WO2019102974A1 - Outil de maintien pour ostéotomie, et écarteur pour ostéotomie - Google Patents

Outil de maintien pour ostéotomie, et écarteur pour ostéotomie Download PDF

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Publication number
WO2019102974A1
WO2019102974A1 PCT/JP2018/042740 JP2018042740W WO2019102974A1 WO 2019102974 A1 WO2019102974 A1 WO 2019102974A1 JP 2018042740 W JP2018042740 W JP 2018042740W WO 2019102974 A1 WO2019102974 A1 WO 2019102974A1
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WIPO (PCT)
Prior art keywords
pair
osteotomy
members
opener
opening
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PCT/JP2018/042740
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English (en)
Japanese (ja)
Inventor
智章 平川
智大 平山
Original Assignee
ＨＯＹＡ Ｔｅｃｈｎｏｓｕｒｇｉｃａｌ株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Priority claimed from JP2018173325A external-priority patent/JP6688355B2/ja
Application filed by ＨＯＹＡ Ｔｅｃｈｎｏｓｕｒｇｉｃａｌ株式会社 filed Critical ＨＯＹＡ Ｔｅｃｈｎｏｓｕｒｇｉｃａｌ株式会社
Publication of WO2019102974A1 publication Critical patent/WO2019102974A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices

Definitions

  • the present invention relates to a holding device for osteotomy and a dilator for osteotomy, which are used, for example, in surgery for correcting the angle of the tibia.
  • High tibial osteotomy which changes the angle of the tibia is performed.
  • One of the high-level tibial osteotomy is an open wedge method in which a wedge-shaped bone graft material is inserted into a notch formed in a tibia near a knee joint to correct an angle of the tibia in standing position.
  • an opener for osteotomy is proposed in which the incision is opened when inserting the bone filling material (see, for example, Patent Documents 1 and 2).
  • this opener for osteotomy has a large number of parts including the hinge part, and there is a problem that it takes time and effort when performing maintenance such as washing. Also, when the tibial incision is held open by the pair of rocking members left in the incision, and it is attempted to insert the bone filling material into the incision, the tip of the pair of rocking members including the hinge portion However, there is a problem that not only the entire depth of the incision can not be seen but also the bone filling material can not be inserted into the entire depth of the incision.
  • FIG. 23 (a) is an explanatory view when an example of a state in which the incision K1 is opened and held using the opener 500 for osteotomy according to the above-mentioned proposal is viewed from above.
  • (B) is an explanatory view when the state shown in (a) is viewed from the front with respect to the incision K1. As shown in FIGS.
  • the opener 500 for osteotomy in the opener 500 for osteotomy according to the above-mentioned proposal, after removing a pair of swinging members (not shown) from the incision K1, one more pair is further removed.
  • the swinging member 520 remains in the cut K1 in a state where the swing member 520 is held in the open state by the opening and closing mechanism 512. In this state, since the tip of the pair of swing members 520 including the hinge portion 511c is in the back of the incision, not only the entire depth of the incision K1 can not be seen, but the bone replacement material is inserted in the entire depth of the incision K1. I understand that I can not do it.
  • the maintenance device can be easily performed by a simple mechanism, and when the incision is opened and the implant is inserted, the holding device for osteotomy and the bone in which the entire depth of the incision becomes visible
  • the purpose is to provide a dilator for cutting.
  • the first and second separating members are inserted into the incision formed in the bone, and the holding portion holds the open and closed states of the first and second separating members.
  • a holding device for The retainer is formed in a wedge shape gradually thickened with respect to the first inner surface from the first inner surface and the front end side to the rear end side, and has a first separating member having a first outer surface contacting the bone; And a second separating member having a wedge shape which is gradually thicker than the second inner surface from the rear end side and having a second outer surface contacting the bone.
  • the holder is provided on the rear end side of the second separating member with a first base provided with a guide member provided on the rear end side of the first separating member to guide the opening and closing operation of the first separating member and the second separating member.
  • a second base provided with an opening into which the guide member is inserted, and a holding portion that holds the slide between the guide member and the opening.
  • the first outer surface and the second outer surface include a roughened surface that is non-slippery to the bone.
  • the holding portion includes a screw provided on the second base and in contact with the outer peripheral surface of the guide member to hold the slide between the guide member and the opening.
  • the guide member of the first base has a stopper member so that the second base can not be removed from the open end of the guide.
  • the guide member be formed with an angle scale that allows visual recognition of the open / close angle of the first and second separating members.
  • the opener for osteotomy according to the present embodiment is disposed on any one of the holding device for osteotomy described above, the first spacing member and the second spacing member, and the second spacing member is separated from the second spacing member. And a first opening / closing mechanism that adjusts an opening / closing angle with respect to the other of the members. Further, it is preferable that one of the first separating member and the second separating member is longer than the other.
  • the opener for osteotomy comprises: a blade for opening a bone incision; and a holding device detachably attached to the blade and for holding the opened bone incision. It is an opener for The blade has a pair of pivoting members relatively pivotably connected by a hinge disposed at the tip and having an inner surface and an opposite outer surface, and the holding device has the configuration described above Is preferred.
  • the blade of the present embodiment includes a second opening and closing mechanism that opens and closes the pair of pivoting members around the axis of the hinge portion.
  • the outer surfaces of the pair of pivoting members preferably include an inclined outer surface gradually thickened with respect to the inner surface from the front end side to the rear end side, and a parallel outer surface parallel to the inner surface from the front end side to the rear end side.
  • the first inner surface of the retainer is disposed on one of the parallel outer surfaces of the pair of pivot members, and the first outer surface is flush with the one inclined outer surface of the pair of pivot members and the second of the retainer is
  • the inner surface is preferably disposed on the other parallel outer surface of the pair of pivoting members, and the second outer surface is preferably flush with the other inclined outer surface of one pivoting member.
  • the blade has a connecting member connected to at least one of the first base and the second base of the holding device.
  • the opener for osteotomy is an opener for osteotomy, which is inserted into an incision formed in a bone, and the incision is opened to form a space into which an implant can be inserted.
  • the osteotomy opener includes opening and closing means and a holding device.
  • the opening and closing means of the opener for osteotomy comprises a pair of pivoting members relatively rotatably connected by a hinge disposed at the tip, and the pair of pivoting members as the hinge
  • a holder for an osteotomy opener is disposed on the open side of a pair of pivoting members, and is mounted on a pair of spacing members interlocked with the pair of pivoting members; And a holding mechanism for holding the separated member in a separated state.
  • the maintenance can be easily performed by a simple mechanism, and when the incision is opened and the implant is inserted, The entire depth of the cut can be seen.
  • (A) is a schematic perspective view which shows the holding
  • (b) is a top view which shows the holding
  • (A) and (b) is a first example of the holding mechanism.
  • (A) is a transparent top view which shows the state before holding of a holding mechanism
  • (b) is a transparent top view which shows the state after holding of a holding mechanism.
  • (A) and (b) is a second example of the holding mechanism.
  • (A) is a transparent top view which shows the state before holding of a holding mechanism
  • (b) is a transparent top view which shows the state after holding of a holding mechanism.
  • FIG. 10 is a schematic perspective view of an opener for osteotomy according to a fourth embodiment.
  • FIG. 1 is a schematic plan view which shows the opener for osteotomy of 4th Embodiment.
  • FIG. 2 is a schematic plan view showing the blade with the holding device removed from the osteotomy opener.
  • C is a CC sectional view of (b).
  • D is a schematic rear view which shows the opener for osteotomy, It is the figure which showed another example of the holding device fixing pin. It is a figure explaining how to open the blade of the opener for osteotomy inserted in the incision of a bone, and open the incision. It is a figure explaining how to close connection of a blade and a holding tool, and to close a blade in the state where a holding tool opened a cut.
  • FIG. 12 A) is a schematic perspective view which shows an example of the opener for osteotomy of 5th Embodiment.
  • (B) is a schematic perspective view which shows the blade of the opener for osteotomy shown to (a).
  • (C) is a schematic perspective view which shows the holding
  • (A) is a schematic top view of the opener for osteotomy shown in FIG. 12 (a).
  • (B) is a schematic rear view of the opener for osteotomy shown in FIG. 12 (a).
  • C) is a schematic side view of the opener for osteotomy shown in FIG. 12 (a).
  • (A) is a schematic perspective view which shows an example of a spreader fixed pin.
  • (B) is a schematic perspective view which shows another example of a spreader fixing pin.
  • (A) is explanatory drawing about the operation
  • (B) is explanatory drawing about the operation
  • (A) is a transparent rear view which shows an example of operation
  • (B) is a transparent rear view which shows an example of operation
  • (A) is explanatory drawing when seeing from the side to a cut about operation which inserts an opener into a cut.
  • (B) is explanatory drawing when the operation
  • A) is explanatory drawing when it saw from the side with respect to an incision about operation
  • B) is explanatory drawing when the operation
  • A) is explanatory drawing when it sees from the side with respect to a cut about operation
  • B) is explanatory drawing when the operation
  • (A) is explanatory drawing when it saw from the side with respect to an incision about operation
  • (B) is explanatory drawing when the operation
  • (A) is explanatory drawing when it sees from a side with respect to an incision about the operation
  • (B) is explanatory drawing when the operation
  • A) is explanatory drawing when it saw from the side with respect to an incision about operation
  • (B) is an explanatory view when the blade is pulled out of the incision in (a) and the spreader opens and holds the incision as viewed from the front with respect to the incision.
  • (A) is explanatory drawing when an example of the state which opened and held the incision using the conventional opener for osteotomy was seen from the upper surface.
  • (B) is explanatory drawing when the state shown to (a) is seen from a front with respect to incision.
  • an osteotomy opener For an osteotomy opener, for example, it is inserted into an incision formed in the deformed femur or tibia of a patient with osteoarthritis of the knee, and the incision is opened to form a space into which the implant can be inserted. It has the purpose of In addition, the opener for osteotomy may be called an "opener" below.
  • the osteoarthritis of the knee is a disease in which a load is applied to the inside of the knee joint due to the progress of deformation of the O leg, and the knee cartilage is worn away and damaged.
