JP7066809B2 - Ultrasonic probe and ultrasonic treatment assembly - Google Patents

Description

The present invention relates to an ultrasonic probe and an ultrasonic treatment assembly.

For example, Patent Document 1 discloses an ultrasonic probe capable of forming a hole in a bone at a tip when ultrasonic vibration is transmitted. In this ultrasonic probe, a hole in the shape of a tip is formed. When a hole is formed in the bone with this ultrasonic probe, the cutting powder is discharged to the proximal end side of the ultrasonic probe.

US Patent Application Publication No. 2010/121197

For example, when performing treatment using an ultrasonic probe, it is required to make the treated surface as smooth as possible.
It is an object of the present invention to provide an ultrasonic probe and an ultrasonic treatment assembly capable of smoothing a treated surface as much as possible.

In the ultrasonic probe according to one aspect of the present invention, the ultrasonic vibration generated in the ultrasonic transducer arranged on the proximal end side along the longitudinal axis is directed from the proximal end side to the distal end side along the longitudinal axis. A first cutting surface that is provided on the tip end side of the probe main body along the longitudinal axis and is orthogonal to or substantially orthogonal to the longitudinal axis, and the above-mentioned A second cutting surface provided on the proximal end side along the longitudinal axis from the first cutting surface, and a tip surface protruding from the first cutting surface toward the distal end side along the longitudinal axis. It has a convex portion and a treatment portion having a convex portion. The convex portion is provided at a position recognizable as an index recognized in the field of view of the endoscope when the distal end side is viewed from the proximal end side along the longitudinal axis.

FIG. 1 is a schematic view showing a treatment system according to the first and second embodiments. FIG. 2 shows an ultrasonic probe of the treatment system according to the first embodiment, and in particular, is a schematic diagram showing an enlarged view of the treatment section and its vicinity. FIG. 3 is a schematic view of the treated portion of the ultrasonic probe seen from the direction of arrow III in FIG. FIG. 4 is a schematic perspective view of the treated portion of the ultrasonic probe shown in FIG. FIG. 5A is a schematic cross-sectional view of the portion shown by the virtual surface α1 in FIG. 4 along the line 5A-5A in FIG. FIG. 5B is a schematic cross-sectional view of the portion shown by the virtual surface α2 in FIG. 4 along the line 5B-5B in FIG. FIG. 5C is a schematic cross-sectional view of the portion shown by the virtual surface α3 in FIG. 4 along the line 5C-5C in FIG. FIG. 6A is a schematic cross-sectional view of the portion shown by the virtual surface β1 in FIG. 4 along the line 6A-6A in FIG. FIG. 6B is a schematic cross-sectional view of the portion shown by the virtual surface β2 in FIG. 4 along the line 6B-6B in FIG. FIG. 7 is a schematic view showing a state in which a concave hole is formed in a bone with a treatment tool having an ultrasonic probe having a treatment portion having a cross section shown in FIG. 5B. FIG. 8 is a schematic diagram showing a transplanted tendon taken from the tendon between the patella and the tibia. FIG. 9A is a schematic view showing a state in which a bone hole is formed in the footprint portion of the anterior cruciate ligament on the femoral side in order to reconstruct the anterior cruciate ligament of the transplanted tendon shown in FIG. FIG. 9B is a schematic view showing a state in which a bone hole is formed parallel to the bone hole shown in FIG. 9A so as to accommodate the bone fragment of the transplanted tendon shown in FIG. FIG. 9C is a schematic view showing a state in which the transplanted tendon shown in FIG. 8 has a bone hole formed in the footprint portion of the anterior cruciate ligament on the tibial side for reconstruction of the anterior cruciate ligament. FIG. 9D is a schematic view showing a state in which a bone hole is formed parallel to the bone hole shown in FIG. 9C so as to accommodate the bone fragment of the transplanted tendon shown in FIG. FIG. 9E is a schematic view showing a state in which a through hole is formed in the bone hole on the femur side shown in FIG. 9D. FIG. 10 is a schematic perspective view showing a treated portion of the ultrasonic probe according to the first modification of the first embodiment and its vicinity. FIG. 11A is an example showing a cross section in an appropriate YX plane in the vicinity of the tip portion of the treatment portion shown in FIG. FIG. 11B is an example different from FIG. 11A, showing a cross section in an appropriate YX plane in the vicinity of the tip portion of the treatment portion shown in FIG. FIG. 11C is an example different from FIGS. 11A and 11B, showing a cross section in an appropriate YX plane near the tip of the treatment portion shown in FIG. 10. FIG. 12A is an example showing a cross section of the treatment portion shown in FIG. 10 in an appropriate YX plane. FIG. 12B is an example different from FIG. 12A, showing a cross section of the treatment portion shown in FIG. 10 in an appropriate YX plane. FIG. 12C is an example different from FIGS. 12A and 12B, showing a cross section of the treatment portion shown in FIG. 10 in an appropriate YX plane. FIG. 13A is a schematic perspective view showing a treated portion of the ultrasonic probe according to the second modification of the first embodiment and its vicinity. FIG. 13B is a schematic perspective view showing the treated portion of the ultrasonic probe and its vicinity according to the modified example of the second modified example of the first embodiment. FIG. 13C is a schematic perspective view showing a treated portion of the ultrasonic probe according to a further modification of the second modification of the first embodiment. FIG. 14A is a schematic perspective view showing a treated portion of the ultrasonic probe according to the third modification of the first embodiment and its vicinity. FIG. 14B is a schematic view of the treated portion of the ultrasonic probe seen from the direction indicated by the arrow 14B in FIG. 14A. FIG. 15A is a schematic perspective view showing a treated portion of the ultrasonic probe according to the fourth modification of the first embodiment and its vicinity. FIG. 15B is a schematic view of the treated portion of the ultrasonic probe seen from the direction indicated by the arrow 15B in FIG. 15A. FIG. 16A is a schematic perspective view showing the treated portion of the ultrasonic probe and its vicinity according to the modified example of the fourth modified example of the first embodiment. FIG. 16B is a schematic view of the treated portion of the ultrasonic probe seen from the direction indicated by the arrow 16B in FIG. 16A. FIG. 17A is a schematic perspective view showing a treated portion of the ultrasonic probe according to the fifth modification of the first embodiment and its vicinity. FIG. 17B is a schematic view of the treated portion of the ultrasonic probe seen from the direction indicated by the arrow 17B in FIG. 17A. FIG. 17C is a schematic view showing a treatment portion having an outermost edge different from that of FIG. 17B. FIG. 17D is a schematic view showing a treatment portion having an outermost edge different from that of FIGS. 17B and 17C. FIG. 17E is a schematic view showing a treatment portion having an outermost edge different from that of FIGS. 17B to 17D. FIG. 18A is a schematic perspective view showing the treated portion of the ultrasonic probe according to the second embodiment and its vicinity. FIG. 18B is a schematic perspective view showing a state in which the treated portion of the probe shown in FIG. 18A is observed using an arthroscope in the state shown in FIG. FIG. 19A is a schematic perspective view showing a treated portion of the ultrasonic probe according to the first modification of the second embodiment and its vicinity. FIG. 19B is a schematic perspective view showing a state in which the treated portion of the probe shown in FIG. 19A is observed using an arthroscope in the state shown in FIG. 1. FIG. 20A is a schematic perspective view showing a treated portion of the ultrasonic probe according to the second modification of the second embodiment and its vicinity. FIG. 20B is a schematic perspective view showing a state in which the treated portion of the probe shown in FIG. 20A is observed using an arthroscope in the state shown in FIG. 1. FIG. 21A is a schematic perspective view showing the treated portion of the ultrasonic probe according to the third modification of the second embodiment and its vicinity. 21B is a schematic perspective view showing a state in which the treated portion of the probe shown in FIG. 21A is observed using an arthroscope in the state shown in FIG. 1.

Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings.
(First Embodiment)
The first embodiment will be described with reference to FIGS. 1 to 9E.

As shown in FIG. 1, the treatment system 10 according to this embodiment includes an ultrasonic treatment assembly 12, a power supply (first controller) 14, an arthroscope (endoscope) 16, and a controller (second controller) 18. And a display 20. The treatment system 10 is preferably used with a perfusion device (not shown). Therefore, when performing treatment using the treatment system 10, for example, the perfusate can be circulated while being filled in the joint cavity 110a of the knee joint 110. The ultrasonic treatment assembly 12 and the arthroscope 16 of the treatment system 10 can be used for treatment in the joint cavity 110a filled with the perfusate.

The arthroscope 16 observes the patient, for example, in the knee joint 110, that is, in the joint cavity 110a. The controller 18 captures the image obtained by the arthroscope 16 and performs image processing. The display 20 displays an image generated by image processing by the controller 18. The arthroscope (endoscope) 16 in the treatment system 10 is not always necessary in so-called open surgery, for example, when the treatment is performed while directly visually observing the treatment target site.

The ultrasonic treatment assembly 12 includes a treatment tool 22 and an ultrasonic transducer 24. The treatment tool 22 and the ultrasonic transducer 24 are arranged on a common longitudinal axis (central axis) L. In particular, the ultrasonic probe 46 and the vibrating body 34, which will be described later, are arranged on a common longitudinal axis (central axis) L.

The ultrasonic transducer 24 has a housing (oscillator case) 32 and a vibrating body 34 disposed inside the housing 32. The vibrating body 34 has a bolt-clamped Langevin-type Ultrasonic Transducer 34a and a connection portion 34b between the base end of the ultrasonic probe 46, which will be described later. The connecting portion 34b is formed at the tip of the vibrator 34a. It is preferable that the connecting portion 34b projects toward the tip end side of the housing 32 along the longitudinal axis (central axis) L of the ultrasonic transducer 24. A cable 36 having one end connected to the oscillator 34a and the other end connected to the power supply 14 extends from the base end of the housing 32 of the ultrasonic transducer 24.

When the electric power from the power source 14 is supplied to the oscillator 34a of the ultrasonic transducer 24, the oscillator 34a generates a longitudinal vibration having an appropriate amplitude along the longitudinal axis L. The ultrasonic transducer 24 appropriately expands the amplitude of the ultrasonic vibration generated in the ultrasonic transducer 34a due to the shape (horn shape) of the connection portion 34b on the distal end side along the longitudinal axis L. Then, the ultrasonic transducer 24 inputs ultrasonic vibration to the base end of the ultrasonic probe 46 along the longitudinal axis L and transmits the ultrasonic vibration to the treatment unit 54 described later.

A switch 14a is connected to the power supply 14. The power supply 14 supplies appropriate energy (power) to the ultrasonic transducer 24 in response to the operation of the switch 14a to generate ultrasonic vibration in the ultrasonic transducer 34a. The switch 14a maintains, for example, a state in which the ultrasonic vibrator 34a is driven while being pressed, and when the pressing is released, the state in which the ultrasonic vibrator 34a is driven is released. It is also preferable that the switch 14a is provided on the handle 42, which will be described later.

The treatment tool 22 has a handle 42, a sheath 44, and an ultrasonic probe 46. As shown in FIG. 2, the ultrasonic probe 46 integrally has a probe main body portion 52 and a block-shaped treatment portion 54. In FIG. 2, the treatment unit 54 and its vicinity are enlarged. The treatment portion 54 has a gentler inclined surface 54a at its base end than is orthogonal to the longitudinal axis L. The inclined surface 54a is formed at the proximal end portion on the proximal end side of the outermost edge 80 of the treated portion 54. Therefore, the proximal end portion of the treatment portion 54 forms a smaller cross-sectional area of the cross section orthogonal to the longitudinal axis L toward the proximal end side along the longitudinal axis L. Therefore, the inclined surface 54a has a smaller diameter from the tip end side to the base end side along the longitudinal axis L. Then, the inclined surface 54a smoothly connects the tip of the probe main body 52 and the treatment portion 54. Due to the presence of the inclined surface 54a, the length of the end faces 82 and 84 forming the outermost edge 80 described later of the treatment portion 54 is shortened along the longitudinal axis L, and cutting powder such as bone B is placed on the proximal end side along the longitudinal axis L. It is easy to discharge.

A scale 56 indicating the distance from the tip of the treatment portion 54 is formed in the vicinity of the tip of the probe main body 52. The scale 56 can be observed with the arthroscope 16.

The ultrasonic probe 46 is made of a material that can transmit ultrasonic vibration from the base end to the tip along the longitudinal axis L, such as a metal material such as a titanium alloy material. The ultrasonic probe 46 is preferably formed in a straight line. At the base end of the probe main body 52, there is a connecting portion 52a connected to the connecting portion 34b of the vibrating body 34 of the ultrasonic transducer 24. Therefore, the connection portion 34b of the ultrasonic transducer 24 fixed to the housing 32 is fixed to the connection portion 52a at the base end of the probe main body portion 52. Therefore, the ultrasonic transducer 24 is arranged on the proximal end side along the longitudinal axis L of the probe 46.

The probe main body 52 transmits the ultrasonic vibration of the longitudinal vibration generated in the ultrasonic transducer 24 from the proximal end side to the distal end side along the longitudinal axis L. The ultrasonic vibration generated in the ultrasonic vibrator 34a is transmitted to the treatment portion 54 via the connection portion 34b and the probe main body portion 52. The treatment portion 54 is provided on the tip end side of the probe main body portion 52 along the longitudinal axis L, and cuts the treatment target by the transmitted ultrasonic vibration. The treatment unit 54 can form a hole in the bone to be treated by ultrasonic vibration. From the ultrasonic transducer 34a to the tip of the treatment section 54, it is on a straight longitudinal axis L (central axis). Therefore, longitudinal vibration is transmitted to the treatment unit 54.

It is preferable that the total length of the probe 46 is, for example, an integral multiple of a half wavelength based on the resonance frequency of the vibrator 34a. The total length of the probe 46 is not limited to an integral multiple of the half wavelength based on the resonance frequency of the vibrator 34a, and is appropriately adjusted depending on the material, the amplitude expansion rate, and the like. Therefore, the total length of the probe 46 may be a substantially integral multiple of the half wavelength based on the resonance frequency of the transducer 34a. As a whole, the vibrating body 34 and the probe 46 are appropriately set in a shape including a material, a length, and a diameter so as to vibrate at the resonance frequency of the vibrator 34a and the frequency at the output of the power supply 14.

The connection portion 34b at the tip of the vibrating body 34 and the base end of the vibrating body 34 are antinodes of vibration. Of the ultrasonic probe 46, the proximal end connected to the connecting portion 34b of the vibrating body 34 is the antinode of vibration, and the treatment portion 54 is the antinode of vibration. On the outer peripheral surface of the probe main body 52 of the probe 46, a spacer (not shown) is disposed between the outer peripheral surface of the sheath 44 and the inner peripheral surface of the sheath 44. The spacer is arranged on the outer circumference at the position of the vibration node that does not move along the longitudinal axis L. Further, the probe main body 52 is supported by the outer periphery of the position of the vibration node indicated by the reference numeral 52b with respect to the handle 42.

