JP6601812B2 - Surgical tools for joint replacement - Google Patents

Description

  The present invention relates to an improvement of a surgical tool suitable for performing joint replacement.

  In joint replacement, for example, as pointed out in Non-Patent Document 1 below, the reconstruction of the lower limb function axis and the reconstruction of the balance of the soft tissue determine the postoperative clinical outcome. The lower limb functional axis is the axis through which the body weight passes through the femoral head center, knee joint center, and ankle joint center. In artificial knee joint replacement, the bone is cut and placed perpendicular to this functional axis. It is necessary to distribute the load evenly over the knee prosthesis. Further, in order to reconstruct the balance of the soft tissue, it is necessary to perform bone resection in parallel with the attachment portion of the collateral ligament that becomes the rotation center of the knee joint.

  However, during knee joint surgery, it is difficult to know the femoral head center of the hip joint that does not expand and the center of the ankle joint. In addition, it is difficult to accurately recognize the position of the ligament attachment portion such as the collateral ligament even during the operation. In order to perform appropriate osteotomy from these backgrounds, a three-dimensional surgical plan based on image data obtained by CT (Computerized Tomography) or the like before operation is reflected during the operation, and the three-dimensional limb position of the lower limbs is reflected. It is necessary to have a surgical instrument that can assist the surgeon by grasping this during the operation.

  By the way, as a conventional technique for knowing the femoral head center during surgery in knee joint replacement, there is a femoral head center position specifying device described in Patent Document 1 below. According to this, the patient is supported on the operating table so that the frontal plane is horizontal. A marking plate is disposed so as to cover a portion of the patient's body where the center of the femoral head is located from a direction orthogonal to the frontal plane, and a rotation shaft having a rotation shaft that is disposed to extend in a direction orthogonal to the frontal plane. A moving arm and a marker that forms an arc on the marking plate as the rotating arm rotates are provided. The pivot axis is disposed at the distal end of the patient's femur, and the distance from the pivot axis to the marker in a direction parallel to the frontal plane is measured in advance from the distal femur end to the femoral head center. Is set to be the same as the distance to

  Thus, the distance from the pivot axis to the marker in the direction parallel to the frontal plane is the same as the distance from the distal end of the femur measured in advance to the femoral head center, and the pivot axis is far from the femur. Since it is arranged at the distal end, when the pivot arm is pivoted and an arc is marked with a marker on the marking plate, the arc passes through a point facing the femoral head center. Accordingly, when the hip joint is turned inward or outward and the femur is positioned at the first position and the second position where they are separated from each other, and the first arc and the second arc are marked on the marking plate at these positions, The first arc and the second arc intersect at a point opposite to each other, and the position of the femoral head center can be specified in a plane parallel to the frontal plane by the intersection.

P114-P119 of "All about Artificial Joint Replacement TKA" published by Medical View Inc., Toru Katsuro et al. "Overview of TKA technique" Bone cutting ""

JP 2012-29769 A

  However, in the background art described above, since the marking plate is attached to the operating table side, if the position of the patient on the operating table shifts, the relative positional relationship between the marking plate and the patient will also shift. As a result, the intersection point specified on the marking plate and the position of the femoral head center also shift. In the background art, the center of the head of the head can be specified on the frontal plane, but it is not possible to obtain alignment information on the direction of bending / extension in the sagittal plane and the direction of rotation in the transverse plane. In addition, since it is not possible to obtain alignment information of the tibia, which is a component bone of the knee joint, it is impossible to grasp the limb position and alignment information of the entire lower limb important for reconstruction of the knee joint during the operation.

  The present invention pays attention to the above points, and its purpose is to grasp the femoral head center well during artificial joint replacement. The other purpose is to perform a bone resection perpendicular to the functional axis whose weight passes through the femoral head center, knee joint center, and ankle joint center, and to satisfactorily install the artificial knee joint. Still another object is to perform a bone resection parallel to the attachment part of the collateral ligament that becomes the rotation center of the knee joint or at an angle of a three-dimensional surgical plan, and to satisfactorily install the artificial knee joint. Still another purpose is not only to adjust the front and lower varus to the hip, knee and ankle joints, but also to the entire lower limb including sagittal flexion and extension, and cross-sectional rotation. By visualizing the limb position and alignment in three dimensions, the distal end of the femur parallel to the direction perpendicular to the functional axis and parallel to the center of rotation of the knee while grasping the tension state of the soft tissue that varies depending on the limb position of the lower limb And allowing cutting of the proximal end of the tibia.

  The surgical tool for joint replacement at the distal end of the femur according to the present invention is a surgical tool for performing cutting of the distal end of the femur based on a preoperative plan when performing artificial joint replacement. A pelvic attachment that indicates the direction of the functional axis passing through the center of the femoral head and the functional axis indicated by the pelvic attachment, and indicates the cutting position at the distal end of the femur A connecting rod that connects the patient's left or right upper anterior iliac spine and the intercondylar fossa of the knee joint, and a left or right thigh corresponding to the upper anterior iliac spine. The pelvic attachment and the distal femoral end attachment are connected by a center indicating rod that passes through the center of the bone head.

  One of the main forms is that the pelvic attachment includes three poles that contact the left and right upper anterior iliac spines and the pubic joint in the patient's pelvis from above the skin. It is characterized by comprising an interval adjusting means for adjusting in accordance with the interval between the upper anterior iliac spine and the pubic joint.

  In another form, the pelvic attachment includes first rod receiving means for supporting the rods by adjusting a distance and an angle between the center indicating rod and the connecting rod, The distal end attachment includes second rod receiving means for supporting the rods by adjusting an angle between the center indicating rod and the connecting rod.

  One of the other forms is a line connecting the left and right upper anterior iliac spines of the patient when the fully extended state of the patient's lower limb is viewed from the frontal plane, and a line indicated by the connecting rod. The line indicated by the center indicating rod constitutes a right triangle.

  In still another embodiment, the attachment of the distal end of the femur abuts the front surface of the femur at the distal end of the femur exposed by deploying the patient's knee joint and is provided in the intercondylar fossa of the knee joint Rotating means is provided for rotating the second rod receiving means so that the second rod receiving means is fixed so as to be parallel to an axis connecting the adhering portion of the patient's collateral ligament.

The surgical instrument for joint replacement at the upper end of the tibia according to the present invention is a surgical tool for performing cutting of the upper end of the tibia based on a preoperative plan when performing artificial joint replacement. Installed from the skin and sandwiched between the left and right fruits of the ankle joint to indicate the cutting position at the upper end of the tibia using the ankle joint attachment indicating the direction of the functional axis and the functional axis indicated by the ankle joint attachment A tibial upper end attachment, and the tibial upper end attachment includes a rotation unit that adjusts the cutting direction at the upper end of the tibia to be a posterior tilt angle within a target sagittal plane. The tibial upper end attachment is connected to the ankle attachment by a support column indicating a functional axis indicated by the ankle attachment.

  One of the main forms is that the ankle attachment is installed by rotating the support column in a transverse section with the center point of the left and right fruits of the patient's ankle joint sandwiched from the skin (preferably equally left and right) as the center of rotation. Rotation adjusting means for adjusting the rotation is provided. One of the other forms is characterized in that a contact ring having a long hole formed in the direction of variation of the position of the fruit is provided at a part of the ankle attachment that contacts the fruit from above the skin.

