KR101714285B1 - The invention relates to a surgical perforation guide, in particular for performing open wedge and closing wedge osteotomies of the knee. - Google Patents

The invention relates to a surgical perforation guide, in particular for performing open wedge and closing wedge osteotomies of the knee. Download PDF

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Publication number
KR101714285B1
KR101714285B1 KR1020157011776A KR20157011776A KR101714285B1 KR 101714285 B1 KR101714285 B1 KR 101714285B1 KR 1020157011776 A KR1020157011776 A KR 1020157011776A KR 20157011776 A KR20157011776 A KR 20157011776A KR 101714285 B1 KR101714285 B1 KR 101714285B1
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South Korea
Prior art keywords
drill
guide
bone
surgical perforation
surgical
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KR1020157011776A
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Korean (ko)
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KR20150068432A (en
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폴 파브로브
톰 오버레스
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리오스 메디칼 아게
이그나이트-콘셉츠 게엠베하
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/151—Guides therefor for corrective osteotomy
    • A61B17/152—Guides therefor for corrective osteotomy for removing a wedge-shaped piece of bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body

Abstract

The present invention relates to a surgical perforation guide (200) for securing to a target bone. The surgical perforation guide 200 of the present invention includes at least one first elongated slot 201 or at least one protrusion 250 that determines a first osteotomy plane A and at least one protrusion 250 that has a diameter and a central axis X Wherein a plurality of drill guide holes (202a-202z) are provided, the central axes (X) of the plurality of drill guide holes (202a-202z) being parallel to the first osteotomy plane (A) The diameters of the holes 202a-202z are fixed to the target bone across the osteotomy plane A. Each drill guide hole 202a-202z includes a drill seat 203a- And the drill seats 203a-203z are characterized by limiting the depth to be drilled to the required specific drill depth 312 of each of the plurality of drill guide holes 202a-202z.

Description

Surgical Perforation Guides {The invention relates to a surgical perforation guide, in particular for performing open wedge and closing wedge osteotomies of the knee.

The present invention relates to a surgical perforation guide, and more particularly to an open wedge and a closed wedge osteotomy of the knee.

The knee osteotomy is a surgical procedure using the Mikulicz-line of the hip joints, such as the hip, knee and ankle. The normal axis of alignment of the legs is the center of the buttocks between the joints of the tibial plateau, and the center of the ankle joint lies on a line to become the mechanical axis of the so-called Mikulicz-line, the leg bone. For example, arthritic injuries to one direction of the knee, birth defects or surgical injuries can cause excessive wear of the knee cartilage, known as knee joints, due to interference by this alignment method.

The purpose of the knee osteotomy technique is to subdivide the force exerted on the knee in an unhealthy area of the knee in an initially damaged area. This allows the strength and muscle force from the patient's body to spread better in the knee joint.

In clinical practice, two techniques are typical: opening wedge osteotomy and closing wedge osteotomy. Both techniques aim at partially or completely resetting the aforementioned Microlith line.

When closed wedge osteotomy is performed, the wedge bone of the tibia is removed. Pull the tibial plateau to close the gap and fix it with the external plate and screws.

If an open wedge osteotomy is performed, the bone is incised horizontally above the tibial plateau by more than 80% of the surface area.

A wedge-shaped spacer is inserted. The force of the tibial plateau in one direction to align the axis of the leg. The wedge-shaped spacer can be made of a natural bone, an artificial bone, or a biocompatible or osteointegrative material. The spacer is generally fixed by means of an iron plate or a screw.

The surgical technique of osteotomy gives the patient an important advantage of delaying the time required for comprehensive knee replacement to 10 years.

A number of guides have been disclosed as prior art to assist the practitioner in wedge osteotomy.

For example, US 7,185, 645 (Hudson Surgical Design Inc.) has disclosed an apparatus that provides a guiding surface for a planar cutting tool, such as a vibrating bone saw. The cutting tool is guided by a vertical plane of a plurality of pin members located within the bone to be calibrated. Two or more pin members determine the ablation surface formed by the cutting tool.

US 2008/0262500 A1 (Howmedica Osteonics Corp.) discloses a cutting guide for osteotomy with a first arm having a first guide surface and a second arm forming a second guide surface. The first and second times ?? The arms pivot together. Additionally, the cutting guide surfaces may include round grooves forming a drill guide, which guides the drill into the bone with the two arms closed.

US 5,021,056 (Intermedics Orthopedics Inc.) discloses a method and apparatus for osteotomy. The apparatus includes a first guide assembly having a pair of mirror clamp arm assemblies including a clamp plate. The clamp arm is freely slidable along the first guide assembly. The clamp plate has a plurality of holes and guide slots for the cutting tool. By a first guide assembly, a first cut is made through the guide slot into the bone, and the clamp plate is secured by a bone fixture inserted through the plurality of holes. Thereafter, the first guide assembly is removed, a second guide assembly is installed on the bone, and the flat blade element is inserted into the ablation portion of the bone. The second guide assembly includes a plurality of guide slots to induce formation of cuts at different angles relative to the first cut to form a suitable wedge in the bone.