The treatment portion 54 is formed in a polygonal shape such as a rectangle whose projected shape (outermost edge) 80 when the proximal end side is viewed from the distal end side along the longitudinal axis L of the treatment portion 54. The outermost edge 80 of the treatment portion 54 of the treatment tool 22 according to the present embodiment is formed in a rectangular shape (rectangular shape) when the proximal end side is viewed from the distal end side along the longitudinal axis L. The outermost edge 80 of the treatment portion 54 defines the outer shape of the bone hole (tunnel) 100, which will be described later. The outermost edge 80 has a pair of end faces 82 forming a short side and a pair of end faces 84 forming a long side. As an example, the outermost edge 80 has a short side of 4 mm and a long side of 5 mm. The outermost edge 80 may be a regular polygon as described in the fourth modification (FIG. 15A) described later. The shape of the outermost edge 80 can be appropriately formed depending on the shape of the hole to be formed by one or a plurality of treatments.

Here, the direction along the long side of the outermost edge 80 (long side direction) is defined as the X axis, and the direction along the short side (short side direction) is defined as the Y axis. The X-axis is the first orthogonal direction to the longitudinal axis L. The Y-axis is the second orthogonal direction to the longitudinal axis L. The first orthogonal direction and the second orthogonal direction are orthogonal to each other. The direction along the longitudinal axis L is defined as the Z axis. That is, the XYZ coordinate system for the probe 46 is defined as described above.

The center line Cx is taken at the center of the pair of end faces 82 forming the short side, and the center line Cy is taken at the center of the pair of end faces 84 forming the long side. The center line Cx is parallel to the Y axis. The center line Cy is parallel to the X-axis. The treatment unit 54 according to the present embodiment is formed symmetrically with respect to the center line Cx and symmetrically with respect to the center line Cy. In the present embodiment, the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 are relative to a virtual surface (ZX plane) formed by the longitudinal axis L and the center line Cx. Is formed symmetrically. In the present embodiment, the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 are symmetrical with respect to a virtual surface (YZ plane) including the longitudinal axis L and the center line Cy. Is formed in.
The outermost edge 80 is preferably formed symmetrically with respect to the virtual plane (YZ plane) formed by the longitudinal axis L and the center line Cx. The outermost edge 80 is preferably formed symmetrically with respect to the virtual plane (ZX plane) formed by the longitudinal axis L and the center line Cy.

As shown in FIGS. 3 and 4, the treatment portion 54 is formed in a stepped shape. The treatment portion 54 projects from the proximal end side toward the distal end side along the longitudinal axis L. The treatment unit 54 has a first surface 62, a pair of second surfaces 64, two pairs of third surfaces 66, and two pairs in order from the distal end side to the proximal end side along the longitudinal axis L. Has a fourth surface 68 of. These first surfaces 62, one pair of second surfaces 64, two pairs of third surfaces 66, and two pairs of fourth surfaces 68 are on the longitudinal axis L rather than the portion forming the outermost edge 80. It is provided on the tip side along the line. The treatment portion 54 is formed in a stepped shape in which the fourth surface 68, the third surface 66, the second surface 64, and the first surface 62 rise from the proximal end side toward the distal end side along the longitudinal axis L. Has been done. The first surface 62 is formed as the tip surface of the treatment portion 54. It is preferable that the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 are each formed as a plane orthogonal to the longitudinal axis L. That is, it is preferable that the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 are parallel to the XY plane formed by the X-axis and the Y-axis, respectively.
Here, the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 are described as being parallel to the XY plane, but for example, with respect to the XY plane, for example. It may be slightly inclined and substantially parallel, such as in the range of several degrees (°). That is, it is permissible that the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 are in a state of being substantially orthogonal to each other even if they are not orthogonal to the longitudinal axis L. ..

It is preferable that the entire surface of the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 is formed as a flat surface. If the region including the first edge portion (outer edge) 63 is formed as a flat surface on the first surface 62, for example, a concave portion and / or a convex portion is formed in the vicinity of the region indicated by the center line Cy described later. Is also good. Similarly, if the region including the second edge portion (outer edge) 65 and the inner edge 65a is formed as a flat surface, the second surface 64 has a recess and a recess in the vicinity of a region close to the first side surface 72, which will be described later. / Or a convex portion may be formed. Further, if the region including the third edge portion (outer edge) 67 and the inner edge 67a is formed as a flat surface, the third surface 66 has irregularities in the vicinity of the region close to the second side surface 74, which will be described later. It may have been done. If the region including the fourth edge portion (outer edge) 69 and the inner edge 69a is formed as a flat surface, the fourth surface 68 has a concave portion and / or a convex portion in the vicinity of the region close to the third side surface 76, which will be described later. The portion may be formed. In particular, a region including the first edge (outer edge) 63 of the first surface 62, a region including the second edge (outer edge) 65 of the second surface 64, and a third edge of the third surface 66. The region including the portion (outer edge) 67 and the region including the fourth edge portion (outer edge) 69 of the fourth surface 68 are preferably formed as a plane orthogonal to the longitudinal axis L.
The projected shape of the first surface 62 when viewed from the distal end side along the longitudinal axis L (inside the outer edge 63 of the first surface 62) is such that the second surface 64 is the longitudinal axis L. It is smaller than the projected shape (inside of the outer edge 65 of the second surface 64) when the base end side is viewed from the tip end side along the above. Therefore, the projected shape of the first surface 62 is inside the outer edge 65 of the second surface 64, inside the outer edge 67 of the third surface 66, and the outer edge of the fourth surface 68 (outermost edge 80). ) Is inside.

The first surface 62 has right-angled isosceles triangular surfaces 62a and 62b adjacent to the end surface 82 in the X-axis direction, and a substantially square surface 62c between the surfaces 62a and 62b. The first surface 62 has a surface 62a, a surface 62c, and a surface 62b continuous along the X-axis direction. The first surface 62 is formed on a substantially central center line Cy between one end and the other end in the Y-axis direction. A virtual longitudinal axis (central axis) L penetrates the substantially square surface 62c.

The pair of second surfaces 64 are formed at positions deviated from the center line Cy toward both ends (end surfaces 84) in the Y-axis direction. The second surface 64 is a position close to both ends in the Y-axis direction with respect to the first surface 62, and a position close to the probe main body 52 along the Z-axis direction with respect to the first surface 62. It is formed in each. The second surface 64 is formed in a substantially M-shape or a substantially W-shape, respectively.
There are four substantially rectangular first surfaces between the outer edge (first edge) 63 of the first surface 62 and one of the pair of second surfaces 64 and between the other. 72 is formed. Each of the first side surfaces 72 is parallel to the Z axis. The first side surface (step) 72 is continuous with the first surface 62 and the second surface 64.

Of the substantially rectangular outermost edges 80 that define the outer shape of the bone hole 100, the pair of end faces 82 that form the short sides are the end faces of the first face 62 and the second face 64 together with the first side surface 72. Formed as.

The third surface 66 is formed at a position shifted from the center line Cy toward both ends (end surface 84) in the Y-axis direction with respect to the second surface 64. The third surface 66 is located close to both ends in the Y-axis direction with respect to the second surface 64, and is close to the probe main body 52 along the Z-axis direction with respect to the second surface 64. It is formed in each. Each of the third surfaces 66 is formed in a substantially V shape.
Four substantially rectangular second side surfaces 74 are formed between the outer edge (second edge portion) 65 of one of the second surfaces 64 and the pair of third surfaces 66. Four substantially rectangular second side surfaces 74 are formed between the other second surface 64 and the pair of third surfaces 66. The second side surface 74 is parallel to the Z axis, respectively.

The fourth surface 68 is formed at a position shifted from the center line Cy toward both ends (end surface 84) in the Y-axis direction with respect to the third surface 66. The fourth surface 68 is located close to both ends in the Y-axis direction with respect to the third surface 66, and is close to the probe main body 52 along the Z-axis direction with respect to the third surface 66. It is formed in each. Each of the fourth surfaces 68 is formed in a substantially triangular shape.
The long side of the substantially rectangular outermost edge 80 that defines the outer shape of the bone hole 100 is formed by the third surface 66 and the fourth surface 68.
Two substantially rectangular third side surfaces 76 are formed between one of the four third surfaces 66 and one fourth surface 68. The third side surface 76 is parallel to the Z axis, respectively.

Therefore, when the treatment portion 54 is viewed from the distal end side along the longitudinal axis L from the distal end side, as shown in FIG. 3, not only the first surface 62 but also the second surface 64 and the third surface The entire surface of 66 and the fourth surface 68 is exposed so as to be recognized.

5A to 5C show cross sections of a plane parallel to the center line Cx in FIGS. 3 and 4 and orthogonal to the center line Cy, that is, parallel to the YZ plane. 6A and 6B show cross sections of a surface orthogonal to the center line Cx in FIGS. 3 and 4 and parallel to the center line Cy, that is, parallel to the ZX plane.

It is preferable that the edge between the first edge 63 of the first surface 62 and the first side surface 72 is formed at a right angle as sharp as possible. In this case, it is easy to form the concave hole 100 having the outer shape of the first surface 62. It is preferable that the edge between the second edge 65 of the second surface 64 and the second side surface 74 is formed at a right angle as sharp as possible. In this case, it is easy to form the concave hole 100 having the outer shape of the second surface 64. Similarly, the edge between the third edge 67 of the third surface 66 and the third side surface 76, and the edge between the fourth edge 69 of the fourth surface 68 and the outermost edge 80. Is preferably formed at a right angle as sharp as possible. In these cases, it is easy to form the concave hole 100 having the outer shape of the third surface 66, and it is easy to form the concave hole 100 having the outer shape of the fourth surface 68.

Of the substantially rectangular outermost edges 80 that define the outer shape of the bone hole 100, the pair of end faces 84 forming the long sides are the third surface 66 and the third surface 66 together with the second side surface 74 and the third side surface 76. It is formed as the end face of the face 68 of 4. It is preferable that the edge between the third surface 66 and the outermost edge 80 of the treatment portion 54 is formed at a right angle as sharp as possible. In this case, it is easy to form a concave hole 100 or a through hole (tunnel) having an outer shape of the third surface 66. It is preferable that the edge between the fourth surface 68 and the outermost edge 80 of the treatment portion 54 is formed at a right angle as sharp as possible. In this case, it is easy to form a concave hole 100 or a through hole having an outer shape of the fourth surface 68.

The area S1 of the first surface 62 of the treatment unit 54 according to the present embodiment is larger than the area S2 of each of the two second surfaces 64. The area S2 of each second surface 64 is larger than the area S3 of each of the four third surfaces 66. The area S3 of each third surface 66 is larger than the area S4 of each of the four fourth surfaces 68.

FIG. 5A shows a cross section along the first virtual surface α1 (line 5A-5A in FIG. 3) parallel to the YZ plane formed by the Y-axis and the Z-axis and passing through the center line Cx. The first virtual surface α1 is defined as a region including a longitudinal axis L (Z axis) and a first orthogonal direction (Y axis) orthogonal to the longitudinal axis L.
FIG. 5B shows a cross section along the second virtual surface α2 (line 5B-5B in FIG. 3). The second virtual surface α2 is parallel to the first virtual surface α1 and is located at a position deviated from the center line Cx toward the end surface 82 in the X-axis direction.
FIG. 5C shows a cross section along the third virtual surface α3 (line 5C-5C in FIG. 3). The third virtual surface α3 is parallel to the first virtual surface α1 and the second virtual surface α2, and is located at a position deviated from the second virtual surface α2 toward the end surface 82 in the X-axis direction.

In the example shown in FIGS. 5A to 5C, the first surface 62 at the tip has a first width (dimension) W1 in the first orthogonal direction (Y-axis direction) orthogonal to the longitudinal axis L. A pair of second surfaces 64 located on the base end side by one step from the first surface 62 to the first side surface 72 has a second width (from the center line Cy toward the end surface 84 on the long side). Dimensions) has W2. The two pairs of third surfaces 66, which are one step closer to the base end side from the second surface 64, have a third width (dimension) W3 from the second surface 64 toward the end surface 84 on the long side. The fourth surface 68, which is one step closer to the base end from the third surface 66, has a fourth width (dimension) W4 from the third surface 66 toward the end surface 84 on the long side.

Hereinafter, the width W1 on the first surface 62 and the width W2 on the second surface 64 will be compared.
In the example shown in FIG. 5A, the first width W1 (Wα1) of the first surface 62 is larger than each of the pair of second widths W2 of the second surface 64. The first width W1 shown in FIG. 5A is the maximum width of the first surface 62 along the Y-axis direction.
In the example shown in FIG. 5B, the first width W1 (Wα2) of the first surface 62 is equal to each of the pair of second widths W2 of the second surface 64.
In the example shown in FIG. 5C, the first width W1 (Wα3) of the first surface 62 is smaller than each of the pair of second widths W2 of the second surface 64. The first width W1 shown in FIG. 5C is the minimum width along the Y-axis direction of the first surface 62.
As described above, in the present embodiment, the width W1 in the Y-axis direction on the first surface 62 of the treatment unit 54 changes depending on the position in the X-axis direction.

FIG. 6A shows a cross section along the first virtual surface β1 (line 6A-6A in FIG. 3) parallel to the ZX plane formed by the Z-axis and the X-axis and passing through the center line Cx. The first virtual surface β1 is defined as a region including a longitudinal axis L (Z axis) and a second orthogonal direction (X axis) orthogonal to the longitudinal axis L.
FIG. 6B shows a cross section along the second virtual surface β2 (line 6B-6B in FIG. 3). The second virtual surface β2 is parallel to the first virtual surface β1 and is located at a position deviated from the center line Cy toward the end surface 84 in the Y-axis direction.

In this embodiment, of the width Wb between the inner edge 65a and the outer edge 65 of the second surface 64 and the width Wc between the inner edge 67a and the outer edge 67 of the third surface 66 shown in FIG. It is preferable that some of them are formed in the same manner. Therefore, the widths W2 and W3 of the second surface 64 and the third surface 66 in the Y-axis direction at appropriate positions in the X-axis direction are the same.

Next, the operation of the treatment system 10 according to the present embodiment will be described.

The joint has cartilage and cortical and cancellous bone. The ultrasonic treatment tool 22 according to the present embodiment can be used for treatment of cartilage and bone (cortical bone and cancellous bone). Here, the case where the bone hole 100 is formed in the bone B will be described as an example. A series of procedures for performing an operation to reconstruct the anterior cruciate ligament in the knee joint 110 will be briefly described later.