  • the deformed femur or tibia of a patient with osteoarthritis of the knee means the femur or tibia of a patient with O leg having advanced deformity.
  • the incision is formed by a chisel or a bone saw while maintaining the continuity of the bone cortex so as not to completely cut the bone.
  • the incision is made inside the tibia and the femoral or tibial angle during standing is changed by inserting the implant with the incision open. O can correct the leg.
  • an implant there is no restriction
  • a shape of a bone grafting material According to the objective, it can select suitably, For example, solid form (block), granular form, paste form etc. are mentioned.
  • a wedge-shaped block In the case of a patient with a deformed O-leg, as the shape of the bone filling material, a wedge-shaped block having a shape according to the condition is preferable. If the shape of the bone graft material is a wedge-shaped block, the O leg can be corrected by inserting it into the incision formed on the inside of the tibia.
  • a ceramic material is preferable. If the material of the bone filling material is a ceramic material, it is easy to adjust the shape according to the case by cutting or the like because it is excellent in processability.
  • a ceramic material bioceramics, such as an alumina, a zirconia, a calcium-phosphate type compound, are preferable, for example.
  • Examples of calcium phosphate compounds include apatites such as hydroxyapatite, fluoroapatite, carbonate apatite, dicalcium phosphate, tricalcium phosphate, tetracalcium phosphate, octacalcium phosphate, etc. You may use individually and may use 2 or more types together. In this case, osteoarthritic knee osteoarthritis is targeted as a disease, and the incision to be formed is opened and the bone into which the implant is inserted is a femur or a tibia, but the invention is not limited thereto and can be appropriately selected according to the purpose. .
  • the opener for osteotomy of the present invention for the above purpose, maintenance can be easily performed by a simple mechanism in which the number of parts including the hinge portion is reduced, and the incision is opened and the implant is opened.
  • the entire depth of the incision is visible and the implant can be inserted into the entire depth of the incision.
  • the shape of the opener for osteotomy is not particularly limited as long as it can be inserted into the incision, and can be appropriately selected according to the purpose, but may be changed according to the size of the target bone preferable.
  • a material of the openers for osteotomy According to the objective, it can select suitably, For example, a metal material etc. are mentioned. Examples of the metal material include noble metal alloys, stainless steels, cobalt chromium alloys, titanium, titanium alloys and the like.
  • limiting in particular as a size of the openers for osteotomy Although it can select suitably according to the objective, It is preferable to change according to the size of the bone
  • the structure of the osteotomy opener includes a blade, a holding device, and other means as needed.
  • the blade is used to open the incision formed in the femur or tibia and is closed and pulled out of the incision after being held in the desired open state of the incision by an open holding tool in conjunction with the blade .
  • the blade may be referred to as "opening and closing means".
  • the shape and size of the blade are not particularly limited, and may be appropriately selected according to the purpose.
  • the structure of the blade includes a pair of pivoting members and one opening / closing mechanism, and further includes other members or mechanisms as required.
  • the pair of pivoting members are inserted into the incision from the tip at which the hinge portion is disposed, and are used for pivoting at the hinge portion to open the incision.
  • the structure of the pair of rotation members is not particularly limited as long as it is relatively rotatably connected by the hinge portion disposed at the tip, and can be appropriately selected according to the purpose, for example, A pair of rectangular flat plates, one end of which has a short side connected with a hinge portion so as to be relatively rotatable, and the like.
  • the shape of the pair of pivoting members is preferably formed in a substantially wedge shape which gradually thickens from the tip in a closed state.
  • One opening and closing mechanism is used to open and close the pair of pivoting members about the axis of the hinge portion.
  • opening and closing the pair of pivoting members pivots at least one of the pair of pivoting members, and the pair of pivoting members abut on the rear end side from the hinge portion It means changing from a state (closed state) to a non-contacting state (opened state) or from an open state to a closed state.
  • the structure of one opening and closing mechanism is not particularly limited as long as the pair of pivoting members can be opened and closed about the axis of the hinge portion, and can be appropriately selected according to the purpose.
  • the rotating member on the screw hole side to be screwed is about the axis of the hinge portion Can be opened and closed.
  • the screw shaft is opposite in winding direction at the point where it is screwed into each of the two screw holes, and is made to have a relationship of so-called "forward screw” and "reverse screw”. Good.
  • the pair of pivoting members can be efficiently pivoted simultaneously to open and close.
  • the coupling member couples the holding device to the pair of pivoting members in order to more securely interlock the holding device with respect to the opening operation of the pair of pivoting members.
  • the connecting member can release the connection between the pair of pivoting members and the retainer when closing the pair of pivoting members after the retainer holds the incision in the open state.
  • a shape of a connection member a pin shape etc. are mentioned, for example. If the connecting member has a pin shape, it is preferable to use a positioning pin in combination in order to connect more securely.
  • a positioning pin a ball plunger etc. are mentioned, for example.
  • the holding device is used to hold the cut-out state by the blade.
  • the holding tool may be referred to as a "spreader” or a "large opening holding means”.
  • the holder can be placed on the open surface of the pair of pivoting members, and a pair of separating members described later can be interlocked with the opening operation of the pair of pivoting members.
  • the structure of the holding device includes a pair of spacing members and a holding mechanism, and further includes other members or mechanisms as required.
  • One pair of spacing members The pair of spacing members are placed on the open side of the pair of pivoting members so as to be interlocked with the pair of pivoting members and the notch is opened by the pair of pivoting members. It is used to hold the stationary state.
  • the state in which the pair of separating members are separated means the state in which the pair of rotating members with which the pair of separating members are interlocked is opened.
  • the state in which the pair of separating members is not separated means the state in which the pair of rotating members with which the pair of separating members interlock is closed.
  • the shape of the pair of separating members is not particularly limited as long as it can be stacked on the surface of the opening side of the pair of rotating members, and can be appropriately selected according to the purpose.
  • the pair of separating members is not particularly limited as long as it can be interlocked with the pair of rotating members, and can be appropriately selected according to the purpose.
  • the holding mechanism is used to hold the pair of spacing members apart.
  • the holding mechanism keeps the pair of separating members separated, the pair of separating members is not in the depth of the cut, so that the entire depth of the cut becomes visible and the entire depth of the cut is Implants can be inserted.
  • the structure of the holding mechanism is not particularly limited as long as it can hold the state in which the pair of spacing members are separated, and can be appropriately selected according to the purpose.
  • the sliding mechanism is used to slide in conjunction with the pair of spacing members while connecting the pair of spacing members.
  • the shape and size of the sliding mechanism are not particularly limited as long as they are not thick and large so that the entire depth of the incision can not be visually recognized, and can be appropriately selected according to the purpose.
  • the structure of the sliding mechanism is not particularly limited and may be appropriately selected according to the purpose.
  • the sliding mechanism is provided on the rear end side of the pair of separating members, and is used for cutting The position which does not enter is preferred.
  • a guide member control part which has a guide member base part, a guide member, and an opening part into which a guide member is inserted.
  • the shape, structure, and size of the guide member base portion are not particularly limited as long as the guide member can be fixed, and can be appropriately selected according to the purpose.
  • the openers for osteotomy there is no restriction
  • a blade for opening and closing a pair of pivoting members whose hinge portion is disposed at the tip end and a pair of separating members for interlocking with the pair of pivoting members are opened. Since the mechanism is a simple mechanism in which the number of parts including the hinge portion is reduced by the holding device for holding the separated state, the maintenance can be easily performed.
  • this opener for osteotomy after holding the open state of the cut by the pair of separating members of the holding device, the pair of rotating members of the blade is closed and removed from the cut. However, since the entire depth of the incision is visible and the implant can be inserted into the entire depth of the incision.
  • the present invention is not limited to this embodiment at all.
  • the osteotomy of this embodiment in order to insert the wedge-shaped bone graft material into the incision formed in the tibia near the knee joint for the purpose of correcting the “O leg” of the osteoarthritic knee patient, the osteotomy of this embodiment The case where the incision is opened using the opening device will be described.
  • FIG. 1 (a) shows a cut formed in the deformed femur or tibia of a patient with osteoarthritis of the knee, a blade 210 described later, an osteotomy opener disclosed in Patent Document 1 proposed conventionally
  • FIG. 10 is a perspective view showing a holding device 220 for osteotomy, which holds a state in which a cut is opened by the retractor assembly of Patent Document 2 or the like.
  • FIG. 1 (b) is a plan view of the holding device 220.
  • the holding device 220 for osteotomy is made of a metal material such as stainless steel, a noble metal alloy, a cobalt chromium alloy, titanium, a titanium alloy, or the like.
  • the osteotomy holding device 220 may be composed of a hard pressic material.
  • Each of the pair of spacing members 221 has an inner surface 221p and an outer surface 221q formed in a wedge shape that is gradually thicker than the inner surface 221p.
  • the shape formed by the inner surface 221 p and the outer surface 221 q in the pair of separating members 221 is not limited to the wedge shape, and may be a flat plate having a uniform or substantially uniform thickness.
  • a pair of base portions 225 is formed on the rear end side (+ X axis side) of the pair of spacing members 221.
  • the length LX2 of the pair of separating members 221 is generally 30 mm to 70 mm, preferably 40 mm to 60 mm, and more preferably 45 mm to 55 mm in the X-axis direction.
  • the length LX2 is also preferably changed appropriately according to the physical constitution of the patient, and in particular, it is preferable that the length be sufficiently in contact with the tibial cortical bone such as the femur. Since the length LX2 of the separation member 221 is shorter than the depth inserted by the dissection device for osteotomy for opening the incision, the entire depth of the incision K1 of the tibia K can be easily seen and a bone graft material (for example, (A small size bone filling material or granular bone filling material) can be easily inserted into the incision.
  • the inner surface 221p of the separating member 221a and the inner surface 221p of the separating member 221b are opposed in parallel in the closed state. In FIG. 1B, the distance between the inner surface 221p of the separation member 221a and the inner surface 221b of the separation member 221b is a distance Dp, but it does not matter.
  • the width Wp of the pair of spacing members 221 is appropriately set so as to be able to maintain the thickness of the bone and the expanded state.
  • the pair of base portions 225 is formed to have a width Wr, and the width Wr is wider than the width Wp.
