部中央ΐέ準局β工消A合竹权印V A7 ___B7_ 五、發明説明（1 ) 本發明涉及酱療技術領域，涉及按相應權利要求的前 序部分所述的方法和器械。該方法和器械用於修復軟骨質 內的缺陷和骨軟骨缺陷，尤其是指關節軟骨及其下面的骨 組織的缺陷。 關節軟骨中的缺陷或涉及關節軟骨或其下方的骨組織 的缺陷按照現有技術是這樣修復的，即用人工的、必要時 含有活體細胞的材料塡充，植入在玻璃管內培養的軟骨組 織，或是在完好的最好是不受力的部位取出軟骨組織並作 爲自體移植物植入到有缺陷的部位》自體移植物尤其通常 是具有外軟骨端側和內骨端側的柱。在缺陷較大時通常相 互鑲嵌式地植入多個這樣的柱。 •爲了植入柱式組織，在缺陷部位制成盡可能精確的圓 柱形孔，這裏是沖出或鑽出圓柱形組織，然後通過在其基 底的旋轉而分離，或者是使用切割式鑽孔器。在不受力的 關節部位（例如女性的髁部）取出其直徑略大於缺陷部位 中形成的孔內徑的柱式組織。要取出的柱式組織用空心鑽 孔器鑽出，然後通過在基底旋轉而分離。已取出的柱式組 織然後裝入形成的缺陷孔中*由於不同的直徑而形成所的 "^壓配合〃，從而使柱保持在孔中。因取出柱而形成的孔 —般用無缺陷的材料塡充，這些材料處於健康的良好狀態 :或用人造材料或用玻璃管內培養的材料封住。 剝離和取出要植入的柱式組織，必要時從缺陷部位的 孔中沖出或取出組織一般採用管形器械，其一端具有一管 狀的切緣，另一端用於握住和導向。爲了檢査沖出的柱式 ml In »^n i -I —.1— ^^1 fcl— -- —CL m HI I. (銷先閱讀背而之注意事項再填寫本頁) 本紙乐尺度速川中國囤家標率（CNS ) Λ4規格（210ΧΜ7公釐} -4- 經漬部中央標消f合竹社印*'!冬 A7 __ ___B7_ 五、發明説明（2 ) 組織的長度和質量，這類器械最好具有一相應的視窗。甲 出的材料借助於一個與器械的內徑一致的插塞而從管狀器 械內移出。這類器械可從市場上買到，例如由Smith & Nephew公司，美國或由Arthrex公司，美國製造。爲了用鑽 孔器在缺陷部份製出孔可以使用偏形鑽孔器。 並已表明，用活體組織的植入來修復關節軟骨的缺陷 的上述方法的成功很大程度上取決於插放修復組織的精度 *以及在取出和植入時對組織的處理。 基於上述理由，本發明的任務在於，通過植入或移植 柱形活體組織來改進修復軟骨缺陷或與軟骨和其下面的骨 組織有關的缺陷尤其是關節軟骨缺陷的方法和器械，以提 高成功機會。按照本發明的方法和器械可以提高修復的精 度，同時很完好地處理所用的組織。盡管如此，本發明的 器械製造簡單，尤其是作簡單。本發明的方法和器械尤其 應適於用鑲嵌方法來修復大的缺陷，當然至少也可部分用 於小的缺陷，即只用植入物來修復》 上述任務用在獨立權利要求中所述的方法和器械加以 解決。從屬權利要求確定了其它的實施形式。 並已表明，爲了解決上述總的任務，需要四個部分改 進，其中根據應用情況，一個改進方面具有最大的效果而 另一方面則只有很小效果或有明顯的效4，因此可以省去 。這四個主要改進方面如下： -在植入多個柱式組織時提高在缺陷範圍內產生的圓 柱形孔的定位精度和平行度精度。這裏通過應用相應的理 (誚先閱讀背面之注意事項再填巧本頁) 訂 線 本纸乐尺度诚州中國因家標肀（（:NS > Λ4規格（210X297公釐） -5- A7 ___- B7_ 五、發明説明（3 ) (#先閱讀背面之注意事項再填寫本頁) 論來制成孔來實現的。通過這一措施一般可以防止植入孔 中的柱式組織相互擠壓而承受附加的負荷，因此要求每個 植入的柱至少在其固定在健康組織中的範圍內盡可能周圍 由天生的組織圍繞，這樣改善了創口愈合。 -用改進的精度對已修復的缺陷的軟骨表面模仿原始 的即健康的或無缺陷的軟骨的局部解剖圖。爲此目的，要 植入的柱式組織的軸向長度和軟骨表面相對於柱的軸線的 定向盡可能對準模仿的軟骨表面。這一措施在缺陷相對大 時尤其重要，這一缺陷要用多個植入柱加以修復。模仿原 始的軟骨表面越好，在已修復關節使用時各植入體表面受 力越均勻，從而總體負荷分佈在各植入體上越均勻。由此 可以阻止已修復缺陷周圍的植入體和天生軟骨的不希望的 變形和受損，作爲修復的效果。 線 -已修復的缺陷是無空隙的和無空隙地接在天生軟骨 上。軟骨表面的無空隙可以用移植的或植入的柱式組織與 玻璃管內培養的軟骨組織的結合來實現，用該組織可以塡 滿植入的柱式組織之間的空隙和柱式組織和天生的軟骨之 間的空隙=由於無空隙的軟骨表面促進了植入體和天生軟、 骨的共同生長，並阻止了因滑液通過軟骨層的空隙流到下 面的軟骨組織所出現的繼續受損。這一措施在要用多個移 植柱修復的較大缺陷時是重要的，而對4小的缺陷用上述 的％壓配合'就足以。 -要植入的材料在切割和植入時要完好尤其是盡可能 無壓地處理，以免柱式組織的移植體和玻璃管內培養的植 本紙张尺度適W中國S家標肀（（、NS ) Λ4規格（210X297公釐） ~Τ «呆部中央椋淖扃另Μ消费合竹社印纪 A7 _____B7_ 五、發明説明（4 ) 入體產生不可控的爱形，從而改善修復精度。 已植入的柱式組織在所有情況下最好是取自不受力部 位的身體移植物，也可以是一種在玻璃管內培養的軟骨組 織的替換材料。在修復過程中這類待植入的柱最好通過沖 孔或鐄孔（空心纘孔器）所成的塊製成。 本發明的方法和器械不僅適用於作爲開放式外科的修 復操作也適用於關節鏡檢査。 結合下面的附圖更詳細地描述用於修復的軟骨質內的 或骨軟骨的缺陷尤其是關節內的缺陷的改進了的方法和器 械的實施例。 圖1表示一按已知的鑲嵌法修復的軟骨缺陷的俯視圖 (左）和截面圖（右）。在俯視圖中可見天生的軟骨層1 的表面和用於修復的已植入的柱式組織2的軟骨層2 >的 圓形表面。在截面圖中可見位於天生軟骨層1下方的天生 的骨組織3和植入相應圓柱形孔中的柱組織2，該柱式組 織2在軟骨層2>下方具有一內骨部分2'，其在移植柱 的情況下由骨組織組成，而在玻璃中培養的柱的情況下由 骨的替代材材料組成。 爲了使已修復的軟骨表面具有盡可能小的空隙，最好 是使有缺陷的軟骨材料具有盡可能小的範圍，通常盡可能 緊密地設柱。出於這一原因，重要的是Θ於待植入的柱2 的孔應盡可能犄確平行。這精度的平行度可以保證，可以 相互很近地製出孔而不相交，這使植入困難並使植入的柱 產生附加的負荷。如果柱2的之間用其它的植入體充塡’ 本纸張尺度通州中國國家標??.（（、NS ) Λ4規格（210X 297公釐） ---------,t*f----- ——{訂------線， (对先閱讀背而之注意事項再峨K?本頁) 經承部中央樣隼历β Η消资合竹.衫印*'!水 A7 B7 五、發明説明（5 ) 如結合圖9、 10還要說明的，則不需要待製孔很高精度 的平行度和孔的定向。 圖2表示導向式器械的實施例，借助於該器械可以在 軟骨缺陷的範圍內制出多個高精度的圓柱形孔。圖示的導 向式器械的實施例適合於實現修復，如圖1所示。該器械 主要由一圚柱形的環狀導向件1 0和至少兩個環狀沖孔或 鑽孔導向件1 1和1 2組成，它們均用俯視圖表示（如圖 1左邊已修復的缺陷的俯視圖）。 環形導向件1 〇圍繞著缺陷定位，並例如借助於基爾 施納氏導線，該導線通過爲此而定的孔1 3或用另一合適 的固定方法固定。可以從一組環形導向件中選出一個其內 表面具有這種形狀和尺寸的一個，使其盡可能精確地與待 修復的缺陷一致。沖孔或鑽孔導向件11和12有一個適 合要使用的沖孔或鑽孔器械的內徑，並且爲了在環形導向 件10內精確定位在外側具有例如至少一個軸向延伸的凸 輪1 4，它插入相應的在環形導向件1 0內表面上軸向延 伸的槽1 5中，其中凸輪1 4的徑向高度與環形導向件 1 0的內表面待製孔之間的距離相適配。在圖2中，沖孔 或環形導向件10用於製成圖1所示修復用的中心孔，沖 孔或鑽孔導向件12用於製成邊緣的孔。 兩個鑽孔導向件1 1和1 2具有兩個凸輪1 4，它們 可以定位在相互相對的環形導向件1 0的槽1 5中。在槽 和凸輪的相應結構形式中也可爲每個沖孔或鑽孔導向件只 設置一個凸輪。 本紙張尺度诚州中國S家標华（CNS ) Λ4規格（210x 297公1 ) -8 - ----------訂 I 1----線.. (讀先閱讀背面之注意事項再填{:?;本頁) A 7 B7 iiT/T·'‘部屮央榡準兵工消於合竹Tt印緊 五、發明説明（6 ) 爲大體爲圓形的缺陷設置圖2所示的導向式器械》按 相同的方式也可以爲不同形狀的缺陷設置導向式器械。 圖'2所示的導向式器械的環形導向件1 0例如用圍繞 著待修復的缺陷定位的基爾施納氏導線固定。爲了避免由 於固定環形導向件1 0引起的缺陷範圍的附加負荷，環形 導向件10例如也可以用三點固定式固定在離開缺陷部位 的骨的固定位置上，在該骨上有缺陷有待修復。這類固定 由關節一假體一外科已知，不僅可用於開放式外科也可用 於關節鏡檢査。 爲了在製作孔時盡可能少的妨礙外科醫生的視線，至 少環形導向件10最好由透光材料組成或具有相應的視窗 〇 圖2所示的導向式器械是這類器械的實施例。這類導 向式器械一般具有可固定位在修復的缺陷的範圍內的裝置 和在多個位置導向沖孔或鑽孔器械的裝置。 用於修復軟骨缺陷的本發明的器械除了用於製作柱式 組織的植入體的孔的沖孔或鑽孔器械外還具有一組不同的 、必要時與待處理的關節和缺陷一致的導向式器械。作修 復手術的外科醫生從這組的導向式器械中選出一合適的， 將環形導向件1 0定位在缺陷上並加以固定。然後他將沖 孔或鑽孔導向件11或12插入環形導向件10中來引導 用於製作相應孔的所使用的沖孔或或纘孔器械。爲了製作 其它的孔更換沖孔或鑽孔導向件或改變其位置。 圖3表示強烈彎曲的關節位置處的軟骨缺陷2 0的截 (諳先閱讀背而之注意事項再續寫本頁) --1---訂—』-----線 本纸浪尺度適州中國囤家標卒（CNS M4規格（210X297公釐） -9- A7 —_____B7 五、發明説明（7 ) 面阖•這類尺寸的缺陷在膝關節和髖關節是普通的。缺陷 2 0和三個在缺陷範圍例如用圖2的的導向式器械製作的 12 1用實線表示，原始的經修復盡可能精確地待再生的 軟骨表面2 2用虛線表示。圖3淸楚地表明，用於確定修 復用必需的柱式組織的軸向長度的製在缺陷範圍內孔的深 度尺寸其近似性很差。 爲了改善近似性建議，原始軟骨表面2 2用異型量規 2 3加以近似。其中在製作孔之前將不同的這類量規2 3 舖開從一組相應的量規中選出最適合於缺陷的軟骨範圍的 量規2 3。 量規組中的量規2 3可以例如是簡單的一維的半徑量 規，用它將原始的軟骨表面2 2近似作爲球形表面。但也 可以考處適合普通尺寸和形狀的關節範圍的一維或二維量 規2 3。 圖4表示用於確定植入孔21中的柱式組織軸向長度 的器械的實施例，孔2 1製在圖3的缺陷中。其表示方法 與圖3的相同，用於確定柱長度的器械用軸向截面表示〃 該器械主要由環形導向件1 0，表面樣板2 4和測桿2 5 組成》 如果孔用圖2的導向式器械製成，則該器械的環形導 向件1 0最好用於確定長度用的環形導^件。其上定位一 個表面樣板2 4。該表面樣板2 4是一組不同形狀的樣板 2 4中的一個，這個樣板的形狀（拱形）與製孔前爲再生 原始軟骨表面2 2所選出的量規2 3相符，它具有一個測 (讀先閱讀背而之注意事項再填寫本頁) 0 ^ *ye 線 本紙张尺度適州中KS家榡準（CNS > Λ4規格（210X 297公釐） -10- A 7 B7 五、發明説明（8 ) 量孔26的圖形，該圖形與製成的孔2 1的圖形相符。表 面樣板2 4的測量孔2 6例如借助於定位凸輪2 7對準孔 2 1的確形。 也可以設想用測量樣板2 4直接用作形狀量規2 3。 如果它由透光的材料製成，則這種情況下是有利的。 測桿2 5具有與測量孔2 6 —致的直徑和測ί:刻度 2 8，該測量刻度用來表示原始軟骨2 2和測量樣板2 4 之間的距離。修復用的柱式組織的必要長度可直接從測量 刻度2 8上讀出，例如精度到0 . 5微米。 對於一組量規中的形狀量規2 3簡單配置組一組樣板 中的一定測量樣板2 4可例如用顏色標碼實現。由於測量 樣板2 4平行於原始軟骨表面2 2延伸，該表面和測量樣 板之間的間距大致與環形導向件1 0的軸向高度相符，因 此測桿2 5足以用於所有測量。因此對於孔軸和原始軟骨 表面2 2之間具有斜角的孔可以保證始終測量同一孔的測 度。測桿2 5和測量孔2 6可以設有軸向延伸的槽和凸輪 (圖4中沒有表示），這樣測桿25引入測量孔26中只 有在一定的旋轉位置才有可能》 圖3和4用於確定缺陷範圍的原始部解剖圖的器械和 用於確定修復缺陷的柱式組織的長度的器械是實施例。這 類器械一般具有形狀量規用來確定局部解剖圖和與形狀量 規一致的裝置用來確定柱的長度，其中形狀本身可以是確 定柱的長度的裝置的一部分。 要修復圖3所示缺陷的外科醫生要執行下述步驟： (誚先閲讀背面之注意事項再填寫本頁)The Ministry of Commerce and Industry of the People's Republic of China 准定 工 β 工 消 A 合 竹 权 印 V A7 ___B7_ V. Description of the invention (1) The present invention relates to the technical field of sauce therapy, and to methods and apparatuses according to the preamble of the corresponding claims. The method and device are used to repair defects in cartilage and osteochondral defects, especially defects in articular cartilage and bone tissue below it. Defects in articular cartilage or defects involving articular cartilage or bone tissue underneath are repaired according to the prior art by artificially filling the cartilage tissue cultured in a glass tube with material containing living cells if necessary Or remove the cartilage tissue at the intact and preferably unstressed site and implant it as an autograft into the defective site. Autografts are usually usually columns with the outer cartilage end side and the inner bone end side. . When the defect is large, a plurality of such posts are usually implanted in one another. • For implantation of cylindrical tissue, make cylindrical holes as precise as possible at the defect site. Here, the cylindrical tissue is punched or drilled, and then separated by rotation on its base, or a cutting drill is used. . The columnar tissue with a diameter slightly larger than the inner diameter of the hole formed in the defect site is taken out at the unstressed joint site (such as the crotch of a woman). The columnar tissue to be removed is drilled with a hollow drill and then separated by rotating on the substrate. The removed pillar structure is then inserted into the formed defective hole * due to the different diameters resulting in " ^ press-fitting〃, so that the pillar remains in the hole. The holes formed by the removal of the column are generally filled with non-defective materials, which are in good health: either with man-made materials or with materials cultured in glass tubes. The columnar tissue to be implanted is removed and removed, and if necessary, the tissue is punched or removed from the hole in the defect site. Generally, a tubular instrument is used. One end has a tubular cutting edge, and the other end is used for holding and guiding. In order to check the column type ml In »^ ni -I —.1— ^^ 1 fcl—-—CL m HI I. (Please read the precautions before filling this page) Store standard rate (CNS) Λ4 specification (210 × 7mm) -4- The central mark of the Ministry of Economic Affairs will cancel the seal of Hezhusha * '! Winter A7 __ ___B7_ 5. Description of the invention (2) The length and quality of the organization, this type The device preferably has a corresponding window. The material from the nail is removed from the tubular device by means of a plug conforming to the inside diameter of the device. Such devices are commercially available, for example from Smith & Nephew, The United States or manufactured by Arthrex Corporation, United States. To make holes in the defective part with a drill, a deviated drill can be used. It has been shown that the above method of repairing articular cartilage defects with the implantation of living tissue is successful To a large extent depends on the accuracy of the inserted repair tissue * and the treatment of the tissue during removal and implantation. For the above reasons, the task of the present invention is to improve the repair of cartilage defects by implantation or transplantation of cylindrical living tissue or With cartilage and bone tissue below it Methods and devices for joint defects, especially articular cartilage defects, to increase