and through which the guide wire 2 can penetrate, and a second framework (second connecting means) on the main body 4. And a plurality of (two in this embodiment) second cylindrical legs 8 that are connected via 7 and are arranged in parallel with each other and through which the guide wire 2 can pass.

  The main body 5 belongs to the first and second frameworks 5 and 7 sides, respectively, and has a shape of a lying cylinder composed of first and second semi-cylindrical portions 9 and 10 that are paired with each other, It can be separated in the diametrical direction and in the axial direction of the first and second cylindrical legs 6, 8.

A wall 10b projecting in a semicircular shape is provided on one end side of the flat side surface 10a of the second semi-cylindrical portion 10 (the separation surface 11 of the main body 5), and the inner surface of the wall 10b extends along the separation surface 11. A hook-like protrusion 12 extending in the width direction of the wall 10b is formed.
On the other hand, on the end surface 9b of the first semi-cylindrical portion 9, a groove 13 corresponding to the hook-shaped protrusion 12 is formed and extends in the width direction of the end surface 9b.

In addition, a plurality of (in this embodiment) the first semi-cylindrical portion 9 extending in parallel with each other through the first semi-cylindrical portion 9 in a direction intersecting the first cylindrical leg 6 from the flat side surface 9a. Two first wire insertion holes 14 are formed, and an alignment recess 15 is formed on the flat side surface 9 a of the first semi-cylindrical portion 9. The alignment recess 15 has a hemispherical shape in this embodiment.
At the opening position of the first wire insertion hole 14 on the curved side surface side of the first semi-cylindrical portion 9, a wire guide cylinder 16 extending on the extension line of the first wire insertion hole 14 is projected.

Furthermore, the first half-cylinder 10 extends in parallel to each other through the second half-cylinder part 10 in a direction intersecting the second cylindrical leg 8 from the flat side surface 10 a to the second half-cylinder part 10. A third wire insertion hole 17 corresponding to the first wire insertion hole 14 of the portion 9 is formed.
At the opening position of the third wire insertion hole on the curved side surface side of the second semi-cylindrical portion 10, a wire guide cylinder 18 extending on the extension line of the third wire insertion hole 17 is projected.

  Thus, the hook-like protrusion 12 is fitted into the groove 13, and the flat side surfaces 9a and 10a (the separation surface 11 of the main body 4) of the first and second semi-cylindrical portions 9 and 10 are in contact with each other and to a certain extent. The first and second semi-cylindrical portions 9 are inserted into the first and third wire insertion holes 14, 17 (and the wire guide tubes 16, 18) that are paired with each other. 10 are combined to form the main body 4.

  Note that “a certain degree of rigidity” means a degree of rigidity that allows the connecting wire 19 to be bent freely if an operator applies a force of a certain degree or more.

  The hook-like protrusion 12 and the groove 13 are formed so that the first and second semi-cylindrical portions 9 and 10 are moved from the first semi-cylindrical portion 9 to the axial direction of the second cylindrical leg portion. Although it can be separated, it constitutes an engaging means for engaging the second semi-cylindrical portion 10 so that separation along the third wire insertion hole 17 from the first semi-cylindrical portion 9 is prevented.

  The connecting wire 19 is extracted from the first and third wire insertion holes 14 and 17 (and the wire guide tubes 16 and 18), so that the main body portion 4 can be separated. The first semi-cylindrical portion 9, the first framework 5 and the first portion 1 a on the first cylindrical leg 6 side, the second semi-cylindrical portion 10 of the main body 4, and the second framework. 7 and the second portion 1b on the second cylindrical leg 8 side.

  As shown in FIG. 4, when the osteotomy guide 1 is pressed and fixed at a predetermined position on the deformed bone W, the first and second cylindrical legs 6 and 8 make a cutting line X on the deformed bone W. The deformed bones are arranged on the opposite sides of each other so as to coincide with the positions and angles at which the guide wires 2 should be inserted, and the separation surface 11 of the main body 4 is located on the same plane as the cutting line X. It is configured to be pressed and fixed on W.

  And each lower end surface 6a, 8a of the 1st and 2nd cylindrical leg parts 6 and 8 has a shape which contacts the deformation | transformation bone W without a gap in the state in which the osteotomy guide 1 was pressed and fixed. .

