TWI655926B - Fixture for osteotomy - Google Patents

Abstract

The osteotomy surgical jig of the present invention is tailor-made according to the patient's tibia. When the surface of the osteotomy surgical jig is exactly against the surface contour of the patient's tibia, it means that the osteotomy surgical jig is placed correctly The location is very convenient for the operator. In addition, the connector of the osteotomy surgical fixture of the present invention also has a gauge that can be used as the incision opening angle. When the convex portion of the connector can just extend into the incision, it means that the incision has been extended to a preset angle. Surgeons can significantly save time in evaluating the incision angle of the incision. The osteotomy surgical jig of the present invention can save the time for doctors to learn HTO surgery, allow HTO surgery to be performed more in the expected manner, and at the same time, for patients, the risk of unpredictable results during HTO surgery is also greatly reduced.

Description

Osteotomy surgery tool

The invention relates to an orthopaedic surgical jig, in particular to a jig suitable for high tibial osteotomy surgery.

High tibial osteotomy (High Tibial Osteotomy) has been developed by the medical community for patients with degenerative arthritis due to rapid wear of the single side cartilage of the knee joint due to bending of the tibia (such as the inner or outer splayed leg). , HTO) for treatment.

The so-called HTO procedure is to make a notch at a specific location of the patient's tibia (near the top of the medial knee), and then propagate the incision at a specific angle according to the degree of flexion of the individual's tibia. Then, bone cement is injected into the opened incision as a support, and bone plates and nails are applied on the outside of the tibia to fix it. The purpose of HTO surgery is to allow the patient's knee cartilage to return to normal after surgery, that is, to apply an average force to the tibial plateau. In addition to solving the patient's knee pain caused by local excessive cartilage wear, It also slows down the rate of cartilage wear in the knee joint.

However, although the current HTO surgery can achieve a very good effect through careful evaluation of each patient before surgery, it still depends to a certain extent on the operator's current judgment and surgical experience. For inexperienced surgeons, the incision depth or incision angle of the incision may be inaccurate; in addition, it may also cause the overall operation time to be prolonged due to the inexperience of the surgeon, increasing the patient's surgical risk.

In view of this, the present invention provides an osteotomy surgical jig, which is suitable for performing a high tibial osteotomy on a tibia to cut a first incision and a second incision. The osteotomy surgical jig includes a first fixation Seat, second fixed seat and connecting seat. The first fixing seat includes: a first abutting portion having a first abutting surface for abutting against the peripheral surface of the tibial plateau of the tibia, and the first abutting portion includes at least one fixing hole; an extension portion , One end is connected to the side of the first abutting portion, and extends from the side of the first abutting portion in a direction away from the first abutting portion, the extending portion has a portion for abutting the first notch One of the upper tibia surfaces extends against the abutment surface; and a first guide portion includes a first flat portion, a first bending portion and a first fixing portion, the first flat portion is connected to the extension portion At the other end, the first bending portion is connected to one side of the first flat portion and is not coplanar with the first flat portion, and the first fixing portion is located on the first flat portion. The second fixing seat includes: a second abutting portion having a second abutting surface for abutting the tibial surface under the first incision, and the second abutting portion includes at least one fixing hole; and one The second guide portion includes a second flat portion, a second bending portion and a second fixing portion, the second flat portion is connected to the second abutting portion, and the second bending portion is connected to the first One side of the two flat portions is not coplanar with the second flat portion. The connecting base detachably connects the first fixing portion and the second fixing portion, and when the connecting base connects the first fixing portion and the second fixing portion, the first flat portion and the second flat portion are defined A first guiding path, a second guiding path is defined between the first bending portion and the second bending portion.