the chance of success. The methods and devices according to the present invention can improve the accuracy of the repair while processing the used tissues intact. Nevertheless, the device of the present invention is simple to manufacture, especially It is simple. The method and device of the present invention should be particularly suitable for repairing large defects by mosaic methods, but of course it can also be used at least partly for small defects, that is, only using implants. "The above tasks are used in the independent claims The methods and devices described in the subsections are addressed. The dependent claims define other implementation forms. It has been shown that in order to solve the above-mentioned general task, four parts of improvement are needed, of which one improvement aspect has the greatest effect depending on the application. On the other hand, there are only small effects or obvious effects4, so they can be omitted. These four main improvements are as follows:-Improving the positioning of cylindrical holes generated within the defect range when implanting multiple columnar tissues Accuracy and parallelism accuracy. By applying the corresponding principles here (诮 read the precautions on the back before filling in the manual (Page) Binding Book Paper Scales Chengzhou China Yinjia Standard ((: NS > Λ4 Specification (210X297mm) -5- A7 ___- B7_ V. Description of the Invention (3)) (#Read the notes on the back first Fill this page again) to make holes. This measure can generally prevent the columnar tissue in the implantation hole from extruding against each other to bear the additional load, so each implanted column is required to be fixed at least Surrounded by natural tissues as much as possible within the range of healthy tissue, which improves wound healing.-Improving the accuracy of the repaired defected cartilage surface with the original local anatomy of healthy or defect-free cartilage For this purpose, the axial length of the columnar tissue to be implanted and the orientation of the cartilage surface relative to the axis of the column are aligned as closely as possible to the mimic cartilage surface. This measure is particularly important when the defect is relatively large, and the defect is repaired with multiple implant columns. The better the surface of the original cartilage is, the more uniform the surface of the implants will be when the repaired joint is used, so that the overall load distribution on the implants will be more uniform. As a result, unwanted deformation and damage of the implant and the natural cartilage around the repaired defect can be prevented as a result of the repair. Line-The repaired defect is void-free and void-free on the natural cartilage. The gap-free surface of the cartilage can be achieved by combining the transplanted or implanted columnar tissue with the cartilage tissue cultured in the glass tube. This tissue can fill the gap between the implanted columnar tissue and the columnar tissue and The gap between the natural cartilage = The non-voided cartilage surface promotes the co-growth of the implant and the natural soft bones, and prevents the continued exposure of the synovial fluid through the gaps in the cartilage layer to the cartilage tissue below. damage. This measure is important when larger defects are to be repaired with multiple implants, and the above-mentioned% press-fitting is sufficient for 4 small defects. -The material to be implanted must be intact during cutting and implantation, especially as pressureless as possible, so as to avoid columnar tissue grafts and planted paper cultured in glass tubes suitable for China S house standard ((,, NS) Λ4 specification (210X297 mm) ~ T «Central part of the dungeon 消费 Consumer Hexian Society Yinji A7 _____B7_ V. Description of the invention (4) Uncontrollable love shape is generated in the body, thereby improving the accuracy of repair. The implanted columnar tissue is preferably in all cases a body graft taken from an unstressed area, or it can be a replacement material for cartilage tissue cultured in a glass tube. This type of implant to be implanted during the repair process The post is preferably made from a block made of punched or countersinked (hollow countersink) methods and instruments of the present invention are not only suitable for open surgical repair operations but also for arthroscopy. In conjunction with the following drawings An embodiment of an improved method and apparatus for repairing intra-cartilage or osteochondral defects, in particular joint defects, is described in more detail. Figure 1 shows a top view of a cartilage defect repaired by a known mosaic method. (left And cross-section view (right). The surface of the natural cartilage layer 1 and the round surface of the cartilage layer 2 of the implanted columnar tissue 2 for repair can be seen in the plan view. The natural cartilage is located in the cross-section view. The natural bone tissue 3 below layer 1 and the column tissue 2 implanted in the corresponding cylindrical hole, this column tissue 2 has an internal bone portion 2 'below the cartilage layer 2>, which in the case of a transplanted column consists of bone Tissue, while in the case of columns cultured in glass, it is composed of bone substitute material. In order to have the smallest possible voids in the surface of the repaired cartilage, it is better to have the smallest possible range of defective cartilage material The columns are usually placed as close as possible. For this reason, it is important that Θ and the holes of the column 2 to be implanted should be as parallel as possible. This parallelism of accuracy can be guaranteed and can be made very close to each other The holes do not intersect, which makes the implantation difficult and puts an additional load on the implanted columns. If other implants are used between the columns 2, the paper size is Tongzhou China National Standard ?? ((, NS) Λ4 specification (210X 297 mm) ---------, t * f ----- —— {Order ------ line, (Notes for reading first, and then E K? This page) The central sample of the Ministry of Economics and Economics β Η 消 合 合 竹. Shirt print * '! Water A7 B7 V. Description of the invention (5) As will be explained in conjunction with Figs. 9 and 10, the high-precision parallelism of the holes to be made and the orientation of the holes are not necessary. In the embodiment, a plurality of high-precision cylindrical holes can be made in the scope of cartilage defects with the aid of the instrument. The embodiment of the illustrated guided instrument is suitable for repair, as shown in FIG. 1. The instrument is mainly composed of a The cylindrical ring-shaped guide 10 and at least two ring-shaped punching or drilling guides 11 and 12 are composed of top views (see the top view of the repaired defect on the left side of FIG. 1). An annular guide 10 is positioned around the defect and, for example, by means of a Kirschner wire, which is fixed by means of a hole 13 for this purpose or by another suitable fixing method. One can be selected from a set of annular guides having one of this shape and size on the inside surface to make it as accurate as possible for the defect to be repaired. The punching or drilling guides 11 and 12 have an inner diameter suitable for the punching or drilling instrument to be used, and for precise positioning in the annular guide 10 on the outside have, for example, at least one axially extending cam 14, It is inserted into a corresponding groove 15 extending axially on the inner surface of the annular guide 10, wherein the radial height of the cam 14 is adapted to the distance between the holes on the inner surface of the annular guide 10. In Fig. 2, a punching or annular guide 10 is used to make the center hole for repair shown in Fig. 1, and a punching or drilling guide 12 is used to make an edge hole. The two drilling guides 1 1 and 12 have two cams 14 which can be positioned in the grooves 15 of the ring guides 10 opposite each other. It is also possible to provide only one cam for each punching or drilling guide in the corresponding construction of the slot and cam. This paper size Chengzhou China S Jiabiao Hua (CNS) Λ4 size (210x 297 male 1) -8----------- Order I 1 ---- line .. (Read the first read on the back Matters needing attention are refilled (:?; This page) A 7 B7 iiT / T · "Ministry of Central Government quasi-military workers disappeared in Hezhu Tt Seal V. Description of the invention (6) Set the diagram for a generally circular defect Guided instrument shown in 2 "In the same way, a guided instrument can also be provided for defects of different shapes. The ring guide 10 of the guided instrument shown in Fig. 2 is fixed, for example, by a Kirschner wire positioned around the defect to be repaired. In order to avoid the additional load of the defect range caused by fixing the annular guide 10, the annular guide 10 can also be fixed at a fixed position of the bone away from the defect