JPH0956727A - Wire inductor for reconstructive operation of posterior cruciate ligament - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a wire inductor capable of inserting a wire for ligament induction into a tibial hole through a satisfactory route without going around the posterior cruciate ligament or the articular capsule of a living body. SOLUTION: The wire inductor 1 for the reconstructive operation of posterior cruciate ligament is a tubular body provided with a tip end part insertable into the opening 42 of a hole 41 formed in the tibia 40 near the knee joint, bendable part connecting to the tip end part so as to induce it into the opening 42 of the hole 41, and a main body connecting to the bendable part. The tubular body is equipped with a wire inserting port 6 provided at the base end of the main body, wire discharging port 7 provided at the tip end part, and a wire passage communicating the wire inserting port 6 with the wire discharging port 7.

Description

Detailed Description of the Invention

[0001]

TECHNICAL FIELD The present invention relates to a wire used for introducing a reconstruction ligament to be transplanted into a bone hole formed in a tibial side bone in a posterior cruciate ligament reconstruction operation in the bone hole. The present invention relates to a wire inductor for inductive placement.

[0002]

2. Description of the Related Art In a posterior cruciate ligament reconstruction operation currently being performed, a first bone hole (tibial hole) is formed on the tibia side for the purpose of transplantation of a reconstruction ligament (for example, artificial ligament), and a femur is formed. A second bone hole (femoral bone hole) is formed on the side, and an artificial ligament is implanted so as to penetrate these two bone holes, near the anterior mouth of the tibial bone hole and the upper mouth of the femoral bone hole. The ligament is being reconstructed by fixing the ligament at. Since it is difficult to insert the ligament directly into the bone hole, a guide wire is used. The guide wire is made of a metal whose tip portion is curved and which is elastically deformable to some extent. Conventionally, this wire is inserted through the lower opening (anterior mouth) of the tibial tunnel, and the part discharged from the upper posterior orifice is confirmed by an arthroscope inserted in the knee joint, and then inserted through the femoral hole. The tibial bone hole and the femoral bone hole are penetrated by pinching and pulling out with the instrument.

[0003]

However, in the above method, the remaining posterior cruciate ligaments and articular vesicles are obstructed, and it is difficult to confirm with an arthroscope inserted into the knee joint. It was not easy to guide the wire tip to the lower opening of the bone hole. Further, the advancement of the wire can be achieved only by pushing it from the proximal end portion of the wire, and it is uncertain what route the distal end portion takes to reach the lower opening of the femoral hole. For this reason, the wire may bypass the posterior cruciate ligament and the articular cyst where the wire remains, and may reach the lower opening of the femoral bone hole. In this case, the reconstruction ligament to be guided later has to bypass the posterior cruciate cruciate ligament and the joint vesicle as well as the wire advancing path, and the insertion resistance of the ligament is large, and this work may be difficult. there were.

An object of the present invention is to insert a wire for guiding a ligament into the tibial bone tunnel into the knee joint by a good route without bypassing the posterior cruciate ligament, articular cyst, etc. A wire guide for posterior cruciate ligament reconstruction that can be easily checked by an arthroscope inserted into the knee joint and pulled up to the femoral bone tunnel by connecting the suture thread to the knee joint. To provide a container.

[0005]

The object of the present invention is to provide a tip portion that can be inserted into an opening of a bone hole formed in a tibia near the knee joint in posterior cruciate ligament reconstruction, and the tip portion. A tubular body which is continuous and has a curved portion for guiding the tip portion to the opening of the bone hole, and a main body portion continuous with the curved portion, wherein the tubular body is A wire introducer for posterior cruciate ligament reconstruction having a wire insertion opening provided at the proximal end, a wire ejection opening provided at the distal end, and a wire passage that connects the wire insertion opening and the wire ejection opening. Is.