  One of the other forms is that the point defined by the pin that presses against the anatomical index point of the rough surface of the tibia exposed at the upper end of the exposed tibia when the patient's knee joint is expanded (for example, the tip of the pin) is the center of rotation. A posterior inclination adjusting means for adjusting the posterior inclination in the sagittal plane of the tibial upper end attachment is provided as the (rotating axis) on the support column. In still another embodiment, the tibial upper end attachment has a positioning pin having at least one positioning pin that presses against the anatomical index point of the rough tibial surface at the upper end of the tibial exposed by expanding the knee joint of the patient. And a rear inclination adjusting means for adjusting the rear inclination of the osteotomy surface in the sagittal plane.

  The surgical instrument for joint replacement according to the present invention includes the surgical instrument for joint replacement at the distal end of the femur as described above and the surgical instrument for joint replacement at the upper end of the tibia as described above. It is characterized by. The above and other objects, features and advantages of the present invention will become apparent from the following detailed description and the accompanying drawings.

  According to the present invention, even if the patient moves by using the pelvic attachment and the distal end attachment of the femur, the femoral head center is grasped well, and the three-dimensional limb position of femoral varus / rotation / flexion is obtained. And the distal end of the femur can be cut in the direction perpendicular to the functional axis. In addition, since the ankle joint attachment and the tibial upper end attachment are used in combination, the upper end of the tibia is cut by attaching a rearward inclination at an appropriate rotation position in the sagittal plane perpendicular to the functional axis on the frontal plane. It can be carried out. In addition, by connecting each attachment, the operator can visualize the position of the entire lower limb with respect to the pelvis during the operation and grasp the limb, and the functional axis passes through the femoral head center, knee joint center, and ankle joint center. As described above, the knee replacement can be performed satisfactorily.

It is a perspective view which shows the Example of the pelvic attachment of this invention. It is the perspective view which looked at the pelvic attachment of the said FIG. 1 from the other side. It is a figure which shows the state which installed the said pelvis attachment in the pelvis. It is a perspective view which shows the Example of the femur distal end attachment of this invention. FIG. 5 is a perspective view of the distal femur attachment of FIG. 4 as viewed from the opposite side. It is a perspective view which shows the coupling | bonding state of the said pelvic attachment and the said femur distal end attachment. It is a perspective view which shows the Example of the ankle joint attachment of this invention. It is the perspective view which looked at the ankle joint attachment of the said FIG. 7 from the other side. It is a perspective view which shows the Example of the tibial upper end attachment of this invention. It is a figure which shows the connection state of the said ankle joint attachment and the said tibial upper end attachment. It is a perspective view which shows the other Example of the pelvis attachment and femur distal end attachment of this invention. FIG. 12 is a plan view showing the pelvic attachment and the distal femur attachment of FIG. 11. It is a perspective view which shows the additional components in the pelvis attachment of the said FIG. It is a perspective view which shows the other Example of the ankle joint attachment of this invention, and the tibial upper end attachment. FIG. 15 is a side view showing the ankle joint attachment and the tibial upper end attachment of FIG. 14. FIG. 15 is an explanatory diagram illustrating an example of a method for attaching the ankle joint attachment of FIG. 14. It is explanatory drawing which shows the principal part of the tibial upper end attachment of the said FIG.

  Hereinafter, the form for implementing this invention is demonstrated in detail based on an Example.

  The present embodiment is configured by a pelvic attachment installed on the patient's pelvis from above the skin and a femoral distal end attachment installed by opening the patient's knee. Initially, the pelvic attachment of the Example of this invention is demonstrated, referring FIGS. 1-3. FIG. 1 shows the entire pelvic attachment, and FIG. 2 shows a state in which the pelvic attachment is viewed from the back side. Moreover, the state installed on the pelvis is shown by FIG.

  In these drawings, the pelvic attachment 100 is configured with a coupling body 110 as a center, arms 120 and 130 are extended to the left and right, and an arm 140 is extended in a direction perpendicular to them. The arm 140 is provided with a telescopic arm 141. Pole 122,132,142 is provided in the tip of these arms 120,130 and telescopic arm 141, respectively. Of these, the tips 122a and 132a of the poles 122 and 132 come into contact with the left and right upper anterior iliac spines BAa and BAb of the patient's pelvis BA from above the skin, respectively. Further, the tip 142a of the pole 142 comes into contact with the pubic joint portion BAc of the patient's pelvis BA from above the skin. The poles 122, 132, and 142 can be freely adjusted in accordance with the patient's skeleton to install the pelvic attachment 100 on the pelvis BA of the patient in the supine position.

  Among the above portions, the coupling body 110 is provided with a ball screw 111 on the inside, and sliders 112 and 113 that slide in opposite directions when the ball screw 111 rotates are provided. The ends of the above-described arms 120 and 130 are fixed to the sliders 112 and 113, respectively, and the ball screw 111 is provided with a knob 114. A scale (scale) 115 is provided on the side surface of the connecting body 110.

  When the knob 114 is turned, the ball screw 111 rotates, the sliders 112 and 113 slide in the reverse direction, and the arms 120 and 130 slide in the reverse direction of the arrow FA, and the distance between the poles 122 and 132 at the tip is adjusted. Be able to. The interval at this time can be known by referring to the scale 115. In this embodiment, the interval between the upper anterior iliac spines BAa and BAb of the patient is measured before the operation from CT image data and the like, and is adjusted in advance so that the interval between the poles 122 and 132 becomes a measured value.

  On the other hand, the arm 140 formed in the direction orthogonal to the ball screw 111 of the coupling body 110 is provided with a bolt and nut 117. The telescopic arm 141 can be expanded and contracted with respect to the arm 140 by fixing the bolt and nut 117 through the elongated hole 144 of the telescopic arm 141. Thereby, the interval (distance) between the pole 142 provided at the tip of the telescopic arm 141 and the poles 122 and 132 can be adjusted. In the present embodiment, the interval between the patient's superior anterior iliac spine BAa, BAb and the pubic bone connecting portion BAc is measured from the CT image data or the like before the operation, and the interval between the poles 122, 132 and the pole 142 becomes a measured value. Adjust in advance.

  The pole 142 is formed with a screw like a bolt, and a height adjusting nut 145 provided at the tip of the telescopic arm 141 is screwed to the pole 142. By rotating the height adjusting nut 145, the pole 142 moves up and down, and the height position of the pelvic attachment 100 with respect to the pubic joint portion BAc is adjusted. Thereby, the inclination of the pelvis attachment 100 with respect to the pelvis BA can be adjusted. This adjustment is performed during the operation, so that the pelvic attachment 100 is substantially parallel to the operating table (not shown).

  On the left and right arms 120 and 130 described above, there are provided rotating plates 124 and 134, respectively, one end of which can rotate in the direction of the arrow FB around the poles 122 and 132. A rod support ring 150 is slidably attached to these rotary plates 124 and 134 in correspondence with the knee of the patient's surgical target. For example, when the surgical site is the patient's left foot, the rod support ring 150 is attached to the left rotating plate 134. The rod support ring 150 has, for example, a spherical sliding bearing structure, and the direction of the inserted rod can be freely changed. In addition, rod receivers 125 and 135 for attaching connection rods 162 to be described later are provided on the poles 122 and 132 side of the rotating plates 124 and 134, respectively, in a direction orthogonal to the longitudinal direction thereof. The connecting rod 162 corresponds to the anatomical axis of the femur BB.