Despite the advantages of open wedge and closed wedge osteotomy, complications associated with this technique that often cause discomfort to the patient during recovery often occur. For example, the most important part of the procedure is to remove the bone only to a certain depth, and lift the proximal portion of the shin bone over the osteotomy surface without breaking or breaking the tibial eminence (so-called iatrogenic fractures).

It is an object of the present invention to provide a perforation guide in the field of the art and to reduce the risk of iatrogenic fractures during open wedge or close wedge osteotomy. The solution of the present invention is shown in claim 1. According to the present invention, the surgical perforation guide is fixed to the target bone and has at least one elongated slot or at least one protrusion that determines the first osteotomy plane. Further, the surgical perforation guide includes a plurality of drill guide holes, each drill guide hole having a diameter and a central axis, the central axis of the drill guide hole being parallel to the first osteotomy plane, The diameter intersects the first osteotomy plane. Further, each of the plurality of drill guide holes includes a drill sheet providing a stop surface of the drill, the stop surface limiting the depth of the drill to a specific required drill depth for each of the plurality of drill guide holes.

By providing a drill sheet, it is possible to prevent the drill from going too far during the procedure to damage the soft tissue on the other side of the bone. Furthermore, the drill sheet allows the drill to precisely control the depth at which the drill punches into the bone, so that when the operator opens or closes the wedge, the bone can be locally weakened without the risk of prosthetic fracture, .

Preferably, the surgical perforation guide is made of a rigid body, more preferably a biodegradable body such as stainless steel, titanium or polyetheretherketone (PEEK) or polylactic acid (PLA) And a biocompatible polymer or the like. It is preferable that the warning body is a cuboid having one side thereof contacting the target bone and has a suitable curvature as an example and the contact surface preferably has a length approximately corresponding to the size of the side of the shin bone .

For a planar cutting tool such as a saw blade for repetitive bone sawing, at least one slot provides two guide surfaces. The at least one elongated slot thereby guides the planar cutting tool precisely along the first osteotomy plane. The thickness of the at least one elongated slot is preferably selected to match the thickness of the saw blade.

Optionally, the surgical perforation guide may have at least one protrusion, and the protrusions are preferably insertable into the cut bone. Thus, the at least one protrusion can precisely align the surgical perforation guide, for example, into a cut formed by the bone saw.

Since the diameter of the plurality of drill guide holes intersects the first osteotomy plane, each drill guide hole includes the first osteotomy plane. Advantageously, the plurality of drill guide holes are arranged such that their central axis relative to the surgical perforation guide lies within the first osteotomy plane.

Optionally, the axes of the plurality of drill guide holes may be spaced from the first osteotomy plane, but are nevertheless not spaced beyond half of their diameters. In the present description, the spacing " offset " means the distance from the first osteotomy plane to the direction perpendicular to the first osteotomy plane.

Preferably, the axes of the drill guide holes are configured to be parallel to each other as well as parallel to the first osteotomy plane.

Optionally, the axis of at least one drill guide hole may be configured to angle with the axes of the other drill guide holes. Preferably, all axes of the drill guide holes are spaced the same distance as the first osteotomy plane.

Optionally, the at least one drill guide hole may be smaller or larger than the distance that the axes of the other drill guide holes are spaced from the first osteotomy plane.

Preferably, all of the plurality of drill guide holes may be evenly distributed throughout the length of the bone contact surface, and for example, the plurality of drill guide holes may be disposed at equal distances from each other. Optionally, the spacing of the two adjacent drill guide holes may vary along the length direction of the bone contact surface.

The term " multiple " should be understood as a concept involving one or more all numbers. Preferably, the surgical perforation guide may comprise 2 to 20 drill guide holes, more preferably 4 to 10 drill guide holes. The drill guide hole preferably has a diameter of 1.2 to 4.0 mm. Accordingly, the drill connected to the surgical perforation guide of the present invention has a corresponding diameter.

Preferably, the drill sheets are formed as a surface corresponding to a stop portion of the drill, so that it is possible physically to prevent the drill from being excessively passed during the procedure.

The specifically required drill depth of each drill guide hole is variously determined by the area of the target bone on which the osteotomy is performed.

Typically, the required drill depth is smaller in the drill guide holes located toward the surgical perforation guide side, which are arranged together on the side of the target bone, while the drill guide holes located in the center of the surgical perforation guide The required drill depth is greater.

Those skilled in the art will appreciate that the required depth of the plurality of drill guide holes may be determined by the type of target bone and osteotomy site, for example proximal tibia, distal femur, proximal femur, .

Further, the size of the patient to be treated and the size of the patient's bones also affect the required drill depth of each of the plurality of drill guide holes. Advantageously, each of the drill sheets arranged in the perforation guide limits the drill depth based on patient specific data. More preferably, the required drill depth of each of the plurality of drill guide holes corresponds to the distance to the cortex opposite the fixation surface of the bone perforation guide.

The patient ' s peculiar data is preferably image data and collected before the procedure and may be collected, for example, as an X-ray computed tomography (CT-scan), magnetic resonance image (MRI = scan) have. Depending on the patient ' s specific image data, the optimal required drilling depth of each of the plurality of drill guide holes can be determined.