site by a three-point fixing, for example, and there is a defect on the bone to be repaired. This type of fixation is known from joint-prosthesis-surgery and can be used not only for open surgery but also for arthroscopy. In order to obstruct the surgeon's vision as little as possible when making the hole, it is preferable that at least the ring-shaped guide 10 is made of a light-transmitting material or has a corresponding window. The guided instrument shown in FIG. 2 is an example of such an instrument. Such guided instruments typically have a device that can be fixed within the range of the defect to be repaired and a device that guides the punching or drilling instrument at multiple locations. The instrument of the invention for repairing cartilage defects has a different set of guides, in addition to the punching or drilling instruments used to make the holes of the implant of the columnar tissue, if necessary consistent with the joints and defects to be treated Device. The repairing surgeon selects an appropriate one from this group of guided instruments, positions the ring guide 10 on the defect and fixes it. He then inserts the punching or drilling guide 11 or 12 into the annular guide 10 to guide the punching or countersinking instrument used to make the corresponding hole. Replace or change the position of the punching or drilling guides to make other holes. Figure 3 shows the cartilage defect 20 at the severely curved joint position (read the precautions before reading this page and then continue to write this page) Shizhou Chinese storehouse (CNS M4 specification (210X297 mm) -9- A7 —_____ B7 V. Description of the invention (7) Face 阖 • Defects of this size are common in knee and hip joints. Defects 2 0 And three in the defect area, such as 12 1 made with the guided instrument of FIG. 2, are represented by solid lines, and the original repaired cartilage surface to be regenerated as accurately as possible 2 2 is represented by dashed lines. Figure 3 clearly shows that The depth of the hole used to determine the axial length of the columnar tissue necessary for repair has a poor approximation of the depth of the hole. To improve the approximation, the original cartilage surface 2 2 is approximated by a profiled gauge 2 3. Among them, different kinds of gauges 2 3 are rolled out before making holes. A cartilage range gauge 2 3 which is most suitable for a defect is selected from a set of corresponding gauges. The gauges 2 3 in the gauge group may be, for example, Simple one-dimensional radius gauge, which approximates the original cartilage surface 2 2 as a sphere Shape surface. However, one- or two-dimensional gauges suitable for joint ranges of common sizes and shapes may also be considered. Figure 3 shows an embodiment of an instrument for determining the axial length of the cylindrical tissue in the implantation hole 21 The hole 21 is made in the defect of Fig. 3. It is expressed in the same way as in Fig. 3. The instrument used to determine the length of the column is represented by an axial section. The instrument is mainly composed of a ring guide 10, a surface template 24, and a measurement. Composition of the rod 2 5 "If the hole is made of the guiding instrument of Fig. 2, the annular guide 10 of the instrument is preferably used for determining the length of the annular guide. A surface template 24 is positioned thereon. The surface The template 24 is one of a set of templates 24 of different shapes. The shape (arch) of this template is consistent with the gauge 2 3 selected for regenerating the original cartilage surface 2 2 before making holes. It has a measurement (read Read the precautions and fill in this page first) 0 ^ * ye The size of the paper is KS standard in Shizhou (CNS > Λ4 specification (210X 297mm) -10- A 7 B7 V. Description of the invention ( 8) The pattern of the measuring hole 26, the pattern is consistent with the pattern of the hole 21 made. The surface template 2 The measuring hole 2 6 of 4 is, for example, aligned with the hole 21 by means of the positioning cam 2 7. It is also conceivable to use the measuring template 2 4 directly as the shape gauge 2 3. If it is made of a light-transmitting material, this It is advantageous in this case. The measuring rod 25 has a diameter equal to that of the measuring hole 26 and a measuring scale 2 8 which is used to indicate the distance between the original cartilage 2 2 and the measuring template 2 4. Repair The necessary length of the columnar tissue used can be read directly from the measurement scale 28, for example, to an accuracy of 0.5 microns. For the shape gauge in a set of gauges 2 3 Simple configuration group A certain measurement template in a set of templates 2 4 can be implemented, for example, with color coding. Since the measurement template 24 extends parallel to the original cartilage surface 22, the distance between this surface and the measurement template roughly corresponds to the axial height of the annular guide 10, so the measurement rod 25 is sufficient for all measurements. Therefore, for a hole with an oblique angle between the hole axis and the original cartilage surface 22, the measurement of the same hole can always be measured. The measuring rod 25 and the measuring hole 26 can be provided with axially extending grooves and cams (not shown in FIG. 4), so that the introduction of the measuring rod 25 into the measuring hole 26 is only possible in a certain rotational position. "Figures 3 and 4 The instrument used to determine the anatomical view of the original part of the defect range and the instrument used to determine the length of the columnar tissue that repairs the defect are examples. Such instruments generally have a shape gauge to determine the anatomy and a device consistent with the shape gauge to determine the length of the column, where the shape itself can be part of the device that determines the length of the column. To repair the defect shown in Figure 3, the surgeon performs the following steps: (诮 Read the precautions on the back before filling out this page)
-、1T 線’ 本紙张尺度適用中國®家標卒（CNS ) Λ4規格（210X 297公釐） • 11 - 妗"部中央椋準局β工消费合竹社印妒 Α7 Β7 五、發明説明（9 ) _必要時用量規2 3確定相應於缺陷的表面樣板2 4 t -定位並安裝環形導向件1 0 ; 一必要時用導向件1 1和1 2製成孔2 1 ; -定位表面樣板2 4並確定待植入的柱式組織的軸向 長度； -爲了取出預定軸向長度的柱式組織調節沖孔器械和 鐄孔器械； -在取出部位取出柱並植入孔中。 圖5表示強烈彎曲的關節處的如圖3的相同缺陷》由 圖5可以看出，原始軟骨表面2 2可以按高精度再生，條 件是始軟骨表面和孔21 . 1、21 . 2、21 . 3的軸 線之間的角度α 1，α 2和α 3不是聽其自然的，而是有 目的再生的。因此，對於提高修復的成功機會而言，確定 不同待植入的柱式組織的角度α和按目的從另一部位取出 柱式組織或從玻璃管中培養的軟骨中沖出柱式組織是有利 的。 最簡單的是爲取出移植的柱式組織要尋找一取出部位 ，該部位的形狀與缺陷範圍相符，並用一裝置取出該柱式 組織，所用的裝置與在缺陷部位製作孔的裝匱相同。這樣 做不僅不利而且根本不可能。用於取出^式組織的尤其是 如性負荷小的髁狀突起部位，該部位具有其合適的形狀’ 取出按順序進行並且在取出部位之間保持盡可能大的間距 是有利的。 —^1 " I n I.. m ^yf-ι-,ί I (讀先閲讀背而之注意事項再填艿本頁) ------ 訂 線 本紙张尺度適;fl中國®家標準（CNS ) Λ4規格（210X297公釐） -12- 經淨部中央榡卑局Μ工消費合；sri.1印來 Α7 Β7 五、發明説明（10 ) 出於這一原因，對於精確再生原始軟骨表面2 2要確 定角度α並在取出部位按相應的角度取出柱式組織。 圖Θ表示這類取出部位和與孔21 . 1、21 . 2和 21 . 3相應的待取出的柱式組織2 . 1、2 . 2和 2 . 3。軟骨表面和柱式軸線之間的角度α與角度αΐ、 α 2和α 3相符。 爲了取出圖6的柱式組織2.1、 2.2和2.3和 將其植入圖5的孔21.1、 21.2和21.3中設置 了一器械，借助於該器械可以按預定的柱軸線和軟骨表面 之間的角度並在預定旋轉位置取出柱，並且可在同樣確定 的旋轉位置植入。 圖7表示這類取出器械的實施例，該器械大致由一取 出器導向件3 0和一取出器3 1組成。 取出器導向件3 0大體爲管狀並在其一端具有一支承 凸緣3 2，該支承凸緣按角度α指向管軸。盡管圖7中實 施例表示相對於管軸角度α是固定的，自然也可以將該器 械設計成角度〇:是可調的。支承凸緣3 2爲了固定可以具 有孔（未示出），通過這些孔可以將具有基爾施納導線的 支承凸緣3 2釘在組織上。爲了固定取出器導向件也可以 採用外部三點固定法，如已結合圖2說明的。 取出器導向件3 0具有與取出器3 致的內徑和一 個在內表面上軸向延伸的導向槽3 3，該導向槽例如在內 圓周的與支承凸緣3 2的最高或最低位置相應的位置處延 伸。在取出器導向件3 0的變寬的端部3 4其內徑變寬到 本紙張尺度適用中國®家標嗥（CNS > Λ4規格（2丨0X297公釐） -13 - ------------,,---r>iT— ^-----線 (請先閲讀背而之注意事項再堉巧本頁) 經濟部中央標it-t?兵工消费合竹社印»'!冬 A7 B7 五、發明说明（11 ) 導向槽3 3的徑向外延伸。該端部3 4通向支承凸緣3 2 〇 取出器31必要時爲管形並具有與待取出柱相符的內 徑》其一端面弄尖，在其外表面上該取出器31具有一導 向凸輪3 5，該導向凸輪在取出器3 1引入取出器導向件 3 0中時在取出器導向件3 0的導向槽3 3中移動。該導 向凸輪3 5軸向設置成定位在取出器導向件3 0的變寬的 端部，這時取出器3 1弄尖的端面到達這組織的與待取出 的柱的長度相符的濺度。取出器3 1由於導向凸輪而只能 在一確定的旋轉位置插入取出器的導向件3 0中，但是爲 了在基底分離柱而可在取出器導向件中旋轉。 爲了使待分離的柱在通過旋轉而分離時不在取出器 3 1中旋轉，取出器3 1在其內表面上盡可能靠近弄尖的 端面具有至少一個徑向伸入內腔的、軸向延伸的最好爲刀 片形旋轉止檔3 6。業已表明，這類旋轉止擋徑向延伸段 不需要大於一微米。 可以使用通過取出器導向件3 0導引的取出器3 1， 以便沖出用線S表示的柱式組織，並通過在基底旋轉而分 離。最好在用空心鑽孔器（未圖示）取出柱之前沿著線S 預鑽孔。這種空心鑽孔器的形狀與取出器3 1相符，其中 沒有導向凸輪3 5和旋轉止檔3 6。弄4的邊緣最好由含 鑽石的材料製成或用類似材料塗層。此外，該纘空器具有 確定孔深度的適合裝置。 此外，圖7表示用於從取出器3 1中推出已提取的柱 本紙张尺度適用中囷S家標準（（’NS ) Λ4規格（210X 297公釐} - 14 - (#先閲讀背面之注意事項再填巧本頁) -訂 經漭部中央榡工消frAt竹社印黧 Α7 Β7 五、發明説明（12 ) 式組織的推桿3 7。最好推桿上有一遠側端面’該端像支 承凸緣3 2那樣相對於推桿軸形成α角。爲了使推桿3 7 只能在與凸緣位置相應的旋轉位置插入取出器中，它具有 一軸向延伸的導向槽3 8，該取出器3 1具有一相應的導 向凸緣3 9，但是該導向凸緣伸至位於取出器中柱式組織 的範圍。推桿的遠側端具有減小了的直徑，以便該端能經 過旋轉止檔3 6至取出器3 1的端部。 圖8表示用於植入用圖7的取出器械取出的柱式組織 的植入器械。該器械用俯視圖表示。這裏是指一植入導向 件4 0，它的結構與圖2的沖孔或鑽孔導向件1 1和1 2 相同並可定位在環形導向件1 0中（用圓的點劃線表示） 。植入導向件4 0的內徑與取出器3 1的外徑一致。爲了 使取出器3 1只能在預定的旋轉位置插入植入導向件4 0 中，該植入導向件在其內表面具有一軸向延伸的導向槽 4 1，取出器3 1的導向凸輪3 5可定位在該導向槽中。 待植入的柱式組織的角度α可通過用於每個柱的前面 已選出的表面樣板2 4 (圖4 )的形狀而明確確定。這是 以爲外科醫生提供一取出器械及一組不同的取出器導向件 3 0。這些導向件例如用標確與表面樣板的測量孔或在缺 陷部件製成的相應的孔相關聯。作爲標碼可考慮不同數目 ( 的線條，用於不同的測量孔和表面樣板的取出導向件的相 關聯的，其中用於不同表面樣板的剌線具有不同的顔色， 取出器導向件3 0也可以用角度α表示並將相同的數値除 測量孔外標明在表面樣板上。 本纸张尺度適川中國囚家標埤（CNS ) Λ4規格（210X 297公釐） -15- ----------- (請先閱讀背面之注意事項再填寫本頁) '訂 線 .¾^部屮央榡冷局βτ-消費合竹.^印t A7 B7 五、發明説明（13 ) 圖7和8的器械表示的是實施例。