  • a sliding mechanism 222 and a holding mechanism 223 are provided at the part of the widened base 225.
  • the outer surfaces 221 q of the pair of spacing members 221 are preferably roughened so as not to slip against bone.
  • the rough surface of the outer surface 221 q is preferably, for example, a fine lattice groove formed by knurling or a fine linear groove extending in the Z-axis direction, or a random fine uneven groove formed by sandblasting.
  • the base portion 225 has a sliding mechanism 222, and the sliding mechanism 222 has a guide member base 222a, a guide member 222b and an opening 222c.
  • One 225b of the pair of bases 225 has a guide member base 222a, and is arc-shaped to draw an arc along the Z axis at an intersection point of the outer surfaces 221q of the pair of spacing members 221 extended to the -X axis side.
  • the (arch-shaped) guide member 222b is fixed. Further, on the upper surface (+ Z side surface) of the arch-shaped guide member 222b, there is a scale indicating the angle formed by the spacing member 221a and the spacing member 221b.
  • the scale of the angle may be provided on the lower surface (-Z side surface) of the guide member 222b.
  • the outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the arch-shaped guide member 222b may be roughened.
  • the holding mechanism 223 abuts on the outer peripheral surface 222 f to ensure holding of the angle of the pair of spacing members 221.
  • the rough surface of the outer peripheral surface 222f is preferably a fine lattice-like groove, a fine linear groove or a random fine uneven groove.
  • the outer peripheral surface 222f of the guide member 222b and the inner peripheral surface 222g opposed to the outer peripheral surface 222f preferably have an arc shape (arch shape), but even if the outer peripheral surface 222f and the inner peripheral surface 222g are rectangular parallel to each other Good.
  • the length of the arc (arch shape) of the guide member 222b can insert the implant into the back of the notch K1 of the tibia K if the opening and closing angle of the pair of separating members is up to about 25 degrees.
  • a stocker member 222h is provided at the end of the arc of the guide member 222b. The guide member 222b and the opening 222c are not separated due to the stocker member 222h.
  • the stopper member 222h is a cylindrical pin, but may be another shape.
  • the storage member 222h is disposed to protrude on the lower surface (-Z side surface) of the guide member 222b, the storage member 222h is disposed to protrude on the outer peripheral side (+ X axis side) or the inner peripheral side (-X axis side) of the guide member 222b. It may be done.
  • the other 225 a of the pair of bases 225 has an opening 222 c.
  • the guide member 222b enters the opening 222c, and the opening 222c supports the sliding of the arc-shaped (arch-shaped) guide member 222b.
  • the opening 222c covers the upper surface, the lower surface, the inner peripheral surface, and the outer peripheral surface of the guide member 222b.
  • the opening 222c is notched.
  • the upper surface of the member 222b may not be covered.
  • a holding mechanism 223 is provided in the opening 222c + X axis direction.
  • the holding mechanism 223 includes a first fixing screw 223a of the first example and a second fixing screw 223b of the second example.
  • the first fixing screw 223a has a hexagonal hole in the + X axis direction
  • the second fixing screw 223b also has a hexagonal hole in the + X axis direction. For this reason, a medical worker can easily perform the holding operation of the pair of spacing members 221 by the holding mechanism 223 from the + X axis direction.
  • FIGS. 2 (a) and 2 (b) A first example of the holding mechanism 223 will be described using FIGS. 2 (a) and 2 (b).
  • FIGS. 2A and 2B are both drawn in a state where the periphery of the base portion 225 is seen through, and the guide member 222b of the opening 222c and the first fixing screw 223a are drawn.
  • the first fixing screw 223a is not in contact with the outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the guide member 222b.
  • FIG. 2B shows a state in which the first fixing screw 223a is in contact with the outer peripheral surface 222f of the guide member 222b.
  • the first fixing screw 223a Since the first fixing screw 223a has a hexagonal hole (see FIG. 1 (a)), the first fixing screw 223a can be turned with a hexagonal wrench (not shown). As shown in FIG. 2A, when the end of the first fixing screw 223a is not in contact with the outer peripheral surface 222f, the guide member 222b can slide in the opening 222c, and a pair of separating members 221a and 221b move relatively. As shown in FIG. 2B, when the front end of the first fixing screw 223b is in contact with the outer peripheral surface 222f, the pair of spacing members 221a and 221b are held. Even if the outer peripheral surface 222 f is not roughened, the outer peripheral surface 222 f can be held by the first fixing screw 223 a.
  • the first fixing screw 223a ensures holding of the angle of the pair of separating members 221, it is preferable that a fine lattice groove, a fine linear groove or a random fine uneven groove be formed on the outer peripheral surface 222f. .
  • a plus screw or a hexagonal bolt may be used instead of the first fixing screw 223a having a hexagonal hole.
  • FIGS. 3A and 3B are both drawn in a state where the periphery of the base portion 225 is seen through, and the guide member 222b of the opening 222c and the second fixing screw 223b are drawn.
  • FIG. 3A shows a state in which the second fixing screw 223b is not tightened.
  • FIG. 3B shows a state in which the second fixing screw 223b is tightened.
  • a slit 223s extending in the Y-axis direction is formed in the base portion 225a, and the slit 223s penetrates to the opening 222c.
  • the second fixing screw 223b is longer in the X-axis direction than the first fixing screw 223a.
  • the second fixing screw 223b can be turned with a hexagonal wrench (not shown).
  • FIG. 3A when the first fixing screw 223b is not tightened, the distance SX between the slits 223s is wide, and the guide member 222b can slide in the opening 222c, and a pair of separating members 221a and 221b can move relatively.
  • FIG. 3A when the first fixing screw 223b is not tightened, the distance SX between the slits 223s is wide, and the guide member 222b can slide in the opening 222c, and a pair of separating members 221a and 221b can move relatively.
  • FIG. 3A when the first fixing screw 223b is not tightened,
  • the space SX of the slits 223s becomes narrow, and the guide member 222b is held in the opening 222c. Therefore, the pair of separating members 221a and 221b are held.
  • the outer circumferential surface 222 f may or may not be roughened.
  • the use of the holding device 220 for osteotomy is described with reference to FIG.
  • the medical worker uses the incision K1 of the tibia K, the opener 200 for osteotomy described later, and the tip of the opener (retractor assembly) for osteotomy which has been proposed conventionally, to the back of the tibia K Insert into and abut. Thereafter, the incision K1 is enlarged by the opener 200 or the like for the osteotomy.
  • the medical worker contacts the holding device 220 for osteotomy with a predetermined depth (for example, the tibial cortical bone of the femur) in a dilated incision with the pair of spacing members 221 closed. To the desired depth).
  • the healthcare worker extends the outer surface 221 q of the pair of spacing members 221 of the osteotomy holding device 220 to an angle at which it abuts the expanded bone.
  • the tip of the first fixing screw 223a is not in contact with the outer peripheral surface 222f, the opening / closing operation by the sliding mechanism of the holding device 220 for osteotomy is performed smoothly.
  • the pair of spacing members 221 of the holding device 220 for osteotomy is opened and closed while the distal end side is maintained in the separated state.
  • the medical worker rotates the first fixing screw 223a until the tip of the first fixing screw 223a abuts on the outer peripheral surface 22f in order to maintain the opened state.
  • the pair of spacing members 221a and 221b are held at the predetermined angle, so that the cut K1 of the tibia K can be maintained in the expanded state.
  • FIG. 4 is a view showing a state in which the opener 220 for osteotomy is removed and only the holding tool 220 for osteotomy remains in the incision K1 of the tibia K. Since the blade 210 is pulled out, the medical worker can visually recognize the back of the notch K1 of the tibia K, and can insert the bone graft material into the back. When the outer surface 221 q of the pair of spacing members 221 a and 221 b is roughened, the tibia K and the spacing members 221 a and 221 b do not slip easily when the bone replacement material is inserted.
  • the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of spacing members 221a and 221b, and withdraws the holding device 220.
  • the medical staff may further insert a bone substitute into the space formed by removing the holding device 220.
  • FIGS. 5 (a) and 5 (b) are plan views showing the dilator 320 for osteotomy of the second embodiment.
  • Fig. 5 (a) shows a state in which the opener 320 for osteotomy is closed
  • Fig. 5 (b) shows a state in which the opener 320 for osteotomy is open.
  • the longitudinal direction of the opener 320 for osteotomy is X axis
  • the direction in which the first opening and closing mechanism 327 is opened and closed is Y axis
  • the width direction of the opener 320 for osteotomy is Z It explains as an axis.
  • the opener 320 for osteotomy according to the second embodiment has the first open / close mechanism 327 attached to the holder 220 for osteotomy described in the first embodiment.
  • the osteotomy opener 320 of the second embodiment is basically similar to the osteotomy holding device 220 of the first embodiment. Therefore, in the opener 320 for osteotomy, members having the same function are denoted by the same reference numerals as the members of the holding device 220 of the first embodiment. Moreover, the explanation is omitted regarding the same code. In the osteotomy opener 320, the length LX2 of the pair of spacing members 221 (221a, 221b) is also the same as the holding device 220 of the first embodiment.
  • the base 325a is provided with a first opening / closing mechanism 327.
  • the first opening and closing mechanism 327 has a screw hole 327a provided in the base portion 325a, a screw shaft 327c screwed through the screw hole 327a, and a hexagonal hole 327h provided in one end of the screw shaft 327c.
  • the hexagonal hole 327 h of the screw shaft 327 c may be a plus screw or a hexagonal bolt shape or the like.
  • the first opening and closing mechanism 327 may be provided to the other base 325 b instead of the base 325 a.
  • a hexagonal wrench driver (not shown) can be inserted into a hexagonal hole 327h provided at one end of the screw shaft 327c. Then, the screw shaft 327c is rotated by a driver or the like.
  • the other end of the screw shaft 327c is formed in a hemispherical shape, and is in contact with a wall surface (+ Y axial surface) which is a flat surface of the base 325b. Since the other end of the screw shaft 327c is hemispherical, even if the angle of the screw shaft 327c changes from FIG. 5 (a) to the state shown in FIG. 5 (b), it stably contacts the wall surface of the base 325b. .