  In this case, positioning of the osteotomy guide 1 with respect to the deformed bone W is such that the lower end surfaces 6a and 8a of the first and second cylindrical leg portions 6 and 8 of the osteotomy guide 1 are in contact with the bone surface without any gaps. However, the osteotomy guide 1 designed for a plurality of specified positions on the bone surface does not conform to other positions on the bone surface at all. Thereby, the accuracy of positioning is guaranteed.

  As shown in FIGS. 3, 6 and 7, the correction guide 3 includes a first portion 1 a of the osteotomy guide 1 and a third portion 3 a connected to the first portion 1 a via a connecting wire 19. And.

  The third portions 3a are connected via connecting means (third connecting means) and arranged in parallel with each other, and are inserted into the divided deformed bone W2 through the second portion 1b of the osteotomy guide 1. In addition, a plurality of (in this embodiment, two) third cylindrical legs 20 through which the corresponding guide wires 2 can pass are provided.

  The lower end surface 20a of the third cylindrical leg portion 20 has a shape that contacts a predetermined position on the divided deformed bone W2 without a gap.

  In this embodiment, the connecting means includes a spherical nucleus 21a and a framework 21b connected to the nucleus 21a, and one third cylindrical leg portion 17 is integrally formed with the nucleus 21a, and the other third The cylindrical leg portion 17 is coupled to the framework 21b.

The cores 21a pass through the core 21a and extend in parallel to each other in the direction intersecting the third cylindrical leg portion 20, and two cores 21a respectively correspond to the two first wire insertion holes 14 of the first portion 1a. The second wire insertion hole 22 and an alignment rod 23 that protrudes from the core 21a and has a shape (a hemisphere in this embodiment) whose tip 23a matches the alignment recess 15 of the first portion 1a. Yes.
Further, a wire guide cylinder 24 extending on an extension line of the second wire insertion hole 22 is provided on the outer peripheral surface of the core 21 a at an opening position on the side away from the alignment rod 23 of the second wire insertion hole 22. ing.

  Then, the guide wire 2 corresponding to each of the first and third cylindrical legs 6 and 20 is inserted, and the first and third portions 1a and 3a are brought into contact with the deformed bones W1 and W2. 7 (see FIG. 6), as shown in FIG. 7, the connecting wire 19 is inserted into the first and second wire insertion holes 14 and 22 (and the wire guide tubes 16 and 24) paired with each other, and the first The tip 23a of the alignment rod 23 of the third portion 3a is fitted into the alignment recess 15 of the first portion 1a without being displaced, so that the first and third portions 1a, 3a are connected, thereby The mutual positional relationship between the divided deformed bones W1 and W2 is corrected.

Next, how to use the guide of the present invention will be described.
After the surgical site of the patient is opened by the operator and the deformed bone W is exposed, the osteotomy guide 1 is pressed and fixed at a predetermined position of the deformed bone W by the operator.
In this case, the osteotomy guide 1 is positioned so that the lower end surfaces 6a and 8a of the first and second cylindrical legs 6 and 8 of the osteotomy guide 1 are in contact with the bone surface without any gaps. Is done by confirming with the sense of touch of the hand.

Next, as shown in FIG. 4, the guide wire 2 is inserted into the deformed bone W through the first and second cylindrical legs 6, 8 of the osteotomy guide 1 by the operator, and thereafter, in FIG. 5. As shown, after the connecting wire 19 is extracted and the osteotomy guide 1 is separated into the first and second portions 1a, 1b, the second portion 1b is removed.
In this state, the operator can clearly see the cutting line X on the deformed bone W on the extension of the separation surface 11 on the first portion 1 a side of the osteotomy guide 1.

The surgeon can smoothly cut the bone by moving the bone saw body along the separation surface 11 of the first portion 1a while applying the cutting edge of the bone saw to the deformed bone W.
At this time, since the osteotomy guide 1 is not cut by the bone saw, chips of the osteotomy guide 1 are not scattered.

  After completion of the osteotomy, as shown in FIG. 6, the first portion 1 a is left as it is, and the third portion 3 a of the correction guide 3 is divided by the operator through the third cylindrical leg portion 20. The deformed bone W2 is fitted into the corresponding guide wire 2 (the guide wire 2 inserted through the second portion 1b of the osteotomy guide 1) and brought into contact with a predetermined position on the deformed bone W2.