The sheath 44 and the handle 42 are attached to the probe 46 to form the ultrasonic treatment tool 22. The treatment portion 54 of the probe 46 projects from the tip of the sheath 44 toward the tip along the longitudinal axis L. The ultrasonic transducer 24 is attached to the ultrasonic treatment tool 22 to form the ultrasonic treatment assembly 12. At this time, the connecting portion 52a at the base end of the ultrasonic probe 46 and the connecting portion 34b of the vibrating body 34 of the ultrasonic transducer 24 are connected.

The surgeon arranges the arthroscope 16 in a positional relationship as shown in FIG. 1 with respect to the treatment portion 54 of the ultrasonic probe 46 described later in the ultrasonic treatment assembly 12. The treatment unit 54 is arranged in the field of view of the arthroscope (endoscope) 16 when looking from the proximal end side to the distal end side along the longitudinal axis L. That is, the treated portion 54 of the ultrasonic probe 46 is observed from the rear by the image obtained by using the arthroscope 16 and displayed on the display 20. The surgeon observes the state of the portion of the bone B in which the concave hole 100 is desired to be formed on the display 20, and the tip (first surface) of the treatment portion 54 of the treatment tool 22 is in the portion where the concave hole 100 is desired to be formed. 62) is brought into contact. The surgeon aligns the direction in which the concave hole 100 is desired (the direction of the desired bone hole) with the longitudinal axis L of the treatment tool 22. Therefore, the first surface 62 is pressed against the bone hole formation position in a state orthogonal to or substantially orthogonal to the direction of the desired bone hole formed in the bone B to be treated. The formation of the bone hole 100 is performed in a state where the perfusate is perfused into the joint cavity 110a.

The treatment portion 54 of the treatment tool 22 according to the present embodiment has a longitudinal axis because the projected shape (outermost edge) 80 when the proximal end side is viewed from the distal end side along the longitudinal axis L of the treatment portion 54 is not circular. When rotated around the axis of L, the outer shape of the formed hole is different. Therefore, it can be said that the treatment unit 54 has an orientation. Therefore, the operator rotates the probe 46 around the longitudinal axis L while confirming the image obtained by the arthroscope 16 to determine the shape of the bone hole 100 to be formed.

In this state, the operator operates the switch 14a. When the switch 14a is pressed, energy is supplied from the power supply 14 to the ultrasonic vibrator 34a of the vibrating body 34 fixed to the base end of the ultrasonic probe 46, and ultrasonic vibration is generated in the ultrasonic vibrator 34a. .. Therefore, the ultrasonic vibration is transmitted to the ultrasonic probe 46 via the vibrating body 34. This ultrasonic vibration is transmitted from the proximal end of the ultrasonic probe 46 toward the distal end side. For example, the first surface 62 of the treatment unit 54 or its vicinity is the antinode of vibration. Here, an example in which the vibration antinode is formed on the first surface 62 will be described, but the vibration antinode is formed at any of the positions of the second surface 64, the third surface 66, and the fourth surface 68. May be.

The first surface 62 of the treatment unit 54 is displaced with an appropriate amplitude along the longitudinal axis L at a speed based on the resonance frequency of the vibrator 34a (for example, from several m / s to several thousand m / s). Therefore, when the treatment tool 22 is moved toward the tip side along the longitudinal axis L while the vibration is transmitted and the treatment portion 54 is pressed against the bone B, the action of the ultrasonic vibration causes the bone B to move. Of these, the portion in contact with the treatment portion 54 is crushed. Therefore, in response to moving the treatment tool 22, that is, the probe 46 toward the tip side along the longitudinal axis L (central axis C), the bone B is provided with the longitudinal axis L of the treatment portion 54 of the ultrasonic probe 46 ( The concave hole 100 is formed along the desired direction of the bone hole). Therefore, when the ultrasonic vibration is transmitted to the first surface 62, the ultrasonic probe 46 can form the concave hole (bone hole) 100 toward the longitudinal axis L (desired direction).

When the bone B is under the cartilage, when the treated portion 54 of the ultrasonic probe 46 is pressed against the cartilage along the longitudinal axis L toward the tip side, the treated portion 54 of the cartilage is moved by the action of the ultrasonic vibration. The contacting part is excised and a recess is formed in the cartilage.

The operator maintains the state in which the switch 14a is pressed, that is, the state in which the ultrasonic vibrator 34a is vibrated, and the treated portion 54 of the probe 46 is moved forward along the longitudinal axis L (to the Z axis). Move in the direction along). A concave hole 100 having an opening edge 100a having the size and shape of the outer edge 63 of the first surface 62 is formed in the bone B. That is, on the first surface 62, cutting by ultrasonic vibration is uniformly performed so as to copy the shape of the first surface 62 in the depth direction (Z-axis direction). The opening edge 100a of the concave hole 100 at this time is smaller than the outermost edge 80 of the treatment portion 54. The outer edge 63 of the first surface 62 forms a part of a pair of end faces 82 forming the short side of the outermost edge 80 of the treatment portion 54.

At this time, an example of a cutting mechanism for forming a concave hole (bone hole) 100 in the bone B is a first surface 62 of the treatment portion 54 of the treatment tool 22 in which ultrasonic vibration is transmitted along the longitudinal axis L. It is considered that this is a hammering effect on the bone B. Due to the hammering effect, the position of the bone B that comes into contact with the first surface 62, which is the tip surface, is crushed and cut along the longitudinal axis L.

The debris of the bone B moves from the first surface 62 toward the outer edge 63 of the first surface 62 along the XY plane. At this time, the cutting powder is further finely crushed between the first surface 62 and the portion of the bone B facing the first surface 62, and the outer edge 63 of the first surface 62 along the XY plane. Move towards. The finely crushed cutting powder is passed from the outer edge 63 of the first surface 62 to the second surface 64 through the gap between the first side surface (first step) 72 and the bone B. It is discharged. At this time, since the second surface 64 is not in contact with the bone B, the cutting powder of the bone B is discharged to the proximal end side of the treatment portion 54 through between the bone B and the second surface 64. Further, the cutting powder of the bone B is discharged from the first surface 62 to the proximal end side of the treatment portion 54 through the gap between the end surface 82 and the bone B.

Then, the treatment unit 54 according to the present embodiment crushes the bone B by the first surface 62 having a smaller area S1 than by crushing the bone B at the tip surface of the area S of the outermost edge 80 to proceed with cutting. And proceed with cutting. Therefore, the energy for crushing the bone B can be more concentrated on the first surface 62. Therefore, the concave hole 100 having the shape of the first surface 62, which is smaller than the shape of the outermost edge 80, is more likely to be formed than directly forming the concave hole having the shape of the outermost edge 80. Further, when the bone B is cut on the first surface 62, the probe 46 is equidistantly moved in the depth direction as compared with the case where the bone B is cut on the tip surface of the area S of the outermost edge 80 of the treatment portion 54. Reduce the cutting volume of the case. Therefore, the cutting speed when the concave hole 100 is formed at the same depth by the treated portion 54 of the probe 46 is improved as compared with the case where the bone B is cut on the tip surface of the area S of the outermost edge 80 from the beginning. be able to.

When the concave hole 100 is deepened in the first surface 62 to which the ultrasonic vibration is transmitted, the second surface 64 located at the proximal end side along the longitudinal axis L with respect to the first surface 62 becomes the bone B. Is applied to. Then, due to the hammering effect, the position of the bone B that abuts on the first surface 62 and the position that abuts on the second surface 64 are crushed and cut along the longitudinal axis L. go.

The debris of the bone B moves from the first surface 62 along the XY plane, and from the outer edge 63 of the first surface 62 to the first side surface (first step) 72 and the bone B. It is discharged toward the second surface 64 through the gap between them. Similarly, moving from the second surface 64 along the XY plane, through the gap between the outer edge 65 of the second surface 64 to the second side surface (second step) 74 and the bone B, the third. It is discharged toward the surface 66 of. At this time, since the third surface 66 is not in contact with the bone B, the cutting powder of the bone B is discharged to the proximal end side of the treatment portion 54 through between the bone B and the third surface 66. Further, the cutting powder of the bone B is discharged from the first surface 62 and the second surface 64 to the base end side of the treatment portion 54 through the gap between the end surface 82 and the bone B.

Here, in the X-axis direction, the outer edge 65 of the second surface 64 is a part of a pair of end faces 82 forming the short side of the outermost edge 80 of the treatment portion 54. Therefore, in the X-axis direction, the size of the opening edge 100a formed by the outer edge 65 of the second surface 64 is the same as the opening edge 100a formed by the outer edge 63 of the first surface 62, and does not change.

In the Y-axis direction, the second surface 64 is located at a position deviated from the center line Cy of the first surface 62 toward the end surface 84 forming the long side of the outermost edge 80. Therefore, the opening edge 100a formed by the outer edge 65 of the second surface 64 is larger in the Y-axis direction than the opening edge 100a formed by the outer edge 63 of the first surface 62.

In this way, the treated portion 54 is formed with a concave hole 100 having an opening edge 100a in the shape of the outer edge 65 of the second surface 64. That is, when the treated portion 54 of the probe 46 is moved anteriorly along the longitudinal axis L, the opening edge 100a is the outer edge of the second surface 64 on the bone B, although it is smaller than the outermost edge 80 of the treated portion 54. A concave hole 100 having the same shape as that of 65 is formed. On the second surface 64, cutting by ultrasonic vibration is uniformly performed so as to copy the shape of the second surface 64 in the depth direction (Z-axis direction). At this time, the area inside the opening edge 100a of the concave hole 100 is larger than the area inside the opening edge 100a of the concave hole 100 formed only by the first surface 62. The concave hole 100 at this time is formed as a stepped hole because it has a first side surface (first step) 72 parallel to the longitudinal axis L between the first surface 62 and the second surface 64. To.
Further, when the bone B is cut on both the first surface 62 and the second surface 64, the depth direction is compared with the case where the bone B is cut on the tip surface of the area S of the outermost edge 80 of the treatment portion 54. The cutting volume when the probe 46 is moved equidistantly is reduced. Therefore, the cutting speed when the concave hole 100 is formed at the same depth by the treated portion 54 of the probe 46 is improved as compared with the case where the bone B is cut on the tip surface of the area S of the outermost edge 80 from the beginning. be able to.

Then, while deepening the concave hole 100 in the first surface 62 and the second surface 64, the third surface 66 is applied to the bone B to have an opening edge 100a in the shape of the outer edge 67 of the third surface 66. The concave hole 100 is formed. That is, when the treated portion 54 of the probe 46 is moved anteriorly along the longitudinal axis L, the opening edge 100a is the outer edge of the third surface 66 in the bone B, although it is smaller than the outermost edge 80 of the treated portion 54. A concave hole 100 having the same shape as that of 67 is formed. On the third surface 66, cutting is uniformly performed by ultrasonic vibration so as to copy the shape of the third surface 66 in the depth direction (Z-axis direction). At this time, the area inside the opening edge 100a of the concave hole 100 is larger than the area inside the opening edge 100a of the concave hole 100 formed by the second surface 64.
In the Y-axis direction, the opening edge 100a formed by the outer edge 67 of the third surface 66 is larger in the Y-axis direction than the opening edge 100a formed by the outer edge 65 of the second surface 64. The outer edge of the third surface 66 coincides with a part of the long side (end surface 84) of the outermost edge 80 of the treatment portion 54. The cutting powder of bone B passes through the first surface 62, the first side surface 72, the second surface 64, the second side surface 74, the third surface 66 and the third side surface (third step) 76. It is discharged to the fourth surface 68. That is, the cutting powder formed by the third surface 66 is discharged toward the fourth surface 68 together with the cutting powder formed by the first surface 62 and the second surface 64. Further, a part of the cutting powder of the bone B is discharged to the end surface 84 of the outermost edge 80 through the third side surface 76.
In the X-axis direction, the outer edge of the third surface 66 is the same as the short side (end surface 82) of the outermost edge 80 of the treatment portion 54. Therefore, in the X-axis direction, the size of the opening edge 100a formed by the outer edge 65 of the second surface 64 is the same as the opening edge 100a formed by the outer edge 63 of the first surface 62. Further, the cutting powder of the bone B is discharged from the first surface 62 and the second surface 64 to the end surface 82.

Then, while deepening the concave hole 100 in the first surface 62, the second surface 64, and the third surface 66, the fourth surface 68 is applied to the bone B to form the outer edge of the fourth surface 68. A concave hole 100 (see FIG. 7) having an opening edge 100a is formed. That is, when the treated portion 54 of the probe 46 is moved forward along the longitudinal axis L, the opening edge 100a of the bone B has the same shape as the outermost edge 80 of the treated portion 54 including the fourth surface 68. The concave hole 100 is formed. On the fourth surface 68, cutting by ultrasonic vibration is uniformly performed so as to copy the shapes of the fourth surface 68 and the outermost edge 80 of the treatment portion 54 in the depth direction (Z-axis direction). At this time, the area inside the opening edge 100a of the concave hole 100 is larger than the area inside the opening edge 100a of the concave hole 100 formed by the third surface 66. The concave hole 100 is formed at an appropriate depth with respect to the opening edge 100a.
In the Y-axis direction, the opening edge 100a formed at the outer edge of the fourth surface 68 is larger in the Y-axis direction than the opening edge 100a formed at the outer edge of the third surface 66. Further, the opening edge 100a at this time has the same shape as the long side (end surface 84) of the outermost edge 80 of the treatment portion 54. The cutting powder of the bone B is discharged to the end faces 82 and 84 of the outermost edge 80 of the treatment portion 54. That is, the cutting powder formed by the fourth surface 68 is discharged toward the end surface 84 together with the cutting powder formed by the first surface 62, the second surface 64, and the third surface 66.

Therefore, as shown in FIG. 7, the bone B is formed with a concave hole 100 having an opening edge 100a having the same shape as the outermost edge 80 of the treated portion 54.

In the image taken by the arthroscope 16, the scale 56 at the tip of the probe main body 52 can be observed. The surgeon determines the scale 56 of the image by the arthroscope 16 and estimates the depth of the concave hole 100. When the concave hole 100 having a desired depth is formed, the pressing of the switch 14a is released. The transmission of ultrasonic vibration to the probe 46 is released.

Even if the concave hole 100 having the required depth is not formed, if the observation of the treatment unit 54 is obstructed by cutting powder or the like, the pressing of the switch 14a is temporarily released and the treatment unit is removed. The transmission of ultrasonic vibration to 54 is stopped. After the treatment unit 54 becomes observable again, the switch 14a is pressed again to transmit the ultrasonic vibration to the treatment unit 54.

