WO2021152854A1 - Marking device, marking method, and bone hole forming method - Google Patents

Marking device, marking method, and bone hole forming method Download PDF

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Publication number
WO2021152854A1
WO2021152854A1 PCT/JP2020/003805 JP2020003805W WO2021152854A1 WO 2021152854 A1 WO2021152854 A1 WO 2021152854A1 JP 2020003805 W JP2020003805 W JP 2020003805W WO 2021152854 A1 WO2021152854 A1 WO 2021152854A1
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WO
WIPO (PCT)
Prior art keywords
marking
tip
target position
arthroscope
marking device
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Application number
PCT/JP2020/003805
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French (fr)
Japanese (ja)
Inventor
藤崎　健
Original Assignee
オリンパス株式会社
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Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to JP2021574425A priority Critical patent/JPWO2021152854A5/en
Priority to PCT/JP2020/003805 priority patent/WO2021152854A1/en
Publication of WO2021152854A1 publication Critical patent/WO2021152854A1/en

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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
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions

Definitions

  • the present invention relates to a marking device, a marking method, and a bone hole forming method.
  • anterior cruciate ligament reconstruction which is a technique for reconstructing the ligament of the knee, it is desirable to form the bone hole formed to fix the collected tendon at the target position and shape.
  • Patent Document 1 discloses a drill guide that guides a drill for connecting a plurality of bone holes to form an oval bone hole.
  • the drill guide has a body in which a drill insertion hole is formed and a plurality of protrusions to be inserted into a plurality of bone holes.
  • the plurality of protrusions project forward from the main body in parallel with the center line direction of the drill insertion hole.
  • the bone hole for fixing the tendon used as an alternative to the anterior cruciate ligament to the bone can be stably fixed by forming a rectangular shape having the same shape as the tendon fixture at the target position. ..
  • a circular bone hole is formed by using a drill, a bone hole having a size and shape different from that of the tendon fixture is formed, which is stable. It was difficult to fix the tendon.
  • an ultrasonic treatment tool having a rectangular cutting surface to form a bone hole having the same size and shape as the tendon fixing tool, it is possible to stabilize the fixation of the tendon. ..
  • the cutting surface of the ultrasonic treatment tool is rectangular, if the position where the bone hole is formed is the slope of the bone with respect to the direction of insertion of the ultrasonic treatment tool into the body, the slope of the bone Since the cutting surface of the ultrasonic treatment tool is cut in an inclined posture, it becomes difficult to position the bone hole, and the size and direction of the bone hole are deviated.
  • the cutting surface of the ultrasonic treatment tool can be applied to the target position on the slope of the bone in a posture in which the size and direction of the hole do not deviate. It is desirable to mark the target position.
  • the present invention has been made in view of the above problems, and an object of the present invention is to provide a marking device, a marking method, and a bone hole forming method capable of marking a target position when forming a bone hole. It is to be.
  • the marking device includes a first marking portion having a first tip portion, a second marking portion having a second tip portion, and the like.
  • the first marking portion has a shaft portion extending from the base end side of the first marking portion and the second marking portion, and a handle portion connected to the base end side of the shaft portion.
  • the tip position of the second tip is different from that of the second tip in the direction along the axis.
  • the angle formed by the virtual straight line passing through the first tip portion and the second tip portion and the axis line is 40 degrees or more and 55 degrees or less. be.
  • the distance between the first tip portion and the second tip portion in the direction orthogonal to the direction along the axis is set in the treatment target portion. It is shorter than the longitudinal length of the preset rectangular cutting area.
  • the first tip portion has a first linear portion extending in a first orthogonal direction orthogonal to a direction along the axis, and a first linear portion extending along the axis. It has a second linear portion extending in a second orthogonal direction orthogonal to the first orthogonal direction, and the second tip portion is in the first orthogonal direction. It has an extending third linear portion and a fourth linear portion extending in the second orthogonal direction.
  • the first marking portion and the second marking portion have a marking depth capable of identifying the depth when marking the treatment target portion. Has an identification unit.
  • the marking device is inserted to the position of the bone to be marked while observing in the field of view of the arthroscope, and the first marking target position is in the field of view of the arthroscope.
  • the first marking portion of the marking device is brought into contact with the arthroscope, and the first marking portion is brought into contact with the first marking portion in the field of view of the arthroscope.
  • the marking device is driven into the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are brought into contact with each other. As a result, a first recess and a second recess are formed.
  • the position is confirmed by observing the first recess and the second recess formed in the above invention with the arthroscope.
  • the marking device is inserted to the position of the bone to be marked while observing in the field of view of the arthroscope, and the first marking is made in the field of view of the arthroscope.
  • the first marking portion of the marking device is brought into contact with the target position, and the first marking portion is brought into contact with the target position in the field of view of the arthroscope, and the second marking portion is brought into contact with the second marking target position.
  • the marking device is in contact with the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are in contact with each other.
  • a first recess and a second recess are formed by driving in, and one of the first recess and the second recess formed while observing in the field of view of the arthroscope.
  • the cutting treatment tool is inserted at the position of, and the bone hole is formed by cutting with the cutting treatment tool, and the first dent and the second dent formed while observing in the field of view of the arthroscope.
  • the cutting treatment tool is inserted into the position of the other recess, and the cutting treatment tool is used for cutting to form a bone hole.
  • the bone between the bone hole formed at the position of the one recess and the bone hole formed at the position of the other recess is formed.
  • a bone hole is formed by cutting with the cutting treatment tool.
  • the marking device, marking method, and bone hole forming method according to the present invention have the effect of being able to mark a target position when forming a bone hole.
  • FIG. 1 is a diagram showing a marking device according to the first embodiment.
  • FIG. 2 is an enlarged view of the tip end side of the marking device according to the first embodiment.
  • FIG. 3 is a diagram showing an example of the marking depth identification function.
  • FIG. 4 is a diagram showing an ultrasonic treatment tool system according to the first embodiment.
  • FIG. 5A is a side view showing the tip end side of the ultrasonic probe.
  • FIG. 5B is a front view showing the tip treatment portion of the ultrasonic probe.
  • FIG. 6 is a block diagram showing the configuration of the treatment system according to the first embodiment.
  • FIG. 7 is a perspective view of the femur showing the anterior cruciate ligament attachment portion and the cutting region.
  • FIG. 8 is a side view of the femur showing the anterior cruciate ligament attachment portion and the cutting region.
  • FIG. 9 is a diagram showing a state in which the first tip portion and the second tip portion of the marking device are in contact with the first marking target position and the second marking target position.
  • FIG. 10 is a perspective view of the femur showing a state in which the first tip portion and the second tip portion of the marking device are in contact with the first marking target position and the second marking target position.
  • FIG. 11 is a perspective view of the femur in which the first recess and the second recess are formed at the anterior cruciate ligament attachment portion.
  • FIG. 12 is a side view of the femur in which the first recess and the second recess are formed at the anterior cruciate ligament attachment portion.
  • FIG. 13 is a perspective view of the femur showing a state in which the long side of the tip treated portion of the ultrasonic probe is aligned with the second recess.
  • FIG. 14 is a perspective view of the femur showing a state in which a first bone hole is formed in the anterior cruciate ligament attachment portion.
  • FIG. 15 is a perspective view of the femur showing a state in which the long side of the tip-treated portion of the ultrasonic probe is aligned with the first recess.
  • FIG. 16 is a perspective view of the femur showing a state in which a second bone hole is formed in the anterior cruciate ligament attachment portion.
  • FIG. 17 is a perspective view of the femur showing a state in which the tip treatment portion of the ultrasonic probe is brought into contact with the partition wall portion.
  • FIG. 18 is a perspective view of the femur in which a rectangular bone hole is formed.
  • FIG. 19 is a side view of the femur in which a rectangular bone hole is formed.
  • FIG. 20 is a diagram showing the tip end side of another example of the marking device according to the first embodiment.
  • FIG. 21 is a diagram showing the tip end side of the marking device according to the second embodiment.
  • FIG. 22 is a diagram showing the tip end side of the marking device according to the third embodiment.
  • FIG. 23 is a diagram showing a square bracket-shaped recess marked by the marking device according to the third embodiment.
  • FIG. 24 is a diagram showing the tip end side of another example of the marking device according to the third embodiment.
  • FIG. 25 is a diagram showing an L-shaped recess marked by the marking device shown in FIG. 24.
  • FIG. 26 is a diagram showing an example of a marking method using the marking device according to the fourth embodiment.
  • FIG. 27 is a diagram showing an example of a marking method using the marking device according to the fourth embodiment.
  • FIG. 28 is a diagram showing an example of a marking method using the marking device according to the fifth embodiment.
  • FIG. 29 is a diagram showing an example of a marking method using the marking device according to the fifth embodiment.
  • FIG. 30 is a diagram showing an example of a marking method using the marking device according to the sixth embodiment.
  • FIG. 31 is a diagram showing an example of a marking method using the marking device according to the sixth embodiment.
  • FIG. 1 is a diagram showing a marking device 1 according to the first embodiment.
  • FIG. 2 is an enlarged view of the tip end side of the marking device 1 according to the first embodiment.
  • the marking device 1 has a marking portion 11, a shaft portion 12, and a handle portion 13.
  • the marking portion 11 has a first marking portion 11A and a second marking portion 11B.
  • the first marking portion 11A has a linear first tip portion 111A.
  • the first tip portion 111A forms a side connecting the inner side surface 112A and the outer side surface 113A of the first marking portion 11A to each other.
  • the second marking portion 11B has a linear second tip portion 111B.
  • the second tip portion 111B forms a side connecting the inner side surface 112B and the outer side surface 113B of the second marking portion 11B to each other.
  • the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B differ in tip position by a distance h in the direction along the axis C.
  • the second tip 111B is located closer to the tip than the tip 111A of 1.
  • the angle ⁇ formed by the axis C of 1 is preferably 40 degrees or more and 55 degrees or less.
  • the first tip portion 111A of the first marking portion 11A which is on the short side in the direction along the axis C, marks the first marking target position P1 (see FIG. 6) described later. ..
  • the second tip portion 111B of the second marking portion 11B which is on the long side in the direction along the axis C, marks the second marking target position P2 (see FIG. 6) described later.
  • the distance L between the first tip portion 111A and the second tip portion 111B in the direction orthogonal to the direction along the axis C is the femoral lateral condyle 100 (see FIG. 7), which is a treatment target site to be described later. Shorter than the longitudinal length of the preset rectangular cutting area 150 in. In the first embodiment, the distance L between the first tip portion 111A and the second tip portion 111B is set to 6 [mm], but the description is not limited to this.
  • the shaft portion 12 is connected to the base end side of the first marking portion 11A and the second marking portion 11B, and is connected to the base end side from the first marking portion 11A and the second marking portion 11B along the axis C. It has a rod shape that is stretched to.
  • the handle portion 13 is connected to the base end side of the shaft portion 12 and has a hammer head 131 that is hit by a hammer 4 (see FIG. 9) described later.
  • the hammer head 131 forms an end surface on the proximal end side along the axis C of the marking device 1.
  • the marking device 1 by hitting the hammer head 131 with the hammer 4, the pressing force is applied to the first marking portion 11A and the second marking portion 11B from the handle portion 53 through the shaft portion 12. Is transmitted.
  • the marking device 1 may be provided with a marking depth identification function for identifying the marking depth by the first marking portion 11A and the second marking portion 11B.
  • a marking depth identification function for example, as shown in FIG. 3, linear scales 14A and 14B indicating the marking depth are provided on the side surfaces of the first marking portion 11A and the second marking portion 11B. You may.
  • the marking depth identification function is not limited to the linear scales 14A and 14B, and the marking depth may be identified by the outer diameter shape of the first marking portion 11A and the second marking portion 11B. ..
  • FIG. 4 is a diagram showing the ultrasonic treatment tool system 5 according to the first embodiment.
  • the ultrasonic treatment tool system 5 is mainly composed of an ultrasonic treatment tool 6, a control device 7, and a foot switch 8 for instructing on / off of ultrasonic vibration.
  • the ultrasonic treatment tool 6 and the control device 7 are connected by a cable 68, and drive power is supplied and control signals are communicated.
  • the front surface 71 of the control device 7 is provided with a plurality of connectors 72 for connecting to the cable 68, various operation switches 73, and a display screen 74 for displaying information necessary for treatment.
  • the operation switch 73 functions as, for example, a switching instruction unit that gives an instruction to switch the drive mode of the ultrasonic treatment tool 6.
  • the ultrasonic treatment tool 6 is composed of a device body 61 and an ultrasonic probe 64.
  • the device main body 61 has a tubular shape with a grippable diameter, and has a housing 61a in which an ultrasonic probe 64 penetrates and is arranged, and an ultrasonic vibrator unit 61b which is an ultrasonic generator unit that can be attached to and detached from the housing 61a. It is composed of.
  • the ultrasonic vibrator unit 61b houses an ultrasonic generation unit 62 made of an ultrasonic vibration element such as a piezoelectric body and a horn 63 that efficiently transmits ultrasonic waves.
  • the base end side of the ultrasonic probe 64 and the tip end side of the horn 63 are acoustically connected, and the ultrasonic waves generated by the ultrasonic wave generating unit 62.
  • the vibration is transmitted to the tip treatment portion 65, which will be described later, of the ultrasonic probe 64.
  • an operation switch 67 for instructing the on / off of ultrasonic vibration by the operator's finger operation is provided on the upper surface of the housing 61a.
  • the foot switch 8 has a function of instructing the on / off of ultrasonic vibration by the operator's foot operation.
  • the ultrasonic probe 64 is an elongated rod-shaped shaft member (probe body) that transmits ultrasonic vibrations, and is made of a metal material such as a titanium alloy.
  • the base end portion of the ultrasonic probe 64 is a vibration input unit to which vibration energy (ultrasonic vibration) supplied from the ultrasonic wave generating unit 62 is input.
  • a tip treatment portion 65 for cutting and treating a bone which is a treatment target, is formed by vibrating with a predetermined amplitude.
  • the base end portion of the ultrasonic probe 64 and the tip treatment portion 65 are connected by a probe main body which is a transmission portion that transmits vibration energy (ultrasonic vibration) input to the base end portion to the tip treatment portion 65. ..
  • the ultrasonic probe 64 is covered with a sheath 66 from the housing 61a to an arbitrary length.
  • the sheath 66 is not in close contact with the ultrasonic probe 64, and a slight gap is provided between the sheath 66 and the ultrasonic probe 64 so as not to attenuate the ultrasonic vibration.
  • the sheath 66 is fixed at the node position of ultrasonic vibration on the tip end side of the housing 61a.
  • the tip portion of the tip treatment portion 65 has a staircase that is convex toward the tip side by the first striking surface 65a, the second striking surface 65b, and the third striking surface 65c.
  • a step is formed.
  • the outer shell of the tip treatment portion 65 in the direction orthogonal to the axial direction is a rectangle having a long side length a and a short side length b.
  • the length a of the long side is 5 [mm] and the length b of the short side is 4 [mm], but the description is not limited to this.
  • FIG. 6 is a block diagram showing the configuration of the treatment system 10 according to the first embodiment.
  • the treatment system 10 according to the first embodiment performs a treatment of opening a rectangular bone hole 110 (see FIG. 18) in the femoral lateral condyle 100, which is a treatment target site, and is the ultrasonic treatment tool system 5.
  • the ultrasonic treatment tool system 5 includes an ultrasonic treatment tool 6 having an ultrasonic generation unit 62, an ultrasonic probe 64, and the like, a control device 7, and an operation switch 67.
  • the endoscope system 9 controls an arthroscope 91 made of a rigid endoscope, which is a kind of endoscope, a light source 92 that irradiates visible light as a light source of illumination light, and the entire endoscope system 9.
  • Control unit 93 input unit 94 such as a keyboard or touch panel, display unit 95 that displays treatment information including the photographed treatment status, and water supply, drainage, or drainage of physiological saline to the periphery including the femoral external condyle 100. It is composed of a water supply / drainage unit 96 for perfusing.
  • the water supply / drainage unit 96 sends and drains physiological saline to the periphery including the femoral lateral condyle 100 through the arthroscope 91, but perfusion containing physiological saline or the like from the ultrasonic treatment tool 6
  • the liquid may be supplied and drained.
  • a rectangular bone hole 110 is formed in the anterior cruciate ligament attachment portion 140 to which the anterior cruciate ligament is attached to the femoral lateral condyle 100, which is the treatment target site, shown in FIGS. 7 and 8.
  • the anterior cruciate ligament attachment portion 140 is located on the slope of the lateral femoral condyle 100.
  • the rectangular cutting region 150 shown by the broken line in FIGS. 7 and 8 indicates the position where the bone hole 110 is formed in the anterior cruciate ligament attachment portion 140.
  • the length D of the short sides 150a and 150b of the cutting region 150 and the length W of the long sides 150c and 150d are the same as the length of the short side and the length of the long side of the bone hole 110.
  • the length D of the short sides 150a and 150b of the cutting region 150 is 5 [mm]
  • the length W of the long sides 150c and 150d of the cutting region 150 is 10 [mm]. Do, but are not limited to this.