  • the use of opener 320 for osteotomy is described.
  • the medical worker inserts the osteotomy opener 320 into the notch K1 of the tibia K.
  • the medical worker makes the outer surface 221 q of the pair of separating members 221 sufficiently contact with the tibial cortical bone such as the femur.
  • the medical worker does not have to insert the osteotomy opener 320 as far as the femur or the like, and does not have to hit the osteotomy opener 320 with a hammer.
  • the medical worker After inserting the osteotomy opener 320 into the notch K1 of the tibia K, the medical worker fits a hex wrench driver into the hex hole 327h of the threaded shaft 327c. The healthcare worker then turns the hex wrench driver. Then, the screw shaft 327c is extended, and the separating members 221a and 221b are relatively opened to open the notch K1. The pair of spacing members 221 of the osteotomy opener 320 can open the cut K1 while maintaining the distal end side apart. After opening the bone graft material into the incision K1 to an angle sufficient to insert the bone graft material, the medical worker stops the rotation of the hexagonal wrench driver and rotates the first fixing screw 223a. Then, the first fixing screw 223a and the guide member 222b are held.
  • the medical worker can visually recognize the back of the incision K1 of the tibia K, and can insert the bone graft material into the back. After inserting the bone graft material, the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of spacing members 221a and 221b, and removes the osteotomy opener 320. .
  • FIG. 6 (a) and 6 (b) are cross-sectional views showing the opener 330 for osteotomy according to the third embodiment.
  • the guide member 222b and the first fixing screw 223a and the like are drawn by dotted lines, and the screw shaft 327c is drawn by solid lines.
  • Fig. 6 (a) shows a state in which the opener 330 for osteotomy is closed
  • Fig. 6 (b) shows a state in which the opener 330 for osteotomy is open.
  • the longitudinal direction of the opener 330 for osteotomy is X axis
  • the direction in which the first opening and closing mechanism 327 is opened and closed is Y axis
  • the width direction of the opener 330 for osteotomy is Z It explains as an axis.
  • the opener 320 for osteotomy according to the second embodiment and the opener 330 for osteotomy according to the third embodiment are different in the spacing member 321 b and the base 325 b of the opener 330 for osteotomy. . Moreover, although the screw hole 327a was formed in the base 325a of the opener 320 for osteotomy of 2nd Embodiment, the base 325a of 3rd Embodiment differs by the point which has the top member 327f.
  • the osteotomy opener 330 of the third embodiment is similar to the osteotomy holding tool 220 of the first embodiment. Therefore, in the opener 330 for osteotomy, members having the same functions are denoted by the same reference numerals as the members of the holding device 220 of the first embodiment.
  • the spacing members 321 paired with the spacing members 221a each have an inner surface 321p and an outer surface 321q formed in a wedge shape that is gradually thicker than the inner surface 321p.
  • a pair of base portions 325 b is formed on the rear end side (+ X axis side) of the spacing member 321.
  • the length LX1 of the separating member 321 is the same as the length LX1 of the pivoting member 211 of the blade 210 of the first embodiment.
  • An abutment portion 328 is provided at the tip of the separating member 321, and the abutment portion 328 is a portion to be abutted to the back of the tibia.
  • the thickness Db (in the Y-axis direction) of the spacing member 321 is thicker than the thickness Da of the spacing member 321. This is for striking the opener 330 for osteotomy with a hammer etc., and the contact part 328 ensuring the intensity
  • the base 325 b on the rear end side of the spacing member 321 has a guide member base 222 a and a recess 329.
  • the recess 329 is formed in a Z-axis cross section in a semicircular shape, and is provided to smooth the movement of the screw shaft 327c and to define the movement range.
  • the base 325b is longer by a length LX3 than the end in the + X axis direction of the first fixing screw 223a provided on the base 325a.
  • the base portion 325b also serves as a striking block, so that when the rear end (+ X axis side) of the base portion 325b is hit with a hammer or the like, the hammer or the like does not hit the first fixing screw 223a.
  • the spacing member 221a and the spacing member 321 may be interchanged.
  • the base 325a is provided with a first opening / closing mechanism 327.
  • the first opening and closing mechanism 327 is threaded through a through hole 327d provided in the base portion 325a, a frame member 327f rotatably provided at an intermediate position of the through hole 327d, and a female screw hole provided in the frame member 327f. It has a screw shaft 327c to be engaged, and a hexagonal hole 327h provided at one end of the screw shaft 327c.
  • the top member 327f preferably has a cylindrical shape extending in the Z-axis direction.
  • the hexagonal hole 327 h of the screw shaft 327 c may be a plus screw or a hexagonal bolt shape or the like.
  • the screw shaft 327c When the screw shaft 327c is rotated by a driver or the like, the distance from the other hemispherical end of the screw shaft 327c to the base 325a is increased. The other hemispherical end of the screw shaft 327c enters the recess 329, and the screw shaft 327c can change an angle of about plus or minus 5 degrees by the top member 327f. Therefore, the rotation of the screw shaft 327c can be smoothed.
  • the base 325a moves in the + Y axis direction in FIG. 6 with respect to the base 325b.
  • the use of the opener 330 for osteotomy is described.
  • the medical worker inserts the osteotomy opener 330 into the notch K1 of the tibia K.
  • the medical worker strikes the rear end of the base portion 325 b with a hammer or the like (not shown) to abut the abutment portion 328 of the separating member 321 of the osteotomy large scale 330 against the back of the tibia K.
  • the medical worker After inserting the osteotomy opener 330 into the notch K1 of the tibia K, the medical worker fits a hex wrench driver into the hex hole 327h of the threaded shaft 327c. The healthcare worker then turns the hex wrench driver. Then, the screw shaft 327c is extended, the separating members 221a and 321 are relatively opened, and the cut K1 is enlarged. The pair of spacing members 221 of the osteotomy opener 330 can open the cut K1 while maintaining the distal end side apart. After opening the bone graft material into the incision K1 to an angle sufficient to insert the bone graft material, the medical worker stops the rotation of the hexagonal wrench driver and rotates the first fixing screw 223a. Then, the first fixing screw 223a and the guide member 222b are held.
  • the medical worker can visually recognize the back of the incision K1 of the tibia K, and can insert the bone graft material into the back. After inserting the bone graft material, the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of spacing members 221a and 321, and removes the osteotomy opener 330. .
  • FIG. 7 is a perspective view showing an opener 200 for osteotomy according to a fourth embodiment.
  • the longitudinal direction of the opener 200 for osteotomy is X axis
  • the direction of opening and closing the second opening and closing mechanism 212 is Y axis
  • the width direction of the opener 200 for osteotomy is Z It explains as an axis.
  • the osteotomy opener 200 of the fourth embodiment has a blade 210 and a holding device 220.
  • the blade 210 and the holding device 220 are configured such that the blade 210 and the holding device 220 are fixed, or the blade 210 and the holding device 220 are separated.
  • the holding device 220 may be configured to be fixed to the blade 210 by a connecting member 213 (213a, 213b) provided on the striking block 215 (215a, 215b).
  • the blade 210 can be opened and closed by a second opening and closing mechanism 212 provided in the striking block 215.
  • the opener 200 for osteotomy is made of a metal material such as stainless steel, a noble metal alloy, a cobalt chromium alloy, titanium, a titanium alloy or the like.
  • the osteotomy opener 200 may be constructed of a hard plastic material.
  • the osteotomy opener 200 is inserted into a slit formed in the deformed femur or tibia of a patient with osteoarthritis of the knee, and the slit is opened. 7 from 100 mm to 180 mm in the X-axis direction. Also, the size is preferably changed appropriately according to the physical constitution of the patient.
  • FIG. 8A is a plan view showing the osteotomy opener 200 in which the holding device 220 is attached to the blade 210.
  • FIG. FIG. 8 (b) is a plan view showing the blade 210 in a state in which the holding device 220 is separated
  • FIG. 8 (c) is a CC cross-sectional enlarged view of the blade 210 shown in FIG. 8 (b).
  • FIG. 8 (d) is a back view of the blade 210 showing another example of the retainer fixing pin.
  • the opener 200 for osteotomy shown in FIG. 8 (a) is a notch K1 formed in the tibia K with a hammer or the like (not shown) with the holding device 220 mounted on the blade 210. Plug in The blade 210 can open a bone incision while interlocking the holding device 220 by the second opening and closing mechanism 212. Thereafter, after the holding device 220 holds the cut and enlarged state, the second opening and closing mechanism 212 returns the blade 210 to the closed state and is pulled out of the cut.
  • the blade 210 shown in FIG. 8B has a pair of pivoting members 211, one second opening / closing mechanism 212, holding fixture fixing pins 213a and 213b, and a striking block 215.
  • the pair of pivoting members 211 (211a, 211b) are relatively pivotably connected by a hinge portion 211d disposed at the tip end 211c.
  • Each rotation member 211a, 211b has striking blocks 215a, 215b on the opposite side (+ X axis side) to the hinge part 211d.
  • the length LX1 of the pair of pivoting members 211 inserted into the tibia K is generally 50 mm to 90 mm in the X-axis direction.
  • the length LX1 is preferably changed as appropriate according to the physical constitution of the patient.
  • Each pivoting member 211a, 211b has an inner surface 211r and an outer surface (211p, 211q) based on the X-axis direction from the hinge portion 211d.
  • the outer surfaces in the ⁇ Y-axis direction have parallel outer surfaces 211p and inclined outer surfaces 211q.
  • the parallel outer surface 211p has a shape parallel to the inner surface 211r, and the inclined outer surface 211q has a shape that is gradually thicker than the inner surface from the tip end side ( ⁇ X axis side) to the rear end side (+ X axis side).
  • the thickness (in the Y-axis direction) from the parallel outer surface 211p of the pivoting member 211a to the parallel outer surface 211p of the pivoting member 211b is a thickness Dp.
  • the thickness from the inclined outer surface 211q of the rotating member 211a to the inclined outer surface 211q of the rotating member 211b is a thickness Dq, and the thickness Dq gradually increases from the front end side to the rear end side. For this reason, the thickness Dq of the pair of rotating members 211 in the closed state gradually increases from the tip end side in plan view. Because of the wedge shape, the pair of pivoting members 211 can easily insert the tip to the back of the incision formed in the femur or tibia.