In this way, when the area of the opening edge 100a is increased in order on the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68, each surface (for example, the first surface 62) is increased. ), The amount of cutting powder generated by the action of the ultrasonic vibration is less than that in the case of cutting the bone B on the tip surface having the same area as the area S of the outermost edge 80 of the treatment portion 54. Further, since there is a deviation (first step) along the longitudinal axis L (Z-axis direction) between the first surface 62 and the second surface 64, the first surface 62 and the second surface 62 Even if the bone B is cut at the same time on the surface 64, the timing of discharging the cutting powder is deviated by the length along the longitudinal axis L of the first side surface 72. Further, for example, the cutting powder cut on the first surface 62 moves toward the proximal end side of the treatment portion 54 along the longitudinal axis L, so that the cutting powder is further finely crushed on the second surface 64 and the third surface 64 is used. It can be further finely crushed on the surface 66 and further finely crushed on the fourth surface 68. Similarly, for example, the cutting powder cut on the second surface 64 can be further finely crushed on the third surface 66 and further finely crushed on the fourth surface 68. Therefore, as much as possible, cutting powder is caught between the first side surface 72 and the bone B, between the second side surface 74 and the bone B, and friction is generated between the treatment portion 54 and the bone B. It is preventing. Further, when the bone hole 100 is formed by the treated portion 54 according to the present embodiment, the large area prevents one surface from being compacted. Therefore, the speed at which the cutting powder is smoothly discharged from the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 to form the concave hole 100 having a desired depth. Can be raised as compared with the case where the bone B is cut on the tip surface of the area S of the outermost edge 80 of the treatment portion 54.

Then, as described above, the cutting powder generated by the action of the ultrasonic vibration transmitted to the first surface 62 is crushed by the action of the ultrasonic vibration transmitted to the second surface 64, and the third surface is crushed. It is crushed by the action of the ultrasonic vibration transmitted to the 66, and is crushed by the action of the ultrasonic vibration transmitted to the fourth surface 68. Therefore, the finished surface of the bone hole 100 formed by the edge 65 of the second surface 64 becomes smoother than the finished surface of the bone hole 100 formed by the edge 63 of the first surface 62. obtain. Similarly, the finished surface of the bone hole 100 formed by the edge 67 of the third surface 66 is smoother than the finished surface of the bone hole 100 formed by the edge 65 of the second surface 64. obtain. The finished surface of the bone hole 100 formed by the edge 69 of the fourth surface 68 may be smoother than the finished surface of the bone hole 100 formed by the edge 67 of the third surface 66. Therefore, by using the stepped treatment portion 54 according to the present embodiment, the finished surface when the bone hole 100 is formed can become smoother as the distance from the center line Cy in the Y-axis direction increases.

Further, with reference to FIGS. 5A to 5C, the cutting performance based on the difference in width W in the cross section of the first surface 62 and the second surface 64 of the treatment unit 54 along the Y-axis direction is compared. Here, the relationship between the first surface 62 and one of the pair of second surfaces 64 will be described.

Here, when the ultrasonic vibration is transmitted to the probe 46, the tip end (first surface 62) of the treatment portion 54 or its vicinity is the antinode position of the vibration. Then, the amplitude due to the transmission of ultrasonic vibration is the largest along the longitudinal axis L at the tip (first surface 62) of the treatment portion 54 and its vicinity. The length along the longitudinal axis L from the first surface 62 to the fourth surface 68 is several millimeters. The portion where the first surface 62 to the fourth surface 68 is formed is separated from the vibration node toward the tip side along the longitudinal axis L. The position of the first vibration node from the tip of the treatment unit 54 is located at a position several centimeters away from the first surface 62, for example, at a position on the proximal end side of the inclined surface 54a of the treatment unit 54. be. When the first surface 62 is the antinode position of the vibration, the largest amplitude of the vibration (longitudinal vibration) in the direction along the longitudinal axis L is obtained on the first surface 62. At this time, the amplitude of the longitudinal vibration on the fourth surface 68 is substantially the same level as the abdominal position. Therefore, in the state where the ultrasonic vibration is transmitted, the cutting performance of the bone B per unit area of the fourth surface 68 is almost unchanged as compared with the first surface 62, and is substantially the same level. Become. That is, the cutting performance of the bone B per unit area on the second surface 64 and the third surface 66 located on the tip side along the longitudinal axis L with respect to the fourth surface 68 is also different from that of the first surface 62. There is almost no change, and the level is substantially the same.

In the cross section shown in FIG. 5A on the surface α1 in FIG. 4 of the treatment unit 54, the width W1 in the Y-axis direction of the first surface 62 is larger than the width W2 in the Y-axis direction of the second surface 64. It is assumed that the minute width in the X-axis direction on the first surface 62 and the second surface is the unit width. At this time, it depends on the cutting amount (amount of cutting powder) of the bone B per unit time by the region of the unit width and the width W1 of the first surface 62, and the region of the unit width and the width W2 of the second surface 64. The difference from the cutting amount of bone B (amount of cutting powder) per unit time depends on the size of the widths W1 and W2. Here, the width W1 of the first surface 62 in the Y-axis direction is larger than the width W2 of the second surface 64 in the Y-axis direction. The depth of the concave hole 100 advanced by the first surface 62 and the depth of the concave hole 100 advanced by the second surface 64 are the same because the positional relationship between the first surface 62 and the second surface 64 does not change. , Is the same. Therefore, when the treatment portion 54 is advanced along the longitudinal axis L to deepen the concave hole 100 in a state where the ultrasonic vibration is transmitted, the amount of cutting the bone B on the second surface 64 is the first. Less than the amount of bone B cut on the surface 62. Therefore, the amount of cutting powder generated by the action of the second surface 64 in the state where the ultrasonic vibration is transmitted is smaller than the amount of cutting powder generated from the first surface 62. At this time, assuming that the same energy is supplied to the first surface 62 and the second surface 64 along the longitudinal axis L, the smaller region (second surface 64) is the larger region (second surface 64). It is easier to exhibit cutting performance than the surface 62) of 1. Therefore, in the cross section shown in FIG. 5A of the treated portion 54, the surface (side surface) of the bone hole 100 is formed by the second surface 64 rather than the surface (side surface) of the bone hole 100 being formed by the first surface 62. The finished surface of the cut surface becomes smoother.

In the cross section shown in FIG. 5C on the surface α3 in FIG. 4 of the treatment unit 54, the width W1 in the Y-axis direction of the first surface 62 is smaller than the width W2 in the Y-axis direction of the second surface 64. The width W2 of the second surface 64 in the Y-axis direction and the width W3 of the third surface 66 in the Y-axis direction are the same. The width W4 of the fourth surface 68 in the Y-axis direction is smaller than the widths W1, W2, and W3. It should be noted that those skilled in the art can easily understand that the smaller the contact area with the bone B (the smaller the width W1), such as the pointed tip, the shorter the time until the concave hole 100 starts to be formed in the bone B. Will be done. Therefore, if the treatment is performed in a small area of the area S1 (the position having the first width W1) at the initial stage of the treatment, the treatment portion 54 is moved in the depth direction earlier and recessed in a state where the axis deviation is less likely to occur. The holes 100 can be started to form. Therefore, when the bone hole 100 is formed by using the treated portion 54 having a portion having a small width W1, the position of the treated portion 54 is less likely to be displaced from the desired position. When trying to perform a procedure for forming a concave hole 100 in a hard tissue such as bone B, it is slippery because there is no catch between the bone B and the treated portion 54 at first. However, as shown in the cross section shown in FIG. 5C, by forming a portion having a small width on the first surface (tip surface) 62, the concave hole 100 can be started to be formed at an early stage. Since the concave hole 100 is formed in the shape of the first surface 62 of the treated portion 54, the positional relationship between the bone B and the treated portion 54 can be easily maintained.

In the cross section shown in FIG. 5B on the surface α2 in FIG. 4 of the treatment unit 54, the width W1 in the Y-axis direction of the first surface 62 is the same as the width W2 in the Y-axis direction of the second surface 64. At this time, it is possible to start forming the concave hole 100 earlier while preventing the positional deviation of the treatment portion 54 when forming the bone hole 100, and at the same time, the first step in advancing the formation of the concave hole 100. The first surface 62 and the second surface 64 can make the finished surface of the cutting surface substantially uniform. That is, in the cross section shown in FIG. 5B, the concave hole 100 is formed earlier by balancing the action in the cross section shown in FIG. 5A and the action in the cross section shown in FIG. 5C, and the finished surface of the cut surface is formed. It is uniform.

As described with reference to FIGS. 5A to 5C, when considering a very narrow range in the X-axis direction along the Y-axis direction, the treatment unit 54 according to the present embodiment has a portion having a small width W1 (see FIG. 5C). ), When the bone B is brought into contact with the first surface 62 of the treatment portion 54 to which the ultrasonic vibration is transmitted, the concave hole 100 starts to be formed earlier. Therefore, in the first surface 62, not only the portion having a small width W1 (see FIG. 5C) but also the portion having a large width W1 continuously formed in the portion having a small width W1 (see FIGS. 5A and 5B). ), But the concave hole 100 in the shape of the first surface 62 begins to be formed earlier. Therefore, the position where the concave hole 100 is formed is unlikely to deviate from the desired position of the bone B. Since the area S1 of the first surface 62 is not circular but has an appropriate size, it is possible to suppress the treatment portion 54 from rotating in the circumferential direction of the longitudinal axis L, and the area S1 is straight along the longitudinal axis L. The concave hole 100 is formed.

As described above, the cutting finish between the first surface 62 and the bone B and the cutting finish between the second surface 64 and the bone B depend on the amount of cutting powder discharged per unit time. obtain. In the present embodiment, the size of the width W1 changes along the X-axis direction on the first surface 62. In reality, it is considered that the cutting powder of the cut bone B is affected by the vibration of the first surface 62 and heads in a random direction. Therefore, the finished surface does not change significantly depending on the position along the X-axis direction, but is formed substantially uniformly. Therefore, from a microscopic point of view, in the portion where the width W1 is larger than the width W2 along the Y-axis direction, the cutting finish between the first surface 62 and the bone B is the second surface 64 and the bone. It becomes coarser than the cutting finish between B. However, in the treatment unit 54 according to the present embodiment, since the width W changes along the X-axis direction, the width W1 is larger than the width W2 along the Y-axis direction from a macroscopic point of view. However, the cutting finish between the first surface 62 and the bone B is less likely to be rough than the cutting finish between the second surface 64 and the bone B.

When cutting the bone B, the depth S1 of the first surface 62 is smaller than that when cutting the bone B at the tip surface of the cross-sectional area S of the outermost edge 80 of the treatment portion 54, so that the depth of the concave hole 100 is deep. When the probe 46 is equidistantly moved in the direction, the cutting volume of the bone B can be reduced. Therefore, the cutting speed when the concave hole 100 is formed at the same depth by the treated portion 54 of the probe 46 is improved as compared with the case where the bone B is cut on the tip surface of the area S of the outermost edge 80 from the beginning. be able to.
In order to shorten the treatment time, it is usually desired to perform the formation of a large area bone hole as few times as possible. However, there is a trade-off between the idea of using a probe capable of forming a larger area bone hole and smoothing the finished surface of the bone hole. In the probe 46 according to the present embodiment, the treated portion 54 is formed in a stepped shape to form a bone hole having a larger area, and the fourth surface 68 (the fourth surface 68 on the tip side of the portion forming the outermost edge 80). , The dimension of the third surface 66 or the second surface 64) in the Y-axis direction is formed to be smaller than the dimension of the first surface 62 to smooth the finished surface of the bone hole. It is compatible.

Next, an example of using the patellar tendon 232 to which the bone fragments 232a and 232b are attached to both ends shown in FIG. 8 as the transplant tendon 230 will be described.
One bone fragment 232a is part of the patella (not shown). The bone fragment 232a on the patella side is a substantially triangular columnar shape. The other bone fragment 232b is part of the tibia 114. The bone fragment 232b on the tibia 114 side is rectangular parallelepiped. The outer shapes of the bone fragments 232a and 232b are, for example, about 10 mm × 5 mm, respectively. Specifically, the outer shape of the cross section orthogonal to the longitudinal axis of the transplanted tendon is formed into a substantially rectangular shape or a substantially elliptical shape close to a rectangle. Such a transplanted tendon is referred to as a BTB tendon.

As an example, as schematically shown in FIGS. 9A to 9E, the procedure for forming a recess (bone hole) 100, 101, 102, 103 in the femur 112 and the tibia 114 by using the inside-out method. I will explain briefly. Here, the outer shape of the outermost edge 80 of the treatment portion 54 according to the present embodiment has a short side of 4 mm and a long side of 5 mm. Therefore, a plurality of concave holes 100 and 101 are arranged side by side in the femur 112, and a plurality of concave holes 102 and 103 are arranged side by side in the tibia 114. When the concave holes 100 and 101 are arranged side by side, the opening edges 100a and 101a are formed into a rectangular shape of, for example, about 10 mm × 5 mm. Similarly, when the concave holes 102 and 103 are arranged side by side, the opening edges 102a and 103a are formed into a rectangular shape having, for example, about 10 mm × 5 mm. Depending on the size of the bone fragments 232a and 232b, continuous concave holes may be formed by a plurality of treatments such as 5 times. When fixing the transplanted tendon 230 with a screw, a concave hole may be formed in consideration of a gap for inserting the screw.

The implant tendon 230 is preferably placed in the same location as where the injured anterior cruciate ligament is attached. Therefore, the bone hole 100 is formed at the same site where the anterior cruciate ligament was attached. The part to which the damaged anterior cruciate ligament is attached is dissected using a treatment unit (not shown), and the footprints 116 and 118 to which the anterior cruciate ligament is attached are clarified. At this time, an appropriate ultrasonic treatment tool, abradder, high frequency treatment tool, or the like (none of which is shown) can be used.

In the bone hole 100, the position where the bone fragments 232a and 232b of the transplanted tendon 230 are inserted is preferably the size and shape corresponding to the outer shape of the transplanted tendon 230. Therefore, when the transplanted tendon 230 is collected, the size (outer shape) of the transplanted tendon 230 is measured.

Then, the positions of the bone holes 100, 101, 102, and 103 are marked on the footprint portions 116 and 118 to determine the positions. Although not shown, the footprint 116 is located posterior to the lateral wall of the intercondylar fossa of the femur 112. Further, the footprint portion 118 is inside the anterior intercondylar section of the tibia 114.

The treatment portion 54 of the ultrasonic treatment tool 22 is inserted into the joint cavity 110a of the knee joint 110 from an appropriate portal. Further, the tip of the arthroscope 16 is inserted into the joint cavity 110a. At this time, the treatment unit 54 and the arthroscope 16 are in a positional relationship as shown in FIG. Then, while checking the inside of the joint cavity 110a with the arthroscope 16, the tip of the treatment portion 54 (first surface 62) is brought into contact with the footprint portion 116 of the femur 112.