  Next, the distal femur attachment 200 will be described with reference to FIGS. 4 and 5. FIG. 4 shows the whole of the distal femur attachment, and FIG. In these figures, the distal femoral attachment 200 includes a base axis 210 fixed in contact with the front surface BBa of the femur BB, and a condyle between the medial condyle BBc and the lateral condyle BBd at the distal end of the femur BB. The L-shaped rod support 230 is fixed to a mounting hole BBf provided in the pit BBe. By pressing the leg portion 211 against the front surface BBa of the femur BB, the entire femoral distal end attachment 200 can be pressed and positioned on the femoral front surface BBa.

  The base shaft 210 includes a substantially T-shaped leg portion 211 that comes into contact with the front surface BBa of the femur BB, and a column portion 212 extending in an orthogonal direction therefrom. A convolution support 213 having a plurality of arms is provided. An elongated hole 214 is formed in the rotation support body 213 along the column part 212, and the rotation support body 213 can be expanded and contracted with respect to the column part 212 by loosening the knob 215.

  An arc slider 216 is attached to the rotation support 213, and the rotation installation position or angle of the arc slider 216 with respect to the rotation support 213 can be adjusted by turning a knob 217. The arc slider 216 is formed on an arc centered on a pin 232 described later, and a scale 218 capable of knowing the rotational installation position or angle centered on the pin 232 is provided.

  The rod support 230 is configured with the main column 231 as a center, and is supported by the support frame 219 provided at the center of the arc slider 216 described above so as to be slidable in the functional axis direction. One end of the main column 231 is provided with a pin 232 to be inserted into a mounting hole BBf provided in the femur BB, and the other end is provided with a rod support ring 233 via a slit 229. In the rod support ring 233, rod receivers 125 and 135 of the pelvic attachment 100 installed on the pelvis BA and a connecting rod 162 are inserted through the slit 229.

  The rod support ring 233 is inserted into the cylinder of the rod support 230, and the slit 229, the arm 235, and the angle display plate 237 correspond to the direction of the connecting rod 162 with the rod support 230 as an axis. The structure rotates in the direction of arrow FC (see FIG. 4). The arm 234 extends in an L shape from the rod support 230 and slidably penetrates the support frame 219 of the arc slider 216 described above, and slides in the arrow FD direction (see FIG. 5) by loosening the screw 220. To do. A rod receiver 236 having an oval opening 238 is provided at the distal end of the arm 234, and is connected to a pelvis-side rod support ring 150 by a center indicating rod 160 described later. The value of the angle BBθ (see FIG. 3) between the center indicating rod 160 and the connecting rod 162 is obtained before the operation from the CT image data, and can be read by the angle display plate 237.

  A drill guide 250 for inserting a cutting drill is attached to the base shaft 210 side of the rod support 230, and the distal end of the femur attachment 200 can be easily removed from the drill guide 250 by pressing a button 252. Can be separated.

  Here, the operation of the distal femur attachment 200 will be described. The degree of inclination between the femoral front surface BBa and the axis connecting the adhering portion of the collateral ligament can be known in advance by preoperative planning from CT image data or the like. The parallel rod support 230 is parallel to the axis connecting the adhering portion of the collateral ligament by adjusting the rotation installation position or angle of the arc slider 216 with respect to the rotation support 213 by using this, or three-dimensional surgery. It can be adjusted to the planned angle. Next, the angle display plate 237 of the arm 235 rotating around the rod support 230 is formed at the center of the rod receiver 236 so that the center indicating rod 160 and the connecting rod 162 have an angle BBθ determined in the preoperative plan. By adjusting the angle, the femoral head center Pbb of the femur BB is positioned in the direction of the arm 234. As a result, the cutting surface of the drill guide 250 is parallel to the axis connecting the attachment portion of the collateral ligament that becomes the rotation center of the knee joint or the angle of the three-dimensional surgical plan, and the weight is the center of the femoral head, It is perpendicular to the functional axis passing through the joint center and ankle joint center.

  Next, the overall operation of this embodiment will be described with reference to FIG. Hereinafter, a case where a replacement operation is performed on the left knee joint of a patient will be described as an example. FIG. 6 shows a coupling state between the pelvic attachment 100 installed on the pelvis BA and the distal femur attachment 200 installed on the distal end of the femur BB. Since the relative positional relationship between the poles 122, 132, and 142 in the patient's pelvis BA can be measured in advance from a CT image or the like of the patient's pelvis BA, the pelvis attachment 100 is based on the measurement result. Each part is adjusted and the poles 122, 132, 142 are positioned. On the other hand, the positions of the upper anterior iliac spines BAa and BAb of the patient's pelvis BA can be known from the skin. Therefore, the tips 122a, 132a, and 142a of the poles 122, 132, and 142 are brought into contact with the upper anterior iliac spines BAa and BAb and the pubic bone connecting portion BAc from the skin, respectively, so that the pelvic attachment 100 is in the supine position. Install on patients. Note that the height of the poles 122, 132, 142 is set so that the pelvic attachment 100 is separated so as not to interfere with the patient's abdomen.

  For the distal femoral attachment 200, the patient's knee joint is incised and a hole BBf is drilled into the intercondylar fossa BBe between the medial condyle BBc and the lateral condyle BBd of the knee joint of the femur BB using a drill. It is a position set by the operator in the preoperative plan, for example, a position 15 mm away from the femoral front surface BBa, and is formed on the white side line of the intercondylar fossa. On the other hand, the rotation support body 213 is rotated in accordance with the rotation angle display of the arc slider 216 and fixed with the knob 217 at the rotation installation angle set in the preoperative plan, and the pin 232 of the main column 231 is inserted into the mounting hole BBf. insert. By loosening the knob 215 and bringing the leg portion 211 of the base shaft 210 of the distal femoral end attachment 200 into contact with the front surface BBa of the femoral BB, the femoral distal end attachment 200 is placed in the pre-planned rotation position. To do. Thereby, the rotation installation planned position of the artificial knee joint coincides with the position of the main shaft 231. Further, by placing the leg portion 211 of the base shaft 210 along the femoral front surface BBa, the installation position in the bending direction of the artificial knee joint is guided so as to be parallel to the femoral front surface BBa. As a result, the parallel rod support 230 is parallel to the axis connecting the adhering portions of the collateral ligaments or at an angle of the three-dimensional surgical plan.

  Next, focusing on, for example, the left side of the patient's pelvis BA, the distance LA (see FIG. 3) on the front side from the superior anterior iliac spine BAb to the center Pbb of the femoral head BB's head BBb is obtained in advance from CT image data. be able to. On the other hand, when the lower limb is fully extended with respect to the patient's pelvis BA, that is, the rotating plate 134 that rotates about the pole 132 of the superior anterior iliac spine BAb coincides with the arm 130 as viewed from the front of the patient. Then, the position of the rod support ring 150 can be adjusted so that the center indicating rod 160 passes over the femoral head center Pbb of the femur BB, and the distance LB (see FIG. 3) from the pole 132 indicating the position is It can be calculated in advance by CT from the CT image data.

  Next, the above-described pelvic attachment 100 and the femoral distal end attachment 200 are connected by a connecting rod 162. That is, one end of the connecting rod 162 is sandwiched between the rod receivers 135 on the pole 132 side of the pelvic attachment 100 and the other end is inserted into the rod support ring 233 of the distal femur attachment 200 via the slit 229. Since the rod receiver 135 is provided on the rotating plate 134 and the rod support ring 233 is rotatable, the connecting rod 162 can be easily attached.