Preferably, the surgical perforation guide according to the present invention is customized for each patient. This makes it easily applicable to the position of the drill sheet in each of the plurality of drill guide holes.

Providing the required drill depth to correspond to the distance from the fixation surface of the surgical perforation guide of the bone to the cortex on the opposite side of the fixation area does not break the cortex sufficiently to break the subsequent wedge during the procedure of closing or opening. This greatly reduces the risk of prosthetic fractures.

Preferably, the surgical perforation guide includes a contact surface that is in contact with the target bone, and the bone contact surface has a shape that matches the shape of the outer surface of the target bone.

This facilitates easy positioning or attachment of the surgical perforation guide to the target bone.

Likewise, the shape depends on the patient ' s specific data, and image data is collected prior to the procedure. One of ordinary skill in the art will be able to determine if the bone contact surface is machined to the correct configuration or if a surgical perforation guide is customized for each patient.

The surgical perforation guide includes at least one elongated slot and an outer surface to provide a guide surface for cutting the saw blade into a limited excision depth in the bone. The outer surface is located on the opposite side of the bone contact surface and serves as a stop surface for the blade sheet on which the saw blade is located.

The shape is selected to provide an optimal geometric shape of the ablation zone by the saw blade in the target bone. Preferably, the outer surface is a concave surface. The shape of such an outer surface is such that the depth of cut in the target bone is shallower at the side of the bone and deeper at the center of the bone.

Preferably, the shape of the outer surface determines the ablation depth and varies along at least one elongated slot, and is preferably based on patient specific data.

Preferably, the shape of the outer surface interacts with a blade seat of the bone saw blade, and the shape of the ablation portion produced by the bone saw blade is optimized for the patient's target bone. Accordingly, the shape of the outer surface is preferably determined by the patient's specific data, more preferably, determined by the patient's image data.

Preferably, the surgical perforation guide comprises a first elongated slot and a second elongated slot, wherein the second elongated slot determines a second osteotomy plane and is arranged obliquely with respect to the first elongated slot, The second elongated slot is formed such that the second osteotomy plane intersects the first osteotomy plane within the bone.

The provision of a second elongated slot allows precise removal of the target bone along the second osteotomy plane, and thus two cuts of the wedge-shaped arrangement are made.

Preferably, the position of each of the second elongated slot as well as of the second elongated slot of the surgical perforation guide is selected according to patient specific data, preferably selected according to patient specific image data, Allowing the wedge to be cut precisely and forming an optimally rearranged Mikulicz-line when the wedge is removed.

Preferably, the surgical perforation guide includes a plurality of protrusions, and the protrusions are sized and shaped to be inserted into the resection portion of the target bone.

This surgical perforation guide configuration can be applied to a laparoscopic wedge osteotomy procedure, wherein a plurality of protrusions are inserted into the cutout to allow the surgical perforation guide to be aligned accurately. Thus, by using such a surgical perforation guide, the practitioner can accurately position the drill hole with the target bone, and the drill guide hole can also be accurately positioned at the correct position.

The surgical perforation guide preferably additionally has at least one fastener receiving hole. Bone anchors may be used, e.g., a bone screw may be inserted into the at least one anchor receiving hole to securely attach the surgical perforation guide to the target bone.

The present invention additionally provides a medical kit comprising at least one drill having at least one surgical perforation guide and a stop according to the present invention. The stop of the drill is configured to interact with the drill sheet of the drill guide hole.

The stop is disposed and fixed away from the drill tip. Advantageously, the kit can include several drills, each drill having a stop spaced a different distance from the drill tip. Optionally, instead of the stop, the at least one drill may have at least one marking portion spaced a different distance from the drill tip. In this case, the practitioner can confirm that the specific drilling depth required for the marking to coincide with the drill sheet is reached.

Preferably, the kit may include at least one saw blade having a protrusion forming a blade sheet. In particular, when the surgical perforation guide and the outer surface are connected in a predetermined shape, the interaction of the shape of the blade sheet and the outer surface enables to obtain a cutout having a shape corresponding to the shape of the outer surface in the first osteotomy plane.

The present invention includes a method of manufacturing a surgical perforation guide as described above. The first step determines the location of a number of drill guide holes and the required drill depth according to patient specific data. Preferably, the specific data of the patient is specific image data of the patient. The second step determines the position of the drill sheet relative to each drill guide hole according to the required drill depth of each of the drill guide holes. The third step produces the surgical perforation guide. Preferably by matching or by additional manufacturing techniques.

Those skilled in the art will recognize mechanical techniques such as milling for making surgical perforation guides from block materials such as metal. Additional manufacturing techniques include selective laser sintering, direct metal sintering, selective laser melting, selective heat sintering, electron beam freeform fabrication ) And fused deposition modeling (fused deposition modeling) may be applied.

The surgical perforation guide may be manufactured by other techniques. By way of example, the rigid body may be manufactured by a further alternative manufacturing technique and may be formed by a mechanical process, for example by means of an associated drill guide hole or at least one elongated slot or the like.