The wire inductor is inserted into the knee joint from the front of the knee joint in the posterior cruciate ligament reconstruction operation, and the wire is inserted with the tip portion inserted into the opening of the bone hole. The insertion port is located outside the knee joint. Further, it is preferable that the wire inductor has a grip portion attached to the main body portion.
Further, the outer diameter of the tip portion is preferably 10 mm or less.

[0007] Further, what solves the above-mentioned problems is a cylinder formed in a shape which can pass from the front of the knee joint into the knee joint and reach the posterior mouth of the tibial tunnel for posterior cruciate ligament reconstruction from the proximal posterior edge of the tibia. A tubular body, wherein the tubular body has a wire insertion port provided at a proximal end portion of the tubular body, a wire ejection port provided at a distal end portion of the tubular body, and the wire insertion port. It is a wire inductor for posterior cruciate ligament reconstruction surgery having a wire passage communicating with the wire discharge port.

[0008]

BEST MODE FOR CARRYING OUT THE INVENTION A wire inductor for posterior cruciate ligament reconstruction according to the present invention will be described with reference to an embodiment shown in the drawings. 1 is a front view of an embodiment of a wire inductor for posterior cruciate ligament reconstruction according to the present invention, and FIG. 2 is a sectional view of FIG. 1 and FIG.
4 is a sectional view taken along the line AA of FIG. 1, and FIG. 4 is a sectional view taken along the line BB of FIG. FIG. 5 is a partially cutaway front view of the wire guiding instrument in which the handle is attached to the wire inductor for posterior cruciate ligament reconstruction according to the present invention. 6, FIG. 7, FIG. 8 and FIG.
It is explanatory drawing for demonstrating the effect | action of the wire inductor for posterior cruciate ligament reconstruction surgery of this invention.

[0009] After this, wire inductor 1 for cruciate ligament reconstruction
Is a tibia (tibia bone) near the knee joint, as shown in FIG.
The tip 2 that can be inserted into the opening (posterior opening) 42 of the bone hole 41 formed in 40, and the curved portion 3 that is continuous with the tip 2 and that guides the tip 2 to the opening 42 of the bone hole 41. And a main body 4 which is continuous with the curved portion 3 and is a tubular body 11.
The tubular body 11 includes a wire insertion port 6 provided at the base end portion of the main body portion 4 and a wire discharge port 7 provided at the tip end portion 2.
And a wire passage 8 that connects the wire insertion port 6 and the wire discharge port 6 with each other.

The wire guide 1 for posterior cruciate ligament reconstruction, if expressed differently, passes from the front of the knee joint through the inside of the knee joint, and from the posterior posterior edge of the tibia to the posterior of the tibial bone hole for posterior cruciate ligament reconstruction. A tubular body 11 formed to have a shape that can reach a mouth, the tubular body 11 being provided at a wire insertion port 6 provided at a proximal end portion of the tubular body and at a distal end portion 2 of the tubular body. It also has the wire discharge port 7 and the wire passage 8 which connects the wire insertion port 6 and the wire discharge port 7.

Therefore, the wire inductor 1 for posterior cruciate ligament reconstruction will be described with reference to the drawings. What constitutes the inductor 1 is a tubular body 11, and the tubular body 11 of this embodiment is used.
Has a passage 8 that extends from the proximal end to the distal end 5, as shown in FIGS. The tubular body 11 includes a tip portion 2,
The curved portion 3 and the main body portion 4 are provided and integrally formed.

The tip portion 2 is a portion that penetrates into the opening (posterior opening) of the bone hole, and as shown in FIG. 4, is substantially linear. The length of the straight part is 5 to 20 m
m is preferable, and 7 to 15 mm is particularly preferable.
If the length is 5 mm or more, the tip portion once entering the opening of the bone hole does not easily separate from the bone hole, and is 20 m.
If it is m or less, it is easy to enter the opening of the bone hole. The front end surface 2a of the front end portion 2 is a tapered surface that gently reduces in diameter. Furthermore, its outer surface is a chamfered curved surface. Therefore, when the bone hole enters the opening, the opening is not damaged. An opening (wire discharge port) 7 is formed at the tip 5. A curved portion 3 is formed on the base end side of the tip portion 2. This curved portion is for guiding the above-mentioned tip 2 to the opening of the tibial bone hole from the medial direction of the joint.