Then, as shown in FIG. 9A, a first bone hole (here, a concave hole) 100 is formed in the footprint portion 116 of the femur 112. As shown in FIG. 9B, a second bone hole 101 adjacent to the first bone hole 100 is formed in the footprint portion 116 of the femur 112. At this time, one substantially rectangular opening edge is formed by the opening edge 100a of the first bone hole 100 and the opening edge 101a of the second bone hole 101. At this time, the forming speed of the concave holes 100 and 101 is improved, and the finished surface of the concave holes 100 and 101 is made as smooth as possible.

Similarly, as shown in FIG. 9C, a third bone hole (here, a concave hole) 102 is formed in the footprint portion 118 of the tibia 114. As shown in FIG. 9D, a fourth bone hole 103 adjacent to the third bone hole 102 is formed in the footprint portion 118 of the tibia 114. At this time, one substantially rectangular opening edge is formed by the opening edge 102a of the third bone hole 102 and the opening edge 103a of the fourth bone hole 103. At this time, the forming speed of the concave holes 102 and 103 is improved, and the finished surface of the concave holes 102 and 103 is made as smooth as possible.

As shown in FIG. 9E, a through hole 101b is formed in the femur 112 by using, for example, a drill or the like.
Considering the orientation of the transplanted tendon 230, the transplanted tendon 230 is placed in the bone holes 100 and 101 on the femur 112 side and in the bone holes 102 and 103 on the tibia 114 side. For the fixation of the femur 112 and the transplanted tendon 230 and the fixation of the tibia 114 and the transplanted tendon 230, conventionally known methods may be appropriately used.
At this time, if the inner peripheral surfaces of the bone holes 100 and 101 are smooth, it becomes easier to arrange the bone fragments 232a than in the rough state. Further, when the inner peripheral surfaces of the bone holes 102 and 103 are smooth, it becomes easier to arrange the bone fragments 232b than in the rough state. In the present embodiment, since the inner peripheral surface of the bone holes 100, 101, 102, 103 can be formed as smoothly as possible, the bone fragments 232a, 232b of the transplanted tendon 230 are inserted into the bone holes 100, 101, 102, 103. It is easy and the treatment efficiency is improved.

By forming the bone holes 100, 101 on the femoral bone 112 side and the bone holes 102, 103 on the tibia 114 side according to the shape of the transplanted tendon 230, they are formed between the transplanted tendon 230 and the bone holes 100, 101. The gap and the gap formed between the transplanted tendon 230 and the bone holes 102 and 103 can be made as small as possible. Since the gap between the transplanted tendon 230 and the bone is small, the volume to be regenerated as the bone can be reduced and the transplanted tendon 230 can be easily ligamentized.

Further, by forming the bone holes 100, 101, 102, 103 using the ultrasonic probe 46 having the treatment portion 54 described in the present embodiment, the holes are not expanded by the dilator. Therefore, for example, even for a patient with a low bone density, the fracture can be suppressed, so that the procedure using the transplanted tendon 230 can be facilitated.

In addition, floating soft tissue such as the excised anterior cruciate ligament may exist in the joint cavity 110a. If the appropriate treatment tool rotates around the longitudinal axis L, the floating soft tissue may wrap around the treatment tool. Since the probe 46 of the treatment tool 22 according to the present embodiment moves only in a small range along the longitudinal axis L, it is necessary to prevent the floating soft tissue from being wrapped around the probe 46 and interfering with the treatment. Can be done.

Here, an example of forming the concave holes 100, 101, 102, 103 as the bone holes has been described, but a through hole may be formed by using the ultrasonic probe 46 having the treatment portion 54 described above. Further, after forming the concave holes 100, 101, 102, 103, through holes may be formed in the femur 112 and the tibia 114, respectively, by using a drill or the like.

Further, although the BTB tendon has been described here as an example, the STG tendon may be used as a part of the transplanted tendon as long as it forms a bone hole of a through hole, for example. Since the outer shape of the STG tendon is folded back, it is often not a circular cross section but a rectangular shape close to a substantially ellipse, for example. Also in this case, the bone holes 100, 101, 102, and 103 are formed by using the ultrasonic treatment tool 22 according to the outer shape of the transplanted tendon.

As described above, according to the present embodiment, for example, when forming a hole in a bone, the rate of forming the hole is improved and / or the finished surface of the hole is made as smooth as possible to improve the treatment efficiency. It is possible to provide an ultrasonic probe 46 and an ultrasonic treatment assembly 12 capable of providing an ultrasonic probe 46 and an ultrasonic treatment assembly 12.

(First modification of the first embodiment)
The treatment unit 54 of the above-described embodiment has described an example in which the widths W1 and W2 change along the X-axis direction. The treatment portion 54 shown in FIG. 10 is formed in a stepped shape with the first surface 62 as the top. Specifically, in the treatment unit 54, as the fourth surface 68, the third surface 66, the second surface 64, and the first surface 62 move from the proximal end side to the distal end side along the longitudinal axis L. It is formed in the shape of a staircase that goes up. The shapes of the first surface 62, the pair of second surfaces 64, the pair of third surfaces 66, and the pair of fourth surfaces 68 are rectangular, respectively. The treatment portion 54 of the probe 46 of this modification shows a case where the widths W1 and W2 are constant and do not change along the X-axis direction. Similarly, the treated portion 54 of the probe 46 of this modification has the same widths W3 and W4 along the X-axis direction and does not change. The width W1 of the first surface 62 is larger than the width W2 of the second surface 64. The treatment portion 54 is formed in a stepped shape in which the fourth surface 68, the third surface 66, the second surface 64, and the first surface 62 rise from the proximal end side toward the distal end side along the longitudinal axis L. Has been done. The projected shape of the outermost edge 80 when the treatment portion 54 is viewed from the distal end side to the proximal end side along the longitudinal axis L is rectangular. The fourth surface 68 is adjacent to the tip side along the longitudinal axis L with respect to the portion forming the outermost edge 80.

In the example of the treatment section 54 having the cross section shown in FIG. 11A, the first side surface 72, the second side surface 74 and the third side surface 76 are parallel to the longitudinal axis L. The first side surface (step) 72 is continuous with the first surface 62 and the second surface 64. The second side surface (step) 74 is continuous with the second surface 64 and the third surface 66. The third side surface (step) 76 is continuous with the third surface 66 and the fourth surface 68. Therefore, when the treatment portion 54 is viewed from the distal end side along the longitudinal axis L from the distal end side, not only the first surface 62 but also the second surface 64, the third surface 66, and the fourth surface 68 However, it is fully recognizable and exposed. For example, of the second surface 64, the inner edge 65a is not hidden by the first surface 62. Similarly, the inner edge 67a of the third surface 66 is not hidden by the second surface 64, and the inner edge 69a of the fourth surface 68 is not hidden by the third surface 66. Therefore, the first surface 62, the pair of second surfaces 64, the pair of third surfaces 66 and the pair of fourth surfaces 68, respectively, with respect to the bone B when forming the concave hole 100. Contact is made on the entire surface of each surface 62, 64, 66, 68.
The projected shape of the first surface 62 when viewed from the distal end side along the longitudinal axis L (inside the outer edge 63 of the first surface 62) is such that the second surface 64 is the longitudinal axis L. It is smaller than the projected shape (inside of the outer edge 65 of the second surface 64) when the base end side is viewed from the tip end side along the above. Therefore, the projected shape of the first surface 62 is inside the outer edge 65 of the second surface 64, inside the outer edge 67 of the third surface 66, and the outer edge of the fourth surface 68 (outermost edge 80). ) Is inside. This also applies to the treatment unit 54 shown in FIGS. 11B to 12C.

In the example of the treatment portion 54 having the cross section shown in FIG. 11B, the first side surface 72, the second side surface 74 and the third side surface 76 are inclined to the longitudinal axis L. Between the first edge 63 of the first surface 62 and the second surface 64, there is a surface (first side surface 72) inclined with respect to the longitudinal axis L. The first side surface 72 from the first surface 62 to the second surface 64 approaches the longitudinal axis L toward the second surface 64. The second side surface 74 from the second surface 64 to the third surface 66 approaches the longitudinal axis L toward the third surface 66. The third side surface 76 from the third surface 66 to the fourth surface 68 approaches the longitudinal axis L toward the fourth surface 68. Further, in the second surface 64, the region having a distance D1 from the inner edge 65a in the Y-axis direction is less likely to come into contact with the bone B when forming the concave hole 100. This region is used as a region for discharging cutting powder. Similarly, the region having a distance D2 from the inner inner edge 67a of the third surface 66 in the Y-axis direction is less likely to come into contact with the bone B when forming the concave hole 100. This region is used as a region for discharging cutting powder. The region having a distance D3 in the Y-axis direction from the inner inner edge 69a of the fourth surface 68 is less likely to come into contact with the bone B when forming the concave hole 100. This region is used as a region for discharging cutting powder. Therefore, the contact area with the bone B when forming the concave hole 100 is the largest on the first surface 62. The contact area between the pair of second surfaces 64, the pair of third surfaces 66 and the pair of fourth surfaces 68 and the bone B is smaller than the contact area of the first surface 62.
When the treatment portion 54 is viewed from the distal end side along the longitudinal axis L, not only the first surface 62 but also a part of the second surface 64, a part of the third surface 66, and the third surface 66. A portion of the fourth surface 68 is also recognizable and exposed. The second surface 64 is partially (inside) hidden by the first surface 62, but a part of the second surface 64 is exposed to the first surface 62. The third surface 66 is partially (inside) hidden by the second surface 64, but a part of the third surface 66 is exposed to the second surface 64. The fourth surface 68 is partially (inside) hidden by the third surface 66, but a part of the fourth surface 68 is exposed to the third surface 66.

The region at a distance D1 from the inner inner edge 65a of the second surface 64 in FIG. 11B is less likely to come into contact with the bone B when forming the concave hole 100. This region is used as a region for discharging cutting powder. Similarly, the region at a distance D2 from the inner inner edge 67a of the third surface 66 is less likely to come into contact with the bone B when forming the recess 100. This region is used as a region for discharging cutting powder. The region at a distance D3 from the inner inner edge 69a of the fourth surface 68 is less likely to come into contact with the bone B when forming the concave hole 100. This region is used as a region for discharging cutting powder.
The portion of the second surface 64 that contributes to cutting the bone (treatment target) B is formed in an area smaller than that of the first surface 62. Similarly, of the third surface 66, the portion that contributes to cutting the bone (treatment target) B is formed in an area smaller than that of the first surface 62. Further, the portion of the fourth surface 68 that contributes to cutting the bone (treatment target) B is formed in an area smaller than that of the first surface 62. In FIG. 11B, the portion of the third surface 66 that contributes to cutting the bone (treatment target) B is formed in an area smaller than that of the second surface 64. The portion of the fourth surface 68 that contributes to cutting the bone (treatment target) B is formed in an area smaller than that of the third surface 66.
In this case, when the treatment portion 54 is moved along the longitudinal axis L while transmitting ultrasonic vibration, the vicinity of the boundary between the first side surface 72 and the second surface 64 does not come into contact with the bone B. Therefore, in the vicinity of the boundary between the first side surface 72 and the second surface 64, friction with the bone B does not occur and the perfusate is in contact with the perfusate. Therefore, the force required for processing the bone hole 100 using the ultrasonic probe 46 can be minimized. In addition, the drag received from the bone B can be reduced during treatment using the ultrasonic probe 46. Further, the vicinity of the boundary between the first side surface 72 and the second surface 64 is used as a discharge path for cutting powder. Therefore, the speed at which the concave hole 100 is formed can be increased.

Further, the width of the treatment unit 54 along the Y-axis direction (width between the end faces 84) is smaller than the width Da of the example shown in FIG. 11A. Therefore, in the examples shown in FIGS. 11A and 11B, when the areas S1, S2, S3, and S4 of the first surface 62 to the fourth surface 68 are the same, the size between the end surfaces 84 of the treatment unit 54 is the same. Is the example shown in FIG. 11B and can be smaller than the example shown in FIG. 11A.
The cutting amount (amount of cutting powder) of bone B per unit time in the cross section along the Y-axis direction (first orthogonal direction) orthogonal to the longitudinal axis shown in FIG. 11B is 62, 64, 66 on each surface. , 68, which depends on the width (dimensions) of the part that contributes to cutting the bone B. Here, the first surface 62 is used as a portion where the entire surface contributes to cutting the bone B. On the second surface 64, the portion that contributes to cutting the bone B depends on the dimension of the width W2 minus the width D2. On the third surface 66, the portion that contributes to cutting the bone B depends on the dimension of the width W3 minus the width D3. On the fourth surface 68, the portion that contributes to cutting the bone B depends on the dimension of the width W4 minus the width D4.
The portion of the second surface 64 that contributes to cutting the bone B is more than the first surface 62 along the Y-axis direction (first orthogonal direction) orthogonal to the longitudinal axis L. It is formed to a small size. The portion of the third surface 66 that contributes to cutting the bone B is formed to have a smaller size than the portion that contributes to cutting the treatment target of the second surface 64. The portion of the fourth surface 68 that contributes to cutting the bone B is formed to have a smaller size than the portion that contributes to cutting the bone B of the third surface 66. Therefore, the treatment portion 54 shown in FIG. 11B reduces the size of the portion that contributes to cutting the bone B from the distal end side to the proximal end side along the longitudinal axis L.
Here, the positional relationship between the first surface 62 and the second surface 64 does not change between the depth of the concave hole 100 advanced by the first surface 62 and the depth of the concave hole 100 advanced by the second surface 64. Therefore, they are the same. Similarly, the depth of the recess 100 advanced by the first surface 62 coincides with the depth of the recess 100 advanced by the third surface 66 and the fourth surface 68, respectively. Therefore, when the treatment portion 54 is advanced along the longitudinal axis L to deepen the concave hole 100 in a state where the ultrasonic vibration is transmitted, the amount of cutting the bone B on the second surface 64 is the first. Less than the amount of bone B cut on the surface 62. Therefore, the amount of cutting powder generated by the action of the second surface 64 in the state where the ultrasonic vibration is transmitted is smaller than the amount of cutting powder generated from the first surface 62. At this time, assuming that the same energy is supplied to the first surface 62 and the second surface 64 along the longitudinal axis L, the smaller dimensional region (a part of the second surface 64) is used. Can be processed more finely than the area of large size (first surface 62). Therefore, the treatment portion 54 shown in FIG. 11B has a surface (side surface) of the bone hole 100 at the outer edge 65 of the second surface 64 rather than forming a surface (side surface) of the bone hole 100 at the outer edge 63 of the first surface 62. ) Is formed to make the finish of the cutting surface smoother.
This also applies to the relationship between the surface (fourth surface) 68 forming the outermost edge 80 and the surface (third surface) 66 one step above the surface (fourth surface) 68. That is, by making the portion that contributes to cutting the bone B of the fourth surface 68 smaller than the portion that contributes to cutting the bone B of the third surface 66, the size is the same as that of the outermost edge 80. The wall surface of the concave hole 100 when forming the opening edge 100a of the above can be made smoother.
Therefore, the area of the portion that contributes to cutting the bone B of each surface 62, 64, 66, 68 along the longitudinal axis L (Z-axis direction) from the distal end side to the proximal end side and along the Y-axis direction. Is gradually reduced. Therefore, the treatment portion 54 of the example shown in FIG. 11B is opened by cutting the bone B at the edges 63, 65, 67, 80 of the surfaces 62, 64, 66, 68 approaching the outermost edge 80 from the longitudinal axis L. The wall surface of the concave hole 100 when forming the edge 100a can be smoothed.