  • the shape of the pair of pivoting members 211 is not limited as long as they are relatively pivotably connected by the hinge portion 211d disposed on the tip end side.
  • the parallel outer surface 211p and the inclined outer surface 211q are formed, but the inclined outer surface may not be inclined, and may be another parallel outer surface having different heights in the Y-axis direction. It is also good.
  • the rotating members 211a and 211b have parallel outer surfaces 211p of width Wp (distance from the front surface 211s to the intermediate surface 211t) and width Wq (in the width direction (Z-axis direction)). It is the inclined outer surface 211q of the distance from the middle surface 211t to the back surface 211u).
  • the width Wp of the parallel outer surface 211 p is formed to match the width of the holding device 220.
  • the width Wq and the width Wp may be the same width or different widths.
  • the width (in the Z-axis direction) of each striking block 215a, 215b is preferably a width obtained by combining the width Wp and the width Wq.
  • the width Wq and the width Wp may be appropriately changed in accordance with the physical size of the patient, but generally 10 mm to 20 mm is preferable.
  • the striking block 215 is provided with one second opening / closing mechanism 212.
  • the striking blocks 215a and 215b respectively have screw holes 212a (see also FIG. 7) and 212b on the surfaces on the ⁇ Y-axis side.
  • the screw holes 212a and 212b formed in the surface on the ⁇ Y-axis side are preferably formed on the ⁇ Z-axis side (the far side in FIG. 8) of the striking blocks 215a and 215b.
  • the second opening and closing mechanism 212 has a screw shaft 212c which is screwed through the screw holes 212a and 212b.
  • the screw shaft 212c which is an external thread, is opposite in winding direction at the points where it is screwed with the screw holes 212a and 212b, and has a relationship of so-called "positive screw” and "reverse screw”. Further, a hexagonal hole (see FIG. 7) is provided at an end of the screw shaft 212c, and the screw shaft 212c can be rotated by fitting a hexagonal wrench driver or the like.
  • the screw holes 212a and 212b which are internal threads are a "forward screw hole” and a "reverse screw hole” according to the winding direction of the screw shaft 212c.
  • the screw holes 212a and 212b are provided with an inclination such that the rotation of the screw shaft 212c is not restricted when the blade 210 is opened. For this reason, when the screw shaft 212c is rotated, one second opening and closing mechanism 212 can relatively rotate the pivoting members 211a and 211b to smoothly open and close the pair of pivoting members 211.
  • a hexagonal hole is provided at the end of the screw shaft 212c, it may be a hexagonal bolt or the like.
  • the striking blocks 215a, 215b have holding fixture fixing pins 213a, 213b which are connection members.
  • the holder fixing pins 213a and 213b are preferably formed on the + Z-axis side of the striking blocks 215a and 215b so as to avoid the screw holes 212a and 212b (see FIG. 7).
  • the block on the + X axis side of the retainer fixing pin 213a, 213b is preferably formed flush with the surface of the striking block 215 so as to be easily hit by a hammer (not shown). Further, as shown in FIG.
  • recessed holes 213g and 213h are formed on the tip end side ( ⁇ X axis side) of the holder fixing pins 213a and 213b.
  • a ball plunger (not shown) of the holding device 220 enters the recessed holes 213 g and 213 h, and the holding device 220 is held by the blade 210.
  • Notched surfaces 213d and 213e are formed in parts of the holding device fixing pins 213a and 213b. The notched surfaces 213d and 213e specify the + Z-axis direction of the recessed holes 213g and 213h.
  • the fourth embodiment has the pair of holding fixture fixing pins 213a and 213b, the holding fixture 220 may be held by the blade 210 with only one holding fixture fixing pin.
  • holding fixture fixing pins 213c and 213d are provided at the rear end side of the pair of pivoting members 211 at the position of the back surface 211u as shown in FIG. Also good.
  • the holding fixtures fixing pins 213c and 213d can move a predetermined distance in the + Z-axis direction from the -Z-axis side in the pair of rotation members 211.
  • the holding fixture fixing pins 213c and 213d move from the blade 210 toward the holding fixture 220, and the tip end side (+ Z axis side) protrudes from the intermediate surface 211t (see FIG. 8C) and holds the blade 210.
  • the device 220 can be made to hold.
  • the striking direction (X-axis direction) and the moving direction of the holding fixture fixing pins 213c, 213d (Z-axis) Direction) is not coaxial.
  • the holding fixture fixing pins 213c and 213d can prevent separation of the blade 210 and the holding tool 220.
  • the holding fixture 220 may be held by the blade 210 with only one holding fixture fixing pin.
  • the holding device 220 may be fixed to the blade 210 by adhesion, magnetic force or the like instead of the fixing pin.
  • the osteotomy large scaler 220 is inserted into the tibia K by hitting the striking block 215 with a hammer (not shown), the holder 220 does not have to be detached from the blade 210, so the hammer is not shown. If the holding device 220 does not come off the blade 210 even if the striking block 215 is hit, the connecting member may be absent.
  • FIG. 1A is a perspective view showing the holding device 220 removed from the blade 210.
  • FIG. 1 (b) is a plan view of the holding device 220.
  • the holding fixture 220 shown in FIGS. 1A and 1B is placed on the parallel outer surface 211p of the pivoting members 211a and 211b.
  • the holding device 220 is interlocked with the opening and closing operation of the pair of rotation members 211.
  • the holding device 220 has a pair of spacing members 221 (221a, 221b), a sliding mechanism 222, a holding mechanism 223, and a pair of base portions 225 (225a, 225b).
  • Each of the pair of spacing members 221 has an inner surface 221p and an outer surface 221q formed in a wedge shape that is gradually thicker than the inner surface 221p.
  • a pair of base portions 225 is formed on the rear end side (+ X axis side) of the pair of spacing members 221.
  • the length LX2 of the pair of separating members 221 is generally 30 mm to 70 mm, preferably 40 mm to 60 mm, and more preferably 45 mm to 55 mm in the X-axis direction. short.
  • the length LX2 is also preferably changed appropriately according to the physical constitution of the patient, and in particular, the length is preferably sufficiently in contact with the tibial cortical bone such as the femur.
  • the length LX2 of the separation member 221 is shorter than the length LX1 of the rotation member 211, the entire depth of the notch K1 of the tibia K can be easily seen and a bone graft material (for example, a small size bone graft material or granular It is easy to insert the bone filling material into the incision.
  • a bone graft material for example, a small size bone graft material or granular It is easy to insert the bone filling material into the incision.
  • the inner surface 221p of the separating member 221a and the inner surface 221p of the separating member 221b face each other in parallel, and are separated by a distance Dp. This distance Dp coincides with the thickness Dp from the parallel outer surface 211p of the rotating member 211a shown in FIG. 8C to the parallel outer surface 211p of the rotating member 211b.
  • the width Wp of the pair of spacing members 221 matches the width Wp (see FIG. 8C) of the parallel outer surfaces 211p of the pair of pivoting members 211. That is, when the holding device 220 is placed on the blade 210, the inner surfaces 221p of the separating members 221a and 221b are in contact with the parallel outer surfaces 211p of the rotating members 211a and 211b.
  • the pair of base portions 225 is formed to have a width Wr, and the width Wr is wider than the width Wp.
  • a sliding mechanism 222 and a holding mechanism 223 are provided at the part of the widened base 225.
  • the outer surface 221 q of the pair of spacing members 221 will be described.
  • the outer surface 221 q of the holder 220 and the inclined outer surface 211 q of the pivoting member 211 have the same thickening angle that gradually increases in thickness from the tip side in plan view. That is, the outer surface 221 q of the holder 220 is flush with the inclined outer surface 211 q of the pivoting member 221. Because of the same surface, the second opening and closing mechanism 212 can open the bone in a state where the outer surface 221 q of the spacing member 221 and the inclined outer surface 211 q of the rotation member 211 abut on the cut bone.
  • the outer surface 221 q and the inclined outer surface 211 q have no steps, a relatively wide contact surface with the bone can be secured, so that the load on the bone at the time of opening is reduced.
  • the outer surface 221 q of the spacing member 221 may be slightly thicker than the inclined outer surface 211 q of the rotation member 211 because the blade 210 is pulled out when the wedge-shaped bone filling material is inserted.
  • the outer surfaces 221 q of the pair of spacing members 221 are preferably roughened so as not to slip against bone.
  • the rough surface of the outer surface 221 q is preferably, for example, a fine lattice groove formed by knurling or a fine linear groove extending in the Z-axis direction, or a random fine uneven groove formed by sandblasting.
  • the base portion 225 has a sliding mechanism 222, and the sliding mechanism 222 has a guide member base 222a, a guide member 222b and an opening 222c.
  • One of the base portions 225 has a guide member base portion 222a, and an arc-shaped (arch-shaped) guide member 222b is fixed to draw an arc along the axis of the hinge portion 211d (see FIG. 7). It is done.
  • the upper surface (+ Z side surface) of the arch-shaped guide member 222b there is a scale indicating the angle formed by the spacing member 221a and the spacing member 221b. The scale of the angle may be provided on the lower surface (-Z side surface) of the guide member 222b.
  • the scale indicating this angle is also an angle around the axis of the hinge portion 211d (see FIG. 7).
  • the outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the arch-shaped guide member 222b may be roughened.
  • the holding mechanism 223 abuts on the outer peripheral surface 222 f to ensure holding of the angle of the pair of spacing members 221.
  • the rough surface of the outer peripheral surface 222f is preferably a fine lattice-like groove, a fine linear groove or a random fine uneven groove.
  • the outer peripheral surface 222f of the guide member 222b and the inner peripheral surface 222g corresponding to the outer peripheral surface 222f have an arc shape (arch shape)
  • the outer peripheral surface 222 f and the inner peripheral surface 222 g may have a rectangular shape in parallel.
  • the implant can be inserted into the back of the notch K1 of the tibia K if the arc-shaped (arch-shaped) length of the guide member 222b is about 25 degrees around the axis of the hinge portion 211d. Further, at the end of the arc of the guide member 222b, a stocker member 222h is provided.