The bending portion 3 has an intersection angle R between an axis line X of the main body portion 4 immediately on the base end side of the bending portion 3 and an axis line Y of the tip portion 2.
Is 90 ° or less. in this way,
By forming the intersection angle (internal angle) to be 90 ° or less, it becomes easy to guide the tip portion to the opening of the bone hole. Particularly, the crossing angle R is preferably 50 ° to 80 °. A body portion 4 is formed on the base end side of the bending portion 3. The main body portion 4 includes a first bending point 4b and a second bending point 4c from the tip side. By having such two bending points and the above-described bending portion 3 and tip portion 2, the tubular body 11 passes through the inside of the knee joint from the front of the knee joint and the tibia for reconstruction of the posterior cruciate ligament from the posterior proximal edge of the tibia. The shape is such that the posterior ostium of the lateral bone can be easily reached.

A wire insertion opening 6 and a handle attachment portion 9 are provided at the base end 4a of the main body portion 4 on the base end side of the insertion opening 6. The base end portion 4a has a third curved point 4d.
Are formed so as to be substantially parallel to the tip portion 2 and the base end and the tip end face substantially the same direction. This curved point 4
d is not a site to be inserted into the knee joint and does not necessarily have to be provided, but by having such a shape,
The work of inserting the inductor into the knee joint becomes easy. The wire insertion port 6 is provided slightly closer to the base end side than the bending point 4d, and is formed to have a predetermined angle with respect to the axis of the base end portion 4a. That is, the insertion port 6 is formed obliquely from the base end portion 4a toward the curved point. Therefore, the wire can be easily inserted. The passage 8 may not be provided on the base end side of the insertion port 6. Further, as shown in FIGS. 2 and 3, the inner surface of the passage 8 is a smooth surface having no protrusion or the like which hinders the movement of the wire. And
At the time of surgery, the proximal side of the bending point 4d of the inductor 1 is not inserted into the knee joint but is exposed to the outside of the living body. Therefore, at the time of surgery, the wire insertion port is also located outside the living body, so that the wire can be easily inserted. The main body 4 is not limited to the shape shown in FIGS. 1 and 2, and may be, for example, a substantially linear shape. In this case, the base end opening may be used as a wire insertion opening. Good.

It is preferable that the tubular body 11 has a hardness such that it is not easily deformed, and a metal, a hard synthetic resin or the like can be used as a forming material. Preferably, it is a metal, for example, SUS304, SUS31
6, stainless steel such as SUS321, copper alloy such as Cu—Zn alloy, and the like. Further, as the hard synthetic resin, thermoplastic resins such as polycarbonate, polyamide, polysulfone, polyarylate, and methacrylate-butylene-styrene copolymer can be preferably used.

The tubular body 11 has substantially the same outer diameter except for the tip. The outer diameter is preferably 13 mm or less,
Particularly, 12 mm to 4 mm is preferable. Also, the outer diameter of the tip portion that penetrates into the opening of the bone hole is preferably 13 mm or less, and particularly preferably about 10 mm to 4 mm. Further, the outermost diameter is preferably about 6 mm to 3 mm. Furthermore, the length of the tubular body 11 from the wire insertion port to the wire discharge port is preferably about 100 mm to 200 mm, and particularly preferably 120 mm to 160 mm.
No. Further, the distance from the wire insertion port to the wire ejection port is preferably about 90 mm to 150 mm.

The handle attachment portion 9 of the tubular body 11 has a partially formed flat surface portion, and the handle 20 is attached to the attachment portion 9 as shown in FIG.
FIG. 5 is a partially cutaway front view of the wire guiding device 20 including the inductor shown in FIG. 1. In this guide device 20,
The inductor 1 and the handle 21 can be separated. In addition, the inductor 1
As shown in FIG. 2, since has a passage 8 that is open from the base end to the tip, it is easy to clean the inside of the passage for removing blood and living tissue that have entered the passage 8 during use.