  • the cutting region 150 is not shown in the actual anterior cruciate ligament attachment portion 140. Therefore, in the first embodiment, the anterior cruciate ligament attachment portion 140 is used to mark the target position when the bone hole 110 is formed by using the ultrasonic treatment tool 2 so that the bone hole 110 can be formed in the cutting region 150. The surface is marked by the marking device 1.
  • FIG. 9 is a side view showing an example of the marking procedure under the arthroscope 91 using the marking device 1. It is a side view of the femoral lateral condyle 100.
  • FIG. 10 is a perspective view showing an example of the marking procedure under the arthroscope 91 using the marking device 1. The figures shown in FIGS. 10 to 19 show images in a range that can be visually recognized as a field of view of the arthroscope 91.
  • the operator inserts the marking portion 11 and the shaft portion 12 of the marking device 1 from the portal 121 opened in the skin 120.
  • the operator observes the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91, and the marking device until the marking portion 11 reaches the anterior cruciate ligament attachment portion 140.
  • Insert 1 in the field of view of the arthroscope 91, the operator makes the first marking portion 11A at the first marking target position P1 (the position corresponding to the short side 150a of the cutting region 150 in FIG. 10). The tip portion 111A of the above is brought into contact with the surface.
  • the operator makes the second marking target position P2 (short side in the cutting region 150 in FIG.
  • the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B are oriented in the direction along the axis C.
  • the tip position is different. Therefore, in the marking device 1 according to the first embodiment, the first tip portion 111A and the second tip portion 111B can be easily brought into contact with the slope of the bone, and the bone hole can be easily contacted by using the ultrasonic treatment tool 2.
  • Marks (first recess 161 and second recess 162) of the target position when forming the 110 can be marked on the anterior cruciate ligament attachment portion 140.
  • the width W 1 obtained by subtracting the distance L between the first recess 161 and the second recess 162 from the lateral length W of the cutting region 150 shown in FIG. 11 is super It is the same as the length b of the short side of the tip treatment portion 65 of the ultrasonic probe 64.
  • the bone hole forming the bone hole by the ultrasonic treatment tool 6 under the arthroscope 91 The forming method will be described.
  • the operator confirms the position of the second dent 162 formed in the anterior cruciate ligament attachment portion 140 by the arthroscope 91.
  • the operator inserts the ultrasonic probe 64 of the ultrasonic treatment tool 6 from the portal opened in the skin.
  • the operator observes the tip treatment portion 65 of the ultrasonic probe 64 on the side of the first recess 161 with respect to the second recess 162, as shown in FIG.
  • One long side of the tip treatment portion 65 is aligned with the position of the second recess 162 so as to be located on the opposite side to the above.
  • FIG. 1 A square tubular first bone hole 101 as shown in the above is formed.
  • the operator confirms the position of the first dent 161 formed in the anterior cruciate ligament attachment portion 140 by the arthroscope 91.
  • the operator observes in the field of view of the arthroscope 91, and as shown in FIG. 15, the tip treatment portion 65 of the ultrasonic probe 64 has a first bone hole 101 with respect to the first recess 161. Align one long side of the tip treatment portion 65 with the position of the first recess 161 so that it is located on the side.
  • the operator vibrates the ultrasonic probe 64 ultrasonically while observing in the field of view of the arthroscope 91, and cuts the bone in the vibration direction (axial direction) of the ultrasonic probe 64.
  • FIG. A square tubular second bone hole 102 is formed as shown in the above.
  • the surgeon confirms the position of the bone partition 103 existing between the first bone hole 101 and the second bone hole 102 by the arthroscope 91, which is shown in FIG.
  • the operator brings the tip treatment portion 65 of the ultrasonic probe 64 into contact with the partition wall portion 103 while observing in the field of view of the arthroscope 91.
  • the surgeon vibrates the ultrasonic probe 64 ultrasonically while observing in the field of view of the arthroscope 91, and cuts the partition wall portion 103 in the vibration direction (axial direction) of the ultrasonic probe 64.
  • the first bone hole 101 and the second bone hole 102 are communicated with each other to form a rectangular bone hole 110 as shown in FIG.
  • the rectangular bone hole 110 having a short side length of D and a long side length of W, as shown in FIG. 19, is formed in the anterior cruciate ligament attachment portion 140. It can be easily formed at the target position.
  • the second recess 162 was first cut by aligning the tip treatment portion 65 of the ultrasonic probe 64, but the first one was first cut.
  • the tip treatment portion 65 of the ultrasonic probe 64 may be aligned with the recess 161 of the ultrasonic probe 64 to perform cutting.
  • the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B May be connected by a curved surface 115 to form the marking portion 11.
  • the marking portion 211 of the marking device 201 is connected to the tip end side of the shaft portion 212, and has a linear first tip portion 2111A forming a pair of short sides and It has a second tip portion 2111B, and a rectangular opening 2112 surrounded by a pair of linear third tip portions 2111C and a fourth tip portion 2111D forming a long side.
  • the marking portion 211 includes a first marking portion having a first tip portion 2111A, a second marking portion having a second tip portion 2111B, and a third tip portion 2111C. It also serves as a third marking portion having the above and a fourth marking portion having the fourth tip portion 2111D.
  • the portion where the first tip portion 2111A and the second tip portion 2111B bite into the living tissue is made small so as to concentrate the stress. There is.
  • the first tip portion 2111A and the second tip portion 2111B forming a pair of short sides have different tip positions in the direction along the axis C, and the second tip portion 2111B is the first tip portion 2111A. It is located on the tip side in the direction along the axis C. Further, the third tip portion 2111C and the fourth tip portion 2111D forming a pair of long sides are inclined in an upward gradient from the first tip portion 2111A to the second tip portion 2111B.
  • the first marking target is formed by the first tip 2111A, the second tip 2111B, the third tip 2111C, and the fourth tip 2111D of the marking portion 211.
  • a rectangular recess can be formed that includes the position P1 and the second marking target position P2.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set in front of the slope of the femoral lateral condyle 100.
  • the cruciate ligament attachment portion 140 can be marked.
  • the marking portion 311 of the marking device 301 is connected to the tip end side of the shaft portion 312, and the first marking portion 311A and the second marking portion 11B are connected to each other.
  • Each is configured in a square bracket shape when viewed from the tip side of the axis C.
  • the first marking portion 311A has a first side wall 3111A, a second side wall 3112A, and a third side wall 3113A erected from the tip surface 3110 of the marking portion 311 along the axis C. ..
  • the first side wall 3111A extends along the lateral direction (the first orthogonal direction orthogonal to the direction along the axis C) on the tip surface 3110 of the marking portion 311.
  • the second side wall 3112A and the third side wall 3113A are along the longitudinal direction (the direction along the axis C and the second orthogonal direction orthogonal to the first orthogonal direction) on the tip surface 3110 of the marking portion 311. It is postponed.
  • the second side wall 3112A is connected to one end of the first side wall 3111A in the lateral direction.
  • the third side wall 3113A is connected to the other end of the first side wall 3111A in the lateral direction.
  • a linear tip 3114A is provided at the tip of the first side wall 3111A.
  • a linear tip 3115A is provided at the tip of the second side wall 3112A.
  • a linear tip portion 3116A is provided at the tip of the third side wall 3113A.
  • the linear tip portion 3114A provided at the tip of the first side wall 3111A is the first linear portion in the present invention.
  • the linear tip portion 3115A provided at the tip of the second side wall 3112A and the linear tip portion 3116A provided at the tip of the third side wall 3113A are the second linear portion in the present invention. Is.
  • the first tip portion is composed of the tip portions 3114A, 3115A, and 3116A.
  • the length of the tip portion 3114A is substantially the same as the length of the short side of the tip surface 3110 of the marking portion 311.
  • the lengths of the tip portions 3115A and 3116A are shorter than the length of the tip portion 3114A and shorter than half the length of the long side of the tip surface 3110 of the marking portion 311.
  • the second marking portion 311B has a first side wall 3111B, a second side wall 3112B, and a third side wall 3113B which are erected from the tip surface 3110 of the marking portion 311 along the axis C. ..
  • the first side wall 3111B extends along the lateral direction (first orthogonal direction) of the tip surface 3110 of the marking portion 311.
  • the second side wall 3112B and the third side wall 3113C extend along the longitudinal direction (second orthogonal direction) of the tip surface 3110 of the marking portion 311.
  • the second side wall 3112B is connected to one end of the first side wall 3111B in the lateral direction.
  • the third side wall 3113B is connected to the other end of the first side wall 3111B in the lateral direction.
  • a linear tip 3114B is provided at the tip of the first side wall 3111B.
  • a linear tip 3115B is provided at the tip of the second side wall 3112B.
  • a linear tip portion 3116B is provided at the tip of the third side wall 3113B.
  • the linear tip portion 3114B provided at the tip of the first side wall 3111B is the third linear portion in the present invention.
  • the linear tip portion 3115B provided at the tip of the second side wall 3112B and the linear tip portion 3116B provided at the tip of the third side wall 3113B are the fourth linear portion in the present invention. Is. Then, in the second marking portion 311B, the tip portion 3114B, 3115B, 3116B constitutes the second tip portion.
  • the length of the tip portion 3114B is substantially the same as the length of the short side on the tip surface 3110 of the marking portion 311.
  • the lengths of the tip portion 3115B and the tip portion 3116B are shorter than the length of the tip portion 3114B and shorter than half the length of the long side on the tip surface 3110 of the marking portion 311.
  • the first tip portion of the first marking portion 311A and the second tip portion of the second marking portion 311B are different in tip position in the direction along the axis C, and the first tip position is different.
  • the second tip is located closer to the tip than the tip.
  • the first marking portion 311A and the second marking portion 311B are used to form a bone hole 110 with respect to the slope of the femoral lateral condyle 100 at a target position.
  • Marking can be performed by forming the square bracket-shaped first recess 163 and the square bracket-shaped second recess 164 shown in FIG. 23.
  • the marking device 301 has a marking depth identification function for identifying the marking depth by the first marking unit 311A and the second marking unit 311B.
  • Scales 15A and 15B indicating the depth of marking may be provided on the side surfaces of the first marking portion 311A and the second marking portion 311B.
  • the first side wall 3111A of the first marking portion 311A and the first side wall 3111B of the second marking portion 311B shown in FIG. 23 are formed in FIG. 24.
  • the cutout portion 3117A and the cutout portion 3117B shown in the above may be provided, respectively.
  • the tip portion 3114A of the first marking portion 311A shown in FIG. 23 is divided into two tip portions 3114Aa and 3114Ab with the notch portion 3117A as a boundary.
  • the tip portion 3114Aa and the tip portion 3115A form an L-shape
  • the tip portion 3114Ab and the tip portion 3116A form an L-shape when viewed from the tip side of the axis C.
  • the tip portion 3114B of the second marking portion 311B shown in FIG. 23 is divided into two tip portions 3114Ba and 3114Bb with the notch portion 3117B as a boundary.
  • the tip portion 3114Ba and the tip portion 3115B form an L-shape
  • the tip portion 3114Bb and the tip portion 3116B form an L-shape when viewed from the tip side of the axis C.
  • the first marking portion 311A and the second marking portion 311B are positioned at a target position for forming the bone hole 110 with respect to the slope of the femoral lateral condyle 100.
  • Marking can be performed by forming a pair of L-shaped recesses 165a and 165b and a pair of L-shaped recesses 166a and 166b shown in 25.
  • the first marking portion 411A, the second marking portion 411B, the first shaft portion 412A, the second shaft portion 412B, and the handle It has a part 413.
  • the first marking portion 411A and the second marking portion 411B each have a long cubic shape in a direction orthogonal to the axis C.
  • the short side 4111A located on the outside marks the first marking target position P1
  • the first tip of the present invention is a department.
  • the short side 4112B located inside marks the second marking target position P2
  • the second tip of the present invention is a department.
  • the first shaft portion 412A is connected to the base end side of the first marking portion 411A, and has a rod shape extending from the first marking portion 411A to the base end side along the axis C.
  • the second shaft portion 412B is connected to the base end side of the second marking portion 411B, and has a rod shape extending from the second marking portion 411B to the base end side along the axis C.
  • the handle portion 413 has a hammer head 4131 that is hit by the hammer 4.
  • the hammer head 4131 forms an end surface on the proximal end side along the axis C of the marking device 401.
  • the handle portion 413 is connected to the base end side of the first shaft portion 412A and the base end side of the second shaft portion 412B, and the first shaft portion 412A and the second shaft portion 412B are connected to each other. At least one is held movable in the direction along the axis C.
  • the first shaft portion 412A is fixed to the handle portion 413
  • the second shaft portion 412B is held by the handle portion 413 so as to be movable along the axis C with respect to the handle portion 413.
  • the second shaft portion 412B is fixed to the handle portion 413 by a fixing member such as a screw when it is not moved to the handle portion 413, and is fixed to the handle portion 413 when it is moved to the handle portion 413. Is released. Further, the first shaft portion 412A and the second shaft portion 412B may be bundled by magnetic force, for example, by providing magnets to each other.
  • the surgeon first marks the marking device 401 from the portal 121 opened in the skin 120, the first marking portion 411A, the second marking portion 411B, the first shaft portion 412A, and the second. Insert the shaft portion 412B.
  • the operator reaches the anterior cruciate ligament attachment portion 140 with the first marking portion 411A while observing the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 within the field of view of the arthroscope 91. Insert the marking device 401 up to.
  • the operator brings the short side 4111A of the first marking portion 411A into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG. 27.
  • the operator puts the second shaft portion 412B on the handle portion 413 on the axis C in a state where the short side 4111A of the first marking portion 411A is in contact with the first marking target position P1. It is moved to the tip side, and the short side 4112B of the second marking portion 411B is brought into contact with the second marking target position P2.
  • the short side 4111A of the first marking portion 411A and the short side 4112B of the second marking portion 411B are tipped in the direction along the axis C.
  • the short side 4112B is positioned closer to the tip side than the short side 4111A by changing the position.
  • the operator hits the hammer head 4131 of the handle portion 413 with the hammer 4 in a state where the short side 4111A and the short side 4112B are in contact with the first marking target position P1 and the second marking target position P2.
  • the short side 4111A and the short side 4112B are driven into the first marking target position P1 and the second marking target position P2.
  • linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100.
  • a certain anterior cruciate ligament attachment portion 140 can be marked.
  • the first marking portion 511A, the second marking portion 511B, the first shaft portion 521A, the second shaft portion 521B, and the handle It has a part 513.
  • the first marking portion 511A has a linear first tip portion 5111A that comes into contact with the first marking target position P1.
  • the first tip portion 5111A forms a side connecting the inner side surface 5112A and the outer side surface 5113A of the first marking portion 511A to each other.
  • the second marking portion 511B has a linear second tip portion 5111B that comes into contact with the second marking target position P2.
  • the second tip portion 5111B forms a side connecting the inner side surface 5112B and the outer side surface 5113B of the second marking portion 511B to each other.
  • the first shaft portion 512A is connected to the base end side of the first marking portion 511A, and has a rod shape extending from the first marking portion 511A to the base end side along the axis C.
  • the second shaft portion 512B is connected to the base end side of the second marking portion 511B, and has a rod shape extending from the second marking portion 511B to the base end side along the axis C.
  • the handle portion 513 has a hammer head 5131 that is hit by the hammer 4.
  • the hammer head 5131 forms a proximal end surface of the marking device 501 along the axis C.
  • the handle portion 513 is connected to the proximal end side of the first shaft portion 512A and the proximal end side of the second shaft portion 512B, and at least one of the first shaft portion 512A and the second shaft portion 512B. Is movably held in the direction along the axis C.
  • the first shaft portion 512A is fixed to the handle portion 513
  • the second shaft portion 512B is held by the handle portion 513 so as to be movable along the axis C with respect to the handle portion 513.
  • the second shaft portion 512B is fixed to the handle portion 513 by a fixing member such as a screw when it is not moved to the handle portion 513, and is fixed to the handle portion 513 when it is moved to the handle portion 513. Is released. Further, the first shaft portion 512A and the second shaft portion 512B may be bundled by magnetic force, for example, by providing magnets to each other.
  • the surgeon has a first marking portion 511A, a second marking portion 511B, a first shaft portion 512A, and a second marking device 501 from the portal 121 opened in the skin 120. Insert the shaft portion 512B.
  • the operator reaches the anterior cruciate ligament attachment portion 140 with the first marking portion 511A while observing the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91. Insert the marking device 501 up to.
  • the operator brings the first tip portion 5111A of the first marking portion 511A into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG. 29.
  • the operator moves the second shaft portion 512B to the tip side of the axis C with respect to the handle portion 513 in a state where the first tip portion 5111A is in contact with the first marking target position P1. Then, the second tip portion 5111B of the second marking portion 511B is brought into contact with the second marking target position P2.
  • the first tip portion 5111A of the first marking portion 511A and the short side 5111B of the second marking portion 511B are oriented along the axis C.
  • the second tip portion 5111B is positioned closer to the tip side than the first tip portion 4111A.
  • the operator makes the hammer head of the handle portion 513 in a state where the first tip portion 5111A and the second tip portion 5111B are in contact with the first marking target position P1 and the second marking target position P2.