用於按軟骨表面和 柱軸之間的預定角度取出柱的取出器械一般具有可固定的 裝置，用於按預定的角度引導取出器和必要時的空心鑽孔 器，以及一植入器械，其中取出器械和植入器械具有在相 關的旋轉位置用於取出和植入的相關裝置。 爲了再生，外科醫生要讀出柱軸線和表面樣板2 4上 的原始軟骨表面之間的角度，外科轚生爲取出每個柱式組 織要使用取出器導向件3 0。他將取出器導向件3 0安放 在適當的取出部位，並通過引導取出器導向件3 0對柱式 組織預鑽孔，同時內外冷卻，將取出器3 1放入預鑽孔中 ，通過旋轉取出器使柱式組織與其基底分離，將取出器轉 回其原始旋轉位置，然後從取出器導向件3 0中取出取出 器3 1及柱式組織。然後他將植入導向件4 0插入還安裝 在缺陷部位的環形導向件1 0內，將取出器和柱式組織移 入植入導向件4 0中，並借助於推桿3 7將柱式組織移入 位於植入導向件下方的孔內。該孔已事先製成，如結合圖 1和2所作的說明。 如果沒有可以用來調節插入組織中的取出器的孔的深 度和插入探度的裝置，則就可確定已取出的柱式組織的軸 向長度。盡管如此，在植入之前檢査其長度並在必要時作 出修正是有利的。爲此，在取出器3 1 ΐ設有視窗（參見 圖13和17)。該視窗被設置成，已取出的柱的軟骨表 面可位於視窗範圍，用視窗範圍的長度刻度可確定取出器 弄尖的邊緣和柱式組織的軟骨表面之間的間距。如果已取 (讀先閱讀背面之注意事項再楨寫本頁) ---------------^Γι----_----- 訂---------線，----11---I----- 本紙乐尺度適用中KK家標苹（rNS ) Λ4規格（210X297公釐） -16- A7 B7 五、發明説明（14 ) 出的柱式組織太長，則可用推桿3 7略微前推並將伸出取 出器的部分切掉。 圖Θ和10作爲俯視圖和截面圖表示已修復的軟骨缺 陷，其除了已植入的柱式組織Q之外具有一玻璃管中培養 的植入的軟骨層5 0。軟骨層5 0塡滿柱式組織2之間的 空隙以及柱式組織2和天生軟骨層1之間的空隙。植入的 軟骨層5 0在缺陷深度不大於軟骨層5 0厚度的地方用適 當的塡充材料51塡滿。 相當於圖1沒有這類軟骨層的修復，圖9和1 0的用 植入的軟骨層5 0來修復的主要優點在於，用軟骨層5 0 完全封住植入的柱式組織2之間的空隙，從而能夠阻止滑 液浸入骨組織。由此這些柱可以無缺點地相互略微隔開地 植入，從而可以圍繞著天生的骨組織的周圍，這將明顯加 快天生的和植入的組織的完全生長。 相對於只具有一種在玻璃管內培養的軟骨層（必要時 用適當的材料事後塡滿）的修復而言，圖9和1 0的用植 入的軟骨層5 0和移植的柱式組織的修復的優點在於，通 過移植的爲此具有足夠機械強度的軟骨承受了大部分負荷 ，以致剛剛在修復手術後，玻璃管內培養的軟骨就在保護 下（很小負荷）長好，從而可達到與天生軟骨相當的最終 的機械強度。 \ 軟骨層5 0事先由身體細胞或在骨骨替代材料的底層 上或沒有這一底層培養。其中通過在培養時爲細胞提供的 空間而確定所生成的軟骨形狀。 ----------------—f--訂-------線 I (請先閱讀背面之注意事項再填寫本頁) 本紙张尺度適州中國园家標率（（'阳>八4規格（2丨0><297公釐> -17- A7 __B7 五、發明説明（15 ) 爲了植入，玻璃管內培養的軟骨層5 0必須盡可能精 確地沖成或切割成與在待修復的缺陷範圍內製成的孔相符 的形狀；，而且必須在其中製出柱式組織用的孔，該孔爲了 •壓配合'應具有比柱式組織小一些的直徑。此外，爲了 精確事後塡滿軟骨層或相應切除缺陷必須確定培養的軟骨 層的厚度。 爲了對要植入的軟骨層5 0製出孔，例如在缺陷範圍 安裝有環形導向件10(圖2)並沿著該環形導向件用相 應的環形沖孔器械或手術刀豎直切出天生的軟骨組織，然 後切除缺陷，使得在環形導向件內，軟骨表面或骨表面要 比始的軟骨表面低至少待植入的軟骨層的厚度。 在圖9和10中表示用六個旋轉對稱設置的柱式組織 2的修復。當然按相同方式也可用具有不同數目的柱式組 織尤其是只有一人個柱式組織的其它的柱的設置。 圖1 1表示用於由軟骨5 0製出所需植入體用於修復 的沖孔器械的實施例*如圖9和1 0所示。沖孔器械主要 由一支撐面6 0和沖模6 1組成。支撐面6 0的形狀（拱 形）最好與待再生的軟骨表面2 2 (圖3和4)或表面樣 板24(圖4)的形狀相符》軟骨表面按照表面樣板24 再生。沖模6 1具有一與支撐面6 0相符的形狀，並具有 與待製出的植入體的輪廓和待製出的柱4組織用的孔相符 的沖孔刀刃，其中沖孔刀刃的寬度要大於待沖孔的軟骨層 的厚度。 爲了產生更精度的沖孔，最好在支撐面6 0上安置與 本紙張尺度適州中國S家標準（CNS ) Λ4况格（210X297公釐） -18- (請先閲讀背面之注意事項再填寫本頁) *va A7 B7 五、發明説明（16 ) 沖模6 1的沖孔刀刃6 2相符的寬度很小的相配刀刃（未 圖示）。 將培養的軟骨層5 0定位在支撐面6 0上，使得沖孔 模6 1用適當的傳動機械平行地相對於支撐面6 0運動， 直至沖孔刀刃6 2位於支撐面6 0上或相配刀刃上，而使 位於預定位置的軟骨層5 0完全分開。 圖1 2表示用於確定在玻璃管內培養的軟骨層5 0 ( 用骨替代材料作基層或沒有基層）厚度的器械的實施例。 該器械大體由一具有不同深度凹口 7 1的測量塊7 0和一 加重塊7 2組成；該加重塊最好由透光的材料組成，其在 支撐面上的重量大體與植入時所用的壓力相符。凹口 7 1 最好具有待修復的缺陷的形狀或在該缺陷範圍爲植入軟骨 層5 0而製出的孔的形狀相符。 爲了確定厚度將沖出的軟骨層5 0放入一凹口 7 1中 並用加重塊7 2加重。軟骨層5 0修復用的相關厚度與這 一凹口 7 1的深度相等，當軟骨層5 0位於凹口中時，加 重塊7 2正好不再位於凹口上。 用於修復圖9和10所示缺陷的本發明的器械除了上 述部分器械外還具有用於沖孔或切割玻璃管中培養的軟骨 層5 0用的器械，該器械具有一組不同對的支撐面6 0和 沖孔模6 1。此外，該器械最好具有用4測量這類軟骨層 植入用的相關厚度的器械或具有一組這類器械，以用於不 同的缺陷形狀。 —位外科醫生爲了作如圖9和11所示的修復例如要 ------------1---^訂 — ------線. (誚先閱讀背面之注意事項再填艿本頁) 本纸张尺度適州中國阀家標導（（’NS > Λ4現格（210X 297公釐} -19- A7 B7 五、發明説明（17 ) 按已給定的順序完成下述步驟： -確定待再生的軟骨表面2 2的形狀； -確定待植入的軟骨層5 0用的孔和待植入的柱式組 織2的圖案； -由玻璃管內培養的軟骨層5 0製出植入體確定其厚 度： 一安裝環形導向件1 0 : —製出待植入的軟骨層5 0用的孔； -對於每個柱式組織2 :製出孔2 1，取出柱式組織 ，將柱式組織植入孔2 1中； 一取走環形導向件1 0 ; -如果需要採用塡充材料5 1 : 一植入沖出的軟骨層5 0。 圖1 3至1 6表示用於取出和植入柱式組織的器械的 實施例的一部分（圚1 3至1 5爲與軸線平行的橫截面） 。圖13爲一取出器31 . 1，圖14爲一取出器導向件 30 . 1，用於在取出柱式組織時引導取出器3 1 . 1， 圖1 5是植入導向件，用於在植入柱式組織時引導取出器 31 . 1，和圖16是推桿37 . 1，用於從取出器 3 1 . 1中推出柱式組織。 器械部件 31.1、30.1、4(i.l 和 37.1 許多特徵與結合圖7和8所作說明的功能相同的器械部件 31、 30、 40、 37相同。在此只描述與上述特徵不 同的特徵。其它特徵用圖7和8中的標號表示。 本紙张尺度遺州中國Κ家標肀（CNS ) Λ4規格（210X 297公釐） -20- ^^^1 11· ^^^1 —^n 1^1 —f^i In i n u^rfi (誚先閱讀背面之注意事項再填ft?本頁)-, 1T line 'This paper size applies to China® Family Standards (CNS) Λ4 specification (210X 297 mm) • 11-妗 " Ministry of Central Standards and Technology Bureau β Industrial Consumption Hezhu Society Printing Envy Α7 Β7 V. Description of the invention (9) _ If necessary, use a gauge 2 3 to determine the surface template corresponding to the defect 2 4 t-Locate and install the ring guide 10;-If necessary, use the guides 1 1 and 12 to make holes 2 1;-Position the surface Template 24 and determine the axial length of the columnar tissue to be implanted;-Adjust the punching and countersinking instruments to remove the columnar tissue with a predetermined axial length;-Remove the column at the removal site and implant it into the hole. Figure 5 shows the same defect at the strongly curved joint as in Figure 3. From Figure 5, it can be seen that the original cartilage surface 22 can be reproduced with high precision, provided that the original cartilage surface and holes 21.1, 21. 2, 21 The angles α 1, α 2 and α 3 between the axes of 3 are not natural, but purposefully reproduced. Therefore, in order to improve the chance of successful repair, it is advantageous to determine the angle α of the different columnar tissues to be implanted and to remove the columnar tissue from another site according to the purpose or to flush out the columnar tissue from the cartilage cultured in the glass tube. of. The simplest is to find a removal site for removing the transplanted columnar tissue, the shape of the site is consistent with the defect range, and use a device to remove the columnar tissue, the device used is the same as that used to make holes in the defect site. This is not only unfavorable, it is simply impossible. It is particularly advantageous to remove 组织 -shaped tissues, such as ridge-shaped protrusions with a small sexual load, which have their proper shape. It is advantageous to take out the steps in sequence and to keep the distance between the removed parts as large as possible. -^ 1 " I n I .. m ^ yf-ι-, ί I (Read first, read the precautions before filling in this page) ------ The paper size of the booklet is suitable; fl China® Home Standard (CNS) Λ4 specification (210X297 mm) -12- The Ministry of Economic Affairs, Central Ministry of Economic Affairs, the Ministry of Industry and Commerce; sri.1 printed to A7 Β7 V. Description of the invention (10) For this reason, for accurate regeneration The original cartilage surface 22 needs to determine the angle α and remove the columnar tissue at the corresponding angle at the removal site. Figure Θ shows this type of extraction site and the columnar tissues 2.1, 2.2, and 2.3 corresponding to the holes 21.1, 21.2, and 21.3. The angle α between the cartilage surface and the cylindrical axis coincides with the angles αΐ, α 2 and α 3. In order to remove the columnar tissues 2.1, 2.2, and 2.3 of FIG. 6 and implant them in the holes 21.1, 21.2, and 21.3 of FIG. 5, an instrument is provided by which a predetermined angle between the column axis and the cartilage surface can be set. The column is removed at a predetermined rotation position and can be implanted at a similarly determined rotation position. Fig. 7 shows an embodiment of this type of extraction device, which is roughly composed of an extractor guide 30 and an extractor 31. The extractor guide 30 is generally tubular and has a support flange 32 at one end thereof, which supports flange is directed at the pipe axis at an angle α. Although the embodiment in FIG. 7 shows that the angle α with respect to the tube axis is fixed, it is naturally also possible to design the device such that the angle 0: is adjustable. The support flange 32 may have holes (not shown) for fixing, through which the support flange 32 with the Kirschner wire can be nailed to the tissue. To fix the extractor guide, an external three-point fixing method can also be used, as already explained in connection with FIG. 2. The extractor guide 30 has an inner diameter corresponding to the extractor 3 and a guide groove 33 extending axially on the inner surface, which guide groove corresponds, for example, to the highest or lowest position of the supporting flange 32 on the inner circumference. Extended at the location. At the widened end 3 4 of the extractor guide 30, the inner diameter is widened to the paper size. China® House Standard 嗥 (CNS > Λ4 specification (2 丨 0X297 mm) -13----- -------- ,, --- r > iT— ^ ----- line (please read the precautions on the back first, and then clever this page) Ministry of Economic Affairs central standard it-t?