  • the stopper member 222h is a cylindrical pin, but may be another shape.
  • the storage member 222h is disposed to protrude on the lower surface (-Z side surface) of the guide member 222b, the storage member 222h is disposed to protrude on the outer peripheral side (+ X axis side) or the inner peripheral side (-X axis side) of the guide member 222b. It may be done.
  • the other of the pair of bases 225 has an opening 222c.
  • the opening 222c supports the sliding of the arc-shaped (arch-shaped) guide member 222b.
  • the opening 222c covers the upper surface, the lower surface, the inner peripheral surface, and the outer peripheral surface of the guide member 222b.
  • the opening 222c is notched.
  • the upper surface of the member 222b may not be covered.
  • a holding mechanism 223 is provided in the opening 222c + X axis direction.
  • the holding mechanism 223 includes a first fixing screw 223a of the first example and a second fixing screw 223b of the second example.
  • the first fixing screw 223a has a hexagonal hole in the + X axis direction
  • the second fixing screw 223b also has a hexagonal hole in the + X axis direction.
  • FIGS. 2 (a) and 2 (b) A first example of the holding mechanism 223 will be described using FIGS. 2 (a) and 2 (b).
  • FIGS. 2A and 2B are both drawn in a state where the periphery of the base portion 225 is seen through, and the guide member 222b of the opening 222c and the first fixing screw 223a are drawn.
  • the first fixing screw 223a is not in contact with the outer peripheral surface 222f on the outer peripheral side (+ X axis side) of the guide member 222b.
  • FIG. 2B shows a state in which the first fixing screw 223a is in contact with the outer peripheral surface 222f of the guide member 222b.
  • the first fixing screw 223a Since the first fixing screw 223a has a hexagonal hole (see FIG. 1 (a)), the first fixing screw 223a can be turned with a hexagonal wrench (not shown). As shown in FIG. 2A, when the end of the first fixing screw 223a is not in contact with the outer peripheral surface 222f, the guide member 222b can slide in the opening 222c, and a pair of separating members 221a and 221b move relatively. As shown in FIG. 2B, when the front end of the first fixing screw 223b is in contact with the outer peripheral surface 222f, the pair of spacing members 221a and 221b are held. Even if the outer peripheral surface 222 f is not roughened, the outer peripheral surface 222 f can be held by the first fixing screw 223 a.
  • the first fixing screw 223a ensures holding of the angle of the pair of separating members 221, it is preferable that a fine lattice groove, a fine linear groove or a random fine uneven groove be formed on the outer peripheral surface 222f. .
  • a plus screw or a hexagonal bolt may be used instead of the first fixing screw 223a having a hexagonal hole.
  • FIGS. 3A and 3B are both drawn in a state where the periphery of the base portion 225 is seen through, and the guide member 222b of the opening 222c and the second fixing screw 223b are drawn.
  • FIG. 3A shows a state in which the second fixing screw 223b is not tightened.
  • FIG. 3B shows a state in which the second fixing screw 223b is tightened.
  • a slit 223s extending in the Y-axis direction is formed in the base portion 225a, and the slit 223s penetrates to the opening 222c.
  • the second fixing screw 223b is longer in the X-axis direction than the first fixing screw 223a.
  • the second fixing screw 223b can be turned with a hexagonal wrench (not shown).
  • FIG. 3A when the first fixing screw 223b is not tightened, the distance SX between the slits 223s is wide, and the guide member 222b can slide in the opening 222c, and a pair of separating members 221a and 221b can move relatively.
  • FIG. 3A when the first fixing screw 223b is not tightened, the distance SX between the slits 223s is wide, and the guide member 222b can slide in the opening 222c, and a pair of separating members 221a and 221b can move relatively.
  • FIG. 3A when the first fixing screw 223b is not tightened,
  • the space SX of the slits 223s becomes narrow, and the guide member 222b is held in the opening 222c. Therefore, the pair of separating members 221a and 221b are held.
  • the outer circumferential surface 222 f may or may not be roughened.
  • opener 200 for osteotomy is described with reference to FIGS. 9-11.
  • the operation of inserting the osteotomy opener 200 into the incision K1 of the tibia K, opening the incision K1 and holding the opened state will be described.
  • 9 to 11 are explanatory views when the cut K1 is viewed from the front.
  • An opener 200 for the osteotomy in a closed state is provided.
  • the opener 200 for osteotomy is in a state where the holding device 220 is connected to the blade 210 by the holding device fixing pins 213a and 213b.
  • the medical worker inserts the tip of the osteotomy opener 200 into the notch K1 of the tibia K.
  • the medical worker taps the striking block 215 with a hammer or the like (not shown) to abut the distal end of the osteotomy opener 200, that is, the distal end of the pivoting member 221 of the blade 210 against the back of the tibia K . That is, the tip of the pair of pivoting members 211 is inserted into the cut K1.
  • the medical worker fits the hexagonal wrench driver SD drawn in solid lines into the hexagonal holes provided at the end of the screw shaft 212c. Then, the medical worker rotates the hexagonal wrench driver SD drawn by a solid line in the direction indicated by the arrow CR1 in FIG. Since the screw shaft 212c has a relationship of "positive screw” and "reverse screw", the rotating members 211a and 211b rotate in the directions indicated by arrows D11 and D12 in FIG. 9, respectively. As the pivoting members 211a and 211b relatively open, the holding device 220 also opens interlockedly, and the cut K1 is enlarged. In FIG. 9, the pivoting members 211 a and 211 b are in a state of being opened 12 degrees.
  • the medical worker After opening the incision K1 to an angle sufficient to insert the bone graft material, the medical worker stops the rotation of the hexagonal wrench driver SD drawn by a solid line. The rotation of the screw shaft 212c is stopped, and the rotating members 211a and 211b remain relatively open even if the hexagonal wrench driver SD drawn by a solid line is removed from the hexagonal hole of the screw shaft 212c.
  • the medical worker moves the hexagonal wrench driver SD in the state drawn in solid lines to the hexagonal wrench driver SD drawn in dotted lines, to the hexagonal hole provided at the end of the first fixing screw 223a. Fit a hexagonal wrench driver SD drawn in dotted lines. Then, the medical worker rotates the hexagonal wrench driver SD drawn by a dotted line in the direction indicated by the arrow CR2 in FIG. Then, the tip of the first fixing screw 223a abuts on the outer peripheral surface 222f of the arch-shaped guide member 222b. The first fixing screw 223a and the guide member 222b are held.
  • the healthcare worker releases the connection between the holding device 220 and the blade 210.
  • the medical worker pulls the holding device fixing pins 213a and 213b in the directions indicated by arrows D13 and D14 in FIG. 10, respectively, as shown in FIG.
  • the ball plunger comes out of the recessed hole 213g (see FIG. 8 (b)) of the retainer fixing pin 213a and the recessed hole 213h (see FIG. 8 (b)) of the retainer fixing pin 213b.
  • the connection between the holding device 220 and the blade 210 is released.
  • the medical worker inserts the hexagonal wrench driver SD into the hexagonal hole provided at the end of the screw shaft 212c, and rotates the hexagonal wrench driver SD in the direction indicated by the arrow CR3 in FIG. , 211b relatively rotate in the closing direction, and the pair of pivoting members 211 close.
  • the holding device 220 is released from the connection with the blade 210, and the tip of the first fixing screw 223a is in contact with the outer peripheral surface 222f.
  • the pair of spacing members 221a and 221b are held at a predetermined angle, the cut K1 of the tibia K is maintained in the expanded state.
  • the pair of pivoting members 211 shown in FIG. 10 is in the closed state and has moved in the + Y axis direction.
  • FIG. 11 is a view showing a state in which the blade 210 is pulled out and only the holding device 220 remains in the notch K1 of the tibia K. Since the blade 210 is pulled out, the medical worker can visually recognize the back of the notch K1 of the tibia K, and can insert the bone graft material into the back.
  • the outer surface 221 q of the pair of spacing members 221 a and 221 b is roughened, the tibia K and the spacing members 221 a and 221 b do not slip easily when the bone replacement material is inserted.
  • the medical worker releases the holding of the guide member 222b by the first fixing screw 223a, closes the pair of spacing members 221a and 221b, and withdraws the holding device 220.
  • the medical staff may further insert a bone substitute into the space formed by removing the holding device 220.
  • FIG.12 (a) is a schematic perspective view which shows an example of the opener for osteotomy of 5th Embodiment.
  • Fig. 12 (b) is a schematic perspective view showing the blade of the osteotomy opener shown in (a).
  • (C) is a schematic perspective view which shows the holding
  • FIG. 13 (a) is a schematic top view of the opener for osteotomy shown in FIG. 12 (a).
  • Fig. 13 (b) is a schematic rear view of the opener for osteotomy shown in Fig. 12 (a).
  • Fig. 13 (c) is a schematic side view of the opener for osteotomy shown in Fig. 12 (a).
  • the opener 100 as an opener for osteotomy comprises a pair of blades 110 and a spreader as a holding device. And 120.
  • the holding device may be referred to as a "spreader".
  • the blade 110 can be inserted into the incision formed in the tibia with the spreader 120 mounted or coupled thereto, and the incision can be opened while the spreader 120 is interlocked. Thereafter, after the spreader 120 holds the cut open, the blade 110 is returned to the closed state and pulled out of the cut.
  • the blade 110 has a pair of rotation members 111, one opening / closing mechanism 112, and spreader fixing pins 113a and 113b.
  • the pair of pivoting members 111 is formed in a substantially wedge shape which becomes thicker gradually from the tip end 111 c in the closed state.
  • the pair of pivoting members 111 includes pivoting members 111a and 111b that are relatively pivotably connected by a hinge portion 111d disposed at the tip end 111c.
  • a recess step
  • the spreader 120 is placed in the recess, so that a surface having no step in the short direction is formed on the opening surface of the separating members 121a and 121b and the rotating members 111a and 111b.
  • the pivoting members 111a and 111b are pivoted relative to each other by an opening and closing mechanism 112 provided on the rear end side.
  • One opening and closing mechanism 112 has screw holes 112a and 112b respectively provided on the rear end side of the rotating members 111a and 111b in order to open and close the pair of rotating members 111 about the axis of the hinge portion 111d; And a screw shaft 112c screwed through each screw hole.
