JPH0563513U - Stripper - Google Patents

Abstract

(57) [Summary] (Modified) [Purpose] Safely and easily detach the periosteum between the psoas muscle and the vertebral body. [Structure] The peeler includes a shaft 1, a curved peeling portion 2 provided at one end of the shaft 1, and a handle 3 provided at the other end of the shaft 1. The peeling portion 2 has a curved portion that follows the outer shape of the vertebral body of the bone, has a straight portion A at the root portion thereof with the shaft 1, and exerts a force on the ventral side of the body when the peeler is inserted into the body. , Never bite into the vertebral body.

Description

[Detailed description of the device]

[0001]

[Industrial applications]

 The present invention relates to a dissector, and more particularly to a dissector suitable for corrective surgery for scoliosis and kyphoscoliosis due to spinal deformity.

[0002]

[Prior Art]

 Humans have 32 vertebrae from just below the head to below the waist. The vertical connection of these vertebrae is called the vertebral column, and they are classified into five parts from the top, the cervical vertebra, the thoracic vertebra, the lumbar vertebra, the sacral vertebra, and the tail vertebra. The shape of the spine is slightly different for each part, but it is common in that there is a round vertebral body on the abdominal side and an arcuate arch on the back side.

As shown in FIG. 16, the spine L ₁ includes spinous processes 20, vertebral arches 21, transverse processes 4, 4, pedicles 5, 5 and vertebral bodies 6. A vertebra 7 is formed by the vertebral arch 21 and the vertebral body 6, and the vertebra 7 accommodates a spinal nerve 9 which is surrounded by a dura 8. The spine L ₁ is surrounded by the back muscles 10 and 10 and the psoas muscles 11 and 11, and the aorta 12 and the inferior vena cava 13 exist near the abdominal side of the vertebral body 6.

By the way, an intervertebral disc is interposed between the vertebral bodies 6 arranged above and below in order to prevent the vertebral bodies from directly contacting each other. Of the vertebral body 6 is deformed, resulting in deformation of the vertebral body 6. The deformation of the vertebral body 6 causes a disease in which the spinal column S is abnormally bent, that is, a high degree of scoliosis / kyphoscoliosis (see FIG. 17).

In order to correct severe scoliosis and kyphoscoliosis, the spine L extending over the entire periphery of the spinal nerve 9 ₁ Is required, and when the spinal nerve 9 is pressed by osteophytes, ossification lesions, etc., the spinal vertebra L that surrounds the entire spinal nerve 9 should be removed in order to remove the pressure.₁ Bone cutting is required.

Conventionally, corrective surgery for scoliosis / kyphoscoliosis which requires osteotomy of the spine L ₁ has been performed twice from both the abdominal side and the back side.

[0007]

[Problems to be solved by the device]

 The site to be operated is a place where important blood vessels such as the spinal nerve or aorta, the inferior vena cava, or the epidural venous plexus that control movement and perception are intermingled. There is a problem that it is difficult to correct scoliosis and kyphoscoliosis because it is necessary to cut the bone or peel the periosteum.

The present invention has been made in view of such circumstances, and an object thereof is to provide a dissector capable of safely and easily exfoliating the periosteum.

[0009]

[Means for Solving the Problems]

 In order to solve the above-mentioned problems, a detacher of the present invention comprises a shaft portion, a curved peeling portion provided at one end of the shaft portion, and a handle portion provided at the other end of the shaft portion, and is provided with a periosteum. In the dissector to be peeled off, the peeling portion as a whole has a curved shape close to the outer shape of the vertebral body, and the root portion of the peeling portion that bends from the shaft portion has a linearly extending portion, and this root portion has a predetermined curvature. It is characterized in that curved portions having a radius are connected.

[0010]

[Action]

 As mentioned above, the exfoliated part is curved as a whole close to the outer shape of the vertebral body, and its root extends linearly.Therefore, it is possible that the tip of the curved part bites into the vertebral body during periosteal exfoliation. However, when the dissector is inserted around the bone, it becomes easier to insert it, and the periosteum is extremely easily separated.