合 竹 社 印 »'! Winter A7 B7 V. Description of the invention (11) The guide groove 33 extends radially outward. The end portion 34 leads to the supporting flange 3 2. The take-out 31 is tubular and has The inner diameter corresponding to the column to be removed is sharpened on one end surface. On its outer surface, the remover 31 has a guide cam 35, which is taken out when the remover 31 is introduced into the remover guide 30. The guide groove 3 3 of the extractor guide 30 is moved. The guide cam 35 is axially arranged to be positioned at the widened end of the extractor guide 30, and the sharpened end face of the extractor 31 reaches this tissue. Spatter in accordance with the length of the column to be removed. The extractor 31 can only be inserted into the guide 30 of the extractor in a certain rotation position due to the guide cam, but it can be removed at the base to separate the column In order to prevent the column to be separated from rotating in the extractor 31 during separation by rotation, the extractor 31 has at least one radially protruding inner cavity on its inner surface as close to the sharpened end surface as possible. The best axial extension is blade-shaped rotary stop 36. It has been shown that the radial extension of this type of rotary stop does not need to be greater than one micron. An extractor 3 guided by an extractor guide 30 can be used 1. In order to punch out the columnar tissue indicated by line S and separate it by rotating on the base. It is best to pre-drill along line S before removing the column with a hollow drill (not shown). This hollow drill The shape of the perforator corresponds to the extractor 31 without the guide cam 35 and the rotation stop 36. The edge of the perforator 4 is preferably made of a diamond-containing material or coated with a similar material. In addition, the hollower A suitable device for determining the depth of the hole. In addition, FIG. 7 shows the paper size used to push out the extracted column paper from the extractor 31, and the applicable Chinese standard (('NS) Λ4 size (210X 297 mm)-14 -(#Read the notes on the back before filling out this page) -The central part of the booklet cymbal frAt Bamboo Society Seal A7 Β7 V. Description of the invention (12) -type putter 3 7. It is best to have a distal end surface on the putter 'This end is like the supporting flange 3 2 Form an angle α with respect to the shaft of the push rod. In order to make the push rod 3 7 can only be inserted into the extractor in a rotation position corresponding to the flange position, it has an axially extending guide groove 3 8, and the extractor 3 1 has a A corresponding guide flange 39, but this guide flange extends to the extent of the columnar tissue located in the extractor. The distal end of the pusher has a reduced diameter so that the end can pass through the rotation stop 36 to the removal器 31 1 的 端 部。 The end of the device 31. Fig. 8 shows an implantation device for implanting a columnar tissue taken out by the extraction device of Fig. 7. The instrument is shown in a top view. This refers to an implantation guide 40, which has the same structure as the punching or drilling guides 1 1 and 12 of FIG. 2 and can be positioned in the ring guide 10 (indicated by a circled dotted line). . The inner diameter of the implantation guide 40 is consistent with the outer diameter of the extractor 31. In order to enable the extractor 31 to be inserted into the implant guide 40 only at a predetermined rotation position, the implant guide has an axially extending guide groove 41 on its inner surface, and the guide cam 3 of the extractor 31 5 can be positioned in the guide groove. The angle α of the columnar tissue to be implanted can be clearly determined by the shape of the surface template 2 4 (FIG. 4) selected for the front of each column. This is to provide the surgeon with an extraction instrument and a different set of extractor guides 30. These guides are associated, for example, with the measuring holes of the surface template or the corresponding holes made in the defective part. As the code, it is possible to consider the association of different numbers of lines (for different measurement holes and surface template extraction guides, where the stern lines for different surface templates have different colors, and the extractor guides 3 0 also It can be expressed by the angle α and the same number is marked on the surface template except the measurement hole. The paper size is suitable for Sichuan Chinese Prisoner's Mark (CNS) Λ4 size (210X 297 mm) -15- ----- ------ (Please read the precautions on the back before filling in this page) 'Ordering line. ¾ ^ Department 屮 Central 榡 Cold Bureau βτ-Consumer Bamboo. ^ Print t A7 B7 V. Description of the invention (13) The instruments of 7 and 8 show examples. The extraction instrument for removing a column at a predetermined angle between the cartilage surface and the column shaft generally has a fixable device for guiding the extractor and a hollow if necessary A drill, and an implantation instrument, wherein the extraction instrument and the implantation instrument have associated devices for extraction and implantation in an associated rotational position. For regeneration, the surgeon reads out the column axis and the surface template 24. Angle between primitive cartilage surfaces, surgical In order to remove each column tissue, the extractor guide 30 is used. He places the extractor guide 30 in an appropriate extraction site, and pre-drills the column tissue by guiding the extractor guide 30, and at the same time Cool inside and outside, put the extractor 3 1 into the pre-drilled hole, separate the columnar tissue from its base by rotating the extractor, turn the extractor back to its original rotation position, and then remove the extractor 3 from the extractor guide 30 1 and columnar tissue. Then he inserted the implantation guide 40 into the annular guide 10 also installed in the defect site, moved the extractor and the columnar tissue into the implantation guide 40, and with the aid of a push rod 3 7 Move the columnar tissue into the hole located under the implant guide. This hole has been made in advance, as explained in conjunction with Figures 1 and 2. If there is no depth of the hole that can be used to adjust the extractor inserted into the tissue And inserting the probe device, the axial length of the removed columnar tissue can be determined. Nevertheless, it is advantageous to check its length before implantation and to make corrections if necessary. For this reason, the extractor 3 1 ΐ with window (see (Figures 13 and 17). The window is set so that the cartilage surface of the removed column can be located in the window range, and the length scale of the window range can be used to determine the distance between the sharpened edge of the extractor and the cartilage surface of the columnar tissue. If you have taken (read the precautions on the back before writing this page) --------------- ^ Γι ----_----- Order ----- ---- Line, ---- 11 --- I ----- This paper music scale is applicable to the KK family standard apple (rNS) Λ4 specification (210X297 mm) -16- A7 B7 V. Description of the invention (14 ) The columnar tissue is too long, you can use the pusher 3 7 to push forward slightly and cut off the part protruding from the extractor. Figures Θ and 10 show the repaired cartilage defect as a top view and a cross-sectional view, which have an implanted cartilage layer 50 cultured in a glass tube in addition to the implanted columnar tissue Q. The cartilage layer 50 is filled with the space between the columnar tissue 2 and the space between the columnar tissue 2 and the natural cartilage layer 1. The implanted cartilage layer 50 is filled with an appropriate filling material 51 where the depth of the defect is not greater than the thickness of the cartilage layer 50. It is equivalent to FIG. 1 that there is no such cartilage layer repair. The main advantage of repairing with the implanted cartilage layer 50 in FIGS. 9 and 10 is that the cartilage layer 50 is used to completely seal the implanted columnar tissue 2 The voids can prevent the synovial fluid from penetrating into the bone tissue. As a result, these columns can be implanted slightly apart from each other without fault, so that they can surround the natural bone tissue, which will significantly accelerate the complete growth of the natural and implanted tissue. In contrast to the repair with only one cartilage layer cultured in a glass tube (filled with appropriate materials afterwards if necessary), the implanted cartilage layer 50 and the transplanted columnar tissue of FIGS. 9 and 10 are used. The advantage of repair is that the cartilage with sufficient mechanical strength for this purpose bears most of the load through the transplantation, so that just after the repair operation, the cartilage cultured in the glass tube will grow under protection (small load), so that it can reach Final mechanical strength comparable to natural cartilage. The cartilage layer 50 is previously cultured by body cells or on the bottom layer of bone substitute material or without this bottom layer. The shape of the cartilage produced is determined by the space provided to the cells during culture. ----------------— f--Order ------- Line I (Please read the notes on the back before filling this page) House standard rate (('Yang> 8, 4 specifications (2 丨 0 > < 297 mm > -17- A7 __B7 V. Description of the invention (15) In order to implant, the cartilage layer cultured in the glass tube 50 must Punched or cut as accurately as possible to match the shape of the hole made within the range of the defect to be repaired; and a hole for columnar tissue must be made in it, this hole should have a specific column for press-fitting The tissue has a smaller diameter. In addition, the thickness of the cultured cartilage layer must be determined in order to accurately fill the cartilage layer afterwards or to remove the defect accordingly. In order to make a hole in the cartilage layer to be implanted 50, for example, a ring is installed in the defect