The handle 21 comes into contact with a hole 22 for inserting the handle attaching portion 9 of the inductor 1 and a flat surface portion of the attaching portion 9 at the tip, and a fixing screw for fixing the inductor 1 to the handle 21. 24 and a screw hole 23 for the screw 24 are provided. Further, the surface of the handle 21 has a notch 2 for preventing slippage.
5 are formed.

Next, the operation of the inductor of the present invention will be described with reference to an induction device equipped with an inductor. As shown in FIG. 6, the hook 31 of the posterior cruciate ligament reconstruction bone hole forming device 30 is pushed in from the front of the knee joint, and the tip portion is passed through the knee joint and hooked on the posterior edge of the tibia. Although not shown, an arthroscope is inserted in the knee joint. Then, the drill 32 of the forming tool 30
Is advanced toward the tip of the hook 31 to form the tibial bone hole 41. Then, as shown in FIG.
Alternatively, the femoral bone hole 51 is formed in the femur 50 using another bone hole forming device. After the bone hole forming device 30 is removed, the tip 2 of the guide device 1 of the guide device 20 is inserted through the wound formed on the skin surface of the knee joint after the hook 31 is removed,
The inductor is pushed forward in sequence, and after the tip 2 reaches near the posterior edge of the tibia, the handle is operated to move the tip appropriately. When the tip reaches the posterior mouth 42 of the tibial tunnel 41, the shape of the curved portion 3 and the tip 2 allows the tip 2 to enter the posterior mouth 42.

Then, the reconstruction ligament guide wire 10 is inserted through the wire insertion port 6. The wire 10 passes through the passage 8 in the inductor 1, protrudes from the wire discharge port 7 formed at the distal end opening, passes through the tibial bone hole 41, and the tibial bone hole 41.
Projects from the front opening 43. With the portion of the wire 10 protruding from the front opening 43 being held, the inductor 1 is removed from the knee joint and the suture thread 15 is attached to the proximal end of the wire 10. This state is shown in FIG.

Then, the tip of the wire 10 protruding from the anterior port 43 of the tibial bone hole 41 is pulled to replace the wire 10 with the suture thread 15, and the suture thread 15 is inserted with an arthroscope inserted into the knee joint. After checking, a grasping instrument is inserted through the femoral bone hole 51, the suture thread 15 is grasped, and the suture thread 15 is pulled up. As a result, as shown in FIG. 9, the suture thread 15 is attached to the tibial tunnel 41.
And it will be in the state which penetrated the femoral bone hole 51. And
A ligament for reconstruction is attached to the suture thread 15, and the suture thread 15 is pulled to make the ligament for reconstruction pass through the tibial bone hole 41 and the femoral bone hole 51, and both ends thereof are fixed, thereby performing the ligament reconstruction procedure. Ends.

[0022]

EFFECTS OF THE INVENTION The wire inductor for posterior cruciate ligament reconstruction according to the present invention includes a distal end that can be inserted into an opening of a bone hole formed in a tibia near the knee joint in the posterior cruciate ligament reconstruction, and the distal end. A tubular body which is continuous and has a curved portion for guiding the tip portion to the opening of the bone hole, and a main body portion continuous with the curved portion, wherein the tubular body is It has a wire insertion port provided at the base end portion, a wire ejection port provided at the distal end portion, and a wire passage that connects the wire insertion port and the wire ejection port. Further, the wire inductor for posterior cruciate ligament reconstruction according to the present invention is formed into a shape that can pass through the inside of the knee joint from the front of the knee joint and reach the posterior mouth of the tibial tunnel for posterior cruciate ligament reconstruction from the proximal posterior edge of the tibia. And a wire insertion port provided at a base end portion of the tubular body, a wire discharge port provided at a distal end portion of the tubular body, and the wire. It has a wire passage which connects the insertion port and the wire discharge port.