  Next, the center indicating rod 160 is passed through the rod support ring 150 of the positioned pelvic attachment 100 and the tip thereof is inserted into the opening 238 of the rod receiver 236 of the distal femoral attachment 200.

  In this state, the lower limb is fully extended with respect to the pelvis BA, that is, the rotating plate 134 rotating around the pole 132 of the superior anterior iliac spine BAb is seen from the front of the patient in a state of being parallel to the arm 130. Then, the femoral head center Pbb of the femur BB is always located on the center indicating rod 160, and the operator can know the femoral head center Pbb without incising the vicinity of the femoral head. The direction of the rod receiver 236 is always directed toward the head center Pbb. When this is viewed from the front of the patient, the rotating plate 134, the center indicating rod 160, and the connecting rod 162 form a right triangle.

  As described above, the knee joint functional axis of the human body passes through the center of the femoral head → the center of the knee joint → the center of the ankle joint in the frontal plane direction. Among these, the femoral head center Pbb is on the center indicating rod 160, and the direction of the rod receiver 236 is always directed to the direction of the head center Pbb. If the distal end of the bone is cut, the distal end of the femur of the knee joint is cut in a direction perpendicular to the functional axis. Specifically, the drill guide 250 of the distal femur attachment 200 is positioned and fixed to the distal end of the femur BB, and the button 252 is pressed to remove the entire distal femur attachment 200.

  By determining the direction as described above, the surgeon is parallel to the axis connecting the adhering portion of the collateral ligament, or is an angle of the three-dimensional surgical plan, and is perpendicular to the functional axis. Thus, the distal end of the femur BB can be cut along the drill guide 250.

  Note that the angle BBθ between the center indicating rod 160 and the connecting rod 162 in a state where the lower limb is completely advanced with respect to the pelvis BA can also be obtained in advance from CT image data by a preoperative plan. If the coincidence of the angle BBθ is confirmed during the operation with reference to the data, it is possible to avoid mistakes, which is convenient.

  As described above, according to the present embodiment, by using the pelvic attachment 100 and the distal end attachment 200 of the femur, even if the patient moves during the operation, the femoral head center and the femur can be three-dimensionally well. You can know the correct limb position. For this reason, the three-dimensional limb position of the femur BB is determined in parallel to the axis connecting the adhering part of the collateral ligament, or the angle of the three-dimensional surgical plan, and the functional axis The distal end of the femur can be cut so that it is perpendicular to, and a good prosthesis replacement with a femoral component is possible.

  Next, Embodiment 2 of the present invention will be described with reference to FIGS. The above embodiment is a case of replacement on the distal end side of the femur, but this embodiment is a case of replacement on the upper end side of the tibia. As described above, the functional axis of the human body passes through the center of the femoral head → the center of the knee joint → the center of the ankle joint. Focusing on the ankle joint, the functional axis is orthogonal to the midpoint of the axis connecting the fruits of the patient. The tibial joint surface of the human body is inclined backward (bent in the sagittal plane) in the front-rear direction in which the knee bends, and there is an axis in the cross section. If the rotation direction of the artificial joint is not aligned with this axis, the bending function may be hindered. The angle formed by the axis connecting the rotation target angle to be installed and the result of the ankle joint (rotation angle in the cross section) can be measured from CT image data in the preoperative plan. Therefore, in this embodiment, the rotation position on the tibia side and the center point of the functional axis are specified by using the ankle joint attachment. Further, the bending / extension angle in the sagittal plane is appropriately set by the operator in the preoperative plan.

  FIG. 7 shows an ankle joint attachment 300 of the present embodiment, and FIG. In these drawings, an ankle joint attachment 300 is configured around a center block 310, and a pinion gear that is rotated by a knob 320 is provided in the center block 310. 322 and 323 are provided in parallel through the side surface of the center block 310. That is, when the knob 320 is rotated, the rack bars 322 and 323 move in opposite directions.

  Arms 332 and 333 sandwiching the fruits BCa and BCb of the patient's ankle joint BC are provided at the tips of the rack bars 322 and 323, respectively. That is, by rotating the knob 320 of the center block 310, the interval between the arms 332 and 333 is configured to be opened or closed. The arms 332 and 333 preferably sandwich the fruits BCa and BCb of the patient's ankle joint BC equally on the left and right.

  On the top surface of the center block 310, an arc-shaped slit guide 340 having a midpoint (functional axis center point) of the fruits BCa and BCb as a vertex is provided. The slit guide 340 has a rectangular parallelepiped slider 341. Is slidable in an arc shape (see arrow FE). The slider 341 can be moved and fixed by turning the knob 342. A support column 343 is provided upright at the front end of the slider 341, and a long hole 344 is provided at the rear end. The long hole 344 extends in the normal direction with respect to the arc of the slit guide 340.

  Next, a rectangular parallelepiped extension block 350 is provided at the tip of the column 343. The extension block 350 is held and fixed in parallel with the slider 341, an extension column 351 is provided on the front end side, and a slit 352 is provided on the rear end side. The slit 352 is provided in parallel along the elongated hole 344 of the slider 341.

  FIG. 9 shows a tibial upper end attachment 400, which is generally configured around a center block 410 having a substantially cross shape. A guide fixture 420 is attached to the arm 411 and the protrusion 412 on the tibia BD side of the central block 410 so as to come into contact therewith, and the knob 422 can be pulled to be removed. The guide fixture 420 is provided with a standing portion 421 at the end on the tibial BD side, and a pin 425 is provided outside the standing portion 421. A drill guide mounting portion 423 using nuts and bolts is provided in parallel with the standing portion 421 so that the height of the drill guide 430 can be adjusted. A slit 414 is formed in the arm 413 opposite to the central block 410, and an extension leg 440 is connected to the lower leg 415.

  The extension leg 440 is provided with a fan-shaped portion 443 having an arc (see FIG. 10) centered on the tip of the pin 425 between the column upper portion 441 and the column lower portion 442 connected to the leg 415. The front end portion 444 is provided at the front end. A knob 445 is provided on the column lower portion 442. The point is not limited to the tip of the pin 425, and a point defined by the pin 425 may be the center.

  FIG. 10 shows a state where the ankle joint attachment 300 and the tibial upper end attachment 400 are coupled. Among these, the ankle joint attachment 300 is installed on the fruits BCa and BCb of the patient's ankle joint BC from above the skin, whereas the upper tibial attachment 400 cuts and unfolds the patient's knee, The pin 425 is placed against the reference point (anatomical index point of the tibial rough surface) BDa on the rough surface of the tibia, which is an index of the anatomical position in the tibia BD. The position of the tibial rough surface reference point BDa of the tibial BD on the rough tibial surface is determined by the operator during preoperative planning.

  The extension strut 351 of the ankle joint attachment 300 and the extension leg 440 of the tibial upper end attachment 400 are coupled by a fan-shaped coupling body 370. That is, the extension strut 351 penetrates the coupling body 370 and the fan-shaped portion 443 and the tip end portion 444 of the extension leg 440 are sandwiched to couple them together. The combined body 370 is provided with a slit 372 along an arc centering on the tip of the pin 425, and by loosening the knob 445, the inclination of the tibial upper end attachment 400 with respect to the extension column 351 can be adjusted. (See arrow FF).