  • the 5131 is hit with a hammer 4, and the first tip portion 5111A and the second tip portion 5111B are driven into the first marking target position P1 and the second marking target position P2.
  • linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100.
  • a certain anterior cruciate ligament attachment portion 140 can be marked.
  • the marking device 601 has a marking portion 611, a shaft portion 612, and a handle portion 613.
  • the marking portion 611 has a cubic shape that is long in the direction orthogonal to the axis C, and has a triangular first marking portion 11A and a triangular second marking portion at both ends in the longitudinal direction of the tip surface, respectively. It has 11B and.
  • the first marking portion 11A has a linear first tip portion 6111A that comes into contact with the first marking target position P1.
  • the first tip portion 6111A forms a side connecting the inner side surface 6112A and the outer side surface 6113A of the first marking portion 611A to each other.
  • the second marking portion 611B has a linear second tip portion 6111B that comes into contact with the second marking target position P2.
  • the second tip portion 6111B forms a side connecting the inner side surface 6112B and the outer side surface 6113B of the second marking portion 611B to each other.
  • the tip end side of the shaft portion 12 is connected to the marking portion 611 by a shaft pin 614, and has a rod shape extending from the marking portion 611 toward the base end side along the axis C.
  • the marking portion 611 is rotatable about the shaft pin 614 with respect to the shaft portion 612.
  • the handle portion 613 has a hammer head 6131 that is hit by the hammer 4.
  • the hammer head 6131 forms an end surface on the proximal end side along the axis C of the marking device 601.
  • the operator inserts the marking portion 611 and the shaft portion 612 of the marking device 601 from the portal 121 opened in the skin 120.
  • the operator observes the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91, and the marking device until the marking portion 611 reaches the anterior cruciate ligament attachment portion 140. Insert 601.
  • the operator brings the first tip portion 6111A of the marking portion 611 into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG.
  • the operator further inserts the shaft portion 612 into the tip end side of the axis C with the first tip portion 6111A in contact with the first marking target position P1, centering on the shaft pin 614.
  • the marking portion 611 is rotated so that the second tip portion 6111B of the second marking portion 611B is brought into contact with the second marking target position P2.
  • the operator makes the hammer head of the handle portion 613 in a state where the first tip portion 6111A and the second tip portion 6111B are in contact with the first marking target position P1 and the second marking target position P2.
  • the 6131 is hit with a hammer 4, and the first tip portion 6111A and the second tip portion 6111B are driven into the first marking target position P1 and the second marking target position P2.
  • the marking device 601 As a result, linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100.
  • a certain anterior cruciate ligament attachment portion 140 can be marked.
  • the present invention can provide a marking device, a marking method, and a bone hole forming method capable of marking a target position when forming a bone hole.

Abstract

This marking device (1) for marking a target position when forming a bone hole has: a first marking part (11A) having a first leading end section (111A); a second marking part (11B) having a second leading end section (111B); a shaft part (12) provided to extend from base end sides of the first marking part and the second marking part; and a handle part (13) connected to the base end side of the shaft part, wherein the first leading end section and the second leading end section have different leading end positions in a direction along the axis line.

Description

マーキングデバイス、マーキング方法、及び、骨孔形成方法Marking device, marking method, and bone hole formation method
　本発明は、マーキングデバイス、マーキング方法、及び、骨孔形成方法に関する。 The present invention relates to a marking device, a marking method, and a bone hole forming method.
　膝の靭帯を再建する手技の一手法である前十字靭帯再建術においては、採取した腱を固定するために形成する骨孔を、狙いの位置及び形状に形成することが望まれる。 In anterior cruciate ligament reconstruction, which is a technique for reconstructing the ligament of the knee, it is desirable to form the bone hole formed to fix the collected tendon at the target position and shape.
　特許文献１には、複数の骨孔の間を連結して長円形の骨孔を形成するためのドリルを案内するドリルガイドが開示されている。このドリルガイドは、ドリル挿通孔が形成された本体と、複数の骨孔に挿入される複数の突出部とを有している。複数の突出部は、本体から前方に向かってドリル挿通孔の中心線方向と平行に突設されている。そして、ドリルガイドを用いて骨孔を形成するときには、予め治具を用いて開けた２つの穿孔に、ドリルガイドの複数の突出部を挿し、骨に対してドリルガイドを固定して、ドリル挿通孔にドリルを挿通して骨を切削する。 Patent Document 1 discloses a drill guide that guides a drill for connecting a plurality of bone holes to form an oval bone hole. The drill guide has a body in which a drill insertion hole is formed and a plurality of protrusions to be inserted into a plurality of bone holes. The plurality of protrusions project forward from the main body in parallel with the center line direction of the drill insertion hole. When forming a bone hole using a drill guide, a plurality of protrusions of the drill guide are inserted into two perforations opened in advance using a jig, the drill guide is fixed to the bone, and the drill is inserted. A drill is inserted into the hole to cut the bone.
特許第５７７１６７０号公報Japanese Patent No. 5771670
　前十字靭帯の代替として用いる腱を骨に固定するための骨孔は、狙いの位置に腱の固定具と同じ形状である長方形状に形成することによって、安定して腱を固定することができる。しかしながら、特許文献１に開示された技術では、ドリルを用いて円形の骨孔を形成しているため、腱の固定具とは異なる大きさ及び形状の骨孔が形成されてしまい、安定して腱を固定することが難しかった。 The bone hole for fixing the tendon used as an alternative to the anterior cruciate ligament to the bone can be stably fixed by forming a rectangular shape having the same shape as the tendon fixture at the target position. .. However, in the technique disclosed in Patent Document 1, since a circular bone hole is formed by using a drill, a bone hole having a size and shape different from that of the tendon fixture is formed, which is stable. It was difficult to fix the tendon.
　これに対して、長方形状の切削面を有する超音波処置具を用いて、腱の固定具と同じ大きさ及び形状の骨孔を形成することによって、腱の固定の安定化を図ることができる。ところが、超音波処置具の切削面が長方形状であるために、超音波処置具の体内への挿入方向に対して、骨孔を形成する位置が骨の斜面であると、骨の斜面に対して超音波処置具の切削面が傾いた姿勢での切削となるため、骨孔の位置出しが困難になり、骨孔の大きさと方向にずれが生じてしまう。そのため、骨の斜面に骨孔を形成する際、骨孔の大きさと方向にずれが生じない姿勢にて、骨の斜面の狙った位置に超音波処置具の切削面をあてがうことができるよう、前記狙いの位置にマーキングを行うことが望まれる。 On the other hand, by using an ultrasonic treatment tool having a rectangular cutting surface to form a bone hole having the same size and shape as the tendon fixing tool, it is possible to stabilize the fixation of the tendon. .. However, since the cutting surface of the ultrasonic treatment tool is rectangular, if the position where the bone hole is formed is the slope of the bone with respect to the direction of insertion of the ultrasonic treatment tool into the body, the slope of the bone Since the cutting surface of the ultrasonic treatment tool is cut in an inclined posture, it becomes difficult to position the bone hole, and the size and direction of the bone hole are deviated. Therefore, when forming a bone hole on the slope of the bone, the cutting surface of the ultrasonic treatment tool can be applied to the target position on the slope of the bone in a posture in which the size and direction of the hole do not deviate. It is desirable to mark the target position.
　本発明は、上記課題に鑑みてなされたものであって、その目的は、骨孔を形成する際の狙いの位置にマーキングすることができるマーキングデバイス、マーキング方法、及び、骨孔形成方法を提供することである。 The present invention has been made in view of the above problems, and an object of the present invention is to provide a marking device, a marking method, and a bone hole forming method capable of marking a target position when forming a bone hole. It is to be.
　上述した課題を解決し、目的を達成するために、本発明に係るマーキングデバイスは、第１の先端部を有する第１のマーキング部と、第２の先端部を有する第２のマーキング部と、前記第１のマーキング部及び前記第２のマーキング部の基端側から延伸して設けられたシャフト部と、前記シャフト部の基端側に接続されたハンドル部と、を有し、前記第１の先端部と前記第２の先端部とは、軸線に沿った方向の先端位置が異なる。 In order to solve the above-mentioned problems and achieve the object, the marking device according to the present invention includes a first marking portion having a first tip portion, a second marking portion having a second tip portion, and the like. The first marking portion has a shaft portion extending from the base end side of the first marking portion and the second marking portion, and a handle portion connected to the base end side of the shaft portion. The tip position of the second tip is different from that of the second tip in the direction along the axis.
　また、本発明に係るマーキングデバイスは、上記の発明において、前記第１の先端部と前記第２の先端部とを通る仮想直線と、前記軸線とのなす角度が、４０度以上５５度以下である。 Further, in the marking device according to the present invention, in the above invention, the angle formed by the virtual straight line passing through the first tip portion and the second tip portion and the axis line is 40 degrees or more and 55 degrees or less. be.
　また、本発明に係るマーキングデバイスは、上記の発明において、前記第１の先端部と前記第２の先端部との前記軸線に沿った方向に対して直交する方向における間隔が、処置対象部位における予め設定された長方形状の切削領域の長手方向の長さよりも短い。 Further, in the marking device according to the present invention, in the above invention, the distance between the first tip portion and the second tip portion in the direction orthogonal to the direction along the axis is set in the treatment target portion. It is shorter than the longitudinal length of the preset rectangular cutting area.
　また、本発明に係るマーキングデバイスは、前記第１の先端部は、前記軸線に沿った方向に対して直交する第１の直交方向に延在する第１の線状部と、前記軸線に沿った方向及び前記第１の直交方向に対して直交する第２の直交方向に延在する第２の線状部と、を有し、前記第２の先端部は、前記第１の直交方向に延在する第３の線状部と、前記第２の直交方向に延在する第４の線状部と、を有する。 Further, in the marking device according to the present invention, the first tip portion has a first linear portion extending in a first orthogonal direction orthogonal to a direction along the axis, and a first linear portion extending along the axis. It has a second linear portion extending in a second orthogonal direction orthogonal to the first orthogonal direction, and the second tip portion is in the first orthogonal direction. It has an extending third linear portion and a fourth linear portion extending in the second orthogonal direction.
　また、本発明に係るマーキングデバイスは、上記の発明において、前記第１のマーキング部及び前記第２のマーキング部は、処置対象部位に対してマーキングを行った際の深さを識別可能なマーキング深さ識別部を有する。 Further, in the marking device according to the present invention, in the above invention, the first marking portion and the second marking portion have a marking depth capable of identifying the depth when marking the treatment target portion. Has an identification unit.
　また、本発明に係るマーキング方法は、関節鏡の視野内にて観察しながら、マーキング対象となる骨の位置までマーキングデバイスを挿入し、前記関節鏡の視野内にて、第１のマーキング対象位置に前記マーキングデバイスの第１のマーキング部を当接させ、前記関節鏡の視野内にて、前記第１のマーキング部を当接させた状態にて、第２のマーキング対象位置に第２のマーキング部を当接させ、前記第１のマーキング部及び前記第２のマーキング部を共に当接させた状態にて、前記第１のマーキング対象位置及び前記第２のマーキング対象位置に前記マーキングデバイスを打ち込むことによって、第１の凹み及び第２の凹みを形成する。 Further, in the marking method according to the present invention, the marking device is inserted to the position of the bone to be marked while observing in the field of view of the arthroscope, and the first marking target position is in the field of view of the arthroscope. The first marking portion of the marking device is brought into contact with the arthroscope, and the first marking portion is brought into contact with the first marking portion in the field of view of the arthroscope. The marking device is driven into the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are brought into contact with each other. As a result, a first recess and a second recess are formed.
　また、本発明に係るマーキング方法は、上記の発明において、形成した前記第１の凹み及び前記第２の凹みを前記関節鏡によって観察して位置を確認する。 Further, in the marking method according to the present invention, the position is confirmed by observing the first recess and the second recess formed in the above invention with the arthroscope.
　また、本発明に係る骨孔形成方法は、関節鏡の視野内にて観察しながら、マーキング対象となる骨の位置までマーキングデバイスを挿入し、前記関節鏡の視野内にて、第１のマーキング対象位置に前記マーキングデバイスの第１のマーキング部を当接させ、前記関節鏡の視野内にて、前記第１のマーキング部を当接させた状態にて、第２のマーキング対象位置に第２のマーキング部を当接させ、前記第１のマーキング部及び前記第２のマーキング部を共に当接させた状態にて、前記第１のマーキング対象位置及び前記第２のマーキング対象位置に前記マーキングデバイスを打ち込むことによって、第１の凹み及び第２の凹みを形成し、前記関節鏡の視野内にて観察しながら、形成された前記第１の凹み及び前記第２の凹みのうちの一方の凹みの位置に切削処置具を挿入し、前記切削処置具によって切削して骨孔を形成し、前記関節鏡の視野内にて観察しながら、形成された前記第１の凹み及び前記第２の凹みのうち他方の凹みの位置に前記切削処置具を挿入し、前記切削処置具によって切削して骨孔を形成する。 Further, in the bone hole forming method according to the present invention, the marking device is inserted to the position of the bone to be marked while observing in the field of view of the arthroscope, and the first marking is made in the field of view of the arthroscope. The first marking portion of the marking device is brought into contact with the target position, and the first marking portion is brought into contact with the target position in the field of view of the arthroscope, and the second marking portion is brought into contact with the second marking target position. The marking device is in contact with the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are in contact with each other. A first recess and a second recess are formed by driving in, and one of the first recess and the second recess formed while observing in the field of view of the arthroscope. The cutting treatment tool is inserted at the position of, and the bone hole is formed by cutting with the cutting treatment tool, and the first dent and the second dent formed while observing in the field of view of the arthroscope. The cutting treatment tool is inserted into the position of the other recess, and the cutting treatment tool is used for cutting to form a bone hole.
　また、本発明に係る骨孔形成方法は、上記の発明において、前記一方の凹みの位置に形成された骨孔と、前記他方の凹みの位置に形成された骨孔と、の間の骨を前記切削処置具によって切削して骨孔を形成する。 Further, in the method for forming a bone hole according to the present invention, in the above invention, the bone between the bone hole formed at the position of the one recess and the bone hole formed at the position of the other recess is formed. A bone hole is formed by cutting with the cutting treatment tool.
　本発明に係るマーキングデバイス、マーキング方法、及び、骨孔形成方法は、骨孔を形成する際の狙いの位置にマーキングすることができるという効果を奏する。 The marking device, marking method, and bone hole forming method according to the present invention have the effect of being able to mark a target position when forming a bone hole.