  • the screw shaft 112c which is an external thread, is opposite in winding direction at the point where it is screwed with each of the screw holes 112a and 112b, and has a relationship of so-called "positive screw” and "reverse screw”.
  • a hexagonal hole is provided at the end of the screw shaft 112c, and the screw shaft 112c can be rotated by fitting a hexagonal driver or the like.
  • the screw holes 112a and 112b which are internal threads, are a "forward screw hole” and a “reverse screw hole” according to the winding direction of the screw shaft 112c. Further, the screw holes 112a and 112b are provided with an inclination such that the rotation of the screw shaft 112c is not restricted when the blade 110 is opened. For this reason, when the screw shaft 112c is rotated in one opening and closing mechanism 112, the turning members 111a and 111b can be relatively turned to open and close the pair of turning members 111 smoothly.
  • the spreader fixing pin 113a as a connecting member has a shape as shown in FIGS. 14 (a) and 14 (b).
  • the spreader fixing pin 113b also has the same shape.
  • the spreader fixing pins 113a and 113b are provided on the back side of the pivoting members 111a and 111b of the blade 110, respectively.
  • the spreader fixing pins 113a, 113b can couple the spreader 120 to the blade 110 and can release the connection.
  • the first and second examples of the spreader fixing pin 113a shown in FIGS. 14 (a) and 14 (b) include a grip portion 113l, a movement restricting portion 113m, and a lock portion 113n.
  • the gripping portion 1131 is sized to be easily held by a medical worker, and is formed in a shape integrated with the osteotomy opener.
  • the movement restricting portion 113m is formed to restrict the movement range of the spreader fixing pin 113a.
  • the fixing portion 113n is formed to be fixed by a ball plunger 124a described later.
  • the movement restricting portion 113m and the lock portion 113n are formed in a cylindrical shape, but may be a quadrangular prism or any shape in cross section. Further, the movement restricting portion 113m and the lock portion 113n have cylindrical shapes different in diameter but may have the same diameter. The reason why the diameter of the lock portion 113 n is small is to match the size of the spreader 120.
  • the movement restricting portion 113m has a notch 113q.
  • the notch 113q can be in contact with the movement restricting pin 113p described in FIG. That is, it is preferable to limit the moving range of the spreader fixing pin 113a by bringing the movement limiting pin 113p into contact in the + X axis direction and the ⁇ X axis direction of the notch 113q. In particular, if there is no movement restriction in the + X axis direction, the spreader fixing pin 113a may fall off, so that the adverse effect is prevented.
  • the fixing portion 113n also has a positioning hole 113r.
  • the ball plunger 124a is fitted into the positioning hole 113r.
  • the movement restricting portion 113 m has two protrusions 113 tq.
  • the protrusion 113 t can abut on the movement restricting pin 113 p described in FIG. That is, it is preferable to restrict the movement range of the spreader fixing pin 113a by bringing the movement restriction pin 113p into contact in the + X axis direction and the ⁇ X axis direction of the projection 113t.
  • the fixing portion 113n has a notch groove 113s extending around the entire circumference.
  • the ball plunger 124a is fitted into the notch groove 113s. Even if the spreader fixing pin 113a is slightly rotated about the axial direction, the ball plunger 124a fits in because the notch groove 113s is provided on the entire circumference. Although not particularly illustrated, the notch 113q in FIG. 14A and the protrusion 113t in FIG. 14B may be replaced. A specific operation will be described with reference to FIGS. 15A and 15B using the spreader fixing pin 113a of the first example.
  • FIGS. 15 (a) and 15 (b) are diagrams for explaining the operation of connecting the spreader to the blade using the spreader fixing pin, and a part of the upper surface of the rotating member 111a and a part of the upper surface of the spacing member 121a. Shown through. As shown in FIG. 15 (a), when connecting the rotating member 111a and the spreader 120 using the spreader fixing pin 113a, the direction (-X axis direction) indicated by the arrow D1 in FIG. 15 (a) Push in the spreader fixing pin 113a. Then, as shown in FIG.
  • the movement limiting pin 113p abuts on the + X axis side end of the notch 113q, and the ball plunger 124a is in the positioning hole 113r provided at the tip of the spreader fixing pin 113a.
  • the spreader 120 and the pivoting member 111a can be connected.
  • the spreader 120 can be coupled to the pivoting member 111b as in the case of the spreader fixing pin 113a.
  • the connection in order to release the connection between the spreader 120 and the blade 110, the connection can be released by pulling the spreader fixing pins 113a and 113b in the direction opposite to the direction indicated by the arrow D1 in FIG.
  • the movement restricting pin 113p abuts on the end on the ⁇ X axis side of the notch 113q, and the spreader fixing pin 113 does not fall off from the rotating member 111.
  • the spreader is connected to the blade by the spreader fixing pin, but in the fifth embodiment, the spreader may be interlocked with the opening operation of the blade by placing the spreader on the blade. It does not have to be connected to the blade.
  • the spreader 120 can be mounted on the surface of the open side of the pair of pivoting members 111. Thus, the spreader 120 interlocks with the opening and closing operation of the pair of pivoting members 111. In addition, the spreader 120 can hold the open state of the incision formed in the tibia by the holding mechanism 123 described later.
  • the spreader 120 includes a pair of spacing members 121, a sliding mechanism 122, and a holding mechanism 123.
  • the pair of spacer members 121 In the closed state, the pair of spacing members 121 face each other in parallel and are spaced apart, and become in the opened state when interlocked with the opening and closing operation of the pair of pivoting members 111.
  • the pair of spacer members 121 includes spacer members 121 a and 121 b shorter than the pair of pivot members 111 in the longitudinal direction.
  • the sliding mechanism 122 has a guide member base portion 122a, a guide member 122b, and a guide member control portion 122c having an opening into which the guide member 122b is inserted.
  • the guide member base portion 122a is provided on the rear end side of the separating member 121a, and the guide member 122b is fixed.
  • a portion of the guide member 122 b has an arch shape that forms an arc along the axis of the hinge portion 111 d. Further, on the upper surface of the arch-shaped guide member 122b, there is a scale indicating the angle formed by the spacing member 121a and the spacing member 121b.
  • the guide member control unit 122c is provided on the rear end side of the spacing member 121b, similarly to the guide member 122b, and guides the sliding of the arch-shaped guide member 122b.
  • a holding mechanism 123 is provided below the guide member control unit 122c.
  • the holding mechanism 123 has a stopper 123a and a screw 123b as shown in FIG. 16 (a).
  • the stopper 123a is provided inside the guide member control unit 122c, and is screwed with the screw 123b. Since the screw 123b is disposed outside the guide member control unit 122c, the guide member control unit 122c is provided with a screw hole for screwing the screw 123b with the stopper 123a. Further, the shape of the screw hole is long in the vertical direction in FIG. 16A, and the contact portion between the stopper 123a and the guide member control portion 122c is inclined. When the screw 123b is turned in the direction indicated by arrow R1 in FIG.
  • the stopper 123a is indicated by arrow D2 in FIG. 16A when the screw 123b is tightened. Move in the direction. Then, as shown in FIG. 16B, the stopper 123a abuts on the guide member 122b, and the sliding of the guide member 122b is restricted, whereby the pair of spacing members 121 hold the open state of the incision. be able to.
  • FIGS. 17 (a), 18 (a), 19 (a), 20 (a), 21 (a), 22 (a) and 22 (a) correspond to the incision K1. It is an explanatory view when it sees from the front, and Drawing 17 (b), Drawing 18 (b), Drawing 19 (b), Drawing 20 (b), Drawing 21 (b), Drawing 22 (b), and Drawing 22 (B) is explanatory drawing when it sees from the side with respect to the cut K1. Further, the opener 100 before inserting into the cut K1 is in a state where the spreader 120 is connected to the blade 110 by the spreader fixing pins 113a and 113b.
  • the tip of the opener 100 that is, the tip 111c of the pair of pivoting members 111 is inserted into the cut K1, and the arrow D3 in FIG.
  • the opener 100 is inserted in the direction indicated by.
  • the driver d is inserted into the hexagonal hole provided at the end of the screw shaft 112c, and the direction of the driver d shown by the arrow R2 in FIG. ,
  • the rotating members 111a and 111b of the pair of rotating members 111 rotate in the directions indicated by arrows D4 and D5 in FIG. 18, respectively.
  • the spreader 120 is also interlockedly opened, and the cut K1 is enlarged.
  • the spreader fixing pins 113a and 113b are shown by arrows D5 and D5 in FIG. 20 (a) respectively. It is pulled in the direction shown by D6. Then, in the case of the spreader fixing pin 113a, as shown in FIG. 15 (b), if the ball plunger 124a comes out of the positioning hole of the tip portion of the spreader fixing pin 113a and furthermore the spreader fixing pin 113b is similarly performed, the spreader The connection between 120 and the blade 110 is released.
  • the driver d is inserted into the hexagonal hole provided at the end of the screw shaft 112c, and the direction of the driver d shown by the arrow R4 in FIG.
  • the pivoting members 111a and 111b pivot in the directions indicated by arrows D7 and D8 in FIG. 21, respectively, and the pair of pivoting members 111 close.
  • the spreader 120 is released from the connection with the blade 110 and the slide of the guide member 122b is restricted by the stopper 123a, the spreader K1 is maintained in the opened state.
  • the bone graft material can be inserted into the entire depth of the incision K1.
  • FIG. 22 (b) when the incision K1 is enlarged and the bone filling material is inserted, the entire depth of the incision K1 can be visually recognized even when viewed from the front with respect to the incision K1.
  • the sliding restriction of the guide member 122b by the stopper 123a is released, and the spreader 120 is removed.
  • a bone filling material may be further inserted.
  • the metal plate may be installed by screw fixing so as to straddle the cut which has been enlarged.
  • the dilator for osteotomy is a simple mechanism, maintenance such as cleaning can be easily performed. Moreover, in this opener for osteotomy, since the open state of the incision is held by the pair of spacing members, the entire depth of the incision becomes visible and the implant can be easily inserted.
  • the member configuration may be changed as appropriate between the embodiments.