  Next, the overall operation of this embodiment will be described. The surgeon rotates the knob 320 of the ankle joint attachment 300 so as to sandwich the fruits BCa and BCb of the patient's ankle joint BC by the arms 332 and 333. As described above, the direction perpendicular to the midpoint of the axis connecting the fruits BCa and BCb of the ankle joint BC is the direction of the functional axis. Therefore, by attaching the ankle joint attachment 300 so as to sandwich the fruits BCa and BCb, the direction of the column 343 becomes parallel to the functional axis. Next, the operator uses the knob 342 to adjust the position of the slider 341 to the rotation position of the surgical plan. That is, the position of the column 343 is adjusted so as to be in front of the patient's tibia BD.

  Next, on the front side of the extension block 350 of the ankle joint attachment 300 described above, a fan-like coupling body 370 is attached to the distal end of the extension column 351, and the fan-shaped portion 443 of the extension leg 440 of the tibial upper end attachment 400 is attached by the coupling body 370. And the tip portion 444 are sandwiched and coupled with a knob 445. Here, since the direction of the support column 343 of the ankle joint attachment 300 is a functional axis, if the direction of the extension leg 440 of the tibial upper end attachment 400 matches the direction of the support column 343, the direction orthogonal thereto. Is the direction orthogonal to the functional axis. As a result, the drill direction of the drill guide 430 attached to the tibial upper end attachment 400 is a direction orthogonal to the functional axis. This direction is the direction when the patient's knee is viewed from the frontal plane.

  On the other hand, on the rear side of the extension block 350 of the ankle joint attachment 300, the rod 360 is passed through the slot 344 of the slider 341, the slit 352 of the extension block 350, and the slit 414 of the tibial upper end attachment 400 in this order, and the whole is fixed. .

  By the way, in the resection of the upper end of the tibia BD, the tibial implant of the artificial joint is installed by cutting in a direction orthogonal to the functional axis. The direction of the sagittal plane (corresponding to FIG. 10) In some cases, an inclination is provided in the front-rear direction in which the knee bends, and the degree of inclination is set by the surgeon by determining the tension of the soft tissue during preoperative planning or during the operation. According to the present embodiment, the tibial upper end attachment 400 functions by loosening and adjusting the knob 445 provided in the slit 372 of the arc joint 370 so that the cutting angle of the tibia BD is viewed from the patient's frontal plane. Only the angle in the sagittal plane can be appropriately adjusted without changing the direction and height orthogonal to the axis. Further, by adopting such a structure, the rear side in the target sagittal plane without changing the direction or height of the support column 343 of the ankle joint attachment 300 that is three-dimensionally coincident with the functional axis. Only the tilt angle can be adjusted.

  When the tibial upper end attachment 400 is positioned as described above, the drill guide 430 is fixed to the upper tibial upper end and the knob 422 is pulled to remove the entire tibial upper end attachment 400. By determining the direction as described above, the operator determines the upper end of the tibia along the drill guide 430 so as to have a desired inclination in the direction perpendicular to the functional axis and in the required sagittal plane. Can be cut off.

  As described above, according to the present embodiment, the preoperative plan is guided three-dimensionally by the ankle joint attachment 300 and the tibial upper end attachment 400, and is perpendicular to the functional axis on the frontal plane and on the sagittal plane. The upper end of the tibia can be cut with an appropriate posterior inclination according to the judgment of the surgeon.

  Next, Embodiment 3 of the present invention will be described with reference to FIGS. 11 and 12 each show a case where a replacement operation is performed on the left knee joint of a patient. The present embodiment is an example in which a commercially available one is used instead of the pelvic attachment 100 in the first embodiment. 11 and 12 show a pelvic attachment 500 of the present embodiment. The pelvic attachment 500 is configured using a commercially available hip compass 502 manufactured by Lexi. The entire hip compass 502 has a substantially T-shape, and arms 510 and 520 extend from the center to the left and right, and arms 530 extend in a direction perpendicular to them. Slots 512, 522, and 531 are formed in the arms 510, 520, and 530, respectively. Among these, a pole 532 is attached to the elongated hole 531 of the arm 530 via a sliding fixture 534. That is, the pole 532 is erected and fixed by the sliding fixture 534 so as to be slidable in the axial direction and in the direction of the elongated hole 531. The sliding fixture 534 has a structure in which the pole 532 penetrates a bolt / nut mechanism that sandwiches the arm 530 from above and below in the long hole 531.

  Additional parts 540, 550, 560, and 570 are attached to the arms 510 and 520 with respect to the hip compass 502 as described above. In FIG. 13, these additional parts 540, 550, 560, and 570 are shown enlarged. The additional parts 540 and 560 have the same structure, and the additional parts 550 and 570 have the same structure. The additional parts 540 and 550 are attached to the elongated hole 512 of the arm 510, and the additional parts 560 and 570 are attached to the elongated hole 522 of the arm 520.

  Among these, the additional component 540 has a structure in which the pole 542 is erected and fixed so as to be slidable in the axial direction and the direction of the elongated hole 512. Similarly, the additional component 560 has a structure in which the pole 562 is erected and fixed so as to be slidable in the axial direction and the direction of the elongated hole 522. The additional component 540 has a structure in which a pole 542 passes through a bolt / nut mechanism 544 that sandwiches the arm 510 from above and below. The bolt / nut mechanism 544 is provided with a rod receiver 546. Similarly, the additional component 560 has a structure in which the pole 562 penetrates the clamping mechanism 564 that sandwiches the arm 520 from above and below. The clamping mechanism 564 is provided with a cylindrical rod receiver 566.

  Next, the additional component 550 includes a sliding fixture 552 that sandwiches the penetrating arm 510 from the front and back. The leg of the rod support ring 554 passes through the sliding fixture 552 through the long hole 512. With this sliding fixture 552, the rod support ring 554 is fixed so as to be slidable in the direction of the long hole 521 of the arm 510. The same applies to the sliding fixture 572 and the rod support ring 574 of the additional component 570. Rod guides 556 and 576 are provided on the sliding fixtures 552 and 572, respectively. The rod support direction by the rod support rings 554 and 574 and the guide direction by the rod guides 556 and 576 are made to coincide with each other.

  The above-mentioned tips 542a and 562a of the poles 542 and 562 abut on the left and right upper anterior iliac spines BAa and BAb of the patient's pelvis BA from above the skin, respectively. Further, the tip 532a of the pole 532 comes into contact with the pubic joint BAc in the patient's pelvis BA from above the skin. The poles 532, 542, and 562 can be freely adjusted in accordance with the skeleton of the patient so that the pelvic attachment 500 can be placed on the pelvis BA of the patient in the supine position.

  On the other hand, the femoral distal end attachment 600 basically has the same structure as the femoral distal end attachment 200 of the first embodiment described above, but a rod guide 229a is provided on the arm 235 instead of the slit 229. Is different. However, the action of the rod guide 229a is the same as that of the slit 229.

  Next, the operation of this embodiment will be described. As in the first embodiment, each part of the pelvic attachment 500 is adjusted based on the previous measurement result of the patient's pelvis BA, and the poles 532, 542, and 562 are installed on the patient in the supine position. On the other hand, the distal femur attachment 600 is also installed by cutting the patient's knee joint as in the first embodiment. Also in this embodiment, the center indicating rod 160 passing over the femoral head center Pbb of the femur BB passes through the rod support ring 574 of the additional part 570 from the rod receiver 236 of the femoral distal end attachment 600. Further, the connecting rod 162 passes from the rod receiver 566 of the additional part 560 of the pelvis attachment 500 through the rod guide 229a and the rod support ring 233 of the distal femur attachment 600.