The invention also proposes an osteotomy surgical jig, which is also suitable for performing a high tibial osteotomy on a tibia to cut a first incision and a second incision. The osteotomy surgical jig includes a first fixing seat, The second fixed seat and the connecting seat. The first fixing base includes: a first abutment portion having a first abutment surface for abutting against the peripheral surface of the tibial plateau of the tibia, and the first abutment portion Including at least one fixing hole; an extension portion, one end of which is connected to the side of the first contact portion, and extends from the side of the first contact portion in a direction away from the first contact portion, the extension portion has An extension abutment surface for abutting the tibia surface above the first incision; and a first guide portion including a first flat portion, a first bending portion and a first fixing portion, the first A flat portion is connected to the other end of the extending portion, the first bending portion is connected to one side of the first flat portion and is not coplanar with the first flat portion, the first fixing portion is located on the first flat portion . The second fixing seat includes: a second abutting portion having a second abutting surface for abutting the tibial surface under the first incision, and the second abutting portion includes at least one fixing hole; and one The second guide portion includes a second flat portion, a second bending portion and a second fixing portion, the second flat portion is connected to the second abutting portion, and the second bending portion is connected to the first One side of the two flat portions is not coplanar with the second flat portion. The connecting base includes a connecting portion and a convex portion, and the two ends of the connecting portion respectively include a first connecting end and a second connecting end, and the convex portion protrudes from the first connecting end to the connecting portion; when the connecting base When the first connecting portion is connected to the first fixing portion and the second connecting portion is connected to the second fixing portion, a first guiding path is defined between the first flat portion and the second flat portion, the first A second guiding channel is defined between a bending portion and the second bending portion; when the connecting base is connected to the first fixing portion with its second connecting end, the convex portion passes through the first flat portion and the Between the second flat portions and protruding the second abutment surface and the extended abutment surface.

In a concept of the present invention, the lower surface of the first fixing portion of the osteotomy surgical fixture has a first groove, the upper surface of the second fixing portion has a second groove, and the first of the connecting portion A first projection and a second projection are formed between the connection end and the second connection end; when the connection base is connected to the first fixing portion with its first connection end and connected to the second fixing with its second connection end The first bump is located in the first groove, and the second bump is located in the second groove.

In one concept of the present invention, the above osteotomy surgical fixture further includes a plurality of bone needles for respectively passing through the fixing holes of the first abutting portion and the fixing holes of the second abutting portion to contact the first The connecting portion and the second abutting portion are fixed on the tibia.

In one concept of the present invention, the first abutting portion of the above osteotomy surgical jig includes two fixing holes, and the second abutting portion includes two fixing holes.

10‧‧‧ Osteotomy

11‧‧‧First fixed seat

111‧‧‧The first abutment department

111a‧‧‧First contact

112‧‧‧Extension

112a‧‧‧Extended against the surface

113‧‧‧First Guidance Department

1131‧‧‧First flat

1132‧‧‧The first bending part

1133‧‧‧The first fixed part

1133a‧‧‧First groove

12‧‧‧Second fixed seat

121‧‧‧The second abutment

12a‧‧‧The second contact

123‧‧‧Second Guidance Department

1231‧‧‧Second flat part

1232‧‧‧Second bending part

1233‧‧‧Second fixed part

1233a‧‧‧Second groove

13‧‧‧Connector

131‧‧‧ Connection

1311‧‧‧First connection

1311a‧‧‧First bump

1312‧‧‧Second connector

1312a‧‧‧Second bump

132‧‧‧Convex

15‧‧‧Bone Needle

19‧‧‧Fixed hole

30‧‧‧Bone plate

40‧‧‧Bone screw

90‧‧‧Tibia

91‧‧‧Tibial platform

95‧‧‧ First incision

96‧‧‧Second incision

G1‧‧‧First Guiding Road

G2‧‧‧Second Guideway

Fig. 1 is a schematic diagram of an embodiment of an osteotomy surgical jig of the present invention.

[Fig. 2] It is a schematic diagram (1) of an embodiment of the osteotomy surgery jig of the present invention for high tibial osteotomy.

[FIG. 3] It is a schematic view (2) of performing an operation for high tibial osteotomy using one embodiment of the osteotomy surgical jig of the present invention.

[Fig. 4] It is a schematic diagram (3) of performing an operation for high tibial osteotomy using one embodiment of the osteotomy surgical jig of the present invention.

[Fig. 5] It is a schematic diagram (four) for performing high tibial osteotomy using one embodiment of the osteotomy surgical jig of the present invention.