  • the pair of spacing members 221 a and 221 b are not formed thick, but may be thick as the spacing member 321 of the third embodiment.
  • the recess 329 may be formed also in the base 325 b of the second embodiment, and the base 325 a of the second embodiment may be provided with a top member 327 f.
  • the opener for osteotomy of 5th Embodiment can perform maintenances, such as washing
  • the pair of rotating members are closed and the pair of separating members are connected when the pair of rotating members is closed and removed from the cut. Because the member to be inserted is not in the incision, the entire depth of the incision is visible and the implant can be inserted into the entire depth of the incision.
  • the holding device for osteotomy according to the first embodiment described above and the dilator for osteotomy according to the second to fifth embodiments are not limited to the osteotomy according to the following configuration A. Even with a holding device or an opener for osteotomy with configuration B to configuration K, maintenance can be easily performed with a simple mechanism, and an effect that the incision can be opened and the implant can be easily inserted Have.
  • a first separating member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with a bone;
  • a second spacing member having a second inner surface, and a second outer surface provided opposite to the second inner surface and in contact with a bone;
  • the first separating member is a guide member for guiding the opening / closing operation of the first separating member and the second separating member at a position on the rear end side with respect to the distal end side to be inserted into the incision formed in the bone.
  • the second spacing member has a second base portion having an opening into which the guide member is inserted at a position on the rear end side with respect to the tip end side to be inserted into the incision formed in the bone.
  • the first spacing member and the second spacing member are a holding device for osteotomy, which is disposed such that the first inner surface and the second inner surface face each other,
  • the guide member is fitted to the opening, and the first and second separating members can be opened and closed along the shape of the guide member while the distal end side maintains the separated state.
  • Placed in A holder for osteotomy characterized by comprising a holder for holding an open / close state of the first and second separating members in a predetermined state.
  • a first separating member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with a bone;
  • a second spacing member having a second inner surface, and a second outer surface provided opposite to the second inner surface and in contact with a bone;
  • the first separating member is a guide member for guiding the opening / closing operation of the first separating member and the second separating member at a position on the rear end side with respect to the distal end side to be inserted into the incision formed in the bone.
  • the second spacing member has a second base portion having an opening into which the guide member is inserted at a position on the rear end side with respect to the tip end side to be inserted into the incision formed in the bone.
  • the first spacing member and the second spacing member are osteotomy openers disposed such that the first inner surface and the second inner surface face each other,
  • the guide member is fitted to the opening, and the first and second separating members can be opened and closed along the shape of the guide member while the distal end side maintains the separated state.
  • An opening / closing mechanism which is disposed in any one of the first separating member and the second separating member and which adjusts the open / close state of the first separating member and the second separating member;
  • An opener for osteotomy with
  • An opener for osteotomy comprising: a blade for opening a bone incision; and a holding device detachably mounted on the blade and holding the expanded bone incision,
  • the blade is It has a pair of pivoting members which are relatively pivotably connected by a hinge portion disposed at the tip and which has an inner surface and an opposite outer surface
  • the holding device is A first separating member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with a bone;
  • a second spacing member having a second inner surface, and a second outer surface provided opposite to the second inner surface and in contact with a bone;
  • the first separating member is a guide member for guiding the opening / closing operation of the first separating member and the second separating member at a position on the rear end side with respect to the distal end side to be inserted into the incision formed in the bone.
  • the second spacing member has a second base portion having an opening into which the guide member is inserted at a position on the rear end side with respect to the tip end side to be inserted into the incision formed in the bone.
  • the first separating member and the second separating member are disposed such that the first inner surface and the second inner surface face each other,
  • the guide member is fitted to the opening, and the first and second separating members can be opened and closed along the shape of the guide member while the distal end side maintains the separated state.
  • Placed in An opener for osteotomy characterized by comprising a holding portion for holding an open / close state of the first and second separating members in a predetermined state.
  • An opener for osteotomy comprising: a blade for opening a bone incision; and a holding device detachably mounted on the blade and holding the expanded bone incision,
  • the blade is It has a pair of pivoting members which are relatively pivotably connected by a hinge portion disposed at the tip and which has an inner surface and an opposite outer surface, It has an opening and closing mechanism for opening and closing the pair of rotation members around the axis of the hinge portion,
  • the outer surface of the pair of pivoting members includes an inclined outer surface gradually thickened with respect to the inner surface from the front end side to the rear end side, and a parallel outer surface parallel to the inner surface from the front end side to the rear end side.
  • the holding device is A first separating member having a first inner surface and a first outer surface provided opposite to the first inner surface and in contact with a bone;
  • a second spacing member having a second inner surface, and a second outer surface provided opposite to the second inner surface and in contact with a bone;
  • the first inner surface is disposed on the parallel outer surface of one of the pair of pivoting members, and the first outer surface is flush with the inclined outer surface of one of the pair of pivoting members, and
  • the second inner surface is disposed on the other of the parallel outer surfaces of the pair of pivoting members, and the second outer surface is disposed to be flush with the other of the inclined outer surfaces of the one pivoting member.
  • the first separating member is a guide member for guiding the opening / closing operation of the first separating member and the second separating member at a position on the rear end side with respect to the distal end side to be inserted into the incision formed in the bone.
  • the second spacing member has a second base portion having an opening into which the guide member is inserted at a position on the rear end side with respect to the tip end side to be inserted into the incision formed in the bone.
  • the first separating member and the second separating member are disposed such that the first inner surface and the second inner surface face each other,
  • the guide member is fitted to the opening, and the first and second separating members are arranged along the shape of the guide member while the distal end side of the blade is kept separated by the opening and closing mechanism of the blade. It is arranged to allow opening and closing operation,
  • An opener for osteotomy characterized by comprising a holding portion for holding an open / close state of the first and second separating members in a predetermined state.
  • (Configuration G) The bone cutter according to (Configuration F), wherein the pair of spacing members is shorter in the longitudinal direction than the pair of pivoting members and can be stacked and placed on the rear end side of the pair of pivoting members. Opener for surgery.
  • (Configuration H) The configuration according to any one of (Configuration F) to (Configuration G), further including a sliding mechanism in which the holding fixture slides in conjunction with the pair of spacing members while connecting the pair of spacing members.
  • (Configuration I) The opener for osteotomy described in (Configuration H), wherein the sliding mechanism has a scale indicating an angle formed by the pair of separating members.
  • (Configuration J) The opener for osteotomy according to any one of (Configuration F) to (Configuration I), wherein the blade further comprises a connecting member connecting the pair of spacing members to the pair of pivoting members. It is.
  • (Configuration K) The osteotomy according to any one of (Configuration F) to (Configuration J), wherein the pair of pivoting members are formed in a substantially wedge shape which gradually increases in thickness from the tip in a closed state. It is a large scale device.
  • Spacing members 123, 223 ... Holding mechanisms (123a: stopper, 123b: screw, 223a: first fixing screw 223b: second fixing screw) 122, 222 ... Sliding mechanism (122a, 222a ... guide member base portion, 122b, 222b ... guide member, 122c ... guide member control portion, 222c ... opening portion) 325 (325a, 325b) ... base 372 ... opening and closing mechanism (327a ... screw hole, 372c ... screw shaft, 327d ... through hole, 327f ... top member)

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Abstract

Le problème décrit par la présente invention est de fournir un outil de maintien pour ostéotomie avec lequel toute la profondeur d'une découpe devient visible. La solution selon l'invention porte sur un outil de maintien (220) qui est pourvu : d'un premier élément de séparation (221b) pourvu d'une première surface interne (221p), et d'une première surface externe (221q) qui est formée en une forme de coin qui devient progressivement plus épaisse du côté d'extrémité de pointe au côté d'extrémité arrière par rapport à la première surface interne, et qui vient en contact avec un os; et d'un second élément de séparation (221a) pourvu d'une seconde surface interne (221p), et d'une seconde surface externe (221q) qui est formée en une forme de coin qui devient progressivement plus épaisse du côté d'extrémité de pointe au côté d'extrémité arrière par rapport à la seconde surface interne, et qui vient en contact avec un os. En outre, l'outil de maintien est pourvu : d'une première partie base (225b) qui est disposée sur le côté d'extrémité arrière du premier élément de séparation, et qui est pourvue d'un élément de guidage (222b) pour guider des opérations d'ouverture et de fermeture du premier élément de séparation et du second élément de séparation; d'une seconde partie base (225a) qui est disposée sur le côté d'extrémité arrière du second élément de séparation, et qui est pourvue d'une ouverture (222c) à travers laquelle l'élément de guidage est inséré; et d'une partie de maintien (223) pour maintenir le coulissement entre l'élément de guidage et l'ouverture.
PCT/JP2018/042740 2017-11-27 2018-11-20 Outil de maintien pour ostéotomie, et écarteur pour ostéotomie WO2019102974A1 (fr)

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JP7174463B1 (ja) 2022-03-23 2022-11-17 Ａｕｓｐｉｃｉｏｕｓ株式会社 骨切り術用開大装置

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US20080195099A1 (en) * 2007-02-13 2008-08-14 The Brigham And Women's Hospital, Inc. Osteotomy system
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WO2014147099A1 (fr) * 2013-03-18 2014-09-25 Claes Antoon Dispositif chirurgical pour orientation correcte pendant une ostéotomie
JP2016209435A (ja) * 2015-05-13 2016-12-15 ＨＯＹＡ Ｔｅｃｈｎｏｓｕｒｇｉｃａｌ株式会社 開骨器具および開骨器具セット
JP2017046783A (ja) * 2015-08-31 2017-03-09 ＨＯＹＡ Ｔｅｃｈｎｏｓｕｒｇｉｃａｌ株式会社 開骨器具

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP7174463B1 (ja) 2022-03-23 2022-11-17 Ａｕｓｐｉｃｉｏｕｓ株式会社 骨切り術用開大装置
JP7333670B1 (ja) 2022-03-23 2023-08-25 Ａｕｓｐｉｃｉｏｕｓ株式会社 骨切り術用開大装置
JP2023143580A (ja) * 2022-03-23 2023-10-06 Ａｕｓｐｉｃｉｏｕｓ株式会社 骨切り術用開大装置

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