  Also in this embodiment, the head center Pbb of the femur BB is always located on the center indicating rod 160, and the operator can know the head center Pbb without incising the vicinity of the head of the femur. . As described above, the knee joint functional axis of the human body passes through the center of the femoral head → the center of the knee joint → the center of the ankle joint in the frontal plane. Among these, the femoral head center Pbb is on the center indicating rod 160, and the direction of the rod receiver 236 is always directed to the direction of the head center Pbb. If the distal end of the bone is cut, the distal end of the femur of the knee joint can be cut in a direction perpendicular to the functional axis.

  In Example 1, the lower limb position in which the connecting rod 162 connecting the knee joint center from the pole 122 (left) or 132 (right) on the superior anterior iliac spine is perpendicular to the horizontal line of the pelvis BA is being operated. In the third embodiment, the connecting rod 160 that connects the knee joint center from the sliding fixture 552 (left) or 572 (right) on the femoral head center Pbb of the femur BB is used. This is a structure for guiding the lower limb position perpendicular to the horizontal line of the pelvis BA during the operation.

  Thus, according to the present embodiment, by adding the additional parts 540, 550, 560, and 570 to the commercially available hip compass 502, the same function as the pelvic attachment 100 of the first embodiment described above can be obtained. Obtainable.

  Next, Embodiment 4 of the present invention will be described with reference to FIGS. The present embodiment is another embodiment of an ankle joint attachment and a tibial upper end attachment. FIG. 14 is a perspective view, and FIG. 15 is a plan view. FIG. 16 is a view showing an example of an attachment method of an ankle joint attachment, and FIG. 17 is a view showing a main part of the tibial upper end attachment. In addition, the same code | symbol is used for the component corresponding to Example 2 mentioned above.

  14 and 15, the ankle joint attachment 700 is configured around a center block 310, and a pinion gear that is rotated by a knob 320 (not shown) is provided in the center block 310. With this interposed, rack bars 322 (not shown) and 323 are provided in parallel so as to penetrate the side surface of the center block 310. That is, when the knob 320 is rotated, the rack bars 322 and 323 move in opposite directions. Arms 332 and 333 sandwiching the fruits BCa and BCb of the patient's ankle joint BC are provided at the tips of the rack bars 322 and 323, respectively. That is, by rotating the knob 320 of the center block 310, the interval between the arms 332 and 333 is configured to be opened or closed. The above points are the same as in the second embodiment.

  By the way, in this embodiment, oval or elliptical contact rings 332a and 333a (not shown) having long holes are provided at the contact portions between the arms 332 and 333 and the fruits BCa and BCb of the ankle joint BC. It has been. FIG. 16 shows an example of the attachment method. The operator palpates the innermost part of the fruit BCa and the outermost part of the fruit BCb in advance of the patient's ankle joint BC before the operation, and affixes a commercially available electrocardiograph electrode 880. The electrocardiograph electrode 880 has a structure in which a convex electrode 884 is provided at the center of a resin seal 882 having an adhesive tape on the back surface. By attaching this, the result of the ankle joint BC of the patient is obtained. The positions of BCa and BCb can be accurately grasped. In addition, as long as the positions of the fruits BCa and BCb of the patient's ankle joint BC can be grasped, other than the electrocardiograph electrode 880 may be used.

  On the other hand, the ankle joint attachment 700 may be produced corresponding to the left and right sides of the foot, but in general, it is convenient if the structure is a left-right structure that can be applied to both the left and right sides. Moreover, the height of the fruits BCa and BCb of the patient's ankle joint BC varies depending on the patient. For this reason, the heights of the fruits BCa and BCb of the ankle joint BC will fluctuate, and a structure that allows the ankle joint attachment 700 to be positioned accurately even if there is such a fluctuation is preferable. Therefore, in the ankle joint attachment 700 of the present embodiment, the contact rings 332a and 333a are formed into an oval shape, and the convex shape of the electrode 884 of the electrocardiograph electrode 880 is inserted into the oval hole during the operation. By arranging so as to enter, the peripheral end of the ankle joint attachment 700 is accurately positioned with respect to the fruits BCa and BCb of the patient's ankle joint BC.

  On the top surface of the center block 310, there is provided an arc-shaped slit guide 340 with the midpoint (functional axis center point) of the fruits BCa and BCb as the apex, and a slider 741 is a circle on the slit guide 340. It is slidably provided in an arc shape. The slider 741 can be moved and fixed by turning the knob 342. The slider 741 of this embodiment has a substantially L-shape, and a substantially L-shaped support column holding block 780 is slidably fixed by a knob 782 along the L-shape. The support holding block 780 is provided with a scale 784 so that the amount of sliding of the support holding block 780 relative to the slider 741 can be known.

  The support column holding block 780 is provided with support columns 751 and 760 at the front end and the rear end thereof, and an extension block 750 is provided in the middle. These correspond to the columns 351, 360 and the extension block 350 of the second embodiment, respectively.

  Next, the tibial upper end attachment 800 in the present embodiment will be described. The main part is shown in FIG. 17A, the positioning base 810 is moved in the direction of the arrow FP, the rotation unit 840 is rotated in the direction of the arrow FQ, and the slide body 844 is slid in the direction of the arrow FR. Shown in B). In FIG. 17, a part of the positioning pins 820 and 822 is omitted.

  The tibial upper end attachment 800 has a structure in which a positioning base 810 is suspended and fixed to a support plate 802 fixed and supported vertically (horizontal in the figure) to the above-described columns 751 and 760. At the distal end of the support plate 802, a positioning pin 804 is provided which is installed in the recess of the intercondylar bulge at the upper end of the tibia. The positioning pin 804 can be adjusted in the vertical direction by a knob 806. The support plate 802 is provided with a rectangular long hole 808, and the positioning base 810 is slid in the long hole 808 in the direction of the long hole 808 (direction of arrow FP in FIG. 17B) by the slide fixture 812. It is fixed as possible. That is, the positioning base 810 can be slid by loosening the knobs 812a and 812b of the slide fixture 812, and the positioning base 810 can be fixed by tightening the knobs 812a and 812b.

  The positioning base 810 is configured around a suspended body 814 in which substantially S-shaped plates 814 a and 814 b are provided in parallel at a predetermined interval, and an upper end portion 816 of the positioning base 810 is slidable on the support plate 802 by a slide fixture 812. It is fixed. A positioning pin 817 protrudes from the front side (tibial side) of the hanging body 814, and a positioning pin holding arm 824 for holding the positioning pins 820 and 822 extends from the side of the hanging body 814. ing. Further, below the hanging body 814, there is provided a fan-shaped rotation coupling portion 830 that forms a part of an arc centered on the rotation shaft 840a and has a fan-shaped elongated hole, and a scale 832 is provided. ing. Distance LC1 (see FIG. 15) between the center of the positioning pin 804 and the distal end of the positioning pin 817 installed in the recess of the intercondylar bulge at the upper end of the tibia, and distance LC2 between the front surface of the tibia and the distal ends of the positioning pins 820 and 822 LC3 (see FIG. 14) can be known in advance by preoperative planning.