[Fig. 6] It is a schematic diagram (five) of performing high tibial osteotomy using one embodiment of the osteotomy surgical jig of the present invention.

[Fig. 7] A schematic diagram of high tibial osteotomy using one embodiment of the osteotomy surgical jig of the present invention (six).

[Fig. 8] It is a schematic diagram of performing an operation for high tibial osteotomy using one embodiment of the osteotomy surgical jig of the present invention (7).

[Fig. 9] It is a schematic diagram (eight) for performing high tibial osteotomy operation using one embodiment of the osteotomy surgical jig of the present invention.

10 is a schematic diagram of another embodiment of the osteotomy surgical jig of the present invention.

Please refer to FIG. 1, which depicts an osteotomy surgical tool 10 disposed on the tibia 90 that is to be used for performing high tibial osteotomy (HTO). When performing HTO surgery, two incisions must be made in the tibia 90, namely a first incision 95 and a second incision 96, as shown in FIGS. 3-7. Among them, the first incision 95 is located below the tibial plateau 91 and cuts into the tibia roughly along the radial direction, the second incision 96 is located on the side of the tibial plateau 91 and connects the first incision 95, the role of the second incision 96 This is to make the first cut 95 easier to be opened. Traditionally, when performing HTO surgery, the doctor's experience must be relied on. The doctor determines the position of the first incision 95 and the second incision 96 and cuts the bone according to the shape of each patient's bone. However, the size and shape of the first incision 95 and the second incision 96 may be different due to the doctor's experience due to the doctor's hand during cutting the bone. And through the osteotomy surgical tool 10 tailored according to each patient's situation, it will greatly reduce the variability of the surgical results caused by the different experience of the operator.

As shown in FIG. 1, the osteotomy surgical jig 10 includes a first fixing seat 11, a second fixing seat 12 and a connecting seat 13. The first fixing base 11 includes a first abutting portion 111, an extending portion 112 and a first guiding portion 113. The first abutment portion 111 has a first abutment surface 111a for abutting against the circumferential surface of the tibial plate 91 of the tibia 90, and the first abutment portion 111 includes at least one fixing hole 19 (two fixing holes in this embodiment) 19, but the invention is not limited to one, it can be one, three or more). One end of the extending portion 112 is connected to the side of the first contact portion 111, and extends from the side of the first contact portion 111 in a direction away from the first contact portion 111. The extension portion 112 has a portion for abutting the first cut One of the tibial surfaces above 95 extends against the abutment surface 112a. The first guide portion 113 includes a first flat portion 1131, a first bent portion 1132, and a first fixing portion 1133. The first flat portion 1131 is connected to the other end of the extension portion 112, and the first bent portion 1132 is connected to one side of the first flat portion 1131 and is not on the same plane as the first flat portion 1131. The first fixing portion 1133 is located on the first flat portion 1131.

The second fixing base 12 includes a second contact portion 121 and a second guide portion 123. The second abutment portion 121 has a second abutment surface 12a for abutting the tibia surface below the first incision 95, and the second abutment portion 121 includes at least one fixing hole 19 (in this embodiment, a fixing hole 19) However, the present invention is not limited to one, and may be more than two). The second guide portion 123 includes a second flat portion 1231, a second bent portion 1232, and a second fixing portion 1233, wherein the second flat portion 1231 is connected to the second contact portion 121, and the second bent portion 1232 is connected to the second One side of the second flat portion 1231 is not on the same plane as the second flat portion 1231.

The connecting base 13 detachably connects the first fixing portion 1133 and the second fixing portion 1233. When the connecting base 13 connects the first fixing portion 1133 and the second fixing portion 1233, between the first flat portion 1131 and the second flat portion 1231 A first guide path G1 is defined, and a second guide path G2 is defined between the first bending portion 1132 and the second bending portion 1232. When the osteotomy jig 10 just abuts the surface of the tibia 90, the first guide channel G1 corresponds exactly to the position of the first incision 95, and the second guide channel G2 corresponds exactly to the position of the second incision 96 position. In this way, the operator can easily cut the first incision 95 along the first guide path G1 and the second incision 96 along the second guide path G2.