[0011]

【Example】

 Next, an embodiment of the present invention will be described with reference to the drawings. 1a is a side view showing a peeler according to an embodiment of the present invention, FIG. 1b is a sectional view of a peeling portion, and FIG. 2 is a plan view thereof. The stripper 22 of the present invention has a cylindrical shaft 1, a stripping portion 2 is provided at the tip of the shaft 1, and a handle 3 is provided at the root of the shaft 1. The peeling portion 2 is curved so that its entire shape is close to the outer shape of the vertebral body (FIG. 4), the peeling portion 2 has a flat sectional shape (FIG. 1b), and the shaft 1 has a circular sectional shape. .. As shown in FIG. 1, the base portion of the peeling portion 2 with respect to the shaft 1 has a straight line portion A extending at a predetermined angle θ with respect to the axis of the shaft 1, for example, an angle of 40 ° ± 2 °. A curved portion B having a radius of curvature of, for example, 15 R (mm) is connected to the portion A. The tip of the curved portion B slightly projects upward from the axis a of the shaft 1, and the distance between the lower curved end of the peeling portion 2 and the tip t of the curved portion is set to 14.5 mm. The projecting length from is set to 3 mm. A seam J is provided at an intermediate portion of the shaft 1, and the shaft 1 is welded and joined at the seam J. A large number of grooves 1a along the axis are formed in the root of the shaft 1, and the other end of the shaft 1 is driven and joined to the connecting hole 3a of the handle 3.

Next, based on FIGS. 3 to 15, a case in which this dissector is used for corrective surgery for kyphosis will be described. As shown in FIG. 3, most of the vertebrae L ₁ between both vertebrae L ₂ and L ₃ are removed by removing the vertebral body pieces C and D to correct the kyphosis. Try to overlap body pieces C and D.

First, as shown in FIG. 4, the spine L1 is incised from the back side, the back muscles 10, 10 on both sides are opened laterally, and the vertebral arch 21, spinous process 20, and lateral processes 4, 4 are exposed. .. Next, after the lateral projections 4 and 4 are cut off, as shown on the left side of FIG. 5, the periosteum between the psoas muscle 11 and the vertebral body 6 is peeled off by the peeler 22 of the present invention, and this peeling is performed. As shown on the right side of the figure, the retractor 14 is inserted into the portion and the psoas muscle 11 is deployed to secure the visual field.

As described above, the radius of curvature of the exfoliation part 2 of the exfoliator 22 is substantially along the outer shape of the vertebral body 6, and the shape of the exfoliation part is such that when the exfoliator 22 is inserted between the vertebral body 6 and the periosteum. The force is not applied excessively toward the vertebral body 6 but toward the center of the body, so that the detachment element 22 can be smoothly inserted to the abdominal side of the vertebral body 6. That is, according to this detachment element 22, the tip of the exfoliation part 2 does not bite into the vertebral body 6 and the periosteum between the vertebral body 6 and the psoas muscle 11 is easily detached from the vertebral body 6 while being easily removed. The peeling portion 2 can be inserted along the outer periphery of the vertebral body 6 to the abdominal side, and the periosteum can be peeled safely and easily.

After the periosteum on the outer periphery of the vertebral body 6 is separated by the dissector 22, the psoas muscles 11 and 11 are expanded to both sides by the two retractors 14 and 14 to secure the visual field (FIG. 6), and the spinous process 20 and The pedicle 21 is cut to expose the dura 8 (FIGS. 6 and 7). There is an epidural venous plexus 15 between the dura 8 and the vertebral body 6, and if this site is damaged, it will bleed and it will be difficult to secure a visual field.

Next, the pedicles 5, 5 and part of the vertebral body 6 are cut off (FIG. 8), and the aorta 12 and the inferior vena cava 13 are protected by the two retractors 14, 14. The inside of the vertebral body 6 is cut off by cutting the cancellous bone 6c with the curved chisel 16 leaving the entire cortical bone 6a on the back side of the vertebral body 6 and a part of the cortical bone 6b on the abdominal side (FIGS. 8 and 9). It is dug up to form an empty state.