In FIG. 11B, the width D1 is drawn smaller than the width D2, and the width D2 is drawn smaller than the width D3. The sizes of the widths D1, D2, and D3 can be appropriately set. The widths D1, D2, and D3 may be the same. Then, for example, if the portion of the fourth surface 68 that contributes to cutting the bone B is made smaller than the portion of the third surface 66 that contributes to cutting the bone B, For example, the portion of the second surface 64 that contributes to cutting the bone B may be reduced, and the portion of the third surface 66 that contributes to cutting the bone B may be reduced.

In the example of the treatment portion 54 having the cross section shown in FIG. 11C, the first side surface 72, the second side surface 74 and the third side surface 76 are inclined to the longitudinal axis L. That is, between the first edge 63 of the first surface 62 and the second surface 64, a surface (first side surface 72) inclined with respect to the longitudinal axis L is provided. The first side surface 72 from the first surface 62 to the second surface 64 moves away from the longitudinal axis L toward the second surface 64. The second side surface 74 from the second surface 64 to the third surface 66 moves away from the longitudinal axis L toward the third surface 66. The third side surface 76 from the third surface 66 to the fourth surface 68 moves away from the longitudinal axis L toward the fourth surface 68. Therefore, when the treatment portion 54 is viewed from the distal end side along the longitudinal axis L from the distal end side, not only the first surface 62 but also the second surface 64, the third surface 66, and the fourth surface 68 Is also recognizable and exposed.

Therefore, the first side surface 72, the second side surface 74, and the third side surface 76 function as the cutting surface of the bone B when forming the concave hole 100. In particular, among the first side surface 72, the second side surface 74, and the third side surface 76, the vibration component in the direction along the longitudinal axis L contributes to cutting the bone B. The first side surface 72, the second side surface 74, and the third side surface 76 are easier to process than the examples shown in FIGS. 11A and 11B, and can prevent stress concentration. The treated portion 54 shown in FIG. 11C has a large number of meat portions (the amount removed by processing when the treated portion 54 is formed) even when the treated portion 54 is formed so as to have the same outermost edge 80. Therefore, the durability can be improved as compared with the treatment section 54 shown in FIGS. 11A and 11B.

Let D1 be the distance in the Y-axis direction from the outer outer edge 63 of the first surface 62 in FIG. 11C to the inner inner edge 65a of the second surface 64. Let D2 be the distance in the Y-axis direction from the outer outer edge 65 of the second surface 64 to the inner inner edge 67a of the third surface 66. Let D3 be the distance in the Y-axis direction from the outer outer edge 67 of the third surface 66 to the inner inner edge 69a of the fourth surface 68.

It may be desirable to form a recess 100 with a larger area opening edge 100a by moving as short a distance as possible along the longitudinal axis L. When the areas S1, S2, S3, S4 of each surface 62, 64, 66, 68 are to be the same, when each side surface 72, 74, 76 is parallel to each other, as shown in FIG. 11A, or when shown in FIG. 11B. Needs to increase the number of faces (planes) in the Y-axis direction (number of steps).

As described above, when the ultrasonic vibration is transmitted to the probe 46, the treatment unit 54 has the antinode position of the vibration along the longitudinal axis L, for example, on the first surface 62. At this time, the nth plane (n is a natural number of 2 or more) is located at the proximal end side along the longitudinal axis L with respect to the first plane 62, and is out of the antinode position of vibration. Therefore, in principle, the amplitude in the direction along the longitudinal axis L on the nth plane is smaller than the amplitude in the direction along the longitudinal axis L on the first surface 62. Therefore, the cutting ability on the nth surface may be lower than the cutting ability on the first surface 62. Therefore, if the number of steps (value of n) is too large, there is a possibility that a difference in cutting ability may occur between the first surface 62 and the nth surface.
In this modification, the first side surface 72 is formed as a plane from the outer edge 63 of the first surface 62 to the inner edge 65a of the second surface 64. The inner edge 65a of the second surface 64 is separated from the outer edge 63 of the first surface 62 with respect to the longitudinal axis L. Here, when the proximal end side is viewed from the distal end side along the longitudinal axis L, the first side surface 72 between the outer edge 63 of the first surface 62 and the inner edge 65a of the second surface 64 is recognized. To.

The distance Dc from the position of the center (longitudinal axis L) of the first surface 62 to the end surface 84 of the fourth surface 68 is larger than the distance Da of the example shown in FIG. 11A, and the distance Dc of the example shown in FIG. 11B is larger. Greater than the distance Db. Even when the surfaces 62, 64, 66, and 68 have the same area, the area S of the outermost edge 80 can be increased. Therefore, when the probe 46 having the treatment portion 54 according to the example shown in FIG. 11C of this modification is used, it is not necessary to adjust the length in the direction along the longitudinal axis L, and one operation along the longitudinal axis L is performed. Can form a concave hole 100 with a larger opening edge 100a.

The treatment unit 54 according to the example shown in FIG. 11C also vibrates along the longitudinal axis L on the first side surface 72 due to the transmission of ultrasonic vibration to the probe 46. Therefore, the bone B can also be cut on the first side surface 72.
The first side surface 72, the second side surface 74, and the third side surface 76 have different inclination angles. The second side surface 74 is closer to the direction along the longitudinal axis L than the first side surface 72, and the third side surface 76 is closer to the direction along the longitudinal axis L than the second side surface 74. ..
The cutting amount (cutting powder amount) of the bone B per unit time in the cross section along the Y-axis direction (first orthogonal direction) orthogonal to the longitudinal axis by the treatment unit 54 shown in FIG. 11C is 62 on each surface. , 64, 66, 68, as well as the width (dimensions) of the first side surface 72, the second side surface 74, and the third side surface 76 in the Y-axis direction. Here, the first surface 62 to the fourth surface 68 are used as a portion where the entire surface contributes to cutting the bone B. The first side surface 72 depends on the dimension D1 between the Y-axis edge (outer edge) 63 of the first surface 62 and the Y-axis inner edge 65a of the second surface 64. The second side surface 74 depends on the dimension D2 between the edge (outer edge) 65 of the second surface 64 and the inner edge 67a of the third surface 66. The third side surface 76 depends on the dimension D3 between the edge (outer edge) 67 of the third surface 66 and the inner edge 69a of the fourth surface 68.
Then, for example, the dimension obtained by adding the distance D1 of the first side surface 72 to the width W1 of the first surface 62 adds the distance D2 of the second side surface 74 to the width W2 (= W1) of the second surface 64. Greater than the size. The dimension obtained by adding the distance D2 of the second side surface 74 to the width W2 of the second surface 64 is larger than the dimension obtained by adding the distance D3 of the third side surface 76 to the width W3 (= W2) of the third surface 66. big. The dimension obtained by adding the distance D3 of the third side surface 76 to the width W3 of the third surface 66 is larger than the width W4 (= W3) of the fourth surface 68. Therefore, in the treatment section 54 shown in FIG. 11C, the dimensions of the Y-axis direction components of the side surfaces 72, 74, and 76 are gradually reduced, so that the treatment section 54 moves from the tip end side to the base end side along the longitudinal axis L. The size of the part that contributes to cutting the bone B is reduced.
Here, the positional relationship between the first surface 62 and the second surface 64 does not change between the depth of the concave hole 100 advanced by the first surface 62 and the depth of the concave hole 100 advanced by the second surface 64. Therefore, they are the same. Similarly, the depth of the recess 100 advanced by the first surface 62 coincides with the depth of the recess 100 advanced by the third surface 66 and the fourth surface 68, respectively. Therefore, when the treatment portion 54 is advanced along the longitudinal axis L to deepen the concave hole 100 in a state where the ultrasonic vibration is transmitted, the bone B is cut at the second surface 64 and the second side surface 74. The amount is less than the amount of cutting the bone B on the first surface 62 and the first side surface 72. Therefore, the amount of cutting powder generated by the action of the second surface 64 and the second side surface 74 in the state where the ultrasonic vibration is transmitted is such that the cutting powder is generated from the first surface 62 and the first side surface 72. Less than the amount to make. At this time, assuming that the same energy is supplied to both the first surface 62 and the first side surface 72 and the second surface 64 and the second side surface 74 along the longitudinal axis L, the dimensions are small. Regions (second surface 64 and second side surface 74) can be finer than regions with larger dimensions (first surface 62 and first side surface 72). Therefore, the treatment portion 54 shown in FIG. 11C has an outer edge 65 and a second surface 64 of the second surface 64 rather than forming a surface (side surface) of the bone hole 100 at the outer edge 63 and the first side surface 72 of the first surface 62. When the surface (side surface) of the bone hole 100 is formed on the side surface 74 of 2, the finish of the cut surface becomes smooth. Similarly, rather than forming the surface (side surface) of the bone hole 100 at the outer edge 65 and the second side surface 74 of the second surface 64, the bone hole 100 at the outer edge 67 and the third side surface 76 of the third surface 66. The finish of the cutting surface becomes smoother when the surface (side surface) of the surface is formed. Similarly, the bone hole 100 is formed at the outer edge (outermost edge 80) of the fourth surface 66 rather than forming the surface (side surface) of the bone hole 100 at the outer edge 67 and the third side surface 76 of the third surface 66. The finish of the cutting surface becomes smoother when the surface (side surface) of the surface is formed.
Therefore, the Y-axis direction components of each surface 62, 64, 66, 68 and each side surface 72, 74, 76 along the longitudinal axis L (Z-axis direction) from the tip side to the base end side and along the Y-axis direction. Is gradually reduced. Therefore, in the treatment portion 54 of the example shown in FIG. 11C, the closer to the outermost edge 80 from the longitudinal axis L, the smoother the wall surface of the concave hole 100 when cutting the bone B to form the opening edge 100a. can.

Therefore, as shown in FIGS. 11A to 11C, the width between the end faces 84 is appropriately adjusted by adjusting the directions of the side surfaces 72, 74, ... Of the treatment portion 54. Therefore, for example, a probe 46 having a treatment portion 54 having widths Da, Db, and Dc is lined up. Therefore, the probe 46 is selected from the lineup according to the size of the opening edge 100a of the bone hole 100 to be formed by one operation along the longitudinal axis L. In particular, as shown in FIGS. 11B and 11C, the bone B is cut by providing a treatment portion 54 that reduces the portion contributing to the cutting of the bone B at each stage as the distance from the longitudinal axis L in the Y-axis direction increases. The wall surface of the concave hole 100 when forming the opening edge 100a can be made smoother at a position closer to the opening edge 100a than at a position farther from the final opening edge 100a.

In the example of the treatment section 54 having the cross section shown in FIG. 12B, the first height H1 between the first surface 62 and the second surface 64 is the second surface 64 and the third surface 66. The case where the height is larger than the second height H2 between and is shown. Therefore, the first height H1 along the longitudinal axis L of the first step (first side surface 72) between the first surface 62 and the second surface 64 is the second surface 64 and the second surface 64. It is higher than the second height H2 along the longitudinal axis L of the second step (second side surface 74) with the surface 66 of 3.
In this case, although it depends on the positional relationship between the arthroscope 16 shown in FIG. 1 and the treatment unit 54, the treatment unit 54 is observed by the arthroscopy 16 from the rear of the arrangement shown in FIG. 1 with respect to the treatment unit 54 of the probe 46. The tip of the arthroscope is easily observed. As described above, when the tip of the treatment unit 54 is observed through the arthroscope 16, the position and orientation of the first surface 62 of the treatment unit 54 are stabilized when the concave hole 100 is created in the first surface 62. easy.

In the example of the treatment section 54 having the cross section shown in FIG. 12C, the first height H1 between the first surface 62 and the second surface 64 is the second surface 64 and the third surface 66. The case where it is smaller than the second height H2 between and is shown. Therefore, the first height H1 along the longitudinal axis L of the first step between the first surface 62 and the second surface 64 is between the second surface 64 and the third surface 66. The height is lower than the second height H2 along the longitudinal axis L of the second step.
As described above, even if the height H1 is smaller than the height H2, an appropriate concave hole 100 can be formed on the first surface 62. Since the protrusion height H1 along the longitudinal axis L of the first surface 62 with respect to the second surface 64 is small, the durability of the treatment portion 54 can be increased.

In the example of the treatment section 54 having the cross section shown in FIG. 12A, the first height H1 between the first surface 62 and the second surface 64, and the second surface 64 and the third surface 66. The case where the second height H2 in between is the same is shown. Therefore, the first height H1 along the longitudinal axis L of the first step between the first surface 62 and the second surface 64 is between the second surface 64 and the third surface 66. Corresponds to the second height H2 along the longitudinal axis L of the second step of.
In this case, by making the protrusion heights H1 and H2 the same, the strength of the structure of the treated portion 54 can be maintained higher than in the case where the height H1 is larger than the height H2. That is, the treatment portion 54 having the structure shown in FIG. 12A can maintain high durability even when a reaction force or the like from the bone B is applied, for example. Further, in this case, depending on the positional relationship with the arthroscope 16, the tip of the treatment portion 54, that is, the tip of the first surface 62 can be observed through the arthroscope 16. As described above, when the tip of the treatment unit 54 is observed through the arthroscope 16, the position and orientation of the first surface 62 of the treatment unit 54 are stabilized when the concave hole 100 is created in the first surface 62. easy.