Advantageously, the methods can be applied to manipulate the shape of the contact surface to contact the target bone according to the shape of the intended contact area of the target bone determined on the basis of the patient ' s specific image data collected prior to the procedure .

Preferably, the methods can be applied to shape the shape of the outer surface according to the determined required ablation depth based on the patient's specific image data collected prior to the procedure.

Other advantageous embodiments and combinations of features are described below in the following detailed description and detailed description.

The following drawings illustrate the invention:
Figures 1a and 1b are explanatory diagrams of a knee joint wedge osteotomy;
Figures 2a and 2b are illustrations of an open wedge osteotomy;
Figures 3a and 3b are illustrations of examples of iatrogenic fractures;
4A-4C are perspective views of a surgical perforation guide according to the present invention at another point in time;
Figure 5 is an isometric view of the surface of the tibia associated with the design and manufacture of a surgical perforation guide;
Figures 6a and 6b are side views of another embodiment of the drill coupled to the surgical perforation guide of the present invention;
Figures 7a and 7b are perspective views of another embodiment of a saw blade coupled to a surgical perforation guide of the present invention.
8 is an illustration showing associated anatomical landmarks for the surgical perforation guide design and size of the present invention.
FIGS. 9A to 9C are explanatory views illustrating a surgical procedure of the surgical perforation guide according to FIG. 4A.
10A to 10C are explanatory diagrams showing a drilling process of the surgical perforation guide according to the present invention.
11 is a cross-sectional view showing the drilled state.
12A and 12B are explanatory diagrams of a sawing step by a surgical perforation guide according to the present invention.
13 is a sectional view of a sawed state.
14 is a perspective view of a second embodiment of the surgical perforation guide of the present invention.
15A and 15B are perspective views of a third embodiment of the surgical perforation guide of the present invention.
16A and 16B are perspective views of another alternative embodiment of a surgical perforation guide.
In the drawings, the same components are given the same reference numerals.

Figures 1a and 1b are explanatory diagrams of a knee joint wedge osteotomy;

The femur 100 and the shin bone 101 interact at the knee joint 102.

A first plan resection 104 is formed below the knee joint 102 and is formed to 60-90% of the proximal shin bone cross-section in the defined ablation plane.

Thereafter, a second plane cutout 107 is formed at an angle to the first plane cutout 104.

The first plan cutout 104 and the second plan cutout 107 form a wedge 103.

When the wedge 103 is removed, the proximal portion of the tibia plateau descends in a distal direction and re-establishes a new mechanical axis 106, such as a plate or a screw (not shown) .

Figures 2a and 2b are illustrations of an open wedge osteotomy;

A first plane cut-off portion 104 is formed. Thereafter, the bone wedge 105 is inserted into the first plane ablation portion 104.

The bone wedge 105 lifts the central side of the tibia plateau and reestablishes a corrected new mechanical axis 106 (Mikulicz-line).

The bone wedge 105 is secured using a plate or a screw (not shown).

Ideally, the untrimmed cortex of the tibial eminence should be naturally restored and filled, similar to plastic elastic deformation.

If the uncut cortex is not sufficiently flexible and the applied stress is severe, a crack may occur in the tibial eminence.

Figures 3a and 3b illustrate examples of iatrogenic fractures 107 that may occur during an osteotomy procedure.

The syneresis crack 107 may occur due to the lifting or lowering of the proximal portion of the tibial eminence.

As noted above, the synesthetic crack 107 is due to insufficient flexibility due to the physical properties (E-modulus & elasticity) of the bone-forming material in the unresectable bone region 108.

Moreover, if the ablation depth 110 of the first plane resection portion 104 is too short, the remaining uncut bone portion 108 will have a strong resilience to other bending forces, have.

4A is a perspective view of an embodiment of a surgical perforation guide according to the present invention;

The surgical perforation guide 200 includes a cuboid rigid body 210.

The rigid body has a bone contact surface 204 for contacting the desired bone.

The bone contact surface 204 preferably has a shape corresponding to the outer surface of the bone to be operated.

The surgical perforation guide 200 has an outer surface 205 on the opposite side of the bone contacting surface 204.

The outer surface 205 faces the surgical perforation guide 200 during surgery.

Is formed across the bone contacting surface 204 from the outer surface 205 of the first elongated slot 201 and provides two guiding surfaces for the planar cutting tool.

Further, the surgical perforation guide 200 includes seven drill guide holes 202a-202z.

For the present invention, the a to z indexes are for identifying individual elements of a number of identical shapes, without limiting to numbers.

Each drill guide hole 202a-202z has a central axis X parallel to the first osteotomy plane A defined by the first elongated slot 201. [ For simplicity, only one central axis X is shown.

The central axis X of each of the drill guide holes 202a-202z is parallel to the first osteotomy plane A.

In addition, in this embodiment, the center axis X of all the drill guide holes 202a-202z coincides with the first osteotomy plane A.

Further, each of the drill guide holes 202a-202z includes a drill seat 203a-203z recessed from the outer side surface 205, and the concave drill sheets 203a-203z are concave .

The drill seats 203a-203z provide surfaces that stop when the drill is inserted into the drill guide holes 202a-202z.