図１は、実施の形態１に係るマーキングデバイスを示した図である。FIG. 1 is a diagram showing a marking device according to the first embodiment. 図２は、実施の形態１に係るマーキングデバイスの先端側の拡大図である。FIG. 2 is an enlarged view of the tip end side of the marking device according to the first embodiment. 図３は、マーキング深さ識別機能の一例を示した図である。FIG. 3 is a diagram showing an example of the marking depth identification function. 図４は、実施の形態１に係る超音波処置具システムを示した図である。FIG. 4 is a diagram showing an ultrasonic treatment tool system according to the first embodiment. 図５Ａは、超音波プローブの先端側を示した側面図である。FIG. 5A is a side view showing the tip end side of the ultrasonic probe. 図５Ｂは、超音波プローブの先端処置部を示した正面図である。FIG. 5B is a front view showing the tip treatment portion of the ultrasonic probe. 図６は、実施の形態１に係る処置システムの構成を示したブロック図である。FIG. 6 is a block diagram showing the configuration of the treatment system according to the first embodiment. 図７は、前十字靭帯付着部及び切削領域を示した大腿骨の斜視図である。FIG. 7 is a perspective view of the femur showing the anterior cruciate ligament attachment portion and the cutting region. 図８は、前十字靭帯付着部及び切削領域を示した大腿骨の側面図である。FIG. 8 is a side view of the femur showing the anterior cruciate ligament attachment portion and the cutting region. 図９は、第１のマーキング対象位置及び第２のマーキング対象位置にマーキングデバイスの第１の先端部及び第２の先端部を当接させた状態を示した図である。FIG. 9 is a diagram showing a state in which the first tip portion and the second tip portion of the marking device are in contact with the first marking target position and the second marking target position. 図１０は、第１のマーキング対象位置及び第２のマーキング対象位置にマーキングデバイスの第１の先端部及び第２の先端部を当接させた状態を示した大腿骨の斜視図である。FIG. 10 is a perspective view of the femur showing a state in which the first tip portion and the second tip portion of the marking device are in contact with the first marking target position and the second marking target position. 図１１は、第１の凹み及び第２の凹みが前十字靭帯付着部に形成された大腿骨の斜視図である。FIG. 11 is a perspective view of the femur in which the first recess and the second recess are formed at the anterior cruciate ligament attachment portion. 図１２は、第１の凹み及び第２の凹みが前十字靭帯付着部に形成された大腿骨の側面図である。FIG. 12 is a side view of the femur in which the first recess and the second recess are formed at the anterior cruciate ligament attachment portion. 図１３は、超音波プローブの先端処置部の長辺を第２の凹みに合わせた状態を示した大腿骨の斜視図である。FIG. 13 is a perspective view of the femur showing a state in which the long side of the tip treated portion of the ultrasonic probe is aligned with the second recess. 図１４は、前十字靭帯付着部に第１の骨孔を形成した状態を示した大腿骨の斜視図である。FIG. 14 is a perspective view of the femur showing a state in which a first bone hole is formed in the anterior cruciate ligament attachment portion. 図１５は、超音波プローブの先端処置部の長辺を第１の凹みに合わせた状態を示した大腿骨の斜視図である。FIG. 15 is a perspective view of the femur showing a state in which the long side of the tip-treated portion of the ultrasonic probe is aligned with the first recess. 図１６は、前十字靭帯付着部に第２の骨孔を形成した状態を示した大腿骨の斜視図である。FIG. 16 is a perspective view of the femur showing a state in which a second bone hole is formed in the anterior cruciate ligament attachment portion. 図１７は、隔壁部に超音波プローブの先端処置部を当接させた状態を示した大腿骨の斜視図である。FIG. 17 is a perspective view of the femur showing a state in which the tip treatment portion of the ultrasonic probe is brought into contact with the partition wall portion. 図１８は、長方形状の骨孔が形成された大腿骨の斜視図である。FIG. 18 is a perspective view of the femur in which a rectangular bone hole is formed. 図１９は、長方形状の骨孔が形成された大腿骨の側面図である。FIG. 19 is a side view of the femur in which a rectangular bone hole is formed. 図２０は、実施の形態１に係るマーキングデバイスの他例の先端側を示した図である。FIG. 20 is a diagram showing the tip end side of another example of the marking device according to the first embodiment. 図２１は、実施の形態２に係るマーキングデバイスの先端側を示した図である。FIG. 21 is a diagram showing the tip end side of the marking device according to the second embodiment. 図２２は、実施の形態３に係るマーキングデバイスの先端側を示した図である。FIG. 22 is a diagram showing the tip end side of the marking device according to the third embodiment. 図２３は、実施の形態３に係るマーキングデバイスがマーキングする角括弧状の凹みを示した図である。FIG. 23 is a diagram showing a square bracket-shaped recess marked by the marking device according to the third embodiment. 図２４は、実施の形態３に係るマーキングデバイスの他例の先端側を示した図である。FIG. 24 is a diagram showing the tip end side of another example of the marking device according to the third embodiment. 図２５は、図２４に示したマーキングデバイスがマーキングするＬ字状の凹みを示した図である。FIG. 25 is a diagram showing an L-shaped recess marked by the marking device shown in FIG. 24. 図２６は、実施の形態４に係るマーキングデバイスを用いたマーキング方法の一例を示した図である。FIG. 26 is a diagram showing an example of a marking method using the marking device according to the fourth embodiment. 図２７は、実施の形態４に係るマーキングデバイスを用いたマーキング方法の一例を示した図である。FIG. 27 is a diagram showing an example of a marking method using the marking device according to the fourth embodiment. 図２８は、実施の形態５に係るマーキングデバイスを用いたマーキング方法の一例を示した図である。FIG. 28 is a diagram showing an example of a marking method using the marking device according to the fifth embodiment. 図２９は、実施の形態５に係るマーキングデバイスを用いたマーキング方法の一例を示した図である。FIG. 29 is a diagram showing an example of a marking method using the marking device according to the fifth embodiment. 図３０は、実施の形態６に係るマーキングデバイスを用いたマーキング方法の一例を示した図である。FIG. 30 is a diagram showing an example of a marking method using the marking device according to the sixth embodiment. 図３１は、実施の形態６に係るマーキングデバイスを用いたマーキング方法の一例を示した図である。FIG. 31 is a diagram showing an example of a marking method using the marking device according to the sixth embodiment.
（実施の形態１）
　以下に、本発明に係るマーキングデバイスの実施の形態１について説明する。なお、本実施形態により本発明が限定されるものではない。 (Embodiment 1)
The first embodiment of the marking device according to the present invention will be described below. The present invention is not limited to the present embodiment.
　図１は、実施の形態１に係るマーキングデバイス１を示した図である。図２は、実施の形態１に係るマーキングデバイス１の先端側の拡大図である。 FIG. 1 is a diagram showing a marking device 1 according to the first embodiment. FIG. 2 is an enlarged view of the tip end side of the marking device 1 according to the first embodiment.
　実施の形態１に係るマーキングデバイス１は、マーキング部１１とシャフト部１２とハンドル部１３とを有している。マーキング部１１は、第１のマーキング部１１Ａと第２のマーキング部１１Ｂとを有している。第１のマーキング部１１Ａは、線状の第１の先端部１１１Ａを有している。第１の先端部１１１Ａは、第１のマーキング部１１Ａにおける内側面１１２Ａと外側面１１３Ａとを互いに接続する辺を成している。第２のマーキング部１１Ｂは、線状の第２の先端部１１１Ｂを有している。第２の先端部１１１Ｂは、第２のマーキング部１１Ｂにおける内側面１１２Ｂと外側面１１３Ｂとを互いに接続する辺を成している。 The marking device 1 according to the first embodiment has a marking portion 11, a shaft portion 12, and a handle portion 13. The marking portion 11 has a first marking portion 11A and a second marking portion 11B. The first marking portion 11A has a linear first tip portion 111A. The first tip portion 111A forms a side connecting the inner side surface 112A and the outer side surface 113A of the first marking portion 11A to each other. The second marking portion 11B has a linear second tip portion 111B. The second tip portion 111B forms a side connecting the inner side surface 112B and the outer side surface 113B of the second marking portion 11B to each other.
　第１のマーキング部１１Ａの第１の先端部１１１Ａと、第２のマーキング部１１Ｂの第２の先端部１１１Ｂとは、軸線Ｃに沿った方向にて先端位置が距離ｈだけ異なっており、第１の先端部１１１Ａよりも第２の先端部１１１Ｂのほうが先端側に位置している。また、実施の形態１に係るマーキングデバイス１では、第１のマーキング部１１Ａの第１の先端部１１１Ａと第２のマーキング部１１Ｂの第２の先端部１１１Ｂとを通る仮想直線Ｘと、マーキングデバイス１の軸線Ｃとのなす角度θを、４０度以上５５度以下とすることが好ましい。 The first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B differ in tip position by a distance h in the direction along the axis C. The second tip 111B is located closer to the tip than the tip 111A of 1. Further, in the marking device 1 according to the first embodiment, the virtual straight line X passing through the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B, and the marking device. The angle θ formed by the axis C of 1 is preferably 40 degrees or more and 55 degrees or less.
　マーキング部１１では、軸線Ｃに沿った方向にて短い側である第１のマーキング部１１Ａの第１の先端部１１１Ａが、後述する第１のマーキング対象位置Ｐ１（図６参照）にマーキングを施す。また、マーキング部１１では、軸線Ｃに沿った方向にて長い側である第２のマーキング部１１Ｂの第２の先端部１１１Ｂが、後述する第２のマーキング対象位置Ｐ２（図６参照）にマーキングを施す。 In the marking portion 11, the first tip portion 111A of the first marking portion 11A, which is on the short side in the direction along the axis C, marks the first marking target position P1 (see FIG. 6) described later. .. Further, in the marking portion 11, the second tip portion 111B of the second marking portion 11B, which is on the long side in the direction along the axis C, marks the second marking target position P2 (see FIG. 6) described later. To give.
　なお、第１の先端部１１１Ａと前記第２の先端部１１１Ｂとの軸線Ｃに沿った方向と直交する方向における間隔Ｌは、後述する処置対象部位である大腿骨外顆１００（図７参照）における予め設定された長方形状の切削領域１５０の長手方向の長さよりも短い。実施の形態１においては、第１の先端部１１１Ａと第２の先端部１１１Ｂとの間隔Ｌを６［ｍｍ］として説明を行うが、これに限定されるものではない。 The distance L between the first tip portion 111A and the second tip portion 111B in the direction orthogonal to the direction along the axis C is the femoral lateral condyle 100 (see FIG. 7), which is a treatment target site to be described later. Shorter than the longitudinal length of the preset rectangular cutting area 150 in. In the first embodiment, the distance L between the first tip portion 111A and the second tip portion 111B is set to 6 [mm], but the description is not limited to this.
　シャフト部１２は、第１のマーキング部１１Ａ及び第２のマーキング部１１Ｂの基端側に接続されており、第１のマーキング部１１Ａ及び第２のマーキング部１１Ｂから軸線Ｃに沿って基端側に延伸した棒状となっている。 The shaft portion 12 is connected to the base end side of the first marking portion 11A and the second marking portion 11B, and is connected to the base end side from the first marking portion 11A and the second marking portion 11B along the axis C. It has a rod shape that is stretched to.
　ハンドル部１３は、シャフト部１２の基端側に接続されており、後述するハンマー４（図９参照）によって叩かれるハンマーヘッド１３１を有している。このハンマーヘッド１３１は、マーキングデバイス１における軸線Ｃに沿った基端側の端面を成している。 The handle portion 13 is connected to the base end side of the shaft portion 12 and has a hammer head 131 that is hit by a hammer 4 (see FIG. 9) described later. The hammer head 131 forms an end surface on the proximal end side along the axis C of the marking device 1.
　そして、実施の形態１に係るマーキングデバイス１では、ハンマーヘッド１３１をハンマー４によって叩くことにより、ハンドル部５３からシャフト部１２を通って第１のマーキング部１１Ａ及び第２のマーキング部１１Ｂに押圧力が伝達される。 Then, in the marking device 1 according to the first embodiment, by hitting the hammer head 131 with the hammer 4, the pressing force is applied to the first marking portion 11A and the second marking portion 11B from the handle portion 53 through the shaft portion 12. Is transmitted.
　なお、実施の形態１に係るマーキングデバイス１には、第１のマーキング部１１Ａ及び第２のマーキング部１１Ｂによるマーキングの深さを識別するためのマーキング深さ識別機能を備えていてもよい。前記マーキング深さ識別機能としては、例えば、図３に示すように、第１のマーキング部１１Ａ及び第２のマーキング部１１Ｂの側面に、マーキングの深さを示す線状の目盛り１４Ａ，１４Ｂを設けても良い。前記マーキング深さ識別機能としては、線状の目盛り１４Ａ，１４Ｂに限らず、第１のマーキング部１１Ａ及び第２のマーキング部１１Ｂの外径形状などによってマーキングの深さを識別可能にしてもよい。 The marking device 1 according to the first embodiment may be provided with a marking depth identification function for identifying the marking depth by the first marking portion 11A and the second marking portion 11B. As the marking depth identification function, for example, as shown in FIG. 3, linear scales 14A and 14B indicating the marking depth are provided on the side surfaces of the first marking portion 11A and the second marking portion 11B. You may. The marking depth identification function is not limited to the linear scales 14A and 14B, and the marking depth may be identified by the outer diameter shape of the first marking portion 11A and the second marking portion 11B. ..
　図４は、実施の形態１に係る超音波処置具システム５を示した図である。実施の形態１に超音波処置具システム５は、主として、超音波処置具６と、制御装置７と、超音波振動のオンオフを指示するフットスイッチ８と、によって構成されている。超音波処置具６と制御装置７とは、ケーブル６８により接続され、駆動電力の供給や制御信号の通信が行われる。制御装置７の前面７１には、ケーブル６８と接続するための複数のコネクタ７２と、各種の操作スイッチ７３と、処置に必要な情報を表示する表示画面７４とが設けられている。操作スイッチ７３は、例えば、超音波処置具６の駆動モードを切り替える指示を行う切り替え指示部として機能する。 FIG. 4 is a diagram showing the ultrasonic treatment tool system 5 according to the first embodiment. In the first embodiment, the ultrasonic treatment tool system 5 is mainly composed of an ultrasonic treatment tool 6, a control device 7, and a foot switch 8 for instructing on / off of ultrasonic vibration. The ultrasonic treatment tool 6 and the control device 7 are connected by a cable 68, and drive power is supplied and control signals are communicated. The front surface 71 of the control device 7 is provided with a plurality of connectors 72 for connecting to the cable 68, various operation switches 73, and a display screen 74 for displaying information necessary for treatment. The operation switch 73 functions as, for example, a switching instruction unit that gives an instruction to switch the drive mode of the ultrasonic treatment tool 6.
　超音波処置具６は、デバイス本体６１と、超音波プローブ６４とによって構成されている。デバイス本体６１は、把持可能な径で筒形状を成し、超音波プローブ６４が貫通して配置されたハウジング６１ａと、ハウジング６１ａに着脱可能な超音波発生部である超音波振動子ユニット６１ｂとによって構成されている。超音波振動子ユニット６１ｂは、内部に、圧電体等の超音波振動素子からなる超音波発生部６２、及び、超音波を効率よく伝達するホーン６３が収容されている。ハウジング６１ａに超音波振動子ユニット６１ｂが装着された状態においては、超音波プローブ６４の基端側とホーン６３の先端側とが音響的に接続され、超音波発生部６２によって発生された超音波振動が、超音波プローブ６４の後述する先端処置部６５まで伝達される。ハウジング６１ａの上面には、超音波振動のオンオフを術者の指操作により指示する操作スイッチ６７が設けられている。フットスイッチ８は、超音波振動のオンオフを術者の足操作によって指示する機能を有している。 The ultrasonic treatment tool 6 is composed of a device body 61 and an ultrasonic probe 64. The device main body 61 has a tubular shape with a grippable diameter, and has a housing 61a in which an ultrasonic probe 64 penetrates and is arranged, and an ultrasonic vibrator unit 61b which is an ultrasonic generator unit that can be attached to and detached from the housing 61a. It is composed of. The ultrasonic vibrator unit 61b houses an ultrasonic generation unit 62 made of an ultrasonic vibration element such as a piezoelectric body and a horn 63 that efficiently transmits ultrasonic waves. In the state where the ultrasonic vibrator unit 61b is mounted on the housing 61a, the base end side of the ultrasonic probe 64 and the tip end side of the horn 63 are acoustically connected, and the ultrasonic waves generated by the ultrasonic wave generating unit 62. The vibration is transmitted to the tip treatment portion 65, which will be described later, of the ultrasonic probe 64. On the upper surface of the housing 61a, an operation switch 67 for instructing the on / off of ultrasonic vibration by the operator's finger operation is provided. The foot switch 8 has a function of instructing the on / off of ultrasonic vibration by the operator's foot operation.
　超音波プローブ６４は、超音波振動を伝達する細長い棒状の軸部材（プローブ本体）であって、金属材料、例えば、チタン合金等により形成されている。超音波プローブ６４の基端部は、超音波発生部６２から供給された振動エネルギー（超音波振動）が入力される振動入力部である。超音波プローブ６４の先端には、所定の振幅にて振動することによって処置対象物である骨を切削処置する先端処置部６５が形成されている。超音波プローブ６４の基端部と先端処置部６５とは、前記基端部に入力された振動エネルギー（超音波振動）を先端処置部６５に伝達する伝達部であるプローブ本体によって接続されている。 The ultrasonic probe 64 is an elongated rod-shaped shaft member (probe body) that transmits ultrasonic vibrations, and is made of a metal material such as a titanium alloy. The base end portion of the ultrasonic probe 64 is a vibration input unit to which vibration energy (ultrasonic vibration) supplied from the ultrasonic wave generating unit 62 is input. At the tip of the ultrasonic probe 64, a tip treatment portion 65 for cutting and treating a bone, which is a treatment target, is formed by vibrating with a predetermined amplitude. The base end portion of the ultrasonic probe 64 and the tip treatment portion 65 are connected by a probe main body which is a transmission portion that transmits vibration energy (ultrasonic vibration) input to the base end portion to the tip treatment portion 65. ..
　超音波プローブ６４は、ハウジング６１ａから任意の長さまでシース６６に覆われている。シース６６は、超音波プローブ６４に対して密着しておらず、超音波振動を減衰させないように、超音波プローブ６４との間に僅かな隙間が設けられている。シース６６は、ハウジング６１ａの先端側であって超音波振動の節位置にて固定されている。 The ultrasonic probe 64 is covered with a sheath 66 from the housing 61a to an arbitrary length. The sheath 66 is not in close contact with the ultrasonic probe 64, and a slight gap is provided between the sheath 66 and the ultrasonic probe 64 so as not to attenuate the ultrasonic vibration. The sheath 66 is fixed at the node position of ultrasonic vibration on the tip end side of the housing 61a.
　図５Ａ及び図５Ｂに示すように、先端処置部６５の先端部分には、第１の打面６５ａと第２の打面６５ｂと第３の打面６５ｃとによって、先端側に凸となる階段状の段差が形成されている。先端処置部６５の軸線方向と直交する方向での外郭は、長辺の長さａ及び短辺の長さｂの長方形となっている。なお、実施の形態１においては、前記長辺の長さａを５［ｍｍ］とし、前記短辺の長さｂを４［ｍｍ］として説明を行うが、これに限定されるものではない。 As shown in FIGS. 5A and 5B, the tip portion of the tip treatment portion 65 has a staircase that is convex toward the tip side by the first striking surface 65a, the second striking surface 65b, and the third striking surface 65c. A step is formed. The outer shell of the tip treatment portion 65 in the direction orthogonal to the axial direction is a rectangle having a long side length a and a short side length b. In the first embodiment, the length a of the long side is 5 [mm] and the length b of the short side is 4 [mm], but the description is not limited to this.