  On the back side of the hanging body 814, a rotating portion 840 that rotates about a rotating shaft 840a is provided (see arrow FQ in FIG. 17B). A slide body 844 is provided on the back side of the rotating portion 840, and an osteotomy height adjusting screw shaft 846 is extended below the rotating portion 840. The osteotomy height adjusting screw shaft 846 passes through the lower portion 845 of the slide body 844, and an osteotomy height adjusting screw 848 is provided at the tip. By turning the osteotomy height adjusting screw 848, the slide body 844 can slide in the direction of arrow FR in FIG.

  On the other hand, an osteotomy guide 842 is provided on the upper side of the slide body 844, and the guide groove 842a is formed in the osteotomy guide 842 in a direction orthogonal to the direction of the support columns 751 and 760 described above. . The rotation unit 840 is for adjusting the inclination of the osteotomy guide 842 in the guide direction (backward inclination in the front-rear direction in which the knee bends). When the rotation unit 840 is rotated in the arrow FQ direction, the slide body 844 is also changed. Further, the osteotomy guide 842 is rotated. The degree of inclination at this time can be known from the scale pin 850 that abuts the elongated hole of the rotation coupling portion 830 and the scale 832.

  Next, the overall operation of this embodiment will be described. The surgeon installs the ankle joint attachment 700 on the fruits BCa and BCb of the patient's ankle joint BC from above the skin. That is, as shown in FIG. 16, the electrode 880 for electrocardiograph is used to rotate the knob 320 of the ankle joint attachment 700 to adjust the distance between the arms 332 and 333, and the patient makes contact with the contact rings 332a and 333a. The fruits BCa and BCb of the ankle joint BC are sandwiched. As described above, the direction perpendicular to the midpoint of the axis connecting the fruits BCa and BCb of the ankle joint BC is the direction of the functional axis. Therefore, by attaching the ankle joint attachment 700 so as to sandwich the fruits BCa and BCb, the directions of the columns 751 and 760 become parallel to the functional axis.

  Next, the operator adjusts the position of the slider 741 to the rotation position determined in the preoperative plan by using the knob 342 and adjusts the position of the column holding block 780 with respect to the slider 741 by using the knob 782. Thereby, the position of the support | pillars 751 and 760 is adjusted so that it may become the front of a patient's tibia BD.

  On the other hand, the tibial upper end attachment 800 cuts and unfolds the patient's knee and positions it at a reference point (an anatomical index point of the tibial rough surface) on the tibial rough surface that is an index of the anatomical position in the tibia BD. The pin 817 is installed so as to be pressed against it. The position of the tibial rough surface reference point of the tibial BD on the rough tibial surface is determined by the operator during preoperative planning.

  As described above, the positions of the columns 751 and 760 are adjusted so as to be the position of the sagittal plane of the patient's tibia BD. Since the distance LC1 between the center of the positioning pin 804 installed in the indentation of the intercondylar ridge at the upper end of the tibia and the distal end of the positioning pin 817 can be known in advance by the preoperative plan when viewed from the front of the patient, the slide The positioning base 810 is slid in the direction of the arrow FP by the fixture 812, and the position of the positioning pin 817 of the hanging body 814 is adjusted. Further, since the distances LC2 and LC3 between the front surface of the tibia and the distal ends of the positioning pins 820 and 822 can be known in advance by the preoperative plan, the positioning pins 820 and 822 from the positioning pin holding arm 824 are adjusted so as to have the lengths. The protrusion amount of the tibial bone is adjusted and pressed against the tibia BD so that the posture of the tibial upper end attachment 800 is maintained.

  In this way, by adjusting LC1, LC2, LC3 to the length obtained by the preoperative plan and pressing the positioning pins 817, 820, 822 against the tibia BD, the direction of the columns 751, 760 of the ankle attachment 700 is determined. Therefore, the direction of the support plate 802 fixedly supported by the support columns 751 and 760 is a direction orthogonal to the functional axis. Therefore, by fixing the osteotomy guide 842 along the direction of the support plate 802 and performing cutting, the upper end of the tibia can be cut in a direction perpendicular to the functional axis. The height of the osteotomy guide 842 is adjusted by turning the osteotomy height adjusting screw 848 and sliding the slide body 844 based on the preoperative plan.

  As described above, in the resection of the upper end of the tibia BD, the tibial implant of the artificial joint is installed by cutting in a direction orthogonal to the functional axis. Regarding the resection direction, there is a case where an inclination is provided in the front-rear direction in which the patient's knee bends, and the degree of the inclination is set by the surgeon judging the pre-operative plan or the soft tissue tension during the operation. In the present embodiment, by adjusting the angle of the rotation unit 840, the target rearward inclination angle in the sagittal plane is adjusted.

  When the tibial upper end attachment 800 is positioned as described above, the osteotomy guide 842 is fixed to the upper tibial end. Thereby, the osteotomy guide 842 is fixed so as to have a desired rearward inclination in a direction perpendicular to the functional axis and in a necessary sagittal plane. Therefore, by performing osteotomy along the osteotomy guide 842, the upper end of the tibia can be cut in a direction perpendicular to the functional axis and having a desired posterior inclination.

In addition, this invention is not limited to the Example mentioned above, A various change can be added in the range which does not deviate from the summary of this invention. For example, the following are also included.
(1) The attachment structure shown in the above embodiment is an example, and various modifications such as a slide mechanism and a rotation mechanism can be made so as to achieve the same action.
(2) In the above embodiment, the osteotomy guide positioning of the distal femur is performed by the pelvic attachment and the distal femur attachment, and the osteotomy guide positioning of the upper tibia is performed by the ankle attachment and the upper tibial attachment. However, the two do not necessarily have to be applied together, and the present invention may be applied to positioning one of the osteotomy guides, and another method may be applied to positioning the other osteotomy guide. Moreover, you may make it combine the said Example.
(3) By further connecting the pelvic attachment, the femur distal end attachment, the ankle joint attachment, and the tibial upper end attachment shown in the above embodiment with a rod, the limb position of the entire lower limb with respect to the patient's pelvis BA during surgery is visualized The surgeon may grasp the entire lower limb. At that time, a level that outputs laser light may be used instead of the rod.
(4) It can also be used in combination with a commercially available KNEE balancer that measures the balance of ligaments, and the change in the limb position due to the balance of soft tissue tension can be visualized and clarified, so the operator's judgment is more reliable Can help.
(5) The scale shown in the above embodiment is merely an example, and a scale may be provided on a rotating or rotating part or a sliding part as necessary.

  According to the present invention, since the pelvic attachment and the distal end of the femur are used, the center of the femoral head can be grasped well even if the patient moves, and the axis connecting the attachment portion of the collateral ligament The distal end of the femur can be cut so that it is parallel to the angle of the three-dimensional surgical plan and perpendicular to the functional axis. Further, since the ankle joint attachment and the tibial upper end attachment are used, the upper end of the tibia can be cut so as to be well perpendicular to the functional axis and to have a desired inclination. Furthermore, the artificial knee joint replacement can be performed satisfactorily so that the functional axis passes through the femoral head center, the knee joint center, and the ankle joint center.