As the height of each of the drill sheets 203a-203z varies, a specific drill depth of each drill guide hole 202a-202z can be set.

Further, the surgical perforation guide has two fastening holes 221a and 221b,

The fastener holes 221a and 221b receive a bone fastener for attaching the surgical perforation guide to the target bone.

FIG. 4B is a perspective view of the surgical perforation guide 200 in FIG. 4A viewed from a different point, and FIG. 4C illustrates a surgical perforation guide 200 from the bone contact surface 204.

The following description of FIGS. 5-15 relates to an open wedge osteotomy, which involves partial resection of the medial side of the shin bone toward the side.

The ablation guide is anchored to the anterior mid-portion of the proximal tibial bone, and the lateral cortex of the tibial bone is weakened by puncturing to lift the tibial plateau.

As a technique of closing the wedge, it should be understood that the medial is lateral, the lateral is the center, and the upward force is the downward force.

FIG. 5 shows the planar area of the bone in the shin bone 300, which is related to the design and production of the surgical perforation guide 200 as shown in FIGS. 4A-4C.

The outer surface 205 limits the ablation depth 110, which will be described in detail below.

Associated data for bone planes can be collected by CT-scan, MRI-scan or x-ray images.

The bone contact surface 204 has the shape of a negative image of the center side front portion 301 of the shin bone 300 so that the shape of the center side front portion 301 .

It will be appreciated by those skilled in the art that the shape of the bone contact surface 204 ensures the precise location of the surgical perforation guide 200 during surgery based on preoperative planning and patient specific data.

The side of the shin bone 300 is determined to define the required drilling depth of each drill guide hole 202a-202z for perforating the lateral cortex 303 on the opposite side of the shin bone 300. [

It is preferred that the perforations are made to pass through the lateral cortex 303 and not to the outer cortex.

Deeper perforations can damage soft tissue structures such as muscles, arteries, or nerves that are located next to the lateral cortex 303.

6A shows a preferred embodiment of a drill 400 used in connection with the surgical perforation guide 200 of the present invention.

The drill (400) has a drill length (401) adjusted by the stop (402).

During the drilling process, the stop 402 is caught by the drill seats 203a-203z of the drill guide holes 202a-202z when the drill 400 is inserted so that the drill 400 is no longer inserted into the bone Thereby making it physically possible to limit the required specific depth of the drill guide holes 202a-202z.

6B illustrates another embodiment of a drill 400 having an adjusted drill length 401 as determined by the marking 403. As shown in FIG.

When using the drill 400 according to this embodiment, the practitioner must determine when to stop the drill at a time and determine.

Figure 7a illustrates a preferred embodiment of a saw blade 500 coupled to a surgical perforation guide 200 of the present invention.

The saw blade 500 has an adjusted saw length 501 defined by a fixed blade seat 502.

The blade sheet 502 will collide with the outer surface 205 of the surgical perforation guide 200 and thereby physically limit the depth at which the saw blade enters the bone.

The saw blade 500 has a thickness 503 corresponding to the first elongated slot 201.

Further, the blade 500 has teeth 504 at one end and a coupling portion 505 at the opposite end.

The coupling portion 505 allows the saw blade 500 to be attached to the bone saw.

Fig. 7B shows another embodiment of the saw blade 500. Fig.

In this embodiment, the saw blade 500 includes a marking 503 for adjusting the saw length 501.

In the case of using the saw blade 500 of the embodiment, the practitioner must visually confirm the stopping time of the saw.

Figure 8 shows the anatomical landmarks associated with the design and dimensions of the surgical perforation guide 200.

A partial ablation 316 within the shin bone 300 is planned to correct the mechanical axis 106 shown in Figs. 1A and 1B.

The interpretation of all the anatomical variables and landmarks for calibrating the plane of the partial resection 316 is obtained by the practitioner's education and experience of the present invention and is thus not described separately in the present invention.

The contour 313 of the shin bone 300 is recorded for the remainder of the partial resection 316. [

The adjusted drill length 401 of the drill 400 and the adjusted saw length 501 of the saw blade 500 may be adjusted by the surgical perforation guide < RTI ID = 0.0 > 200 and for positioning the drill seats 203a-203z to control the required drill depth and to provide a bone contact surface 204 for the shape and clear positioning of the outer surface 205 to control the depth of cut ).

The surgical method of surgery using an open perforation guide and / or a corresponding osteotomy kit in open wedge surgery includes the following steps:

1. positioning a surgical perforation guide in a target zero area of a target bone;

2. fixation step with bone fixation element for stable positioning;

3. Drilling through the drill guide hole through the cortex of the other side of the bone;

4. sawing an elongated slot for partial resection;

5. Steps to remove the surgical perforation guide

The following procedure is:

6. bending and opening the partial ablation region 316;

7. inserting a bone wedge;

8. Fixing and stabilizing with an implant such as a plate or screw;

9. Steps to close soft tissues and skin

Steps 3 and 4 can be performed in the reverse order. Steps 1 and 2 are as shown in Figs. 9A to 9C.