　図６は、実施の形態１に係る処置システム１０の構成を示したブロック図である。実施の形態１に係る処置システム１０は、処置対象部位である大腿骨外顆１００に長方形状の骨孔１１０（図１８参照）をあける処置を行うものであって、超音波処置具システム５と、内視鏡システム９とによって構成されている。超音波処置具システム５は、前述したように、超音波発生部６２及び超音波プローブ６４などを有する超音波処置具６と、制御装置７と、操作スイッチ６７とを備えている。 FIG. 6 is a block diagram showing the configuration of the treatment system 10 according to the first embodiment. The treatment system 10 according to the first embodiment performs a treatment of opening a rectangular bone hole 110 (see FIG. 18) in the femoral lateral condyle 100, which is a treatment target site, and is the ultrasonic treatment tool system 5. , The endoscopic system 9. As described above, the ultrasonic treatment tool system 5 includes an ultrasonic treatment tool 6 having an ultrasonic generation unit 62, an ultrasonic probe 64, and the like, a control device 7, and an operation switch 67.
　内視鏡システム９は、内視鏡の一種である硬性鏡からなる関節鏡９１と、照明光の光源として、可視光の照明光を照射する光源９２と、内視鏡システム９の全体を制御する制御部９３と、キーボードやタッチパネル等の入力部９４と、撮影された処置状況を含む処置情報を表示する表示部９５と、大腿骨外顆１００を含む周辺に生理食塩水を送水、排水または灌流する送水排水部９６と、によって構成されている。本実施の形態では、送水排水部９６が関節鏡９１を通じて大腿骨外顆１００を含む周辺に生理食塩水を送水及び排水する構成であるが、超音波処置具６から生理食塩水等を含む灌流液を送水及び排水する構成であってもよい。 The endoscope system 9 controls an arthroscope 91 made of a rigid endoscope, which is a kind of endoscope, a light source 92 that irradiates visible light as a light source of illumination light, and the entire endoscope system 9. Control unit 93, input unit 94 such as a keyboard or touch panel, display unit 95 that displays treatment information including the photographed treatment status, and water supply, drainage, or drainage of physiological saline to the periphery including the femoral external condyle 100. It is composed of a water supply / drainage unit 96 for perfusing. In the present embodiment, the water supply / drainage unit 96 sends and drains physiological saline to the periphery including the femoral lateral condyle 100 through the arthroscope 91, but perfusion containing physiological saline or the like from the ultrasonic treatment tool 6 The liquid may be supplied and drained.
　次に、実施の形態１に係るマーキングデバイス１を用いた関節鏡９１下でのマーキング方法について説明する。 Next, a marking method under the arthroscope 91 using the marking device 1 according to the first embodiment will be described.
　実施の形態１においては、図７及び図８に示した、処置対象部位である大腿骨外顆１００に前十字靭帯が付着していた前十字靭帯付着部１４０に、長方形状の骨孔１１０を形成する。この前十字靭帯付着部１４０は、大腿骨外顆１００の斜面にある。なお、図７及び図８に破線によって示した長方形状の切削領域１５０は、前十字靭帯付着部１４０において骨孔１１０を形成する位置を示している。切削領域１５０の短辺１５０ａ，１５０ｂの長さＤと長辺１５０ｃ，１５０ｄの長さＷとは、骨孔１１０の短辺の長さと長辺の長さと同じである。なお、実施の形態１においては、切削領域１５０の短辺１５０ａ，１５０ｂの長さＤを５［ｍｍ］とし、切削領域１５０の長辺１５０ｃ，１５０ｄの長さＷを１０［ｍｍ］として説明を行うが、これに限定されるものではない。 In the first embodiment, a rectangular bone hole 110 is formed in the anterior cruciate ligament attachment portion 140 to which the anterior cruciate ligament is attached to the femoral lateral condyle 100, which is the treatment target site, shown in FIGS. 7 and 8. Form. The anterior cruciate ligament attachment portion 140 is located on the slope of the lateral femoral condyle 100. The rectangular cutting region 150 shown by the broken line in FIGS. 7 and 8 indicates the position where the bone hole 110 is formed in the anterior cruciate ligament attachment portion 140. The length D of the short sides 150a and 150b of the cutting region 150 and the length W of the long sides 150c and 150d are the same as the length of the short side and the length of the long side of the bone hole 110. In the first embodiment, the length D of the short sides 150a and 150b of the cutting region 150 is 5 [mm], and the length W of the long sides 150c and 150d of the cutting region 150 is 10 [mm]. Do, but are not limited to this.
　ここで、実際の前十字靭帯付着部１４０には、切削領域１５０が示されている訳ではない。そのため、実施の形態１では、切削領域１５０に骨孔１１０を形成できるよう、超音波処置具２を用いて骨孔１１０を形成する際の狙いの位置の目印を、前十字靭帯付着部１４０の表面にマーキングデバイス１によってマーキングする。 Here, the cutting region 150 is not shown in the actual anterior cruciate ligament attachment portion 140. Therefore, in the first embodiment, the anterior cruciate ligament attachment portion 140 is used to mark the target position when the bone hole 110 is formed by using the ultrasonic treatment tool 2 so that the bone hole 110 can be formed in the cutting region 150. The surface is marked by the marking device 1.
　図９は、マーキングデバイス１を用いた関節鏡９１下でのマーキングの手順の一例を示した側面図である。大腿骨外顆１００の側面図である。図１０は、マーキングデバイス１を用いた関節鏡９１下でのマーキングの手順の一例を示した斜視図である。なお、図１０から図１９に示す図は、関節鏡９１の視野として視認される範囲の画像を示している。 FIG. 9 is a side view showing an example of the marking procedure under the arthroscope 91 using the marking device 1. It is a side view of the femoral lateral condyle 100. FIG. 10 is a perspective view showing an example of the marking procedure under the arthroscope 91 using the marking device 1. The figures shown in FIGS. 10 to 19 show images in a range that can be visually recognized as a field of view of the arthroscope 91.
　まず、術者は、皮膚１２０に開けられたポータル１２１からマーキングデバイス１のマーキング部１１及びシャフト部１２を挿入する。次に、術者は、関節鏡９１の視野内にて、大腿骨外顆１００における前十字靭帯付着部１４０付近を観察しながら、前十字靭帯付着部１４０にマーキング部１１が到達するまでマーキングデバイス１を挿入する。次に、術者は、関節鏡９１の視野内にて、第１のマーキング対象位置Ｐ１（図１０中の切削領域１５０の短辺１５０ａに対応する位置）に第１のマーキング部１１Ａの第１の先端部１１１Ａを当接させる。次に、術者は、第１のマーキング対象位置Ｐ１に第１の先端部１１１Ａを当接させた状態にて、第２のマーキング対象位置Ｐ２（図１０中の切削領域１５０内にて短辺１５０ａから長手方向の他端側に離れた位置）に第２のマーキング部１１Ｂの第２の先端部１１１Ｂを当接させる。そして、術者は、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に第１の先端部１１１Ａ及び第２の先端部１１１Ｂを当接させた状態にて、ハンドル部１３のハンマーヘッド１３１をハンマー４によって叩き、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、第１の先端部１１１Ａ及び第２の先端部１１１Ｂを打ち込む。これによって、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、図１１に示すような線状の第１の凹み１６１及び第２の凹み１６２が形成される。 First, the operator inserts the marking portion 11 and the shaft portion 12 of the marking device 1 from the portal 121 opened in the skin 120. Next, the operator observes the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91, and the marking device until the marking portion 11 reaches the anterior cruciate ligament attachment portion 140. Insert 1 Next, in the field of view of the arthroscope 91, the operator makes the first marking portion 11A at the first marking target position P1 (the position corresponding to the short side 150a of the cutting region 150 in FIG. 10). The tip portion 111A of the above is brought into contact with the surface. Next, the operator makes the second marking target position P2 (short side in the cutting region 150 in FIG. 10) in a state where the first tip portion 111A is in contact with the first marking target position P1. The second tip portion 111B of the second marking portion 11B is brought into contact with the position (a position away from the other end side in the longitudinal direction from 150a). Then, the operator makes the hammer head of the handle portion 13 in a state where the first tip portion 111A and the second tip portion 111B are in contact with the first marking target position P1 and the second marking target position P2. The 131 is hit with a hammer 4, and the first tip portion 111A and the second tip portion 111B are driven into the first marking target position P1 and the second marking target position P2. As a result, a linear first recess 161 and a second recess 162 as shown in FIG. 11 are formed at the first marking target position P1 and the second marking target position P2.
　実施の形態１に係るマーキングデバイス１においては、第１のマーキング部１１Ａの第１の先端部１１１Ａと第２のマーキング部１１Ｂの第２の先端部１１１Ｂとは、軸線Ｃに沿った方向にて先端位置が異なっている。そのため、実施の形態１に係るマーキングデバイス１では、骨の斜面に対して第１の先端部１１１Ａと第２の先端部１１１Ｂとを当接させ易くなり、超音波処置具２を用いて骨孔１１０を形成する際の狙いの位置の目印（第１の凹み１６１及び第２の凹み１６２）を、前十字靭帯付着部１４０にマーキングすることができる。 In the marking device 1 according to the first embodiment, the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B are oriented in the direction along the axis C. The tip position is different. Therefore, in the marking device 1 according to the first embodiment, the first tip portion 111A and the second tip portion 111B can be easily brought into contact with the slope of the bone, and the bone hole can be easily contacted by using the ultrasonic treatment tool 2. Marks (first recess 161 and second recess 162) of the target position when forming the 110 can be marked on the anterior cruciate ligament attachment portion 140.
　なお、実施の形態１においては、図１１に示した、切削領域１５０の横の長さＷから、第１の凹み１６１と第２の凹み１６２との間隔Ｌを引いた幅Ｗ１が、超音波プローブ６４の先端処置部６５における短辺の長さｂと同じである。 In the first embodiment, the width W 1 obtained by subtracting the distance L between the first recess 161 and the second recess 162 from the lateral length W of the cutting region 150 shown in FIG. 11 is super It is the same as the length b of the short side of the tip treatment portion 65 of the ultrasonic probe 64.
　次に、実施の形態１に係るマーキングデバイス１によって形成された第１の凹み１６１及び第２の凹み１６２に基づいて、関節鏡９１下にて超音波処置具６により骨孔を形成する骨孔形成方法について説明する。 Next, based on the first recess 161 and the second recess 162 formed by the marking device 1 according to the first embodiment, the bone hole forming the bone hole by the ultrasonic treatment tool 6 under the arthroscope 91. The forming method will be described.
　まず、術者は、関節鏡９１によって前十字靭帯付着部１４０に形成した第２の凹み１６２の位置を確認する。次に、術者は、皮膚にあけたポータルから超音波処置具６の超音波プローブ６４を挿入する。次に、術者は、関節鏡９１の視野内にて観察しながら、図１３に示すように、超音波プローブ６４の先端処置部６５が第２の凹み１６２に対して第１の凹み１６１側とは反対側に位置するように、先端処置部６５の一方の長辺を第２の凹み１６２の位置にあわせる。次に、術者は、関節鏡９１の視野内にて観察しながら、超音波プローブ６４を超音波振動させて、超音波プローブ６４の振動方向（軸線方向）に骨の切削を行い、図１４に示すような角筒状の第１の骨孔１０１を形成する。 First, the operator confirms the position of the second dent 162 formed in the anterior cruciate ligament attachment portion 140 by the arthroscope 91. Next, the operator inserts the ultrasonic probe 64 of the ultrasonic treatment tool 6 from the portal opened in the skin. Next, while observing in the field of view of the arthroscope 91, the operator observes the tip treatment portion 65 of the ultrasonic probe 64 on the side of the first recess 161 with respect to the second recess 162, as shown in FIG. One long side of the tip treatment portion 65 is aligned with the position of the second recess 162 so as to be located on the opposite side to the above. Next, the surgeon vibrates the ultrasonic probe 64 ultrasonically while observing in the field of view of the arthroscope 91, and cuts the bone in the vibration direction (axial direction) of the ultrasonic probe 64. FIG. A square tubular first bone hole 101 as shown in the above is formed.
　次に、術者は、前十字靭帯付着部１４０に形成した第１の凹み１６１の位置を、関節鏡９１によって確認する。次に、術者は、関節鏡９１の視野内にて観察しながら、図１５に示すように、超音波プローブ６４の先端処置部６５が第１の凹み１６１に対して第１の骨孔１０１側に位置するように、先端処置部６５の一方の長辺を第１の凹み１６１の位置にあわせる。次に、術者は、関節鏡９１の視野内にて観察しながら、超音波プローブ６４を超音波振動させて、超音波プローブ６４の振動方向（軸線方向）に骨の切削を行い、図１６に示すような角筒状の第２の骨孔１０２を形成する。 Next, the operator confirms the position of the first dent 161 formed in the anterior cruciate ligament attachment portion 140 by the arthroscope 91. Next, the operator observes in the field of view of the arthroscope 91, and as shown in FIG. 15, the tip treatment portion 65 of the ultrasonic probe 64 has a first bone hole 101 with respect to the first recess 161. Align one long side of the tip treatment portion 65 with the position of the first recess 161 so that it is located on the side. Next, the operator vibrates the ultrasonic probe 64 ultrasonically while observing in the field of view of the arthroscope 91, and cuts the bone in the vibration direction (axial direction) of the ultrasonic probe 64. FIG. A square tubular second bone hole 102 is formed as shown in the above.
　次に、術者は、図１６に示した、第１の骨孔１０１と第２の骨孔１０２との間に存在する骨の隔壁部１０３の位置を、関節鏡９１によって確認する。次に、術者は、図１７に示すように、関節鏡９１の視野内にて観察しながら、超音波プローブ６４の先端処置部６５を隔壁部１０３に当接させる。次に、術者は、関節鏡９１の視野内にて観察しながら、超音波プローブ６４を超音波振動させて、超音波プローブ６４の振動方向（軸線方向）に隔壁部１０３の切削を行い、第１の骨孔１０１と第２の骨孔１０２とを連通させて、図１８に示すような長方形状の骨孔１１０を形成する。 Next, the surgeon confirms the position of the bone partition 103 existing between the first bone hole 101 and the second bone hole 102 by the arthroscope 91, which is shown in FIG. Next, as shown in FIG. 17, the operator brings the tip treatment portion 65 of the ultrasonic probe 64 into contact with the partition wall portion 103 while observing in the field of view of the arthroscope 91. Next, the surgeon vibrates the ultrasonic probe 64 ultrasonically while observing in the field of view of the arthroscope 91, and cuts the partition wall portion 103 in the vibration direction (axial direction) of the ultrasonic probe 64. The first bone hole 101 and the second bone hole 102 are communicated with each other to form a rectangular bone hole 110 as shown in FIG.
　このようにして、実施の形態１では、図１９に示した、短辺の長さがＤであり長辺の長さがＷである長方形状の骨孔１１０を、前十字靭帯付着部１４０の狙いの位置に容易に形成することができる。 In this way, in the first embodiment, the rectangular bone hole 110 having a short side length of D and a long side length of W, as shown in FIG. 19, is formed in the anterior cruciate ligament attachment portion 140. It can be easily formed at the target position.
　なお、上記では、第１の凹み１６１と第２の凹み１６２とのうち、先に第２の凹み１６２に超音波プローブ６４の先端処置部６５を合わせて切削を行ったが、先に第１の凹み１６１に超音波プローブ６４の先端処置部６５を合わせて切削を行ってもよい。 In the above, of the first recess 161 and the second recess 162, the second recess 162 was first cut by aligning the tip treatment portion 65 of the ultrasonic probe 64, but the first one was first cut. The tip treatment portion 65 of the ultrasonic probe 64 may be aligned with the recess 161 of the ultrasonic probe 64 to perform cutting.
　なお、実施の形態１に係るマーキングデバイス１においては、図２０に示すように、第１のマーキング部１１Ａの第１の先端部１１１Ａと、第２のマーキング部１１Ｂの第２の先端部１１１Ｂとを、曲面１１５によって繋いでマーキング部１１を構成してもよい。 In the marking device 1 according to the first embodiment, as shown in FIG. 20, the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B May be connected by a curved surface 115 to form the marking portion 11.
（実施の形態２）
　以下に、本発明に係るマーキングデバイスの実施の形態２について説明する。なお、実施の形態２において、実施の形態１と共通する部分の説明は適宜省略する。 (Embodiment 2)
The second embodiment of the marking device according to the present invention will be described below. In the second embodiment, the description of the parts common to the first embodiment will be omitted as appropriate.