area. The guide 10 (Fig. 2) is used to vertically cut out the natural cartilage tissue along the annular guide with a corresponding annular punching instrument or scalpel, and then remove the defect so that the cartilage surface or the bone surface in the annular guide The thickness of the cartilage layer to be implanted is lower than the original cartilage surface. In Figures 9 and 10, six rotational symmetry are shown. Restoration of the provided columnar tissue 2. Of course, other columns with different numbers of columnar tissues, especially only one person with one columnar tissue, can be used in the same manner. Figure 1 1 shows a cartilage made from 50 cartilage. An example of a punching instrument that requires an implant for repair is shown in Figures 9 and 10. The punching instrument is mainly composed of a support surface 60 and a die 61. The shape (arch) of the support surface 60. It is best to match the shape of the cartilage surface 2 2 (Figs. 3 and 4) or surface template 24 (Fig. 4) to be regenerated "The cartilage surface is regenerated according to the surface template 24. The die 61 has a shape corresponding to the support surface 60, And has a punching blade that matches the contour of the implant to be produced and the hole for the tissue of the column 4 to be produced, wherein the width of the punching blade is greater than the thickness of the cartilage layer to be punched. In order to produce more accuracy Punching, it is best to place on the support surface 60, which is in accordance with the paper size of the Chinese standard (CNS) Λ4 condition (210X297 mm) -18- (Please read the precautions on the back before filling this page) * va A7 B7 V. Description of the invention (16) Punching blade 6 1 punching blade 6 2 width A small matching blade (not shown). Position the cultured cartilage layer 50 on the support surface 60 so that the punching die 61 is moved parallel to the support surface 60 with a suitable transmission mechanism until the punching The cutting edge 62 is located on the supporting surface 60 or the matching cutting edge, so that the cartilage layer 50 at a predetermined position is completely separated. Figure 12 shows the cartilage layer 50 used to determine the culture of the cartilage layer in a glass tube. An example of a device with a thickness of the base layer or without the base layer. The device generally consists of a measuring block 70 with different depth notches 7 1 and a weighting block 7 2; the weighting block is preferably composed of a light-transmitting material, which The weight on the support surface roughly corresponds to the pressure used during implantation. The notch 7 1 preferably has the shape of a defect to be repaired or the shape of a hole made for implantation of the cartilage layer 50 in the range of the defect. To determine the thickness, the punched cartilage layer 50 is placed in a notch 7 1 and weighted with a weighting block 7 2. The relevant thickness for repair of the cartilage layer 50 is equal to the depth of this notch 71. When the cartilage layer 50 is located in the notch, the weight 7 2 is no longer located on the notch. The apparatus of the present invention for repairing the defects shown in Figs. 9 and 10, in addition to some of the above-mentioned instruments, has an apparatus for punching or cutting a cartilage layer 50 cultured in a glass tube. The apparatus has a set of different pairs of supports Face 6 0 and punching die 6 1. In addition, the device preferably has a device for measuring the relevant thickness for such cartilage layer implants with 4 or a set of such devices for different defect shapes. —For a surgeon to make a repair as shown in Figures 9 and 11, for example, ------------ 1 --- ^ order ---------- line. Note: Please fill in this page again.) This paper is the standard of the Chinese valve manufacturer in Shizhou (('NS > Λ4 is now (210X 297mm) -19- A7 B7 V. Description of the invention (17) According to the given Complete the following steps in order:-determine the shape of the cartilage surface 22 to be regenerated;-determine the holes for the cartilage layer 50 to be implanted and the pattern of the columnar tissue 2 to be implanted; The cartilage layer 50 produces the implant to determine its thickness: a ring-shaped guide 10 is installed:-a hole is made for the cartilage layer 50 to be implanted;-for each columnar tissue 2: a hole 2 1 is made Take out the columnar tissue and implant the columnar tissue into the hole 21; one remove the ring guide 10;-if necessary, use the filling material 5 1: one implanted cartilage layer 50 0. Figure 1 3 1 to 16 show part of an embodiment of an instrument for removing and implanting columnar tissue (圚 13 to 15 are cross sections parallel to the axis). FIG. 13 shows an extractor 31.1 and FIG. 14 shows a Extractor guide 30.1, with Guide the extractor 3 1.1 when removing the columnar tissue, FIG. 15 is an implantation guide for guiding the extractor 31.1 when implanting the columnar tissue, and FIG. 16 is a pusher 37.1, Used to push out the columnar tissue from the extractor 3 1.1. Instrument components 31.1, 30.1, 4 (il and 37.1) have many features the same as the instrument components 31, 30, 40, 37 having the same functions as described in connection with FIGS. 7 and 8. Only the features that are different from the above features are described here. Other features are indicated by the symbols in Figures 7 and 8. This paper is a standard of China Paper House (CNS) Λ4 specification (210X 297 mm) -20- ^^ ^ 1 11 · ^^^ 1 — ^ n 1 ^ 1 —f ^ i In inu ^ rfi (诮 Please read the notes on the back before filling in ft? Page)
*9T 線 經".部中央抒準局只工消合竹社印欠 A7 B7 五、發明説明（18 ) 取出器31.1在其朝向弄尖端的範圍具有兩個相對 的視窗8 0和用於檢査和測量已取出的柱式組織長度用的 長度刻度8 1。此外，取出器在視窗8 0的與弄尖端相對 的一側至相反的一端用兩條相對設置的軸向延伸的槽8 2 分成兩個取出器部分。取出器的與弄尖側相反的一端爲便 於操作設有一同樣分成兩部分的手柄8 3，該手柄也用於 限制取出器3 1 . 1插入相應導向件30 · 1、40 . 1 中深度。 在這一位置還應注意的是，圖7所示的旋轉止檔或圖 13的兩個旋轉止檔在擰斷柱式組織時阻止取出器相對於 柱式組織的旋轉（柱式組織始終必須與尙與其'^相連'的 基底分離），如圖13或17所示。尤其是這樣一個旋轉 止檔3 6總是可以在最大長度上延伸，甚至可以在取出器 的總長度上延伸，上述最大長度爲用相應取出器取出的柱 式組織的長度。具有較長旋轉止檔3 6的取出器主要的優 點在於，如果外科醫生或矯形外科醫生將取出器前推至骨 松質的範圍，則骨松質就不再能爲取出提供必要的固定， 以便將柱式組織與尙與其相連的基底擰斷（分離）。較長 的旋轉止檔3 6在任何情況下都延伸至柱式組織的範圍， 在這一範圍提供有足夠的固定以便保證可靠地擰斷柱式組 織，因爲由於骨松質的特性用短的旋轉檔3 6不可能有 這一保證。 取出器導向件3 0 . 1與用於精確取出角度α (圖6 和7 )的取出器導向件3 0不同可以不固定在取出位置。 -----------------訂------線· (誚先閱讀背而之注意事項再硪巧本頁) 本紙乐尺度適用中國园家標唪（CNS ) Λ4規格（210X297公釐} -21 - 赶滅部中央榡翠局β-χ消费合竹社印聚 A7 B7 五、發明説明（19 ) 出於這一原因這一導向件不是很適合於用作空心鑽孔器的 導向。其功能在於，爲外科醫生除了手柄8 3之外提供另 一握持裝置，用於在取出柱式組織時握持取出器31 . 1 。在該導件30.1中，取出器可以自由旋轉，以便同時 阻止至弄尖側的範圍的槽8 2而相互分開的這兩個取出器 部件的不希望有的張開。 也不配備可以固定在缺陷範圍的植入導向件40 . 1 ，它同樣具有相互相對的視窗8 0，通過視窗8 0在植入 時可以通過時齊柱式組織取出器31.1中的視窗而確定 旋轉位置。植入導向件40.1的內徑只有在這端與取出 器3 1 . 1的外徑相符，否則要大於此外徑。因此在植入 期間因槽8 2而分開的兩個取出器部位可以張開。對於所 述的取出器部件的張開，推桿3 7 . 1具有一錐形區8 4 0 在植入時由於取出器部件的張開而減小了取出器和柱 式組織之間的摩擦，從而使必要的作用在柱式組織的軟骨 層上的力減小，以便將柱式組織從取出器中推出，從而完 好地處理柱式組織。 推桿3 7 . 1也具有一手柄8 5，用於舒適地操作， 同時保證推桿至可以被前移至取出器3 1 . 1的弄尖端緣 〇 〆 圖13至16的器械部件31 . 1、30 . 1、 40 . 1、和37 . 1可與圖7和8中的功能相同的器械 部件31、 30、 40、 37的特徵作任意組合。 本紙張尺度遶州中闽國家標华（CNS ) Λ4規格（210X297公釐） -22- (讀先閱讀背而之注意事項再填巧本S ) -----------^fvln- 1- 41 -_-----線·---I--------- A7 _____B7 五、發明説明（20 ) 圖17表示圔13、 15和16中的器械部件 31.1、 40.1和37.1的三維視圖。 在圖1 8和1 9中示出了植入導向件40 . 2和推桿 3 7 . 2的另一實施例，它們與圖1 5和1 6中的植入導 向件40 . 1和推桿37 . 1相類似。取出器3 1 . 1和 取出器導向件3 0 . 1可以是圖1 3或圖1 4中所示的形 狀，大體可保持不變動，尤其是旋轉止檔3 6可以在取出 器31.1的整個長度上延伸。 如圖1 3可見，手柄8 3在其下側具有一個向下凸出 的止檔銷8 3 0。該止檔銷8 3 0對於取出部件處的柱式 組織的取出不再重要，除非取出器導向件30 . 1 (圖 1 4 )具有一個相應的凹槽，以便容納該止檔銷8 3 0。 該凹槽然後聯同止檔銷表示著轉動保險。相反，止檔銷 8 3 0在植入導向件的相應結構中可以獲得重要的意義。 爲了說明這一意義此止檔銷8 3 0例如可以具有3毫米的 高度（從手柄8 3的下側起測量）。 如果在取出部位借助於取出器3 1 . 1取出一柱式組 織，組織位於取出器3 1 . 1內井例如向下與取出器 3 1 . 1齊平，則該柱式組織將植入相應的孔或缺陷部位 的凹口中（如前面已說明的）。植入是這樣實現的，即柱 式組織用壓配合壓入缺陷部位的孔中。β已經說明的，如 果盡可能逼真地模仿軟骨的原始形狀（即產生缺陷前的形 狀），則對於這種植入/移植的成功是有特殊優點，因此 該軟骨在治療過程後具有盡可能好的原始形狀。 (誚先閲讀背面之注意Ϋ項再填巧本頁) 訂 線 本紙烺尺度適州中囡S家標嗥（CNS ) Λ4規格（210X297公釐〉 -23 - A7 B7 五、發明説明（21 ) 與缺陷尺寸有關，爲做到這一點必要的是將柱式組織 借助於植入導向件40 . 2和推桿37 . 2 (圖18或 1 9 )或是完全壓入在缺陷部位製出的孔底’或是柱式組 織在壓入後距孔底具有一預定的間距，從而盡可能逼真地 模仿軟骨的原始形狀。柱式組織絕不能壓入得比孔底更深 。這一危險首先在於孔底位於（疏松的）骨松質內。爲了 完全做到這一些應向外科醫生或矯形外科轚生提供一簡單 的器械。 爲此目的，植入導向件4 0 . 1在其靠近身體的端（ 圖18)具有兩個例如相對設置的凹槽832和833， 其中凹槽8 3 2的深度例如爲1毫米，凹槽8 3 3的深度 爲3毫米。如果在植入時首先將含有柱式組織的取出器 31.1(圖13)連同止檔銷830插入植入導向件 40·2(圖18)，則止檔銷830可以相對於植入導 向件40.2安放在三個不同的位置。 在第一位置止檔銷8 3 0位於凹槽8 3 3內。由於在 所選的實施例中止檔銷8 3 0的長度爲3毫米，凹槽 833的深度同樣爲3毫米，所以取出器31.1的手柄 83的下側與植入導向件40.2的近端面齊平。 在第二位置止檔銷8 3 0位於凹槽8 3 2內。該凹槽 的深度爲1毫米，因此取出器3 1 . 1^手柄8 3的下側 位置植入導向件40.2的近端面上方2毫米處，這時止 檔銷8 3 0位於凹槽8 3 2的底部。 在第三位置止檔銷8 3 0不位於兩個凹槽8 3 2或 本紙張尺度適用中闯囚家標苹（（，NS ) Λ4規格（210X 297公釐） -24- #c.-- (請先閱讀背而之注意事項再^寫本頁) -f-訂 線 妗漭部中决櫺準局只工消费合竹社印y A7 _____B7 五、發明説明（22 ) 833內，而是位於植入導向件40.2的近端面。在這 一位置取出器3 1 . 1的手柄8 3的下側位於植入導向件 40. 12的近端面上方3毫米處。 如果將外科S生將位於三位置之一中的取出器插入植 入導向件40.2中，則將植入導向件40.2放在缺陷 處’使植入導向件40.2的遠端面圍繞著已製出的孔放 在軟骨下的骨上，接著借助於推桿將柱式組織從取出器壓 入孔中。 推桿原則上設計成，在推桿完全插入取出器時推桿手 柄下側靠在取出器3 1 .1手柄的近端面。在這一狀態下 推桿的遠端與取出器的遠端齊平；推桿遠端將柱式組織完 全從取出器推出，但是不必完全從植入導向件4 0 . 2中 推出。這與取出器插入植入導向件40.2的位置有關。 如果取出器的止檔銷8 3 0沉入植入導向件40 . 2 的凹槽833中而被止檔（第一位置），則推桿37. 2 也將柱式組織完全從植入導向件4 0 . 2中壓出（因爲取 出器的遠端也與植入導向件的遠端齊平），從而在正常情 況下柱式組織被前移至缺陷處的孔底，柱式組織不伸出超 過軟骨下的骨。 如果取出器3 1 . 