The structure of the treatment unit 54 shown in FIGS. 12A to 12C is appropriately selected depending on whether the visibility of the tip of the treatment unit 54 using the arthroscope 16 is emphasized or the stability of the structure of the treatment unit 54 is emphasized. Will be done. Therefore, for example, a probe 46 having a treatment portion 54 having an adjusted height H1 is lined up. Therefore, when it is important to place the first surface 62 in an appropriate orientation and position using the arthroscope 16, the probe 46 having the treatment portion 54 having a large height H1 is selected from the lineup. Rather than arranging the first surface 62 in an appropriate orientation and position using the arthroscope 16, it is highly necessary to prevent the treatment unit 54 from wobbling or to emphasize the stability of the structure of the treatment unit 54. A probe 46 having a small H1 treatment section 54 is selected from the lineup.

Then, the treatment unit 54 appropriately adjusts the heights H1 and H2 as shown in FIGS. 12A to 12C, and sets the side surfaces 72, 74, ... To the longitudinal axis L as shown in FIGS. 11A to 11C. It can be formed by appropriately selecting whether or not to make it parallel.

(Second variant of the first embodiment)
As shown in FIG. 13A, the first surface 62 is divided into a plurality of parts along the X-axis direction. In this case, the area S1 of the first surface 62 can be made small. For example, the width (dimensions) of the first surface 62 can be made smaller than the width (dimensions) of the second surface 64 along the Y-axis direction. Therefore, the concave hole 100 can be started to be formed earlier on the first surface 62. Further, a first side surface 72 is formed along the end surface 82 in the X-axis direction. Therefore, it is easy to confirm the orientation of the treatment portion 54 with the arthroscope 16 arranged as shown in FIG. Therefore, the first side surface 72 along the end face 82 is used to recognize the orientation of the treated portion 54 with respect to the bone B through the arthroscope 16.
The projected shape of the first surface 62 when viewed from the distal end side along the longitudinal axis L (inside the outer edge 63 of the first surface 62) is such that the second surface 64 is the longitudinal axis L. It is smaller than the projected shape (inside of the outer edge 65 of the second surface 64) when the base end side is viewed from the tip end side along the above. Therefore, the projected shape of the first surface 62 is inside the outer edge 65 of the second surface 64, inside the outer edge 67 of the third surface 66, and the outer edge of the fourth surface 68 (outermost edge 80). ) Is inside. This also applies to the treatment unit 54 shown in FIGS. 13B to 17E.

In the example shown in FIG. 13A, the height of the first side surface 72 between the first surface 62 and the second surface 64 is, for example, 1 mm. Each of the first surfaces 62 is formed in, for example, 1 mm × 1 mm. Further, in the example of the treatment unit 54 shown in FIG. 13A, it is formed in four stages having the first surface 62 to the fourth surface 68.

The treatment unit 54 of the example shown in FIG. 13B has a larger number of surfaces in the Y-axis direction and a larger number of stages than the example shown in FIG. 13A. The height of the first side surface 72 between the first surface 62 and the second surface 64 is, for example, 0.5 mm. Each of the first surfaces 62 is formed to have, for example, 0.5 mm × 0.5 mm. Further, in the example of the treatment unit 54 shown in FIG. 13B, the treatment unit 54 is formed in six stages having the first surface 62 to the sixth surface 71. In the case of the example shown in FIG. 13B, the heights of the second side surface 74 to the fifth side surface 79 are also formed to be, for example, 0.5 mm, respectively. By adjusting the heights of the first side surface 72 to the fifth side surface 79 in this way, the second surface 62 is between the first surface 62 and the second surface 64 with respect to the example shown in FIG. 13A. The distance in the height direction along the longitudinal axis L, such as between the surface 64 and the third surface 66, is not increased. Therefore, not only in the example shown in FIG. 13A, but also in the example shown in FIG. 13B, it is possible to suppress the occurrence of a difference in amplitude in the direction along the longitudinal axis L on each surface 62, 64, 66, ....

In the examples shown in FIGS. 13A and 13B, an example in which the first surfaces 62 are juxtaposed only in the X-axis direction has been described. As shown in FIG. 13C, it is also preferable that the first surfaces 62 are arranged side by side not only in the X-axis direction but also in the Y-axis direction. In FIG. 13C, the tip surface is formed as the first surface 62. On the second surface 64, the first side surface 72 projects toward the tip end side with respect to the longitudinal axis L. The outermost edge 80 is formed in a substantially rectangular shape. The third surface 66 is formed at a corner portion between the end surfaces 82 and 84, respectively. It is also preferable that the treatment portion 54 is formed in this way.

(Third variant of the first embodiment)
In the above-mentioned example, the treatment portion 54 has a plurality of surfaces (planes) 62, 64, 66, 68 along the Y-axis direction, and the surfaces (planes) are formed stepwise along the Y-axis direction. An example was explained.

Here, as shown in FIGS. 14A and 14B, the treatment unit 54 is formed with a plurality of surfaces (planes) 62, 64, 66, 68 stepwise along the X-axis direction as well as the Y-axis direction. ing. The second surface 64 in the Y-axis direction and the second surface 64 in the X-axis direction are continuous on the same surface (on the XY plane) and are formed in an annular shape. Similarly, the third surface 66 in the Y-axis direction and the third surface 66 in the X-axis direction are continuous on the same surface (on the XY plane) and are formed in an annular shape. That is, it is also preferable that the treatment portion 54 is formed in a stepped shape such as a substantially pyramid shape.

Also in this case, as described in the above-described embodiment, the treatment portion 54 of the probe 46 has a desired depth as compared with the case where the bone B is cut at the tip surface of the area S of the outermost edge 80 from the beginning. The cutting speed when forming the concave hole 100 can be improved.
The dimension Dy2 of the Y-axis direction component of the second surface 62 is larger than the dimension Dy3 of the Y-axis direction component of the third surface 66. The Y-axis direction component Dy3 of the third surface 66 is larger than the Y-axis direction component Dy4 of the fourth surface 68. The dimension Dx2 of the X-axis direction component of the second surface 62 is larger than the dimension Dx3 of the X-axis direction component of the third surface 66. The X-axis direction component Dx3 of the third surface 66 is larger than the X-axis direction component Dx4 of the fourth surface 68. Then, as the distance from the longitudinal axis L in the Y-axis direction, the treatment portion 54 that reduces the number of parts that contribute to the cutting of the bone B is provided in each step, so that the bone B is cut to form the opening edge 100a. The wall surface of the recess 100 can be made smoother at a position closer to the opening edge 100a than at a position farther from the final opening edge 100a.
Here, the dimension of the Y-axis direction component of the first surface 62 is smaller than the dimension Dy2. Therefore, it is sufficient that the dimension Dy4 is smaller than the dimension Dy3 at the position toward the surfaces 66 and 68 far from the longitudinal axis L and close to the outermost edge 80. Similarly, it suffices if a state is formed in which the dimension Dx4 is smaller than the dimension Dx3 at the position toward the surfaces 66 and 68 far from the longitudinal axis L and close to the outermost edge 80. Even in this state, the wall surface of the concave hole 100 when forming the opening edge 100a can be made smoother.

In the first embodiment, an example in which the first surface 62 is continuous with the end surface 82 of the outermost edge 80 has been described. The first surface 62 of the treatment portion 54 of this modification is not continuous with the end surface 82 of the outermost edge 80. Therefore, the area S1 of the first surface 62 can be easily made smaller than the area S1 of the first surface 62 of the treatment unit 54 described in the first embodiment. Then, the speed at which the concave hole 100 starts to be formed on the first surface 62 can be made faster than that described in the first embodiment. Therefore, it is possible to form a concave hole 100 in which the first surface 62 is copied from the first surface 62 of the treatment portion 54 earlier in the bone B.

(Fourth modification of the first embodiment)
As shown in FIGS. 15A to 16B, it is also preferable that the tip portion of the treatment portion 54 has only the first surface 62, the first side surface 72 and the second surface 64. The outer edge of the second surface 64 is formed as the outermost edge 80 of the treatment portion 54.

In the treatment section 54 shown in FIGS. 15A and 15B, the area S1 of the first surface 62 is smaller than the area S2 of the second surface 64. The outermost edge 80 is not limited to a rectangle, and may be a square. That is, the outermost edge 80 may be a regular polygon. Since the area S1 of the first surface 62 is smaller than the area S2 of the second surface 64, it is easy to start forming the concave hole 100. Therefore, on the first surface 62, the concave hole 100 can be formed at an early stage by the bone B. Then, the shape of the outer edge 65 of the second surface 64 can be copied as the shape of the opening edge 100a of the concave hole 100.
Therefore, the number (number of stages) of the surfaces (treatment surfaces) along the longitudinal axis L in the treatment unit 54 is not limited to four or six, and may be two.

In the treatment section 54 shown in FIGS. 16A and 16B, the area S1 of the first surface 62 is larger than the area S2 of the second surface 64. It is considered that the cutting speed in the depth direction on the first surface 62 is inferior to that of the examples shown in FIGS. 15A and 15B, but it is possible to form the concave hole 100 having a large area with the same depth. The shape of the outer edge 65 of the second surface 64 can be copied as the shape of the opening edge 100a of the concave hole 100. Further, since the area S2 of the second surface 64 is reduced, the outer edge 65 of the second surface 64, that is, the finished surface at the outermost edge 80 can be made as smooth as possible.

(Fifth variant of the first embodiment)
The treatment unit 54 shown in FIGS. 17A and 17B has a first surface (plane) 62, a second surface (plane) 64, and a third surface (plane) 66. The treatment unit 54 here has three planes 62, 64, 66 unlike the embodiment including the above-mentioned modification.

In the treatment portion 54 shown in FIGS. 17A and 17B, the first surface 62 is formed in a circular shape, and the second surface 64 is formed in an annular shape. The area S1 of the first surface 62 is the same as or substantially the same as the area S2 of the second surface 64. The third surface 66 is formed in a substantially rectangular shape. The area S3 of the third surface 66 is larger than the area S2 of the second surface 64. Then, the shape of the outer edge 67 of the third surface 66 can be copied as the shape of the opening edge 100a of the concave hole 100. Even if the treatment portion 54 is formed in this way, the operator adjusts the orientation of the longitudinal axis L of the probe 46 around the axis based on the image observed through the arthroscope 16 to obtain the desired concave hole 100. Can be formed.

The number (number of stages) of the surfaces (treatment surfaces) along the longitudinal axis L in the treatment unit 54 is not limited to 4, 6, or 2, and may be 3.

The treatment portion 54 shown in FIG. 17C has a corner portion between the end faces 82 and 84 formed as a 1/4 circle of an appropriate radius with respect to the sharp state shown in FIG. 17B. On the other hand, the edge between the third surface 66 and the outermost edge 80 is preferably formed at a right angle as sharp as possible.
In the treatment section shown in FIG. 17C, the cutting amount (amount of cutting powder) of the bone B per unit time in the cross section along the Y-axis direction (first orthogonal direction) orthogonal to the longitudinal axis is as follows: Of 64 and 66, it depends on the width (dimension) of the portion that contributes to cutting the bone B. As shown in FIG. 17C, the dimension Dy1 of the Y-axis direction component of the first surface 62 is larger than the dimension Dy2 of the Y-axis direction component of the second surface 64. The dimension Dy2 of the Y-axis direction component of the second surface 64 is larger than the dimension Dy3 of the Y-axis direction component of the third surface 66.
Then, regarding the Y-axis direction component, the portion of the second surface 64 that contributes to cutting the bone B is the second along the Y-axis direction (first orthogonal direction) orthogonal to the longitudinal axis L. It is formed to have a size smaller than that of the surface 62 of 1. The portion of the third surface 66 that contributes to cutting the bone B is formed to have a smaller size than the portion that contributes to cutting the treatment target of the second surface 64. For this reason, the treatment portion 54 reduces the size of the portion contributing to cutting the bone B with respect to the Y-axis direction component toward the proximal end side from the distal end side along the longitudinal axis L.
Therefore, as described above, the treatment unit 54 has the outer edge of the second surface 64 rather than forming the surface (side surface) of the bone hole 100 at the outer edge 63 of the first surface 62 for the Y-axis direction component. When the surface (side surface) of the bone hole 100 is formed at 65, the finish of the cut surface becomes smooth. The treatment portion 54 is more likely to form the surface (side surface) of the bone hole 100 with the outer edge 67 of the third surface 66 than to form the surface (side surface) of the bone hole 100 with the outer edge 65 of the second surface 64. , The finish of the cutting surface becomes smooth. That is, the treatment portion 54 of the example shown in FIG. 17C is a surface (third surface 66) that is directed from the distal end side to the proximal end side along the longitudinal axis L and is separated from the longitudinal axis L in the Y-axis direction. The more the part that contributes to cutting the bone B is reduced. Therefore, in particular, the wall surface of the concave hole 100 when the bone B is cut to form the opening edge 100a can be made smoother.

In the treatment section 54 shown in FIG. 17D, when the proximal end side is viewed from the tip end side along the longitudinal axis L, the outermost edge 80 of the treatment section 54 is roughly two long sides and two semicircles. It is formed in a ring shape such as the track shape of an athletics stadium formed by. In the treatment section 54 shown in FIG. 17E, the outermost edge 80 of the treatment section 54 is formed in a substantially elliptical shape.
The treatment unit 54 of the example shown in FIGS. 17D and 17E is a surface (third surface 66) that is directed from the distal end side to the proximal end side along the longitudinal axis L and is separated from the longitudinal axis L in the Y-axis direction. ), The number of parts that contribute to cutting the bone B is reduced. Therefore, in particular, the wall surface of the concave hole 100 when the bone B is cut to form the opening edge 100a can be made smoother.

The outermost edge 80 of the treatment portion 54 is not limited to a quadrangle, but is formed into an appropriate shape such as a pentagon or a hexagon, or a shape close thereto.

The outermost edge (projected shape) 80 of the treatment portion 54 of the ultrasonic treatment tool 22 is formed into an appropriate shape such as a polygonal shape, a substantially polygonal shape, an elliptical shape, or a substantially elliptical shape. Therefore, as shown in FIGS. 9A to 9E, when the concave holes 100, 101, 102, 103 are appropriately formed by the treatment portion 54 according to the outer shape of the transplanted tendon 230, the concave holes 100, 101, 102, 103 are formed. The amount of space between the and the transplanted tendon 230 can be minimized, and the amount of cutting of the femur 112 and the tibia 114 can be reduced.

(Second Embodiment)
The second embodiment will be described with reference to FIGS. 18A and 18B. This embodiment is a modification of the first embodiment including each modification, and the members having the same functions as the members described in the first embodiment or having the same functions are designated by the same reference numerals as much as possible, and are described in detail. The explanation is omitted.