Further, the cortical bone 6a on the back side adjacent to the epidural venous plexus 15 described above is cut. A corneal bone cutting chisel 17 is inserted from the side of the cortical bone 6a (FIGS. 10 and 11) to cut the cortical bone 6a so as not to damage the epidural venous plexus 15. After removing the parenchymal bone 6a from the epidural venous plexus 15, burrs 6c and 6c remain as shown in FIG. 12, and the burrs 18 are then used to remove the burrs of the cortical bone 6a (FIG. 12). .. After deburring, the plate-shaped vertebral body piece C and the vertebral body piece D (FIG. 113) extending from the cortical bone 6b in an open state are joined as shown in FIG. 14 to correct the curvature. Finally, in order to maintain this corrected state, the vertebrae L ₂ and L ₃ above and below the vertebral body pieces C and D are connected by a fixing device (FIG. 15).

This fixing device is composed of screws 19a and 19b that are driven into the vertebral bodies L ₂ and L ₃ and a rod 20 that connects the outer ends of both screws 19a and 19b. A female screw is provided on the head of the rod, and a male screw is threaded on the outer periphery of the rod 20. Screws 19a and 19b are embedded in the vertebrae L2 and L3, respectively, and both ends of the rod 20 are screwed into the heads of these screws 19a and 19b, and the vertebral body pieces C and D are fixedly held in contact with each other. Correct the curvature of S.

[0019]

[Effect of the device]

 As explained above, according to the detacher of the present invention, when the detached portion is inserted between the vertebral body and its periosteum, the tip of the detached portion does not bite into the vertebral body, and the force of insertion is high. Since it acts on the front half of the detached portion, the detached portion smoothly advances along the outer periphery of the vertebral body, and the periosteum on the vertebral body can be detached safely and easily.

[Brief description of drawings]

[1] Figure 1a is a side view of a release element according to the embodiment, FIG. 1b is a cross-sectional view taken along the I _b -I _b line of FIG. 1a.

FIG. 2 is a plan view of a peeler.

FIG. 3 is an explanatory diagram of a curved correction state.

FIG. 4 is a transverse cross-sectional view of the spine when the back side is incised.

FIG. 5 is a transverse cross-sectional view of the spine showing the use of the dissector and retractor.

FIG. 6 is a transverse cross-sectional view of the spine when the psoas muscle is deployed by the retractor.

FIG. 7 is a side view of the spine in the state of FIG.

FIG. 8 is a transverse cross-sectional view of the spine showing a state in which a part of the arch root and the vertebral body is cut off.

FIG. 9 is a transverse cross-sectional view of the spine showing osteotomy of the cancellous bone of the vertebral body with a curved chisel.

FIG. 10 is a transverse cross-sectional view of a spine showing osteotomy of cortical bone of a vertebral body with a flea for cutting cortical bone.

FIG. 11 is a longitudinal cross-sectional view of a spine showing osteotomy of cortical bone of a vertebral body with a flea for cutting cortical bone.

FIG. 12 is a longitudinal sectional view of the spine showing deburring of cortical bone with a chisel for deburring.

FIG. 13 is a longitudinal sectional view of the spine after deburring.

FIG. 14 is a side view showing a joined state of the cervical body piece on the neck side and the vertebral body piece on the leg side.

FIG. 15 is an explanatory view showing a mounting state of a fixing tool for correcting a curvature.

FIG. 16 is a transverse cross-sectional view of the spine.

FIG. 17 is an explanatory diagram illustrating typical kyphosis of the spinal column.

[Explanation of symbols]

 1 ... Shaft 2 ... Peeling part 3 ... Handle 22 ... Peeler A ... Straight part B ... Curved part

Claims (1)

[Scope of utility model registration request] 1. A peeler for peeling periosteum, comprising a shaft portion, a curved peeling portion provided at one end of the shaft portion, and a handle portion provided at the other end of the shaft portion. Has a curved shape close to the outer shape of the vertebral body as a whole, and a root portion that bends from the shaft portion of the peeling portion has a linearly extending portion, and a curved portion having a predetermined radius of curvature is connected to the root portion. A stripper characterized by the above.