　図２１に示すように、実施の形態２に係るマーキングデバイス２０１のマーキング部２１１は、シャフト部２１２の先端側に接続されており、一対の短辺をなす線状の第１の先端部２１１１Ａ及び第２の先端部２１１１Ｂと、一対の長辺をなす線状の第３の先端部２１１１Ｃ及び第４の先端部２１１１Ｄと、によって囲まれた長方形状の開口部２１１２と、を有している。なお、実施の形態２においては、マーキング部２１１が、第１の先端部２１１１Ａを有する第１のマーキング部と、第２の先端部２１１１Ｂを有する第２のマーキング部と、第３の先端部２１１１Ｃを有する第３のマーキング部と、第４の先端部２１１１Ｄを有する第４のマーキング部と、を兼ねている。実施の形態２では、マーキングデバイス２０１をマーキング位置に固定しやすいように、第１の先端部２１１１Ａ及び第２の先端部２１１１Ｂが生体組織へ喰いこむ部分を小さくして応力を集中させる形状にしている。 As shown in FIG. 21, the marking portion 211 of the marking device 201 according to the second embodiment is connected to the tip end side of the shaft portion 212, and has a linear first tip portion 2111A forming a pair of short sides and It has a second tip portion 2111B, and a rectangular opening 2112 surrounded by a pair of linear third tip portions 2111C and a fourth tip portion 2111D forming a long side. In the second embodiment, the marking portion 211 includes a first marking portion having a first tip portion 2111A, a second marking portion having a second tip portion 2111B, and a third tip portion 2111C. It also serves as a third marking portion having the above and a fourth marking portion having the fourth tip portion 2111D. In the second embodiment, in order to easily fix the marking device 201 at the marking position, the portion where the first tip portion 2111A and the second tip portion 2111B bite into the living tissue is made small so as to concentrate the stress. There is.
　一対の短辺をなす第１の先端部２１１１Ａ及び第２の先端部２１１１Ｂは、互いに軸線Ｃに沿った方向にて先端位置が異なっており、第２の先端部２１１１Ｂが第１の先端部２１１１Ａよりも軸線Ｃに沿った方向にて先端側に位置している。また、一対の長辺をなす第３の先端部２１１１Ｃ及び第４の先端部２１１１Ｄは、第１の先端部２１１１Ａから第２の先端部２１１１Ｂに向かって上り勾配にて傾斜している。 The first tip portion 2111A and the second tip portion 2111B forming a pair of short sides have different tip positions in the direction along the axis C, and the second tip portion 2111B is the first tip portion 2111A. It is located on the tip side in the direction along the axis C. Further, the third tip portion 2111C and the fourth tip portion 2111D forming a pair of long sides are inclined in an upward gradient from the first tip portion 2111A to the second tip portion 2111B.
　実施の形態２に係るマーキングデバイス２０１では、マーキング部２１１の第１の先端部２１１１Ａと第２の先端部２１１１Ｂと第３の先端部２１１１Ｃと第４の先端部２１１１Ｄとによって、第１のマーキング対象位置Ｐ１と第２のマーキング対象位置Ｐ２とを含む長方形状の凹みを形成することができる。これにより、実施の形態２に係るマーキングデバイス２０１では、超音波処置具２を用いて長方形状の骨孔１１０を形成する際の狙いの位置の目印を、大腿骨外顆１００の斜面にある前十字靭帯付着部１４０にマーキングすることができる。 In the marking device 201 according to the second embodiment, the first marking target is formed by the first tip 2111A, the second tip 2111B, the third tip 2111C, and the fourth tip 2111D of the marking portion 211. A rectangular recess can be formed that includes the position P1 and the second marking target position P2. As a result, in the marking device 201 according to the second embodiment, the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set in front of the slope of the femoral lateral condyle 100. The cruciate ligament attachment portion 140 can be marked.
（実施の形態３）
　以下に、本発明に係るマーキングデバイスの実施の形態３について説明する。なお、実施の形態３において、実施の形態１と共通する部分の説明は適宜省略する。 (Embodiment 3)
Hereinafter, a third embodiment of the marking device according to the present invention will be described. In the third embodiment, the description of the parts common to the first embodiment will be omitted as appropriate.
　図２２に示すように、実施の形態３に係るマーキングデバイス３０１のマーキング部３１１は、シャフト部３１２の先端側に接続されており、第１のマーキング部３１１Ａと第２のマーキング部１１Ｂとが、それぞれ軸線Ｃの先端側から見て角括弧形状に構成されている。 As shown in FIG. 22, the marking portion 311 of the marking device 301 according to the third embodiment is connected to the tip end side of the shaft portion 312, and the first marking portion 311A and the second marking portion 11B are connected to each other. Each is configured in a square bracket shape when viewed from the tip side of the axis C.
　すなわち、第１のマーキング部３１１Ａは、マーキング部３１１の先端面３１１０から軸線Ｃに沿って立設した、第１の側壁３１１１Ａと第２の側壁３１１２Ａと第３の側壁３１１３Ａとを有している。第１の側壁３１１１Ａは、マーキング部３１１の先端面３１１０における短手方向（軸線Ｃに沿った方向に対して直交する第１の直交方向）に沿って延在している。第２の側壁３１１２Ａ及び第３の側壁３１１３Ａは、マーキング部３１１の先端面３１１０における長手方向（軸線Ｃに沿った方向及び第１の直交方向に対して直交する第２の直交方向）に沿って延在している。第２の側壁３１１２Ａは、第１の側壁３１１１Ａの前記短手方向の一端と繋がっている。第３の側壁３１１３Ａは、第１の側壁３１１１Ａの前記短手方向の他端と繋がっている。第１の側壁３１１１Ａの先端には、線状の先端部３１１４Ａが設けられている。第２の側壁３１１２Ａの先端には、線状の先端部３１１５Ａが設けられている。第３の側壁３１１３Ａの先端には、線状の先端部３１１６Ａが設けられている。なお、第１の側壁３１１１Ａの先端に設けられた線状の先端部３１１４Ａは、本発明における第１の線状部である。また、第２の側壁３１１２Ａの先端に設けられた線状の先端部３１１５Ａと、第３の側壁３１１３Ａの先端に設けられた線状の先端部３１１６Ａとは、本発明における第２の線状部である。そして、第１のマーキング部３１１Ａにおいては、先端部３１１４Ａ，３１１５Ａ、３１１６Ａによって第１の先端部が構成されている。先端部３１１４Ａの長さは、マーキング部３１１の先端面３１１０における短辺の長さと略同じである。先端部３１１５Ａ，３１１６Ａの長さは、先端部３１１４Ａの長さよりも短く、且つ、マーキング部３１１の先端面３１１０における長辺の長さの半分よりも短い。 That is, the first marking portion 311A has a first side wall 3111A, a second side wall 3112A, and a third side wall 3113A erected from the tip surface 3110 of the marking portion 311 along the axis C. .. The first side wall 3111A extends along the lateral direction (the first orthogonal direction orthogonal to the direction along the axis C) on the tip surface 3110 of the marking portion 311. The second side wall 3112A and the third side wall 3113A are along the longitudinal direction (the direction along the axis C and the second orthogonal direction orthogonal to the first orthogonal direction) on the tip surface 3110 of the marking portion 311. It is postponed. The second side wall 3112A is connected to one end of the first side wall 3111A in the lateral direction. The third side wall 3113A is connected to the other end of the first side wall 3111A in the lateral direction. A linear tip 3114A is provided at the tip of the first side wall 3111A. A linear tip 3115A is provided at the tip of the second side wall 3112A. A linear tip portion 3116A is provided at the tip of the third side wall 3113A. The linear tip portion 3114A provided at the tip of the first side wall 3111A is the first linear portion in the present invention. Further, the linear tip portion 3115A provided at the tip of the second side wall 3112A and the linear tip portion 3116A provided at the tip of the third side wall 3113A are the second linear portion in the present invention. Is. In the first marking portion 311A, the first tip portion is composed of the tip portions 3114A, 3115A, and 3116A. The length of the tip portion 3114A is substantially the same as the length of the short side of the tip surface 3110 of the marking portion 311. The lengths of the tip portions 3115A and 3116A are shorter than the length of the tip portion 3114A and shorter than half the length of the long side of the tip surface 3110 of the marking portion 311.
　また、第２のマーキング部３１１Ｂは、マーキング部３１１の先端面３１１０から軸線Ｃに沿って立設した、第１の側壁３１１１Ｂと第２の側壁３１１２Ｂと第３の側壁３１１３Ｂとを有している。第１の側壁３１１１Ｂは、マーキング部３１１の先端面３１１０における短手方向（第１の直交方向）に沿って延在している。第２の側壁３１１２Ｂ及び第３の側壁３１１３Ｃは、マーキング部３１１の先端面３１１０における長手方向（第２の直交方向）とに沿って延在している。第２の側壁３１１２Ｂは、第１の側壁３１１１Ｂの前記短手方向の一端と繋がっている。第３の側壁３１１３Ｂは、第１の側壁３１１１Ｂの前記短手方向の他端と繋がっている。第１の側壁３１１１Ｂの先端には、線状の先端部３１１４Ｂが設けられている。第２の側壁３１１２Ｂの先端には、線状の先端部３１１５Ｂが設けられている。第３の側壁３１１３Ｂの先端には、線状の先端部３１１６Ｂが設けられている。なお、第１の側壁３１１１Ｂの先端に設けられた線状の先端部３１１４Ｂは、本発明における第３の線状部である。また、第２の側壁３１１２Ｂの先端に設けられた線状の先端部３１１５Ｂと、第３の側壁３１１３Ｂの先端に設けられた線状の先端部３１１６Ｂとは、本発明における第４の線状部である。そして、第２のマーキング部３１１Ｂにおいては、先端部３１１４Ｂ，３１１５Ｂ、３１１６Ｂによって第２の先端部が構成されている。先端部３１１４Ｂの長さは、マーキング部３１１の先端面３１１０における短辺の長さと略同じである。先端部３１１５Ｂ及び先端部３１１６Ｂの長さは、先端部３１１４Ｂの長さよりも短く、且つ、マーキング部３１１の先端面３１１０における長辺の長さの半分よりも短い。 Further, the second marking portion 311B has a first side wall 3111B, a second side wall 3112B, and a third side wall 3113B which are erected from the tip surface 3110 of the marking portion 311 along the axis C. .. The first side wall 3111B extends along the lateral direction (first orthogonal direction) of the tip surface 3110 of the marking portion 311. The second side wall 3112B and the third side wall 3113C extend along the longitudinal direction (second orthogonal direction) of the tip surface 3110 of the marking portion 311. The second side wall 3112B is connected to one end of the first side wall 3111B in the lateral direction. The third side wall 3113B is connected to the other end of the first side wall 3111B in the lateral direction. A linear tip 3114B is provided at the tip of the first side wall 3111B. A linear tip 3115B is provided at the tip of the second side wall 3112B. A linear tip portion 3116B is provided at the tip of the third side wall 3113B. The linear tip portion 3114B provided at the tip of the first side wall 3111B is the third linear portion in the present invention. Further, the linear tip portion 3115B provided at the tip of the second side wall 3112B and the linear tip portion 3116B provided at the tip of the third side wall 3113B are the fourth linear portion in the present invention. Is. Then, in the second marking portion 311B, the tip portion 3114B, 3115B, 3116B constitutes the second tip portion. The length of the tip portion 3114B is substantially the same as the length of the short side on the tip surface 3110 of the marking portion 311. The lengths of the tip portion 3115B and the tip portion 3116B are shorter than the length of the tip portion 3114B and shorter than half the length of the long side on the tip surface 3110 of the marking portion 311.
　第１のマーキング部３１１Ａの前記第１の先端部と、第２のマーキング部３１１Ｂの前記第２の先端部とは、軸線Ｃに沿った方向にて先端位置が異なっており、前記第１の先端部よりも前記第２の先端部のほうが先端側に位置している。 The first tip portion of the first marking portion 311A and the second tip portion of the second marking portion 311B are different in tip position in the direction along the axis C, and the first tip position is different. The second tip is located closer to the tip than the tip.
　そして、実施の形態３に係るマーキングデバイス３０１では、第１のマーキング部３１１Ａと第２のマーキング部３１１Ｂとによって、大腿骨外顆１００の斜面に対して骨孔１１０を形成する狙いの位置に、図２３に示した角括弧形状の第１の凹み１６３と角括弧形状の第２の凹み１６４とを形成してマーキングを行うことができる。 Then, in the marking device 301 according to the third embodiment, the first marking portion 311A and the second marking portion 311B are used to form a bone hole 110 with respect to the slope of the femoral lateral condyle 100 at a target position. Marking can be performed by forming the square bracket-shaped first recess 163 and the square bracket-shaped second recess 164 shown in FIG. 23.
　なお、図２２に示すように、実施の形態３に係るマーキングデバイス３０１には、第１のマーキング部３１１Ａ及び第２のマーキング部３１１Ｂによるマーキングの深さを識別するためのマーキング深さ識別機能として、第１のマーキング部３１１Ａ及び第２のマーキング部３１１Ｂの側面に、マーキングの深さを示す目盛り１５Ａ，１５Ｂを設けても良い。 As shown in FIG. 22, the marking device 301 according to the third embodiment has a marking depth identification function for identifying the marking depth by the first marking unit 311A and the second marking unit 311B. , Scales 15A and 15B indicating the depth of marking may be provided on the side surfaces of the first marking portion 311A and the second marking portion 311B.
　また、実施の形態３に係るマーキングデバイス３０１では、図２３に示した、第１のマーキング部３１１Ａの第１の側壁３１１１Ａと、第２のマーキング部３１１Ｂの第１の側壁３１１１Ｂとに、図２４に示した切り欠き部３１１７Ａ及び切り欠き部３１１７Ｂをそれぞれ設けてもよい。これにより、図２３に示した第１のマーキング部３１１Ａにおける先端部３１１４Ａは、図２４に示すように、切り欠き部３１１７Ａを境にして２つの先端部３１１４Ａａ，３１１４Ａｂに分けられる。そのため、第１のマーキング部３１１Ａでは、軸線Ｃの先端側から見て、先端部３１１４Ａａと先端部３１１５ＡとがＬ字状を成し、先端部３１１４Ａｂと先端部３１１６ＡとがＬ字状を成す。同様に、図２３に示した第２のマーキング部３１１Ｂにおける先端部３１１４Ｂは、図２４に示すように、切り欠き部３１１７Ｂを境にして２つの先端部３１１４Ｂａ，３１１４Ｂｂに分けられる。そのため、第２のマーキング部３１１Ｂでは、軸線Ｃの先端側から見て、先端部３１１４Ｂａと先端部３１１５ＢとがＬ字状を成し、先端部３１１４Ｂｂと先端部３１１６ＢとがＬ字状を成す。 Further, in the marking device 301 according to the third embodiment, the first side wall 3111A of the first marking portion 311A and the first side wall 3111B of the second marking portion 311B shown in FIG. 23 are formed in FIG. 24. The cutout portion 3117A and the cutout portion 3117B shown in the above may be provided, respectively. As a result, as shown in FIG. 24, the tip portion 3114A of the first marking portion 311A shown in FIG. 23 is divided into two tip portions 3114Aa and 3114Ab with the notch portion 3117A as a boundary. Therefore, in the first marking portion 311A, the tip portion 3114Aa and the tip portion 3115A form an L-shape, and the tip portion 3114Ab and the tip portion 3116A form an L-shape when viewed from the tip side of the axis C. Similarly, as shown in FIG. 24, the tip portion 3114B of the second marking portion 311B shown in FIG. 23 is divided into two tip portions 3114Ba and 3114Bb with the notch portion 3117B as a boundary. Therefore, in the second marking portion 311B, the tip portion 3114Ba and the tip portion 3115B form an L-shape, and the tip portion 3114Bb and the tip portion 3116B form an L-shape when viewed from the tip side of the axis C.
　そして、図２４に示したマーキングデバイス３０１では、第１のマーキング部３１１Ａと第２のマーキング部３１１Ｂとによって、大腿骨外顆１００の斜面に対して骨孔１１０を形成する狙いの位置に、図２５に示した、一対のＬ字状の凹み１６５ａ，１６５ｂと、一対のＬ字状の凹み１６６ａ，１６６ｂとを形成してマーキングを行うことができる。 Then, in the marking device 301 shown in FIG. 24, the first marking portion 311A and the second marking portion 311B are positioned at a target position for forming the bone hole 110 with respect to the slope of the femoral lateral condyle 100. Marking can be performed by forming a pair of L-shaped recesses 165a and 165b and a pair of L-shaped recesses 166a and 166b shown in 25.
（実施の形態４）
　以下に、本発明に係るマーキングデバイスの実施の形態４について説明する。なお、実施の形態４において、実施の形態１と共通する部分の説明は適宜省略する。 (Embodiment 4)
Hereinafter, a fourth embodiment of the marking device according to the present invention will be described. In the fourth embodiment, the description of the parts common to the first embodiment will be omitted as appropriate.
　図２６に示すように、実施の形態４に係るマーキングデバイス４０１においては、第１のマーキング部４１１Ａ、第２のマーキング部４１１Ｂ、第１のシャフト部４１２Ａ，第２のシャフト部４１２Ｂ、及び、ハンドル部４１３を有している。 As shown in FIG. 26, in the marking device 401 according to the fourth embodiment, the first marking portion 411A, the second marking portion 411B, the first shaft portion 412A, the second shaft portion 412B, and the handle It has a part 413.