This embodiment is a modified example of the treatment unit 54 shown in FIG. In the present embodiment, as shown in FIG. 18A, the position where the concave hole 100 is planned to be formed and the orientation of the first surface 62 immediately before the concave hole 100 is formed at the desired position of the bone B on the first surface 62. An example having an index 90 for recognizing the positional relationship with and will be described.
The projected shape of the first surface 62 when viewed from the distal end side along the longitudinal axis L (inside the outer edge 63 of the first surface 62) is such that the second surface 64 is the longitudinal axis L. It is smaller than the projected shape (inside of the outer edge 65 of the second surface 64) when the base end side is viewed from the tip end side along the above. Therefore, the projected shape of the first surface 62 is inside the outer edge 65 of the second surface 64, inside the outer edge 67 of the third surface 66, and the outer edge of the fourth surface 68 (outermost edge 80). ) Is inside. This also applies to the treatment unit 54 shown in FIGS. 19A to 21B.

The treatment unit 54 according to the present embodiment has a first surface 62, a first side surface 72, a second surface 64, a second side surface 74, a third surface 66, a third side surface 76, and a fourth surface. It has 68 and a fourth side surface 78. The first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 are each formed in a rectangular shape. Therefore, the treatment portion 54 is formed in a stepped shape. The first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 extend along the X-axis direction. The width of the first surface 62, the second surface 64, the third surface 66, and the fourth surface 68 in the Y-axis direction is smaller than the width in the X-axis direction. The area S1 of the first surface 62 is larger than the area S2 of the second surface 64. The area S2 of the second surface 64 and the area S3 of the third surface 66 are the same. The area S3 of the third surface 66 and the area S4 of the fourth surface 68 are the same.
Here, due to the convex portion 92 described later, the tip of the convex portion 92 becomes the tip surface, and the first surface 62 becomes the second surface from the tip.

The treatment unit 54 has an index 90 recognized in the field of view of the arthroscope (endoscope) 16 when looking from the proximal end side to the distal end side along the longitudinal axis L. As an index 90, a convex portion 92 is formed on the first surface 62. The convex portion 92 projects from the rectangular first surface 62 toward the tip end side along the longitudinal axis L. The convex portion 92 is formed at each of the four corners in the present embodiment. The protrusion length along the longitudinal axis L of the convex portion 92 may be about the same as the height between the first surface 62 and the second surface 64 (see FIG. 12A), and the protrusion length of the convex portion 92 is the first. It may be higher or lower than the height between the surface 62 and the second surface 64.

The index 90 has a recess 94 formed on the fourth surface 68 and along the third side surface 76. Although not shown, the recess 94 may be formed in only one of the pair of end faces 84, or may be formed in both.

When the treatment portion 54 of the arthroscope 16 and the treatment tool 22 is arranged in the state shown in FIG. 1, the treatment portion 54 is recognized by the arthroscope 16 as shown in FIG. 18B. Then, both or one of the convex portion 92 and the concave portion 94 of the index 90 is recognized.

At this time, the operator can easily recognize the axial orientation of the longitudinal axis L of the treated portion 54 of the ultrasonic probe 46 with respect to the bone B. Since the convex portion 92 is formed on the center line Cy, it is easy to recognize the positional relationship between the center of the bone hole 100 and the center line Cy. Therefore, the concave hole 100 can be formed by using ultrasonic vibration in a state where the treatment portion 54 for the bone B is arranged at a desired position.

Further, when the cutting powder is continuously discharged by the treatment for forming the concave hole 100, the cutting powder becomes an obstacle toward the tip side of the treatment portion 54, and it becomes difficult to recognize the tip side of the treatment portion 54. Sometimes. Since the concave portion 94 is formed on the outermost edge 80, the orientation of the treated portion 54 with respect to the bone B can be easily recognized even when the cutting powder is continuously discharged by the treatment for forming the concave hole 100.

The area S0 of the tip surface of each convex portion 92 is smaller than the area S1 of the first surface 62. The protrusion 92 extends forward along the longitudinal axis L from the four corners of the first surface 62. As in the present embodiment, the contact area between the first surface 62 of the treatment portion 54 and the bone B is appropriately reduced, and the concave hole 100 is formed by the four convex portions 92 so as to be in a desired position. It is easy to form an initial hole in the bone B in a desired direction. Therefore, in the four convex portions 92, the concave hole 100 in the shape of the outer edge 63 of the first surface 62 is easily formed prior to the first surface 62. By forming four concave holes by the convex portion 92, the treatment portion 54 is moved in the depth direction earlier in a state where the treatment portion 54 is less likely to be displaced in the rotational direction with respect to the longitudinal axis L. The concave hole 100 can be started to be formed. Therefore, when the concave hole 100 is formed by a plurality of convex portions 92 such as four, the bone B is cut on the first surface 62 following the convex portion 92, and the concave hole 100 is cut at a desired position and in a desired direction. Can be formed.

Then, by starting to cut the bone B in the order of the first surface 62, the second surface 64, and the third surface 66, the opening edge 100a of the concave hole 100 can be expanded to a desired shape.

Further, as described with reference to FIGS. 11A to 11C, by forming the surfaces 62, 64, 66, ..., And the side surfaces 72, 74, ..., It is desired to form the surfaces in one operation along the longitudinal axis L. The size of the treatment portion 54 can be set according to the size of the bone hole 100 and the like. Therefore, depending on the size setting of the treatment portion 54, the visibility of the convex portion 92 can be improved.
Further, as shown in FIGS. 12A to 12C, the amount of protrusion of the convex portion 92 protruding from the first surface 62 is appropriately set. Therefore, depending on the setting of the protrusion amount of the convex portion 92, the visibility of the convex portion 92 can be improved.
In the treatment section 54 in the present embodiment, the first surface 62 to the fourth surface 68 and the first side surface 72 to the fourth side surface 78 are formed in the shapes shown in FIGS. 11A to 12C, for example. Of course, it is preferable.

(First modification of the second embodiment)
This modification is a modification of the treatment unit 54 shown in FIG. 13C. In this modification, as shown in FIG. 19A, the convex portion 92 is formed on the center lines Cx and Cy and is continuous with the end faces 82 and 84. The third surface 66 is formed at a corner portion between the end surfaces 82 and 84 as a recess 94 with respect to the second surface 64, respectively. That is, the recess 94 is formed so as to straddle the end faces 82 and 84 of the outermost edge 80.

When the treatment portion 54 of the arthroscope 16 and the treatment tool 22 is arranged in the state shown in FIG. 1, the treatment portion 54 is recognized by the arthroscope 16 as shown in FIG. 19B. Then, both or one of the convex portion 92 and the concave portion 94 of the index 90 is recognized.

At this time, the operator can easily recognize the axial orientation of the longitudinal axis L of the treated portion 54 of the ultrasonic probe 46 with respect to the bone B. Since the convex portion 92 is formed on the center lines Cx and Cy and is continuous with the end faces 82 and 84, it is easy to recognize the positional relationship between the center of the bone hole 100 and the center lines Cx and Cy. Therefore, the concave hole 100 can be formed by using ultrasonic vibration in a state where the treatment portion 54 for the bone B is arranged at a desired position.

Since the recess 94 is formed at the outermost edge 80, the position of the hole of the bone B to be formed and the orientation of the treated portion 54 can be easily recognized.

When the proximal end side is viewed from the distal end side along the longitudinal axis L, the width (dimension) of the convex portion 92 along the Y-axis direction (first orthogonal direction) orthogonal to the longitudinal axis L is the first. Of the surface 62 of 1, it is smaller than the width (dimension) along the Y-axis direction. Similarly, the width (dimensions) along the X-axis direction (second orthogonal direction) is smaller than the width (dimensions) along the X-axis direction of the first surface 62. The area S0 of the tip surface of each convex portion 92 is smaller than the area S1 of the first surface 62. The convex portion 92 is formed on Cx and Cy. The ridges 92 form the four recesses earlier. Therefore, in a state where the treatment portion 54 is less likely to be displaced in the rotational direction with respect to the longitudinal axis L, the treatment portion 54 is moved in the depth direction along the longitudinal axis L earlier to form the concave hole 100. You can start doing it. Therefore, when the concave hole 100 is formed by a plurality of convex portions 92 such as four, the bone B is cut on the first surface 62 following the convex portion 92, and the concave hole 100 is cut at a desired position and in a desired direction. Can be formed.

(Second variant of the second embodiment)
As shown in FIG. 20A, the convex portions 92 are provided at the four corners of the first surface 62, and the concave portions 94 are formed on the center lines Cx and Cy between the end surfaces 82 and 84 of the outermost edge 80. The third surface 66 is formed as a recess 94 with respect to the second surface 64 on the center lines Cx and Cy between the end surfaces 82 and 84 of the outermost edge 80, respectively.

When the treatment portion 54 of the arthroscope 16 and the treatment tool 22 is arranged in the state shown in FIG. 1, the treatment portion 54 is recognized by the arthroscope 16 as shown in FIG. 20B. Then, both or one of the convex portion 92 and the concave portion 94 of the index 90 is recognized.

At this time, the operator can easily recognize the axial orientation of the longitudinal axis L of the treated portion 54 of the ultrasonic probe 46 with respect to the bone B. Since the convex portion 92 is formed at the corner of the first surface 62 and is continuous with the end surfaces 82 and 84, it is easy to recognize the positional relationship between the central position of the bone hole 100 to be formed and the convex portion 92. .. Therefore, the concave hole 100 can be formed by using ultrasonic vibration in a state where the treatment portion 54 for the bone B is arranged at a desired position.

Since the recess 94 is formed at the outermost edge 80, the position of the hole of the bone B to be formed and the orientation of the treated portion 54 can be easily recognized.

When the proximal end side is viewed from the distal end side along the longitudinal axis L, the width (dimension) of the convex portion 92 along the Y-axis direction (first orthogonal direction) orthogonal to the longitudinal axis L is the first. Of the surface 62 of 1, it is smaller than the width (dimension) along the Y-axis direction. Similarly, the width (dimensions) along the X-axis direction (second orthogonal direction) is smaller than the width (dimensions) along the X-axis direction of the first surface 62. The area S0 of the tip surface of each convex portion 92 is smaller than the area S1 of the first surface 62. The protrusion 92 is formed at a corner of the first surface 62. The ridges 92 form the four recesses earlier. Therefore, in a state where the treatment portion 54 is less likely to be displaced in the rotational direction with respect to the longitudinal axis L, the treatment portion 54 is moved in the depth direction along the longitudinal axis L earlier to form a concave hole 100. You can start doing it. Therefore, when the concave hole 100 is formed by the convex portion 92, the bone B is cut on the first surface 62 following the convex portion 92, and the concave hole 100 is formed at a desired position and in a desired direction. can.

(Third variant of the second embodiment)
This modification is a modification of the treatment unit 54 shown in FIGS. 14A and 14B. As shown in FIG. 21A, the treatment portion 54 is formed in a substantially pyramid shape. The first surface 62 has a convex portion 92. The protrusions 92 are formed at the four corners of the first surface 62, respectively.

When the treatment portion 54 of the arthroscope 16 and the treatment tool 22 is arranged in the state shown in FIG. 1, the treatment portion 54 is recognized by the arthroscope 16 as shown in FIG. 21B. Then, the convex portion 92 of the index 90 is recognized.

At this time, the operator can easily recognize the axial orientation of the longitudinal axis L of the treated portion 54 of the ultrasonic probe 46 with respect to the bone B. Since the convex portion 92 is formed at the corner of the first surface 62 and is continuous with the first side surface 72, the positional relationship between the central position of the bone hole 100 to be formed and the convex portion 92 is recognized. easy. Therefore, the concave hole 100 can be formed by using ultrasonic vibration in a state where the treatment portion 54 for the bone B is arranged at a desired position.

The area S0 of the tip surface of each convex portion 92 is smaller than the area S1 of the first surface 62. The protrusion 92 is formed at a corner of the first surface 62. The ridges 92 form the four recesses earlier. Therefore, in a state where the treatment portion 54 is less likely to be displaced in the rotational direction with respect to the longitudinal axis L, the treatment portion 54 is moved in the depth direction along the longitudinal axis L earlier to form the concave hole 100. You can start doing it.

Therefore, in the example shown in FIGS. 18A to 21B, the orientation of the treatment portion 54 of the treatment tool 22 with respect to the position where the bone hole 100 is desired to be formed in the bone B is determined by the index 90 in an appropriate state under the view of the arthroscope 16. Can be easily adjusted to.

Further, when the convex portion 92 is provided as the index 90, the initial cutting can be performed to prevent the treated portion 54 from slipping with respect to the bone B. Therefore, according to the present embodiment, it is possible to provide an ultrasonic probe and an ultrasonic treatment assembly capable of improving the treatment efficiency, for example, when forming a hole in a bone.

So far, some embodiments have been specifically described with reference to the drawings, but the present invention is not limited to the above-described embodiments, and all the embodiments performed without departing from the gist thereof. include.

Claims (7)

A probe main body that transmits ultrasonic vibrations generated by ultrasonic transducers arranged on the proximal end side along the longitudinal axis from the proximal end side to the distal end side along the longitudinal axis.
A treatment portion provided on the distal end side of the probe main body along the longitudinal axis.
A first cutting surface that is orthogonal or substantially orthogonal to the longitudinal axis,
A second cutting surface provided on the proximal end side along the longitudinal axis with respect to the first cutting surface, and
A treatment portion having a convex portion having a tip surface protruding from the first cutting surface toward the tip side along the longitudinal axis is provided .
The convex portion is an ultrasonic probe provided at a position recognizable as an index recognized in the field of view of the endoscope when the distal end side is viewed from the proximal end side along the longitudinal axis . The ultrasonic probe according to claim 1, wherein the area of the tip surface of the convex portion is smaller than the area of the first cutting surface. The first cutting surface has a corner and has an angle.
The ultrasonic probe according to claim 1, wherein the convex portion is arranged at the corner of the first cutting surface. The first cutting surface has an end surface between the first cutting surface and the second cutting surface.
The ultrasonic probe according to claim 3, wherein the convex portion is arranged along the end surface of the first cutting surface. The first cutting surface has an end surface between the first cutting surface and the second cutting surface.
The convex portion defines two axes orthogonal to each other passing through the center of the first cutting surface when the treated portion is viewed from the distal end side to the proximal end side along the longitudinal axis. The ultrasonic probe according to claim 1, which is formed on an axis and is continuous with the end face. According to claim 1, the treated portion has a recess on the end surface of the outermost edge of the treated portion as an index recognized in the field of view of the endoscope when looking from the proximal end side to the distal end side along the longitudinal axis. The described ultrasonic probe. The ultrasonic probe according to claim 1 and
It is connected to the base end of the probe main body along the longitudinal axis, generates ultrasonic vibration by supplying power, and inputs the ultrasonic vibration to the proximal end of the ultrasonic probe along the longitudinal axis. An ultrasonic treatment assembly comprising an ultrasonic transducer that transmits the ultrasonic vibration to the treatment unit.

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