Please refer to FIG. 1 again. In an embodiment, the connecting base 13 may further include a connecting portion 131 and a convex portion 132. The two ends of the connecting portion 131 include a first connecting end 1311 and a second connecting end 1312, respectively. The convex portion 132 protrudes from the first connecting end 1311 to connect with the connecting portion 131 131 constitutes an L-shaped appearance. Similarly, when the connecting base 13 connects the first fixing portion 1133 of the first fixing base 11 with its first connecting end 1311, and connects the second fixing portion 1233 of the second fixing base 12 with its second connecting end 1312, the first A first guiding channel G1 is defined between the first flat portion 1131 of a fixed base 11 and the second flat portion 1231 of the second fixed base 12, the first bent portion 1132 of the first fixed base 11 and the second fixed base A second guide path G2 is defined between the second bent portion 1232 of 12. In this way, the operator can easily cut the first incision 95 along the first guide path G1 and the second incision 96 along the second guide path G2. In addition, after the connecting base 13 of this embodiment rotates 180 degrees, it can connect the first fixing portion 1133 with its second connecting end 1312. When the connecting base 13 is connected to the first fixing portion 1133 through the second connecting end 1312, the convex portion 132 passes between the first flat portion 1131 and the second flat portion 1231 and protrudes from the second abutting surface 12a and extends against面 112a.

The above describes the exemplary structure of the osteotomy surgical jig 10, and the method of use thereof is further described below.

Since the tibial structure of each patient is different, the osteotomy surgical jig 10 must be customized according to the tibial structure of each patient. First, the 3D image of the patient's tibia can be reconstructed by X-ray and tomography or other photography methods, and then the doctor can determine the position of the first incision 95 and the second incision 96 suitable for the patient based on the 3D image of the tibia. At the same time, determine how much the patient should extend the first incision 95, so that the knee articular cartilage of the patient can apply an average force on the tibial plateau 91 when the patient is standing after the operation. Then, an osteotomy surgical tool 10 suitable for the patient is manufactured through a mold or three-dimensional printing.

Please refer to FIG. 2, when HTO operation is to be performed, the connecting base 13 is first connected to the first fixing portion 1133 of the first fixing base 11 and the second fixing portion 1233 of the second fixing base 12 The assembly of the osteotomy surgical jig 10 is completed. Then, the osteotomy jig 10 is placed against the patient's tibia 90. Since the surface contour of the tibia 90 is not symmetrical, when the first abutment surface 111a of the first fixing seat 11 and the extended abutment surface 112 and the second When the second abutment surface 12a of the fixing base 12 can just abut against the surface of the tibia, it means that the placement position of the osteotomy surgical jig 10 is correct. At this time, the bone needle 15 can be driven into the fixing holes 19 of the first fixing base 11 and the second fixing base 12 to fix the first fixing base 11 and the second fixing base 12 on the tibia 90.

Referring to FIG. 3, after the first fixing base 11 and the second fixing base 12 are fixed on the tibia 90 through the bone needle 15, the connecting base 13 can be removed, so that the first guiding channel G1 is completely exposed. Then, the doctor can cut the saw blade along the first guide path G1 to cut the tibia 90 to form a first incision 95, and cut the tibia 90 along the second guide path G2 to form a second incision 96 (second incision 96 Refer to Figure 6 and Figure 7). It should be particularly noted that during the formation of the first incision 95 and the second incision 96, the saw blade will not cut to any element of the osteotomy surgical jig 10, so there will be no residual dust particles outside the bone In the human body, it can cause allergies or inflammation in patients.

Please refer to FIG. 4, then the first slit 95 is stretched out, and then the second connecting end 1312 of the connecting base 13 is connected to the first fixing portion 1133. At this time, the convex portion 132 of the connecting base 13 passes through the first flat portion 1131 and Between the second flat portions 1231, the second abutting surface 12a and the extending abutting surface 112a protrude into the extended first slit 95. Since the size of the convex portion 132 is specially designed, when the expanded first cutout 95 just allows the convex portion 132 to extend, it means that the angle at which the first cutout 95 is expanded at this time is the preset angle.