As shown in FIG. 9A, the surgical perforation guide 200 is positioned at the center side front portion 301 of the shin bone 300 by the practitioner.

The bone contact surface 204 has a shape corresponding to the shape of the center side front portion 301.

Accordingly, it is preferable that the bone contact surface 204 is formed using the characteristic data of the patient.

9B, the surgical perforation guide 200 can be accurately positioned on the central side front portion 301 by matching the bone contact surface 204 and the outer side surfaces of the central side front portions 301 of the shinbone bones 300 Help to position.

The two bone fasteners 220a and 220b are inserted into the two fastener receiving holes 221a and 221b as shown in Fig. 9C and are screwed into the bone part of the shin bone 300, as shown in Fig. So that the surgical perforation guide 200 is fixed to the shin bone 300.

10A, the practitioner uses the drill 400 according to the effective drill depth 401 to drill the drill 400 along the drill guide holes 202a-202z, as shown in FIG. 10B. Hole 402 until it abuts the respective drill seats 203a-203z.

When the surgical perforation guide is used, particularly when the drill sheets 203a-203z are arranged according to patient specific data in the surgical perforation guide 200, the lateral cortex 303 is punctured by the drill holes 310a- But the adjacent soft tissues are not damaged during this process.

As shown in FIG. 10C, the lateral cortex 303 is punctured by the drill holes 310a-310z, thereby weakening the lateral cortex and increasing flexibility.

The increased flexibility reduces the risk of iatrogenic fracture when the wedge is surgically opened.

These pores required for the prevention of iatrogenic fracture are determined by the following factors, including bone quality, size of tibial plateau, resection depth 110, 400 and the degree of correction of the mechanical axis 106.

Figure 11 shows a cross-sectional view of Figure 10c.

As can be seen, the drill sheets 203a-203z are positioned differently from each other in the surgical perforation guide, and are arranged in a stepped manner, as highlighted by thick lines in FIG.

Furthermore, to limit the required drill depth 312 of each drill guide hole 202a-202z, it can be verified that the stop 402 of the drill 400 interacts with the drill seats 203a-203b.

As we have seen, the above limitation prevents the drill 400 from going further by the procedure so that the soft tissue is not damaged.

Only the required specific drill depth 312 for one of the plurality of drill guide holes 202a-202z is shown.

The drill holes 310a-310z through the shin bone 300 along the respective drill guide holes 202a-202z are formed in the drilling process.

FIG. 12A shows a process after the saw blade 500 is inserted into the extended slot 201. FIG.

As shown in FIG. 12B, the practitioner uses the saw blade 500 to slice the cut-off portion 311 into the shin bone 300.

The depth of the cutout portion 311 is determined as the maximum required depth into the shin bone 300 defined at the time of the preparation of the procedure by the interaction of the blade sheet 502 and the outer surface 205 of the surgical perforation guide 205. [

Figure 13 shows a cross-sectional view of the state according to Figure 12b.

The cut surface is the first? It is located in the osteotomy plane.

In this figure, it is possible to confirm how the depth of the cutout portion 311 is affected by the outer surface 205 interacting with the blade sheet 502.

The geometrical shape of the shin bone resection portion 311 matches the shape of the outer surface 205 and the teeth 504 of the saw blade 500 are not inserted any deeper than the adjusted saw tooth length 501. [

Figure 14 shows another embodiment of a surgical perforation guide 200 according to the present invention.

In addition to the embodiment shown in FIG. 4, the surgical perforation guide according to this embodiment includes an elongated slot 240 that defines a second osteotomy plane B.

The axes X of the guide holes 202a-202z are parallel to the first osteotomy plane A and the second osteotomy plane B is angled relative to the first osteotomy plane A.

Both of the two osteotomy planes (A) (B) traverse the intersection line 315, which is located within the target bone during the procedure.

With the surgical perforation guide described above, particularly in a closed wedge scraping, the procedure of ablating a wedge into a bony bone can be done very accurately.

15A and 15B illustrate additional embodiments of the surgical perforation guide 200 of the present invention.

In this embodiment, the surgical perforation guide 200 does not include an elongated sling 201, but instead a plurality of protrusions 250 are disposed on the bone contact surface 204.

The protrusions 250 are arranged in parallel with each other to form a first osteotomy plane A.

Similarly, a plurality of drill guide holes 202a-202z are arranged parallel to the first osteotomy plane A along their axis.

The thickness 251 of the protrusion 250 is set so that the protrusion 250 can be inserted into the cutout portion 311.

This allows the drill guide holes 202a - 202z to be arranged parallel to the cutout 311.

16A and 16B illustrate an alternative embodiment of a surgical perforation guide 200 that is not part of the present invention.

In this embodiment, the elongated slot 201, which determines the first osteotomy plane, is not parallel to the axis X of the drill guide holes 202a-202z, as shown in Figure 16a (only one drill Only the guide hole 202 is shown).

However, the axis X and the elongated slots 201 intersect at an intersection line 315 that is located within the target bone during the procedure.

In addition, in this embodiment, the surgical perforation guide 200 includes a second elongated slot that determines a second osteotomy plane (B).