The wire is inserted by inserting this inductor into the knee joint from the front of the knee joint, inserting the tip into the opening of the bone hole formed in the tibia, and then inserting the wire through the wire insertion opening. It is easily guided into the tibial tunnel. Then, when the inductor is removed, the wire located inside the inductor can be placed in the knee joint, and the suture can be placed in the knee joint by attaching and pulling the suture to this wire. it can. Then, the suture thread can be easily pulled up from the bone hole formed in the femur.
Therefore, the tip of the wire can be easily guided to the lower opening of the femoral bone hole, the entire ligament reconstruction operation can be performed in a short time, and the burden on the patient can be reduced. Furthermore, since the wire is inserted into the tibial tunnel through the shortest path guided by the inductor in the knee joint and through a good path, the wire can bypass the posterior cruciate ligament and articular cyst. In addition, the insertion resistance of the suture thread and the ligament to be performed later is low and the work is easy.

[Brief description of drawings]

FIG. 1 is a front view of an embodiment of a wire inductor for posterior cruciate ligament reconstruction according to the present invention.

FIG. 2 is a cross-sectional view of FIG.

FIG. 3 is a sectional view taken along line AA of FIG. 1;

FIG. 4 is a sectional view taken along line BB of FIG. 1;

FIG. 5 is a partially cutaway front view of the wire guiding instrument in the state where the handle is attached to the wire inductor for posterior cruciate ligament reconstruction according to the present invention.

FIG. 6 is an explanatory view for explaining the action of the wire inductor for posterior cruciate ligament reconstruction according to the present invention.

FIG. 7 is an explanatory view for explaining the action of the wire inductor for posterior cruciate ligament reconstruction according to the present invention.

FIG. 8 is an explanatory view for explaining the action of the wire inductor for posterior cruciate ligament reconstruction according to the present invention.

FIG. 9 is an explanatory view for explaining the action of the wire inductor for posterior cruciate ligament reconstruction according to the present invention.

[Explanation of symbols]

 1 Wire guide for posterior cruciate ligament reconstruction 2 Tip part 3 Curved part 4 Body part 6 Wire insertion port 7 Wire discharge port 8 Wire passage 10 Wire 15 Suture 20 Wire guide device for posterior cruciate ligament reconstruction 21 Handle

Claims (5)

[Claims] 1. A tip portion that can be inserted into an opening of a bone hole formed in a tibia near the knee joint in posterior cruciate ligament reconstruction, and a tip portion that is continuous with the tip portion and that is formed in the opening of the bone hole. A tubular body having a bending portion for guiding and a main body portion that is continuous with the bending portion, wherein the tubular body includes a wire insertion port provided at a proximal end portion of the main body portion, and the distal end. A wire introducer for posterior cruciate ligament reconstruction, comprising a wire discharge port provided in the portion and a wire passage communicating the wire insertion port and the wire discharge port. 2. The wire guider is inserted into the knee joint from the front of the knee joint in posterior cruciate ligament reconstruction, and the wire is used in a state where the tip portion is inserted into the opening of the bone hole. The wire introducer for posterior cruciate ligament reconstruction according to claim 1, wherein the insertion opening is located outside the knee joint. 3. The wire inductor for posterior cruciate ligament reconstruction according to claim 1, wherein the wire inductor has a grip portion attached to the body portion. 4. The wire introducer for posterior cruciate ligament reconstruction according to claim 1, wherein the outer diameter of the distal end portion is 10 mm or less. 5. A tubular body formed in such a shape that it can pass through the inside of the knee joint from the front of the knee joint and reach the posterior mouth of the tibial tunnel for posterior cruciate ligament reconstruction from the posterior proximal edge of the tibia. The tubular body connects the wire insertion port provided at the proximal end of the tubular body, the wire ejection port provided at the distal end of the tubular body, and the wire insertion port and the wire ejection port. A wire inductor for posterior cruciate ligament reconstruction, which has a wire passage.