Referring to FIG. 5, when the first incision 95 is extended to a predetermined angle, bone cement can be filled in the first incision 95 and the second incision 96 as a support.

Referring to FIG. 6, after the bone cement is hardened, the osteotomy surgical jig 10 can be removed, and then the bone plate 30 is placed on the tibia 90 through the bone needle 15.

Referring to FIG. 7, after the bone plate 30 is placed on the tibia 90, the bone needles 15 are removed one by one, and the bone screw 40 is locked in the perforation left by the original bone needle 15 in the tibia 90, and then the patient ’s wound Suture, so far, can be regarded as the completion of HTO surgery.

In addition, unlike FIG. 6 and FIG. 7 above, the bone plate 30 is placed on the tibia 90 through the bone needle 15 and then fixed to the tibia 90 through the bone screw 40. FIGS. 8 and 9 illustrate another type of bone plate fixation. method. As shown in FIGS. 8 and 9, when the bone cement filled in the first incision 95 and the second incision 96 is hardened, the operator now presses the upper edge of the bone plate 30 under the tibial plateau 91 Below the second bone needle 15, the bone plate 30 is also fixed to the tibia 90 using the bone screw 40.

10, in another embodiment of the present invention, the lower surface of the first fixing portion 1133 of the first fixing base 11 has a first groove 1133a above the second fixing portion 1233 of the second fixing base 12 The surface has a second groove 1233a. In addition, between the first connecting end 1311 and the second connecting end 1312 of the connecting base 13, a first protrusion 1311 a and a second protrusion 1312 a protruding in opposite directions are formed. When the connecting base 13 is connected to the first fixing portion 1133 with its first connection end 1311 and connected to the second fixing portion 1233 with its second connection end 1312, the first protrusion 1311a is located exactly in the first groove 1133a, and the second protrusion The block 1312a is located exactly in the second groove 1233a.

In summary, the osteotomy surgical jig 10 of the above embodiment is tailor-made according to the tibia of each patient, and as long as the osteotomy surgical jig 10 is placed on the patient's tibia, the osteotomy surgical jig When the surface of 10 can just lean against the surface contour of the patient's tibia, it means that the osteotomy surgical jig 10 has been placed in the correct position, which is very convenient for the surgical operator. In addition, in an embodiment, in addition to connecting the first fixing base 11 and the second fixing base 12, the connector 13 can also serve as The gauge of the opening angle of the first cut 95, when the convex portion 132 of the connector 13 can just extend into the first cut 95, it means that the first cut 95 has been opened to the preset angle, and can be directly The step of starting bone cement filling can save the operator a significant time for evaluating the opening angle of the first incision 95. For doctors, the present invention can save the time for doctors to learn HTO surgery, so that HTO surgery can be performed in the manner expected by doctors. For patients, the present invention also greatly reduces the unpredictable results during HTO surgery. Risk, improve the accuracy and success rate of surgery.

Although the case has been disclosed as above with examples, it is not intended to limit the case. Anyone with ordinary knowledge in the technical field of the subject can make some changes and retouching without departing from the spirit and scope of the case, so the protection of the case The scope shall be determined by the scope of the attached patent application.

Claims (8)