The second elongated slot 240 is disposed so that the second osteotomy plane B intersects the first osteotomy plane A and the intersection line 315.

Thus, the second osteotomy plane B intersects the axes X of the drill guide holes 202a-202z at an intersection line 315.

16B shows the surgical perforation guide 200 according to the embodiment shown in Fig. 16A as a view from the bone contact surface 204. Fig.

As shown in the figure, the drill guide holes 202a-202z (with only one drill guide hole 202 shown) extend through the first elongated slot 201 and the second elongated slot, .

Further, the positions of the two fixture receiving holes 221a and 221b are well shown in the figure.

This surgical perforation guide is suitable for closing wedge osteotomy and allows for two mutually sloping cuts into the target bone, which will form the wedge of the bone and be removed from the target bone.

100. Femur
101. Shank Bone
102. Knee joints
104. First plane ablation section
106. Mechanical Axis
110. Cutting depth
200. Surgical Perforation Guide
201. Slot
202a-202z. Drill guide hole
203a-203z. Drill sheet
204. Bone contact surface
205. Outer side
220a, 220b. Bone fixture
221a, 221b. Fastener receiving hole
250. Turning
300. Shank Bone
301. Center side front (front)
303. Side Cortex
310a-310z. Drill hole
312. Drill depth
313. Contour
315. Intersection line
316. Partial ablation
400. Drill
401. Drill length
402. Stop
403. Marking
500. saw blade
501. Saw Length
502. Blade sheet
503. Thickness
504. Tooth
505. Coupling portion

Claims (13)

At least one first elongated slot 201 or at least one protrusion 250 that determines the first osteotomy plane A and a plurality of drill guide holes 202a-202z having diameters and central axes X, Wherein the central axes X of the plurality of drill guide holes 202a-202z are parallel to the first osteotomy plane A and the diameters of the plurality of drill guide holes 202a- In a surgical perforation guide 200 secured to a target bone across the osteotomy plane A,
Each of the drill guide holes 202a-202z includes drill sheets 203a-203z that provide a surface on which the drill 400 stops, and each of the drill sheets 203a- Is configured to define a recess in the side surface at a different height to limit the depth to be drilled to a desired specific drill depth (312) of each of the plurality of drill guide holes (202a-202z). The method according to claim 1,
Each of the drill seats 203a-203z is arranged in the surgical perforation guide to limit the depth of the drill according to the patient ' s specific data, and the drill depth is defined by the opposite cortex on the side to which the surgical perforation guide 200 of the bone is fixed Is a required specific drill depth (312) corresponding to the distance to the hole (34). 4. The method of claim 1 or 2, wherein the surgical perforation guide (200) comprises a bone contact surface (204) for contacting a target bone, the bone contact surface (204) having a shape corresponding to the contour of the target bone Wherein the guide member is provided with a guide member. 3. The method of claim 1 or 2, wherein the surgical perforation guide includes at least one elongated slot, wherein the outer surface comprises an ablation depth of the saw blade at a target bone, Wherein the guiding surface is provided with a guiding surface for restricting the guiding surface.  5. The method of claim 4, wherein the shape of the outer surface (205) is formed by a resection depth (110) that varies along at least one elongated slot (201) and is determined by patient specific data Surgical Perforation Guide. 3. The device of claim 1 or 2, wherein the surgical drilling guide (200) comprises a first elongated slot (201) and a second elongated slot (240) And a second osteotomy plane (B) disposed angularly with the first osteotomy plane (A) and the second elongated slot (240) Wherein the guide member is formed to intersect the guide member.  3. The method of claim 1 or 2, wherein the surgical perforation guide (200) comprises a plurality of protrusions (250), wherein the protrusions (250) are sized and shaped to be inserted into the cut- The surgical perforation guide 3. The surgical perforation guide of claim 1 or 2, wherein the surgical perforation guide (200) comprises at least one fixture receiving hole (221a, 221b). A medical kit comprising at least one drill (400) having at least one surgical perforation guide (200) and a stop (402) of claim 1 or 2. 10. The medical kit of claim 9, further comprising at least one saw blade (500) having protrusions forming the blade sheet (502). delete delete delete
KR1020157011776A 2013-07-12 2014-07-11 The invention relates to a surgical perforation guide, in particular for performing open wedge and closing wedge osteotomies of the knee. KR101714285B1 (en)

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CHCH1251/13 2013-07-12
CH12512013 2013-07-12
PCT/CH2014/000102 WO2015003284A2 (en) 2013-07-12 2014-07-11 Surgical perforation guide