100: Pelvic attachment 110: Connector 111: Ball screw 112, 113: Slider 114: Knob 115: Scale 116: Extension part 117: Bolt / nut 120, 130, 140: Arms 122, 132, 142: Pole 122a, 132a 142a: tip 124, 134: rotating plate 125, 135: rod receiver 140: arm 141: telescopic arm 144: elongated hole 145: adjustment nut 150: rod support ring 160: center indicating rod 162: connecting rod 200: distal femur Positional end attachment 210: Base shaft 211: Leg portion 212: Column portion 213: Rotating support 214: Slot 215, 217: Knob 216: Arc slider 218: Scale 219: Support frame 220: Screw 229: Slit 229a: Rod guide 230 : Rod support 231: Main pillar 232: 233: Rod support rings 234, 235: Arm 236: Rod receiver 237: Angle display plate 238: Opening 250: Drill guide 252: Button 300: Ankle joint attachment 310: Center block 320: Knobs 322, 323: Rack bar 332 333: Arms 332a, 333a: Contact ring 340: Slit guide 341: Slider 342: Knob 343: Strut 344: Slot 350: Extension block 351: Extension strut 352: Slit 360: Rod 370: Combined body 372: Slit 400: Tibial upper end attachment 410: center block 411: arm 412: protrusion 413: arm 414: slit 415: leg 420: guide fixture 421: upright portion 422: knob 423: drill guide mounting portion 425: pin 430: drill guide 440 : Extension leg 41: Column upper part 442: Column lower part 443: Fan-like part 444: Tip part 445: Knob 500: Pelvic attachment 502: Hip compass 510, 520, 530: Arm 512, 522, 531: Slot 532, 542, 562: Pole 532a : Tip 534: Sliding fixture 540: Additional parts 540, 550, 560, 570: Additional parts 542, 562: Pole 542 a, 562 a: Tip 544: Bolt / nut mechanism 546, 566: Rod receiver 552, 572: Sliding Fixtures 554, 574: Rod support rings 556, 576: Rod guide 564: Holding mechanism 574: Rod support ring 600: Distal femoral attachment 700: Ankle joint attachment 741: Slider 750: Extension blocks 751, 760: Post 780 : Supporting block 784: Suke 800: Tibial upper end attachment 802: Support plate 804: Positioning pin 806: Knob 808: Slot 810: Positioning base 812: Slide fixture 812a, 812b: Knob 814: Hanging body 814a, 814b: Plate 816: Upper end 817: Positioning pins 820, 822: Positioning pins 824: Positioning pin holding arm 830: Rotating coupling portion 832: Scale 840: Rotating portion 840a: Rotating center axis 842: Osteotomy guide 842a: Guide groove 844: Slide body 845 : Lower part 846: Osteotomy height adjusting screw shaft 848: Osteotomy height adjusting screw 850: Scale pin 880: Electrocardiograph electrode 882: Seal 884: Electrode BA: Pelvis BAa, BAb: Upper anterior iliac spine BAc: Pubic joint BB: femur BBa: anterior surface BBb: head BBc: medial condyle BBd: lateral condyle BBe: Intercondylar fossa BBf: Mounting hole BBθ: Angle BC: Ankle joint BCa, BCb: Fruit BD: Tibial BE: Rib Pbb: Center of head

Claims (11)

A surgical tool for performing cutting of the distal end of the femur based on a preoperative plan when performing artificial joint replacement,
A pelvic attachment that is placed on the patient's pelvis from above the skin and indicates the direction of the functional axis passing through the femoral head center,
A femoral distal end attachment that indicates a cutting position at the distal end of the femur using the functional axis indicated by the pelvic attachment;
With
A connecting rod connecting the left or right upper anterior iliac spine of the patient and the intercondylar fossa of the knee joint, and a central indicating rod passing through the center of the left or right femoral head corresponding to the upper anterior iliac spine A surgical tool for joint replacement at the distal end of the femur, characterized in that the pelvic attachment and the distal femoral end attachment are connected.   The pelvic attachment includes three poles that contact the left and right upper anterior iliac spines and the pubic joint in the patient's pelvis from above the skin, and the interval between the poles is determined according to the distance between the left and right upper iliac spines and the pubic bone. The surgical instrument for joint replacement according to claim 1, further comprising interval adjusting means for adjusting in accordance with the interval between the coupling portions. The pelvic attachment includes first rod receiving means for adjusting the distance and angle between the center indicating rod and the connecting rod to support the rods,
The said femur distal end attachment was equipped with the 2nd rod receiving means which adjusts the angle of the said center indicating rod and the said connection rod, and supports each said rod. Surgical tool for joint replacement.   A line connecting the left and right upper anterior iliac spines of the patient, a line indicated by the connecting rod, and a line indicated by the central indicating rod when the patient's lower limb is fully extended from the frontal plane The surgical instrument for joint replacement according to any one of claims 1 to 3, wherein and constitute a right triangle. The distal end attachment of the femur abuts the front surface of the femur at the distal end of the femur exposed by expanding the patient's knee joint, and is fixed to an attachment hole provided in the intercondylar fossa of the knee joint, claim and further comprising a rotation means for rotation of the second rod receiving means such that the angle of the parallel, or three-dimensional surgical planning with respect to the axis connecting the attachment of the collateral ligaments of the patient 3 The surgical instrument for joint replacement as described. When performing artificial joint replacement, a surgical tool for cutting the upper end of the tibia based on a preoperative plan,
An ankle attachment attached to the patient's ankle joint from above the skin and showing the direction of the functional axis by sandwiching the left and right fruits of the ankle joint,
Using the functional axis indicated by the ankle joint attachment, the tibial upper end attachment showing the cutting position at the upper end of the tibia,
With
The tibial upper end attachment includes a rotating part that adjusts the cutting direction at the tibial upper end so as to be a posterior inclination angle in a target sagittal plane,
A surgical instrument for joint replacement surgery at the upper end of the tibia, wherein the upper end attachment of the tibia is connected to the ankle joint attachment by a support column indicating a functional axis indicated by the ankle joint attachment.   The ankle joint attachment includes a rotation adjusting means for adjusting a rotation installation of the support in a cross section with a midpoint of the left and right fruits of the patient's ankle joint sandwiched from the skin as a rotation center. Item 7. The surgical instrument for joint replacement according to Item 6.   The joint replacement surgery according to claim 7, wherein a contact ring having a long hole formed in a direction of variation of the position of the fruit is provided at a part of the ankle joint attachment that contacts the fruit from above the skin. Surgical tool.   Posterior in the sagittal plane of the tibial upper end attachment with the point defined by the pin pressed against the anatomical index point of the tibial rough surface at the upper end of the tibial exposed by expanding the knee joint of the patient The surgical instrument for joint replacement according to any one of claims 6 to 8, wherein a back inclination adjusting means for adjusting the inclination is provided on the support column. In the tibial upper end attachment,
Positioning means having at least one locating pin that presses against an anatomical index point of the rough surface of the tibia at the exposed upper tibia of the patient's knee joint;
Posterior inclination adjusting means which is provided so as to be rotatable with respect to the positioning means and adjusts the posterior inclination of the osteotomy surface in the sagittal plane;
The surgical instrument for joint replacement according to any one of claims 6 to 8, characterized by comprising:   The surgical instrument for joint replacement surgery for the distal end of the femur according to any one of claims 1 to 5, and the surgical instrument for joint replacement surgery for the upper end of the tibia according to any one of claims 6 to 10. A surgical tool for joint replacement, characterized by comprising:

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