　第１のマーキング部４１１Ａ及び第２のマーキング部４１１Ｂは、それぞれ軸線Ｃと直交する方向に長尺な立方体状である。第１のマーキング部４１１Ａにおける先端側の２つの短辺４１１１Ａ，４１１２Ａのうち、例えば、外側に位置する短辺４１１１Ａは、第１のマーキング対象位置Ｐ１にマーキングを行う、本発明の第１の先端部である。第２のマーキング部４１１Ｂにおける先端側の２つの短辺４１１１Ｂ，４１１２Ｂのうち、例えば、内側に位置する短辺４１１２Ｂは、第２のマーキング対象位置Ｐ２にマーキングを行う、本発明の第２の先端部である。 The first marking portion 411A and the second marking portion 411B each have a long cubic shape in a direction orthogonal to the axis C. Of the two short sides 4111A and 4112A on the tip side of the first marking portion 411A, for example, the short side 4111A located on the outside marks the first marking target position P1, the first tip of the present invention. It is a department. Of the two short sides 4111B and 4112B on the tip side of the second marking portion 411B, for example, the short side 4112B located inside marks the second marking target position P2, the second tip of the present invention. It is a department.
　第１のシャフト部４１２Ａは、第１のマーキング部４１１Ａの基端側に接続されており、第１のマーキング部４１１Ａから軸線Ｃに沿って基端側に延伸した棒状となっている。第２のシャフト部４１２Ｂは、第２のマーキング部４１１Ｂの基端側に接続されており、第２のマーキング部４１１Ｂから軸線Ｃに沿って基端側に延伸した棒状となっている。 The first shaft portion 412A is connected to the base end side of the first marking portion 411A, and has a rod shape extending from the first marking portion 411A to the base end side along the axis C. The second shaft portion 412B is connected to the base end side of the second marking portion 411B, and has a rod shape extending from the second marking portion 411B to the base end side along the axis C.
　ハンドル部４１３は、ハンマー４によって叩かれるハンマーヘッド４１３１を有している。このハンマーヘッド４１３１は、マーキングデバイス４０１における軸線Ｃに沿った基端側の端面を成している。 The handle portion 413 has a hammer head 4131 that is hit by the hammer 4. The hammer head 4131 forms an end surface on the proximal end side along the axis C of the marking device 401.
　また、ハンドル部４１３は、第１のシャフト部４１２Ａの基端側と第２のシャフト部４１２Ｂの基端側とに接続されており、第１のシャフト部４１２Ａと第２のシャフト部４１２Ｂとの少なくとも一方を軸線Ｃに沿った方向にて移動可能に保持している。例えば、第１のシャフト部４１２Ａはハンドル部４１３に固定し、第２のシャフト部４１２Ｂはハンドル部４１３に対して軸線Ｃに沿って移動可能にハンドル部４１３に保持させる。なお、この際、第２のシャフト部４１２Ｂは、例えば、ハンドル部４１３に対して移動させないときにネジなどの固定部材によってハンドル部４１３に固定され、ハンドル部４１３に対して移動させるときに固定部材による固定が解除される。また、第１のシャフト部４１２Ａと第２のシャフト部４１２Ｂとは、例えば、互いに磁石を設けて磁力により束ねるようにしてもよい。 Further, the handle portion 413 is connected to the base end side of the first shaft portion 412A and the base end side of the second shaft portion 412B, and the first shaft portion 412A and the second shaft portion 412B are connected to each other. At least one is held movable in the direction along the axis C. For example, the first shaft portion 412A is fixed to the handle portion 413, and the second shaft portion 412B is held by the handle portion 413 so as to be movable along the axis C with respect to the handle portion 413. At this time, the second shaft portion 412B is fixed to the handle portion 413 by a fixing member such as a screw when it is not moved to the handle portion 413, and is fixed to the handle portion 413 when it is moved to the handle portion 413. Is released. Further, the first shaft portion 412A and the second shaft portion 412B may be bundled by magnetic force, for example, by providing magnets to each other.
　次に、実施の形態４に係るマーキングデバイス４０１を用いたマーキング方法の一例について説明する。 Next, an example of a marking method using the marking device 401 according to the fourth embodiment will be described.
　まず、術者は、図２６に示すように、皮膚１２０に開けられたポータル１２１からマーキングデバイス４０１の第１のマーキング部４１１Ａ、第２のマーキング部４１１Ｂ、第１のシャフト部４１２Ａ及び第２のシャフト部４１２Ｂを挿入する。次に、術者は、関節鏡９１の視野内にて、大腿骨外顆１００における前十字靭帯付着部１４０付近を観察しながら、前十字靭帯付着部１４０に第１のマーキング部４１１Ａが到達するまでマーキングデバイス４０１を挿入する。次に、術者は、関節鏡９１の視野内にて、図２７に示すように、第１のマーキング対象位置Ｐ１に第１のマーキング部４１１Ａの短辺４１１１Ａを当接させる。次に、術者は、第１のマーキング対象位置Ｐ１に第１のマーキング部４１１Ａの短辺４１１１Ａを当接させた状態にて、第２のシャフト部４１２Ｂをハンドル部４１３に対して軸線Ｃの先端側に移動させ、第２のマーキング対象位置Ｐ２に第２のマーキング部４１１Ｂの短辺４１１２Ｂを当接させる。このようにして、実施の形態４に係るマーキングデバイス４０１では、第１のマーキング部４１１Ａの短辺４１１１Ａと、第２のマーキング部４１１Ｂの短辺４１１２Ｂとを、軸線Ｃに沿った方向にて先端位置を異ならせて、短辺４１１１Ａよりも短辺４１１２Ｂを先端側に位置させる。 First, as shown in FIG. 26, the surgeon first marks the marking device 401 from the portal 121 opened in the skin 120, the first marking portion 411A, the second marking portion 411B, the first shaft portion 412A, and the second. Insert the shaft portion 412B. Next, the operator reaches the anterior cruciate ligament attachment portion 140 with the first marking portion 411A while observing the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 within the field of view of the arthroscope 91. Insert the marking device 401 up to. Next, the operator brings the short side 4111A of the first marking portion 411A into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG. 27. Next, the operator puts the second shaft portion 412B on the handle portion 413 on the axis C in a state where the short side 4111A of the first marking portion 411A is in contact with the first marking target position P1. It is moved to the tip side, and the short side 4112B of the second marking portion 411B is brought into contact with the second marking target position P2. In this way, in the marking device 401 according to the fourth embodiment, the short side 4111A of the first marking portion 411A and the short side 4112B of the second marking portion 411B are tipped in the direction along the axis C. The short side 4112B is positioned closer to the tip side than the short side 4111A by changing the position.
　そして、術者は、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に短辺４１１１Ａ及び短辺４１１２Ｂを当接させた状態にて、ハンドル部４１３のハンマーヘッド４１３１をハンマー４によって叩き、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、短辺４１１１Ａ及び短辺４１１２Ｂを打ち込む。これによって、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、それぞれ線状の凹みが形成される。このようにして、実施の形態４に係るマーキングデバイス４０１では、超音波処置具２を用いて長方形状の骨孔１１０を形成する際の狙いの位置の目印を、大腿骨外顆１００の斜面にある前十字靭帯付着部１４０にマーキングすることができる。 Then, the operator hits the hammer head 4131 of the handle portion 413 with the hammer 4 in a state where the short side 4111A and the short side 4112B are in contact with the first marking target position P1 and the second marking target position P2. , The short side 4111A and the short side 4112B are driven into the first marking target position P1 and the second marking target position P2. As a result, linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively. In this way, in the marking device 401 according to the fourth embodiment, the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100. A certain anterior cruciate ligament attachment portion 140 can be marked.
（実施の形態５）
　以下に、本発明に係るマーキングデバイスの実施の形態５について説明する。なお、実施の形態５において、実施の形態１と共通する部分の説明は適宜省略する。 (Embodiment 5)
Hereinafter, a fifth embodiment of the marking device according to the present invention will be described. In the fifth embodiment, the description of the parts common to the first embodiment will be omitted as appropriate.
　図２８に示すように、実施の形態５に係るマーキングデバイス５０１においては、第１のマーキング部５１１Ａ、第２のマーキング部５１１Ｂ、第１のシャフト部５２１Ａ，第２のシャフト部５２１Ｂ、及び、ハンドル部５１３を有している。 As shown in FIG. 28, in the marking device 501 according to the fifth embodiment, the first marking portion 511A, the second marking portion 511B, the first shaft portion 521A, the second shaft portion 521B, and the handle It has a part 513.
　第１のマーキング部５１１Ａは、第１のマーキング対象位置Ｐ１に当接させる線状の第１の先端部５１１１Ａを有している。第１の先端部５１１１Ａは、第１のマーキング部５１１Ａにおける内側面５１１２Ａと外側面５１１３Ａとを互いに接続する辺を成している。第２のマーキング部５１１Ｂは、第２のマーキング対象位置Ｐ２に当接させる線状の第２の先端部５１１１Ｂを有している。第２の先端部５１１１Ｂは、第２のマーキング部５１１Ｂにおける内側面５１１２Ｂと外側面５１１３Ｂとを互いに接続する辺を成している。 The first marking portion 511A has a linear first tip portion 5111A that comes into contact with the first marking target position P1. The first tip portion 5111A forms a side connecting the inner side surface 5112A and the outer side surface 5113A of the first marking portion 511A to each other. The second marking portion 511B has a linear second tip portion 5111B that comes into contact with the second marking target position P2. The second tip portion 5111B forms a side connecting the inner side surface 5112B and the outer side surface 5113B of the second marking portion 511B to each other.
　第１のシャフト部５１２Ａは、第１のマーキング部５１１Ａの基端側に接続されており、第１のマーキング部５１１Ａから軸線Ｃに沿って基端側に延伸した棒状となっている。第２のシャフト部５１２Ｂは、第２のマーキング部５１１Ｂの基端側に接続されており、第２のマーキング部５１１Ｂから軸線Ｃに沿って基端側に延伸した棒状となっている。 The first shaft portion 512A is connected to the base end side of the first marking portion 511A, and has a rod shape extending from the first marking portion 511A to the base end side along the axis C. The second shaft portion 512B is connected to the base end side of the second marking portion 511B, and has a rod shape extending from the second marking portion 511B to the base end side along the axis C.
　ハンドル部５１３は、ハンマー４によって叩かれるハンマーヘッド５１３１を有している。このハンマーヘッド５１３１は、マーキングデバイス５０１における軸線Ｃに沿った基端側の端面を成している。 The handle portion 513 has a hammer head 5131 that is hit by the hammer 4. The hammer head 5131 forms a proximal end surface of the marking device 501 along the axis C.
　ハンドル部５１３は、第１のシャフト部５１２Ａの基端側と第２のシャフト部５１２Ｂの基端側とに接続されており、第１のシャフト部５１２Ａと第２のシャフト部５１２Ｂとの少なくとも一方を軸線Ｃに沿った方向にて移動可能に保持している。例えば、第１のシャフト部５１２Ａはハンドル部５１３に固定し、第２のシャフト部５１２Ｂはハンドル部５１３に対して軸線Ｃに沿って移動可能にハンドル部５１３に保持させる。なお、この際、第２のシャフト部５１２Ｂは、例えば、ハンドル部５１３に対して移動させないときにネジなどの固定部材によってハンドル部５１３に固定され、ハンドル部５１３に対して移動させるときに固定部材による固定が解除される。また、第１のシャフト部５１２Ａと第２のシャフト部５１２Ｂとは、例えば、互いに磁石を設けて磁力により束ねるようにしてもよい。 The handle portion 513 is connected to the proximal end side of the first shaft portion 512A and the proximal end side of the second shaft portion 512B, and at least one of the first shaft portion 512A and the second shaft portion 512B. Is movably held in the direction along the axis C. For example, the first shaft portion 512A is fixed to the handle portion 513, and the second shaft portion 512B is held by the handle portion 513 so as to be movable along the axis C with respect to the handle portion 513. At this time, the second shaft portion 512B is fixed to the handle portion 513 by a fixing member such as a screw when it is not moved to the handle portion 513, and is fixed to the handle portion 513 when it is moved to the handle portion 513. Is released. Further, the first shaft portion 512A and the second shaft portion 512B may be bundled by magnetic force, for example, by providing magnets to each other.
　次に、実施の形態５に係るマーキングデバイス５０１を用いたマーキング方法の一例について説明する。 Next, an example of a marking method using the marking device 501 according to the fifth embodiment will be described.
　まず、術者は、図２８に示すように、皮膚１２０に開けられたポータル１２１からマーキングデバイス５０１の第１のマーキング部５１１Ａ、第２のマーキング部５１１Ｂ、第１のシャフト部５１２Ａ及び第２のシャフト部５１２Ｂを挿入する。次に、術者は、関節鏡９１の視野内にて、大腿骨外顆１００における前十字靭帯付着部１４０付近を観察しながら、前十字靭帯付着部１４０に第１のマーキング部５１１Ａが到達するまでマーキングデバイス５０１を挿入する。次に、術者は、関節鏡９１の視野内にて、図２９に示すように、第１のマーキング対象位置Ｐ１に第１のマーキング部５１１Ａの第１の先端部５１１１Ａを当接させる。次に、術者は、第１のマーキング対象位置Ｐ１に第１の先端部５１１１Ａを当接させた状態にて、第２のシャフト部５１２Ｂをハンドル部５１３に対して軸線Ｃの先端側に移動させ、第２のマーキング対象位置Ｐ２に第２のマーキング部５１１Ｂの第２の先端部５１１１Ｂを当接させる。このようにして、実施の形態５に係るマーキングデバイス５０１では、第１のマーキング部５１１Ａの第１の先端部５１１１Ａと、第２のマーキング部５１１Ｂの短辺５１１１Ｂとを、軸線Ｃに沿った方向にて先端位置を異ならせて、第１の先端部４１１１Ａよりも第２の先端部５１１１Ｂを先端側に位置させる。 First, as shown in FIG. 28, the surgeon has a first marking portion 511A, a second marking portion 511B, a first shaft portion 512A, and a second marking device 501 from the portal 121 opened in the skin 120. Insert the shaft portion 512B. Next, the operator reaches the anterior cruciate ligament attachment portion 140 with the first marking portion 511A while observing the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91. Insert the marking device 501 up to. Next, the operator brings the first tip portion 5111A of the first marking portion 511A into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG. 29. Next, the operator moves the second shaft portion 512B to the tip side of the axis C with respect to the handle portion 513 in a state where the first tip portion 5111A is in contact with the first marking target position P1. Then, the second tip portion 5111B of the second marking portion 511B is brought into contact with the second marking target position P2. In this way, in the marking device 501 according to the fifth embodiment, the first tip portion 5111A of the first marking portion 511A and the short side 5111B of the second marking portion 511B are oriented along the axis C. The second tip portion 5111B is positioned closer to the tip side than the first tip portion 4111A.
　そして、術者は、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に第１の先端部５１１１Ａ及び第２の先端部５１１１Ｂを当接させた状態にて、ハンドル部５１３のハンマーヘッド５１３１をハンマー４によって叩き、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、第１の先端部５１１１Ａ及び第２の先端部５１１１Ｂを打ち込む。これによって、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、それぞれ線状の凹みが形成される。このようにして、実施の形態５に係るマーキングデバイス５０１では、超音波処置具２を用いて長方形状の骨孔１１０を形成する際の狙いの位置の目印を、大腿骨外顆１００の斜面にある前十字靭帯付着部１４０にマーキングすることができる。 Then, the operator makes the hammer head of the handle portion 513 in a state where the first tip portion 5111A and the second tip portion 5111B are in contact with the first marking target position P1 and the second marking target position P2. The 5131 is hit with a hammer 4, and the first tip portion 5111A and the second tip portion 5111B are driven into the first marking target position P1 and the second marking target position P2. As a result, linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively. In this way, in the marking device 501 according to the fifth embodiment, the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100. A certain anterior cruciate ligament attachment portion 140 can be marked.
（実施の形態６）
　以下に、本発明に係るマーキングデバイスの実施の形態６について説明する。なお、実施の形態６において、実施の形態１と共通する部分の説明は適宜省略する。 (Embodiment 6)
Hereinafter, a sixth embodiment of the marking device according to the present invention will be described. In the sixth embodiment, the description of the parts common to the first embodiment will be omitted as appropriate.
　図３０に示すように、実施の形態６に係るマーキングデバイス６０１は、マーキング部６１１とシャフト部６１２とハンドル部６１３とを有している。マーキング部６１１は、軸線Ｃに対して直交する方向に長尺な立方体形状であり、先端面の長手方向の両端に、それぞれ三角形状の第１のマーキング部１１Ａと三角形状の第２のマーキング部１１Ｂとを有している。第１のマーキング部１１Ａは、第１のマーキング対象位置Ｐ１に当接させる線状の第１の先端部６１１１Ａを有している。第１の先端部６１１１Ａは、第１のマーキング部６１１Ａにおける内側面６１１２Ａと外側面６１１３Ａとを互いに接続する辺を成している。第２のマーキング部６１１Ｂは、第２のマーキング対象位置Ｐ２に当接させる線状の第２の先端部６１１１Ｂを有している。第２の先端部６１１１Ｂは、第２のマーキング部６１１Ｂにおける内側面６１１２Ｂと外側面６１１３Ｂとを互いに接続する辺を成している。 As shown in FIG. 30, the marking device 601 according to the sixth embodiment has a marking portion 611, a shaft portion 612, and a handle portion 613. The marking portion 611 has a cubic shape that is long in the direction orthogonal to the axis C, and has a triangular first marking portion 11A and a triangular second marking portion at both ends in the longitudinal direction of the tip surface, respectively. It has 11B and. The first marking portion 11A has a linear first tip portion 6111A that comes into contact with the first marking target position P1. The first tip portion 6111A forms a side connecting the inner side surface 6112A and the outer side surface 6113A of the first marking portion 611A to each other. The second marking portion 611B has a linear second tip portion 6111B that comes into contact with the second marking target position P2. The second tip portion 6111B forms a side connecting the inner side surface 6112B and the outer side surface 6113B of the second marking portion 611B to each other.