  Next, the operator inserts the connecting wire 19 into the first and second wire insertion holes 14 and 22 (and the wire guide tubes 14 and 24) that are paired with each other, and aligns the third portion 3a with the alignment rod. 23, the first and third portions 1a and 3a are connected to each other by fitting the leading end 23a of the first portion 1a to the alignment recess 15 of the first portion 1a without deviation, and the mutual positions of the divided deformed bones W1 and W2 The relationship is corrected.

  At this time, if it is determined by the operator that fine adjustment of the positional relationship between the two deformed bones W1 and W2 is necessary, the connecting wire 19 is bent by the operator and the first and third portions 1a, 1a, The positional relationship 3a is finely adjusted.

FIG. 8A is a perspective view of the state shown in FIG. 4 as viewed in the axial direction of the guide wire, showing the state of the deformed bone W before osteotomy, and FIG. It is the perspective view which looked at the state shown in the axial direction of a guide wire, Comprising: It is a figure which shows the state of the deformation | transformation bone after correction | amendment by the correction guide 3. FIG.
8A and 8B, it will be easily understood that the deformed bone W is corrected by the correction guide 3.

Then, when the correction of the positional relationship between the divided deformed bones W1 and W2 is completed, the two deformed bones W1 and W2 are mutually connected by an internal fixing material (plate, screw, graft for bone defect portion, etc.). Connected and fixed in normal position.
Thereafter, the operator pulls out the guide wire 2 from the bone and sutures the treatment site of the patient.

  Thus, according to the present invention, the osteotomy guide 1 and the correction guide 3 are aligned on the deformed bones W, W1, and W2, and the lower end surfaces of the first to third cylindrical legs 6, 8, and 20 are aligned. Since it is done by contacting the deformed bone surface without gaps, if the undulations of multiple narrow areas on the deformed bone surface can be grasped, the shape of the contact surface with respect to the deformed bone of the osteotomy guide can be designed. The osteotomy guide 1 and the correction guide 3 can be designed quickly and accurately only by information that can be grasped from the three-dimensional projection data of the deformed bone by X-ray CT and MRI.

  Further, the osteotomy guide 1 and the correction guide 3 share a portion (first portion 1a) related to one of the deformed bones W (diverted bone W1) divided into two, while the osteotomy guide and the correction guide 3 share the same. Since the parts (second and third parts 2b and 3a) related to the other (deformed bone W2) of the deformed bone W divided (or divided) into two parts (the second and third parts 2b and 3a) are individually formed. The guide 1 and the correction guide 3 can be manufactured at a lower cost.

Further, according to the present invention, the osteotomy guide 1 can be separated into the first portion 1a and the second portion 1b, and the second portion 1b is removed from the deformed bone W before the osteotomy by the bone saw, The cutting line on the bone is made visible on the extension of the separation surface 11 on the first part 1a side, and the bone saw body is placed along the separation surface 11 on the first part 1a side while applying the cutting edge of the bone saw to the bone. To move the bones.
Thereby, osteotomy can be performed more smoothly, and it is not necessary to cut the osteotomy guide 1 with a bone saw at the time of osteotomy, and chips are not scattered in the patient's body.

  Further, the correction guide 3 is composed of a first portion 1a, a third portion 3a, and a connecting wire 19 having a certain degree of rigidity for connecting the first and third portions 1a, 3a, The operator can finely adjust the positional relationship between the first and third portions 1 a and 3 a by bending the connecting wire 19. Thereby, after correcting the mutual positional relationship between the two divided deformed bones W1 and W2 by the correction guide 3, if further fine adjustment of the positional relationship is necessary, the connecting wire 19 is appropriately bent. The necessary fine adjustment can be easily performed.