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Families Citing this family (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10682195B2 (en) 2015-02-05 2020-06-16 Ossability Limited Surgical guide
US10039559B2 (en) * 2015-09-02 2018-08-07 Wright Medical Technology, Inc. Method and cut guide for biplanar wedge osteotomy
CN106667544A (en) * 2017-02-21 2017-05-17 吴霜 Minimally-invasive perforation surgical tool and machining method thereof
US10314597B2 (en) 2017-08-24 2019-06-11 Limacorporate S.P.A. Ankle arthroplasty systems and methods
US11751890B2 (en) * 2017-10-06 2023-09-12 Med-El Elektromedizinische Geraete Gmbh Drilling platform tool for surgeries
TWI659723B (en) * 2017-11-22 2019-05-21 A Plus Biotechnology Company Limited Universal osteotomy device
TWI686166B (en) * 2018-03-19 2020-03-01 愛派司生技股份有限公司 Location constrain apparatus for osteotomy surgery
GB2608091A (en) 2018-08-24 2022-12-21 Laboratories Bodycad Inc Patient-specific fixation plate with wedge member for knee osteotomies
US11589876B2 (en) 2018-08-24 2023-02-28 Laboratoires Bodycad Inc. Surgical guide assembly for performing a knee osteotomy procedure
GB2591363B (en) 2018-08-24 2023-06-21 Laboratoires Bodycad Inc Surgical kit for knee osteotomies and corresponding preoperative planning method
GB2591365B (en) 2018-08-24 2022-10-26 Laboratoires Bodycad Inc Predrilling guide for an orthopedic surgery fixation plate
US11857206B2 (en) 2018-08-24 2024-01-02 Laboratoires Bodycad Inc. Patient-specific surgical tools
GB2591631B (en) 2018-08-24 2022-09-28 Laboratoires Bodycad Inc Patient-specific fixation plate with spacing elements for knee osteotomies
CN110353760B (en) * 2019-07-26 2023-12-22 中国人民解放军西部战区总医院 Guide plate for bone carrying tibia osteotomy
WO2021051098A1 (en) 2019-09-13 2021-03-18 Inmotus Medical Llc Patient-specific surgical methods and instrumentation
CN110477997A (en) * 2019-09-17 2019-11-22 上海交通大学医学院附属第九人民医院 A kind of 3D printing guide plate of the controllable osteotomy depth for fibular flap moulding operation
USD948719S1 (en) 2019-10-21 2022-04-12 Laboratoires Bodycad Inc. Posterior stabilizer for an osteotomy plate
USD943100S1 (en) 2020-02-18 2022-02-08 Laboratoires Bodycad Inc. Osteotomy plate

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020164905A1 (en) 2000-03-14 2002-11-07 Amei Technologies Inc., A Delaware Corporation Osteotomy guide and method
US20050228389A1 (en) 2002-05-23 2005-10-13 Claes-Olof Stiernborg Mitre instrument, as an example for hallux surgery
US20080015605A1 (en) 2006-06-30 2008-01-17 Howmedica Osteonics Corp. High tibial osteotomy guide

Family Cites Families (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5021056A (en) * 1989-09-14 1991-06-04 Intermedics Orthopedics, Inc. Upper tibial osteotomy system
US5540695A (en) * 1994-02-18 1996-07-30 Howmedica Inc. Osteotomy cutting guide
US5601565A (en) * 1995-06-02 1997-02-11 Huebner; Randall J. Osteotomy method and apparatus
US5722978A (en) * 1996-03-13 1998-03-03 Jenkins, Jr.; Joseph Robert Osteotomy system
US6190390B1 (en) * 1999-10-29 2001-02-20 Howmedica Osteonics Corp. Apparatus and method for creating a dome tibial osteotomy
US6875222B2 (en) * 2002-03-12 2005-04-05 Depuy Products, Inc. Blade for resection of bone for prosthesis implantation, blade stop and method
US7621919B2 (en) * 2004-04-08 2009-11-24 Howmedica Osteonics Corp. Orthopedic cutting block
EP1809209A2 (en) * 2004-08-19 2007-07-25 Kinetikos Medical Incorporated Modular total ankle prosthesis apparatuses, systems and methods, and systems and methods for bone resection and prosthetic implantation
US7185645B1 (en) 2006-02-24 2007-03-06 Hne Technologie Ag Compressed air gun for use by police and firefighter for breaking doors open
GB0606837D0 (en) * 2006-04-05 2006-05-17 Depuy Int Ltd Cutting guide instrument
US8926618B2 (en) 2007-04-19 2015-01-06 Howmedica Osteonics Corp. Cutting guide with internal distraction
CN101827560A (en) * 2007-10-16 2010-09-08 Ebi有限责任公司 Method and apparatus for orthopedic fixation
DK2538854T3 (en) * 2010-02-25 2018-12-10 Depuy Products Inc CUSTOM PATIENT-SPECIFIC SKIN CUTTING BLOCKS
CN103142286B (en) * 2013-03-04 2014-03-12 张英泽 Calcar femorale osteotomy positioner

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020164905A1 (en) 2000-03-14 2002-11-07 Amei Technologies Inc., A Delaware Corporation Osteotomy guide and method
US20050228389A1 (en) 2002-05-23 2005-10-13 Claes-Olof Stiernborg Mitre instrument, as an example for hallux surgery
US20080015605A1 (en) 2006-06-30 2008-01-17 Howmedica Osteonics Corp. High tibial osteotomy guide

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JP2016501644A (en) 2016-01-21
WO2015003284A2 (en) 2015-01-15
WO2015003284A3 (en) 2015-04-09
CN104869919A (en) 2015-08-26
KR20150068432A (en) 2015-06-19

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