　シャフト部１２の先端側は、軸ピン６１４によってマーキング部６１１に接続されており、マーキング部６１１から軸線Ｃに沿って基端側に延伸した棒状となっている。そして、マーキング部６１１は、シャフト部６１２に対して軸ピン６１４を中心に回動可能となっている。 The tip end side of the shaft portion 12 is connected to the marking portion 611 by a shaft pin 614, and has a rod shape extending from the marking portion 611 toward the base end side along the axis C. The marking portion 611 is rotatable about the shaft pin 614 with respect to the shaft portion 612.
　ハンドル部６１３は、ハンマー４によって叩かれるハンマーヘッド６１３１を有している。このハンマーヘッド６１３１は、マーキングデバイス６０１における軸線Ｃに沿った基端側の端面を成している。 The handle portion 613 has a hammer head 6131 that is hit by the hammer 4. The hammer head 6131 forms an end surface on the proximal end side along the axis C of the marking device 601.
　次に、実施の形態６に係るマーキングデバイス６０１を用いたマーキング方法の一例について説明する。 Next, an example of a marking method using the marking device 601 according to the sixth embodiment will be described.
　まず、術者は、図３０に示すように、皮膚１２０に開けられたポータル１２１からマーキングデバイス６０１のマーキング部６１１及びシャフト部６１２を挿入する。次に、術者は、関節鏡９１の視野内にて、大腿骨外顆１００における前十字靭帯付着部１４０付近を観察しながら、前十字靭帯付着部１４０にマーキング部６１１が到達するまでマーキングデバイス６０１を挿入する。次に、術者は、関節鏡９１の視野内にて、図３１に示すように、第１のマーキング対象位置Ｐ１にマーキング部６１１の第１の先端部６１１１Ａを当接させる。次に、術者は、第１のマーキング対象位置Ｐ１に第１の先端部６１１１Ａを当接させた状態にて、さらにシャフト部６１２を軸線Ｃの先端側に挿入し、軸ピン６１４を中心にマーキング部６１１を回動させて、第２のマーキング対象位置Ｐ２に第２のマーキング部６１１Ｂの第２の先端部６１１１Ｂを当接させる。そして、術者は、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に第１の先端部６１１１Ａ及び第２の先端部６１１１Ｂを当接させた状態にて、ハンドル部６１３のハンマーヘッド６１３１をハンマー４によって叩き、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、第１の先端部６１１１Ａ及び第２の先端部６１１１Ｂを打ち込む。これによって、第１のマーキング対象位置Ｐ１及び第２のマーキング対象位置Ｐ２に、それぞれ線状の凹みが形成される。このようにして、実施の形態６に係るマーキングデバイス６０１では、超音波処置具２を用いて長方形状の骨孔１１０を形成する際の狙いの位置の目印を、大腿骨外顆１００の斜面にある前十字靭帯付着部１４０にマーキングすることができる。 First, as shown in FIG. 30, the operator inserts the marking portion 611 and the shaft portion 612 of the marking device 601 from the portal 121 opened in the skin 120. Next, the operator observes the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91, and the marking device until the marking portion 611 reaches the anterior cruciate ligament attachment portion 140. Insert 601. Next, the operator brings the first tip portion 6111A of the marking portion 611 into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG. Next, the operator further inserts the shaft portion 612 into the tip end side of the axis C with the first tip portion 6111A in contact with the first marking target position P1, centering on the shaft pin 614. The marking portion 611 is rotated so that the second tip portion 6111B of the second marking portion 611B is brought into contact with the second marking target position P2. Then, the operator makes the hammer head of the handle portion 613 in a state where the first tip portion 6111A and the second tip portion 6111B are in contact with the first marking target position P1 and the second marking target position P2. The 6131 is hit with a hammer 4, and the first tip portion 6111A and the second tip portion 6111B are driven into the first marking target position P1 and the second marking target position P2. As a result, linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively. In this way, in the marking device 601 according to the sixth embodiment, the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100. A certain anterior cruciate ligament attachment portion 140 can be marked.
　以上のように、本発明は、骨孔を形成する際の狙いの位置にマーキングすることができるマーキングデバイス、マーキング方法、及び、骨孔形成方法を提供することができる。 As described above, the present invention can provide a marking device, a marking method, and a bone hole forming method capable of marking a target position when forming a bone hole.
１，２０１，３０１，４０１，５０１，６０１　マーキングデバイス
４　ハンマー
５　超音波処置具システム
６　超音波処置具
７　制御装置
８　フットスイッチ
９　内視鏡システム
１０　処置システム
１１，６１１　マーキング部
１１Ａ，３１１Ａ，４１１Ａ，５１１Ａ，６１１Ａ　第１のマーキング部
１１Ｂ，３１１Ｂ，４１１Ｂ，５１１Ｂ，６１１Ｂ　第２のマーキング部
１２，６１２　シャフト部
１３，４１３，５１３，６１３　ハンドル部
１４Ａ，１４Ｂ，１５Ａ，１５Ｂ　目盛り
６１　デバイス本体
６１ａ　ハウジング
６１ｂ　超音波振動子ユニット
６２　超音波発生部
６３　ホーン
６４　超音波プローブ
６５　先端処置部
６５ａ　第１の打面
６５ｂ　第２の打面
６５ｃ　第３の打面
６６　シース
６７　操作スイッチ
６８　ケーブル
７１　前面
７２　コネクタ
７３　操作スイッチ
７４　表示画面
９１　関節鏡
９２　光源
９３　制御部
９４　入力部
９５　表示部
９６　送水排水部
１００　大腿骨外顆
１０１　第１の骨孔
１０２　第２の骨孔
１０３　隔壁部
１１０　骨孔
１１１Ａ，２１１１Ａ，５１１１Ａ，６１１１Ａ　第１の先端部
１１１Ｂ，２１１１Ｂ，５１１１Ｂ，６１１１Ｂ　第２の先端部
１１２Ａ，１１２Ｂ，５１１２Ａ，５１１２Ｂ　内側面
１１３Ａ，１１３Ｂ，５１１３Ａ，５１１３Ｂ　外側面
１３１，４１３１，５１３１，６１３１　ハンマーヘッド
１４０　前十字靭帯付着部
１５０　切削領域
１５０ａ，１５０ｂ　短辺
１５０ｃ，１５０ｄ　長辺
１６１，１６３　第１の凹み
１６２，１６４　第２の凹み
１６５ａ，１６５ｂ，１６６ａ，１６６ｂ　凹み
４１２Ａ，５１２Ａ　第１のシャフト部
４１２Ｂ，５１２Ｂ　第２のシャフト部
６１４　軸ピン
２１１１Ｃ　第３の先端部
２１１１Ｄ　第４の先端部
２１１２　開口部
３１１１Ａ，３１１１Ｂ　第１の側壁
３１１２Ａ，３１１２Ｂ　第２の側壁
３１１３Ａ，３１１３Ｂ　第３の側壁
３１１４Ａ，３１１４Ａａ，３１１４Ａｂ　先端部
３１１４Ｂ，３１１４Ｂａ，３１１４Ｂｂ　先端部
３１１５Ａ，３１１５Ｂ，３１１６Ａ，３１１６Ｂ　先端部
３１１７Ａ，３１１７Ｂ　切り欠き部 1,201,301,401,501,601 Marking device 4 Hammer 5 Ultrasonic treatment tool system 6 Ultrasonic treatment tool 7 Control device 8 Foot switch 9 Endoscopic system 10 Treatment system 11,611 Marking part 11A, 311A, 411A , 511A, 611A First marking part 11B, 311B, 411B, 511B, 611B Second marking part 12,612 Shaft part 13,413,513,613 Handle part 14A, 14B, 15A, 15B Scale 61 Device body 61a Housing 61b Ultrasonic transducer unit 62 Ultrasonic generator 63 Horn 64 Ultrasonic probe 65 Tip treatment part 65a First striking surface 65b Second striking surface 65c Third striking surface 66 Sheath 67 Operation switch 68 Cable 71 Front 72 Connector 73 Operation switch 74 Display screen 91 Arthroscopy 92 Light source 93 Control unit 94 Input unit 95 Display unit 96 Water supply / drainage unit 100 Femoral lateral condyle 101 First bone hole 102 Second bone hole 103 Partition part 110 Bone hole 111A, 2111A , 5111A, 6111A First tip 111B, 2111B, 5111B, 6111B Second tip 112A, 112B, 5112A, 5112B Inner side surface 113A, 113B, 5113A, 5113B Outer side surface 131, 4131, 5131, 6131 Hammer head 140 front Cruciate ligament attachment part 150 Cutting area 150a, 150b Short side 150c, 150d Long side 161,163 First dent 162,164 Second dent 165a, 165b, 166a, 166b Recess 412A, 512A First shaft part 412B, 512B Second shaft portion 614 Shaft pin 2111C Third tip portion 2111D Fourth tip portion 2112 Openings 3111A, 3111B First side wall 3112A, 3112B Second side wall 3113A, 3113B Third side wall 3114A, 3114Aa, 3114Ab Tip 3114B, 3114Ba, 3114Bb Tip 3115A, 3115B, 3116A, 3116B Tip 3117A, 3117B Notch

Claims (9)

  1. 　第１の先端部を有する第１のマーキング部と、
    　第２の先端部を有する第２のマーキング部と、
    　前記第１のマーキング部及び前記第２のマーキング部の基端側から延伸して設けられたシャフト部と、
    　前記シャフト部の基端側に接続されたハンドル部と、
    　を有し、
    　前記第１の先端部と前記第２の先端部とは、軸線に沿った方向の先端位置が異なるマーキングデバイス。     A first marking portion having a first tip portion and
    A second marking portion having a second tip portion and
    A shaft portion extending from the base end side of the first marking portion and the second marking portion, and a shaft portion.
    The handle portion connected to the base end side of the shaft portion and the handle portion
    Have,
    A marking device in which the first tip portion and the second tip portion have different tip positions in a direction along an axis.
  2. 　前記第１の先端部と前記第２の先端部とを通る仮想直線と、前記軸線とのなす角度が、４０度以上５５度以下である請求項１に記載のマーキングデバイス。 The marking device according to claim 1, wherein the angle between the virtual straight line passing through the first tip portion and the second tip portion and the axis line is 40 degrees or more and 55 degrees or less.
  3. 　前記第１の先端部と前記第２の先端部との前記軸線に沿った方向と直交する方向における間隔が、処置対象部位における予め設定された長方形状の切削領域の長手方向の長さよりも短い請求項１に記載のマーキングデバイス。 The distance between the first tip and the second tip in the direction orthogonal to the direction along the axis is shorter than the longitudinal length of the preset rectangular cutting region at the treatment target site. The marking device according to claim 1.
  4. 　前記第１の先端部は、前記軸線に沿った方向に対して直交する第１の直交方向に延在する第１の線状部と、前記軸線に沿った方向及び前記第１の直交方向に対して直交する第２の直交方向に延在する第２の線状部と、を有し、
    　前記第２の先端部は、前記第１の直交方向に延在する第３の線状部と、前記第２の直交方向に延在する第４の線状部と、を有する請求項１に記載のマーキングデバイス。     The first tip portion has a first linear portion extending in a first orthogonal direction orthogonal to a direction along the axis, a direction along the axis, and the first orthogonal direction. It has a second linear portion extending in a second orthogonal direction orthogonal to the second linear portion, and has.
    According to claim 1, the second tip portion has a third linear portion extending in the first orthogonal direction and a fourth linear portion extending in the second orthogonal direction. The marking device described.
  5. 　前記第１のマーキング部及び前記第２のマーキング部は、処置対象部位に対してマーキングを行った際の深さを識別可能なマーキング深さ識別部を有する請求項１に記載のマーキングデバイス。 The marking device according to claim 1, wherein the first marking unit and the second marking unit have a marking depth identification unit capable of identifying the depth when marking is performed on a treatment target site.
  6. 　関節鏡の視野内にて観察しながら、マーキング対象となる骨の位置までマーキングデバイスを挿入し、
    　前記関節鏡の視野内にて、第１のマーキング対象位置に前記マーキングデバイスの第１のマーキング部を当接させ、
    　前記関節鏡の視野内にて、前記第１のマーキング部を当接させた状態にて、第２のマーキング対象位置に第２のマーキング部を当接させ、
    　前記第１のマーキング部及び前記第２のマーキング部を共に当接させた状態にて、前記第１のマーキング対象位置及び前記第２のマーキング対象位置に前記マーキングデバイスを打ち込むことによって、第１の凹み及び第２の凹みを形成するマーキング方法。     While observing in the field of view of the arthroscope, insert the marking device to the position of the bone to be marked, and insert the marking device.
    Within the field of view of the arthroscope, the first marking portion of the marking device is brought into contact with the first marking target position.
    In the field of view of the arthroscope, with the first marking portion in contact with the second marking target position, the second marking portion is brought into contact with the second marking target position.
    The first marking device is driven into the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are in contact with each other. A marking method for forming a dent and a second dent.
  7. 　形成した前記第１の凹み及び前記第２の凹みを前記関節鏡によって観察して位置を確認する請求項６に記載のマーキング方法。 The marking method according to claim 6, wherein the formed first dent and the second dent are observed with the arthroscope to confirm the position.
  8. 　関節鏡の視野内にて観察しながら、マーキング対象となる骨の位置までマーキングデバイスを挿入し、
    　前記関節鏡の視野内にて、第１のマーキング対象位置に前記マーキングデバイスの第１のマーキング部を当接させ、
    　前記関節鏡の視野内にて、前記第１のマーキング部を当接させた状態にて、第２のマーキング対象位置に第２のマーキング部を当接させ、
    　前記第１のマーキング部及び前記第２のマーキング部を共に当接させた状態にて、前記第１のマーキング対象位置及び前記第２のマーキング対象位置に前記マーキングデバイスを打ち込むことによって、第１の凹み及び第２の凹みを形成し、
    　前記関節鏡の視野内にて観察しながら、形成された前記第１の凹み及び前記第２の凹みのうちの一方の凹みの位置に切削処置具を挿入し、前記切削処置具によって切削して骨孔を形成し、
    　前記関節鏡の視野内にて観察しながら、形成された前記第１の凹み及び前記第２の凹みのうち他方の凹みの位置に前記切削処置具を挿入し、前記切削処置具によって切削して骨孔を形成する骨孔形成方法。     While observing in the field of view of the arthroscope, insert the marking device to the position of the bone to be marked, and insert the marking device.
    Within the field of view of the arthroscope, the first marking portion of the marking device is brought into contact with the first marking target position.
    In the field of view of the arthroscope, with the first marking portion in contact with the second marking target position, the second marking portion is brought into contact with the second marking target position.
    The first marking device is driven into the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are in contact with each other. Form a dent and a second dent,
    While observing in the field of view of the arthroscope, the cutting treatment tool is inserted into the position of one of the first recess and the second recess formed, and the cutting treatment tool is used for cutting. Form a bone hole and
    While observing in the field of view of the arthroscope, the cutting treatment tool is inserted into the position of the other dent of the first dent and the second dent formed, and the cutting treatment tool is used for cutting. A method for forming a bone hole to form a bone hole.
  9. 　前記一方の凹みの位置に形成された骨孔と、前記他方の凹みの位置に形成された骨孔と、の間の骨を前記切削処置具によって切削して骨孔を形成する請求項８に記載の骨孔形成方法。 The eighth aspect of the present invention, wherein the bone between the bone hole formed at the position of the one recess and the bone hole formed at the position of the other recess is cut by the cutting treatment tool to form the bone hole. The method for forming a bone hole described.
PCT/JP2020/003805 2020-01-31 2020-01-31 Marking device, marking method, and bone hole forming method WO2021152854A1 (en)

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JP2011512943A (en) * 2008-02-27 2011-04-28 イリオン・メディカル・リミテッド・ライアビリティ・カンパニー Tools for performing non-invasive orthopedic joint surgery
WO2015046348A1 (en) * 2013-09-27 2015-04-02 オリンパスメディカルシステムズ株式会社 Probe unit, treatment tool, and treatment system
JP5771670B2 (en) * 2013-11-22 2015-09-02 タキロン株式会社 Drill guide

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Publication number Priority date Publication date Assignee Title
JP2007503921A (en) * 2003-09-02 2007-03-01 ウォーソー・オーソペディック・インコーポレーテッド Devices and techniques for intervertebral disc space preparation and graft insertion with minimal invasion
JP2011512943A (en) * 2008-02-27 2011-04-28 イリオン・メディカル・リミテッド・ライアビリティ・カンパニー Tools for performing non-invasive orthopedic joint surgery
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