1的止檔銷8 3 0沉入凹槽8 3 2 中而被止檔（第二位置）則完全沉入取ai器中的推桿雖然 將柱式組織完全從取出器31.1壓出’但是沒有完全從 植入導向件4 0 . 2中壓出（因爲取出器的遠端剛好不與 植入導向件的遠端齊平），而是還保留3毫米（止檔銷 ---------广---；--il,-----^ (誚先閱讀背面之注意事項再填寫本頁) 本紙張尺度適州屮國S家標辛（CNS ) Λ4規格（210X297公釐） -25- 經漭部中央ttit·-局兵ΐ,消*^合竹社印欠 A7 B7 五、發明説明（23 ) 8 3 0的長度）減去1毫米（孔8 3 2的深度）的長度， 即2毫米的長度，以便柱式組織還伸入導向件4 0 . 2 2毫米I»柱式組織也伸出超過軟骨下的過這一數値，這在 缺陷較大時用於逼真地模仿原始軟骨的形狀是完全希望的 〇 如止檔銷8 3 0位於取出器3 1 . 1的近端面（第三 位置），則在推桿完全插入時柱式組織當伸入値入導向件 有3毫米或者柱式組織伸出超過缺陷處的軟骨下的骨有3 毫米。顯然，凹槽8 3 2和8 3 3深度的這些數値只能看 作是舉例，當然也可以是其它數値。外科醫生或矯形外科 醫生可以屆時根據缺陷處的情況決定將柱式組織壓入孔中 多深。 圖19所示的推桿37 . 2與圖16的推桿31 . 1 相比還具有一特點。推桿37.2的手柄包括兩個部件， 一與推桿桿身牢固相的上手柄部件8 5 1，一沿著桿身可 移動的下手柄部件8 5 2，其外壁沿遠端方向形成錐形。 下手柄部件8 5 2沿著桿身最遠可移動至凸起8 5 3。在 將推桿37.2的桿身插入取出器31.1時，下手柄部 件8 5 2可在取出器中向里移動，並借助於其錐形的外表 面而使具有縱向槽的取出器輕微張開。下手柄部件8 5 2 然而只能移動至下手柄部件8 5 2的下個1貼靠在取出器 3 1 . 1手柄8 3的近端面上。在按這種方式輕微張開取 出器3 1 . 1時，可使柱式組織繼續壓入或壓入孔中變得 容易，因爲輕微張開的取出器使得柱式組織從取出器壓入 本紙张尺度適州中國K家榡嗥（（’NS ) Λ4規格（2丨0X297公釐) -26- ~ (銪先閱讀背而之注意事項再蛾ff:?本頁) 訂 4 A7 B7 經满部中决橾if局β工消於合作社印y 五、發明説明（24) 缺陷處的孔中變得容易。爲了使柱式組織從取出器中的壓 出變得容易，外科醫生或矯形外科醫生也可以輔助使用一 小的錘子，用來輕輕敲擊上手柄部件8 5 1直至上手柄部 件8 5 1貼靠在下手柄部件8 5 2上，該下手柄部件本身 貼靠在取出器31.1手柄83的近端面上》 圖式之簡單說明 圖1按照已知的鑲嵌法修復的軟骨缺陷的示意俯視圖 ，其截面圖用於說明在缺陷範圍內產生的孔的定向和平行 度的精度， 圖2在按圖1的待修復的缺陷範圍內制出孔用的量規 的實施例， 圖3軟骨缺陷示意圖，用於通過待植入的柱式組織的 軸向長度說明仿制始軟骨表面的改進方面，以及用於仿制 原始軟骨表面的量規， 圖4用於確定原始軟骨表面和待修復的如圖3中的缺 陷範圍內的孔的底面之間的距離的器械的實施例， 圖5軟骨缺陷示意圖， 圖6取出位置示意圖，用於說明通過使軟骨表面和待 植入的柱式組織之間的角度的相應適應來使原始軟骨表面 的改進方面， ' 圖7用於取出和植入在軟骨表面和柱之間有一定角度 α的柱式組織的器械的實施例， 圖8爲植入柱式組織配備的圖2所示的量規，在一定 (讨先閱讀背面之注項再續寫本頁) uf 訂 線 本纸张尺度過州中KS家標率（CNS ) Λ4規格（210X297公釐） -27- Α7 Β7 五、發明説明（扔） 的旋轉位置， 圖9已修復的軟骨缺陷的示意俯視圖； 圔il 0爲圖9的截面圖，用於說明已修復的軟骨缺陷 的空隙的改進方面， 圖11由玻璃管中培養旳軟骨組織製成植入體用的沖 孔工具的實施例， 圖12用於確定玻璃管中培養的軟骨層原的器械的實 施例， 圖13至16用於完好取出和植入柱式組織的協作器 械的實施例， 圖17圖，13， 15、 16的器械的三維視圖， 圖1 8具有端面凹槽的植入導向件的實施例，用於接 納設置取出點上的止動銷， 圖19用於從取出器中推出柱式組織的推杆的實施例 (誚先閲讀背面之注意事項再填寫本頁) 訂 赶滅部中央榡準局β工消费合竹.社印麥 -28- 本紙张尺度適州中囚囷家標苹（C'NS ) Λ4規格（210X297公4 )* 9T thread warp ". The Central Government Bureau of the Central Government only eliminates the A7 B7 of the Bamboo Society. 5. Description of the invention (18) The extractor 31.1 has two opposing windows 8 0 in the range facing the tip and is used for Length scale 8 1 for checking and measuring the length of the removed columnar tissue. In addition, the extractor is divided into two extractor portions by two oppositely disposed axially extending grooves 8 2 from the side opposite to the tip of the window 80 to the opposite end. The opposite end of the extractor from the sharpened side is provided with a handle 8 3 which is also divided into two parts for the convenience of operation. This handle is also used to limit the depth of the inserter 3 1.1 into the corresponding guide 30 · 1, 40.1. It should also be noted at this position that the rotation stop shown in Fig. 7 or the two rotation stops shown in Fig. 13 prevent the extractor from rotating with respect to the columnar tissue when the columnar tissue is unscrewed (the columnar tissue must always be Separated from the base where 尙 is connected to ^), as shown in Figure 13 or 17. In particular, such a rotation stop 3 6 can always extend over the maximum length, or even the total length of the extractor. The above maximum length is the length of the columnar tissue taken out by the corresponding extractor. The main advantage of an extractor with a long rotation stop 36 is that if the surgeon or orthopedic surgeon pushes the extractor forward to the range of osteoporosis, the osteoporosis can no longer provide the necessary fixation for the removal, In order to sever (detach) the columnar tissue from the base to which it is attached. The longer rotation stops 3 6 extend in any case to the range of columnar tissue, in this range there is sufficient fixing to ensure reliable unscrewing of the columnar tissue, because of the short characteristics This guarantee cannot be made for the rotary gears 36. The extractor guide 30.1 is different from the extractor guide 30 used for precise extraction angle α (FIGS. 6 and 7) and may not be fixed in the removal position. ----------------- Order ------ line · (诮 Read the precautions on the back first and then 硪 Coincide this page) This paper music scale is applicable to Chinese garden house standard 唪(CNS) Λ4 specification (210X297 mm) -21-Central Jade Bureau of the Ministry of Eradication β-χConsumer Hezhusha Yinju A7 B7 V. Description of the invention (19) For this reason, this guide is not very suitable It is used as a guide for a hollow drill. Its function is to provide the surgeon with another holding device in addition to the handle 8 3 for holding the extractor 31.1 when removing columnar tissue. In 30.1, the extractor can be rotated freely so as to simultaneously prevent the undesired opening of the two extractor parts separated from each other by the groove 8 2 of the sharpened side range. It is also not equipped with a plant that can be fixed in the defect area. The guide member 40.1 also has a window 80 opposite to each other. The rotation position can be determined through the window in the columnar tissue extractor 31.1 during the implantation of the window 80. The inside of the implant guide 40.1 The diameter only matches the outer diameter of the extractor 3 1.1 at this end, otherwise it is larger than this outer diameter. Therefore, during the implantation, the groove 8 2 is The two separate extractor parts can be opened. For the expansion of the extractor part, the pusher 37.1 has a tapered area 8 4 0 which is reduced due to the expansion of the extractor part during implantation. The friction between the extractor and the columnar tissue is reduced, so that the necessary force on the cartilage layer of the columnar tissue is reduced in order to push the columnar tissue out of the extractor, so that the columnar tissue is processed intact. The lever 37. 1 also has a handle 8 5 for comfortable operation, while ensuring that the push rod is brought forward to the tip edge of the extractor 3 1.1. The instrument part 31.1 of Figures 13 to 16 , 30. 1, 40. 1, and 37.1 can be arbitrarily combined with the features of the same functional parts 31, 30, 40, and 37 as shown in Figures 7 and 8. This paper scales around the state-minded national standard Chinese ( CNS) Λ4 specification (210X297 mm) -22- (Read the precautions before reading and then fill in this S) ----------- ^ fvln- 1- 41 -_---- -Line · --- I --------- A7 _____B7 V. Description of the invention (20) Fig. 17 shows three-dimensional views of the instrument parts 31.1, 40.1 and 37.1 in Figs. 13, 15 and 16. In Fig. 1 Shown in 8 and 19 Another embodiment of the implantation guide 40.2 and the pusher 37.2 is similar to the implantation guide 40.1 and the pusher 37.1 in FIGS. 15 and 16. Extractor 3 1.1 and the extractor guide 30.1 can be the shape shown in Fig. 13 or Fig. 14 and can be kept substantially unchanged, especially the rotation stop 3 6 can extend over the entire length of the extractor 31.1 . As can be seen in Figure 13, the handle 83 has a stop pin 830 protruding downward on its lower side. The stop pin 8 3 0 is no longer important for removing the columnar tissue at the removal part, unless the extractor guide 30. 1 (FIG. 14) has a corresponding groove to accommodate the stop pin 8 3 0 . This groove, in conjunction with the stop pin, then indicates rotation safety. On the contrary, the stop pin 830 can have important significance in the corresponding structure of the implantation guide. To illustrate this, the stop pin 8 3 0 can have a height of 3 mm (measured from the lower side of the handle 8 3), for example. If a column of tissue is removed at the removal site by means of the remover 3 1.1, and the tissue is located in the inside of the remover 3 1.1, for example, flush with the remover 3 1.1, the columnar tissue will be implanted accordingly. Hole or defect in the notch (as explained earlier). Implantation is achieved by pressing the columnar tissue into the hole in the defect site with a press fit. β has stated that if the original shape of the cartilage (i.e. the shape before the defect) is simulated as realistically as possible, there are special advantages for the success of this implantation / transplantation, so the cartilage has the best possible after the treatment process Original shape. (Please read the note on the back first and then fill in this page) Binding paper size: Shizhou medium size S house standard (CNS) Λ4 specification (210X297 mm) -23-A7 B7 V. Description of the invention (21) Depends on the size of the defect. To do this, it is necessary to make the columnar tissue with the aid of the implant guide 40.2 and the pusher 37.2 (Fig. 18 or 19) or press it completely into the defect area. The bottom of the hole 'or columnar tissue has a predetermined distance from the bottom of the hole after being pressed to mimic the original shape of the cartilage as realistically as possible. The columnar tissue must not be pressed deeper than the bottom of the hole. The danger lies in the first place The bottom of the hole is located in the (loose) bone cancellous material. To do this completely, a simple instrument should be provided to the surgeon or orthopaedic surgeon. For this purpose, the implant guide 40.1 is placed close to the body. The end (Figure 18) has two grooves 832 and 833, for example, which are oppositely arranged, wherein the depth of the groove 8 3 2 is 1 mm, for example, and the depth of the groove 8 3 3 is 3 mm. The column tissue extractor 31.1 (FIG. 13) is inserted into the implant guide 40 together with the stop pin 830 2 (Figure 18), the stop pin 830 can be placed in three different positions relative to the implant guide 40.2. In the first position, the stop pin 8 3 0 is located in the groove 8 3 3. In the embodiment, the stop pin 830 is 3 mm in length, and the depth of the groove 833 is also 3 mm, so the underside of the handle 83 of the extractor 31.1 is flush with the proximal end surface of the implant guide 40.2. In the second The position stop pin 8 3 0 is located in the groove 8 3 2. The depth of the groove is 1 mm, so the lower side of the extractor 3 1. 