DESCRIPTION OF SYMBOLS 1 Osteotomy guide 1a 1st part 1b 2nd part 2 Guide wire 3 Correction guide 3a 3rd part 4 Main-body part 5 1st framework (1st connection means)
6 1st cylindrical leg part 6a Lower end surface 7 2nd framework (2nd connection means)
8 Second cylindrical leg portion 8a Lower end surface 9 First semi-cylindrical portion 9a Flat side surface (separation surface 11 of main body portion 4)
9b End surface 10 Second semi-cylindrical portion 10a Flat side surface (separation surface 11 of main body 4)
10b Wall 11 Separation surface 12 Gutter-like projection 13 Groove 14 First wire insertion hole 15 Alignment recess 16 Wire guide cylinder 17 Third wire insertion hole 18 Wire guide cylinder 19 Connecting wire 20 Third cylindrical leg 20a Below End surface 21a Core (third connecting means)
21b Framework (third connection means)
22 Second wire insertion hole 23 Alignment rod 23a Tip 24 Wire guide tube W Deformed bone W1 One of the divided deformed bones W2 The other of the divided deformed bones X Cutting line

Claims (2)

A guide for use in osteotomy correction, wherein the deformed bone is cut along a predetermined cutting line across the deformed bone, and is used for splitting, and the deformation through the osteotomy guide. A guide wire inserted into the bone, and a correction guide used to correct the positional relationship between the divided deformed bones via the guide wire,
The osteotomy guide is
The main body,
A plurality of first cylindrical legs connected to the main body via first connecting means and arranged in parallel to each other, each of which can be penetrated by a guide wire;
A plurality of second cylindrical legs that are connected to the main body via second connecting means and are arranged in parallel to each other, each of which can be penetrated by a guide wire;
The osteotomy guide is configured such that the main body is separable along a predetermined separation surface, so that the first portion on the first connecting means side and the second part on the second connecting means side are arranged. It can be separated into two parts,
A plurality of second portions extending in parallel to each other through the portion belonging to the first portion in the direction intersecting the first cylindrical leg portion from the separation surface to the portion belonging to the first portion in the main body portion. 1 wire insertion hole is formed, and an alignment recess is formed on the separation surface of the portion belonging to the first portion,
The osteotomy guide is configured to be pressed and fixed at a predetermined position on the deformed bone without the separation, and the lower end surfaces of the first and second cylindrical leg portions are It has a shape that comes into contact with the predetermined position on the deformed bone without a gap without being separated,
When the osteotomy guide is pressed and fixed at the predetermined position on the deformed bone, the first and second cylindrical legs are positioned on opposite sides of the cutting line on the deformable bone. , Each coincides with the position and angle where the guide wire should be inserted, and the separation surface is located on the same plane as the cutting line,
After insertion of the guide wire into the deformed bone through the first and second cylindrical legs, and before cutting the deformed bone, the osteotomy guide is separated and the second portion is removed. And
The correction guide is
The first portion of the osteotomy guide;
A third portion connected to the first portion via a connecting wire having a certain degree of rigidity,
The third part is
A plurality of guidewires, each connected through a third connecting means and arranged parallel to each other, can be penetrated by the corresponding deformed bones inserted through the second part of the osteotomy guide. A third cylindrical leg,
The lower end surface of the third cylindrical leg has a shape that contacts a predetermined position on the divided deformed bone without a gap,
The third connecting means includes
A plurality of second wires extending parallel to each other in a direction intersecting with the third cylindrical leg through the third connecting means and respectively corresponding to the plurality of wire insertion holes of the first portion An insertion hole,
An alignment rod that protrudes from the third connecting means and has a tip that matches the alignment concave portion of the first portion;
In a state where guide wires corresponding to the first and third cylindrical leg portions are inserted and the first and third portions are brought into contact with the deformed bone, the connecting wires are paired with each other. The first and second wire insertion holes are inserted, and the tip of the alignment rod of the third portion is fitted into the alignment recess of the first portion without deviation. A guide characterized in that the first and third parts are connected to each other, thereby correcting the positional relationship between the divided deformed bones. The portions of the main body portion of the osteotomy guide that belong to the second portion pass through the portion belonging to the second portion in a direction intersecting the second cylindrical leg portion from the separation surface and are parallel to each other. A third wire insertion hole corresponding to the first wire insertion hole of the part belonging to the first part extending is formed,
In the main body portion, the first and second portions can be separated from the first portion in the axial direction of the second cylindrical leg portion. Engaging means is provided for engaging so as to prevent separation along the third wire insertion hole from the first portion of
In a state where the osteotomy guide is not separated, the first and second portions are engaged by the engaging means, and the connecting wire is inserted through the first and third wire insertion holes that are paired with each other. The first portion and the second portion are coupled to each other, and the second portion can be separated from the first portion by pulling out the connecting wire. Described guide.