An osteotomy surgical jig is suitable for performing a high tibial osteotomy on a tibia to cut a first incision and a second incision. The osteotomy surgical jig includes: a first fixing seat, including: a The first abutment portion has a first abutment surface for abutting against the peripheral surface of the tibial plateau of the tibia, and the first abutment portion includes at least one fixing hole; an extension portion, one end of which is connected to the first A side edge of the abutment portion, and extending from a side edge of the first abutment portion away from the first abutment portion, the extension portion having one of the tibia surfaces for abutting above the first incision Abutting surface; and a first guide portion including a first flat portion, a first bending portion and a first fixing portion, the first flat portion is connected to the other end of the extension portion, the first bend The folded portion is connected to one side of the first flat portion and is not coplanar with the first flat portion. The first fixing portion is located on the first flat portion; a second fixing seat includes: a second abutting portion, It has a second abutment surface for abutting the tibia surface under the first incision, and the second abutment portion includes at least one fixing hole; and a second guide portion includes a second flat portion, A second bending portion and a second fixing portion, the second flat portion is connected to the second abutting portion, the second bending portion is connected to one side of the second flat portion and is connected to the second flat portion Non-coplanar; and a connecting base that detachably connects the first fixing portion and the second fixing portion, when the connecting base connects the first fixing portion and the second fixing portion, the first flat portion and the second fixing portion A first guiding path is defined between the second flat portions, and a second guiding path is defined between the first bending portion and the second bending portion. The osteotomy surgical jig as claimed in claim 1, wherein the lower surface of the first fixing portion has a first groove, the upper surface of the second fixing portion has a second groove, and the connecting seat further includes a A connecting part, the two ends of the connecting part respectively include a first connecting end and a second connecting end, and a first protrusion and a second protrusion are formed between the first connecting end and the second connecting end of the connecting part ; When the connecting base connects the first fixing portion with its first connecting end and the second fixing portion with its second connecting end, the first protrusion is located in the first groove, the second protrusion Located in the second groove. The osteotomy surgical jig as described in claim 2 further includes a plurality of bone needles for respectively passing through the fixing holes of the first abutting portion and the fixing holes of the second abutting portion to connect the first abutment The portion and the second abutment portion are fixed on the tibia. The osteotomy surgical jig according to claim 3, wherein the first abutting portion includes two fixing holes, and the second abutting portion includes two fixing holes. An osteotomy surgical jig is suitable for performing a high tibial osteotomy on a tibia to cut a first incision and a second incision. The osteotomy surgical jig includes: a first fixing seat, including: a The first abutment portion has a first abutment surface for abutting against the peripheral surface of the tibial plateau of the tibia, and the first abutment portion includes at least one fixing hole; an extension portion, one end of which is connected to the first A side edge of the abutment portion, and extending from a side edge of the first abutment portion away from the first abutment portion, the extension portion having one of the tibia surfaces for abutting above the first incision Abutting surface; and a first guide portion including a first flat portion, a first bending portion and a first fixing portion, the first flat portion is connected to the other end of the extension portion, the first bend The folded portion is connected to one side of the first flat portion and is not coplanar with the first flat portion. The first fixing portion is located on the first flat portion; a second fixing seat includes: a second abutting portion, It has a second abutment surface for abutting the tibia surface under the first incision, and the second abutment portion includes at least one fixing hole; and a second guide portion includes a second flat portion, A second bending portion and a second fixing portion, the second flat portion is connected to the second abutting portion, the second bending portion is connected to one side of the second flat portion and is connected to the second flat portion Non-coplanar; and a connecting base including a connecting portion and a convex portion, the two ends of the connecting portion respectively include a first connecting end and a second connecting end, the convex portion protruding from the first connecting end Connecting portion; when the connecting base connects the first fixing portion with its first connecting end and connects the second fixing portion with its second connecting end, a first between the first flat portion and the second flat portion is defined A guiding path, a second guiding path is defined between the first bending portion and the second bending portion; when the connecting base is connected to the first fixing portion with its second connecting end, the convex portion passes The second abutment surface and the extended abutment surface protrude between the first flat portion and the second flat portion. The osteotomy surgical jig as claimed in claim 5, wherein the lower surface of the first fixing portion has a first groove, the upper surface of the second fixing portion has a second groove, and the first of the connecting portion A first projection and a second projection are formed between the connection end and the second connection end; when the connection base is connected to the first fixing portion with its first connection end and connected to the second fixing with its second connection end The first bump is located in the first groove, and the second bump is located in the second groove. The osteotomy surgical jig as described in claim 6, further comprising a plurality of bone needles for respectively passing through the fixing holes of the first abutting portion and the fixing holes of the second abutting portion to connect the first abutment The portion and the second abutment portion are fixed on the tibia. The osteotomy surgical jig according to claim 7, wherein the first abutting portion includes two fixing holes, and the second abutting portion includes two fixing holes.