1 ^ handle 8 3 is implanted above the proximal end of the guide 40.2 2 At the millimeter, the stop pin 8 3 0 is located at the bottom of the groove 8 3 2. In the third position, the stop pin 8 3 0 is not located in the two grooves 8 3 2 or the standard of this paper. (, NS) Λ4 specification (210X 297 mm) -24- #c .-- (Please read the precautions below and ^ write this page) -f-Determining the quasi-station only in the department Consumption Hezhusheyin A7 _____B7 5. In the invention description (22) 833, it is located at the proximal end of the implant guide 40.2. In this position, the underside of the handle 8 3 of the extractor 3 1.1 is located at the plant Entry guide 40.12 3 mm above the proximal surface. If the surgical implant is inserted into the implant guide 40.2 with the extractor located in one of the three positions, the implant guide 40.2 is placed at the defect 'to make the implant The distal end of the guide 40.2 is placed on the bone under the cartilage around the prepared hole, and then the columnar tissue is pushed from the extractor into the hole by means of a pusher. The pusher is designed in principle so that the pusher is completely When inserting the extractor, the lower side of the push rod handle rests on the proximal end of the handle of the extractor 3 1.1. In this state, the distal end of the pusher is flush with the distal end of the extractor; the distal end of the pusher completely pushes the columnar tissue out of the extractor, but does not have to completely push out of the implant guide 40.2. This is related to the position where the extractor is inserted into the implant guide 40.2. If the stopper pin 8 3 0 of the extractor is sunk into the groove 833 of the implant guide 40.2 and is stopped (first position), the push rod 37.2 also completely guides the columnar tissue from the implant guide Piece 40.2 (because the distal end of the extractor is also flush with the distal end of the implant guide), so the columnar tissue is normally advanced to the bottom of the hole at the defect. Bone protruding beyond the cartilage. If the stopper pin 8 3 0 of the remover 3 1.1 is sunk into the groove 8 3 2 and the stopper (second position) is completely sunk into the pusher in the remover ai, although the columnar tissue is completely removed from the 31.1 pressed out but not completely pushed out of the implant guide 40.2 (because the distal end of the extractor just happened to be not flush with the distal end of the implant guide), but 3 mm (stop Pin --------- 广 ---; --il, ----- ^ (诮 Please read the notes on the back before filling in this page) CNS) Λ4 specification (210X297 mm) -25- The central part of the Ministry of Economic Affairs ttit · -Bing Bingΐ, eliminate * ^ Hezhusha India owes A7 B7 V. Description of the invention (23) 8 3 0 length) minus 1 mm (The depth of the hole 8 3 2), that is, the length of 2 mm, so that the columnar tissue also extends into the guide 40. 2 2 mm. I »The columnar tissue also extends beyond this number of cartilage, This is completely desirable for realistically mimicking the shape of the original cartilage when the defect is large. If the stop pin 8 3 0 is located at the proximal end (third position) of the extractor 3 1.1, then the pusher is fully inserted Time column The guide is 3 mm or the columnar tissue projects 3 mm below the bone under the cartilage. Obviously, these numbers of the depths of the grooves 8 3 2 and 8 3 3 can only be regarded as examples, and of course, other numbers can be used. The surgeon or orthopaedic surgeon can then decide how much to push the columnar tissue into the hole depending on the defect. The putter 37.2 shown in FIG. 19 also has a feature compared with the putter 31.1 shown in FIG. The handle of the putter 37.2 includes two parts, an upper handle part 8 5 1 that is firmly attached to the putter shaft, and a lower handle part 8 5 2 that is movable along the shaft. The outer wall of the putter is tapered in the distal direction. . The lower handle part 8 5 2 can be moved up to the protrusion 8 5 3 along the shaft. When the shaft of the pusher 37.2 is inserted into the extractor 31.1, the lower handle part 8 5 2 can be moved inward in the extractor, and with its tapered outer surface, the extractor with the longitudinal groove is slightly opened. The lower handle part 8 5 2 can only be moved until the next 1 of the lower handle part 8 5 2 rests on the proximal end of the extractor 3 1. 1 handle 8 3. When the extractor 3 1.1 is slightly opened in this way, it is easy to continue to press the column tissue into or into the hole, because the slightly opened extractor allows the column tissue to be pressed into the paper from the extractor. Zhang scale Shizhou China K furniture (('NS) Λ4 specifications (2 丨 0X297 mm) -26- ~ (铕 read the precautions first and then the moth ff :? This page) Order 4 A7 B7 The ministry of the Ministry of Justice and the Ministry of Science and Technology of the People ’s Republic of China disappeared in the cooperatives ’seals. 5. Description of the Invention (24) The holes in the defect are easy. In order to make it easier to squeeze the columnar tissue out of the extractor, the surgeon or orthopedic The doctor can also use a small hammer to gently strike the upper handle part 8 5 1 until the upper handle part 8 5 1 rests on the lower handle part 8 5 2 which itself rests on the extractor 31.1 On the near end surface of the handle 83 "Brief description of the diagram Fig. 1 A schematic plan view of a cartilage defect repaired according to a known mosaic method. The cross-sectional view is used to explain the orientation of the holes and the accuracy of the parallelism in the defect range. FIG. 2 is an example of a gauge used for making holes in the range of defects to be repaired according to FIG. 1. Example, Fig. 3 Schematic diagram of cartilage defects, used to illustrate the improvement of the original cartilage surface by the axial length of the columnar tissue to be implanted, and a gauge for the original cartilage surface, Fig. 4 is used to determine the original cartilage An embodiment of the instrument for the distance between the surface and the bottom surface of the hole to be repaired as in the defect range in FIG. 3, FIG. 5 is a schematic diagram of a cartilage defect, and FIG. 6 is a schematic diagram of a position taken out for explaining the process of Corresponding adaptation of the angle between the columnar tissues to the improved aspect of the original cartilage surface, 'FIG. 7 An embodiment of a device for removing and implanting a columnar tissue with a certain angle α between the cartilage surface and the column, Fig. 8 shows the gauge shown in Fig. 2 equipped with the implanted column tissue. After a certain period of time (please read the note on the back and continue to write this page) uf guideline paper size has passed the KS family standard rate (CNS) Λ4 specification (210X297 mm) -27- Α7 Β7 V. Rotation position of the invention description (throw), Figure 9 Schematic top view of the repaired cartilage defect; 圔 il 0 is a cross-sectional view of Figure 9, used to illustrate the repaired Empty cartilage defect In terms of improvement, FIG. 11 shows an embodiment of a punching tool for implants made of cultured iliac cartilage tissue in a glass tube, FIG. 12 shows an embodiment of a device for determining a cartilage layer cultured in a glass tube, and FIG. 13 to FIG. 16 An embodiment of a cooperative instrument for intact removal and implantation of columnar tissue, Figs. 17, 3, 15, 16, 3D views of the instrument, Fig. 18 An embodiment of an implantation guide with end grooves, used The stopper pin at the take-out point is set at the receiving position. Fig. 19 is an example of a pusher for pushing out a columnar tissue from the extractor (read the precautions on the back before filling this page). Industrial Consumption Hezhu. Sheyinmai-28- This paper is a standard of C'NS in Shizhou, China. Λ4 specification (210X297 male 4)