WO2022091357A1

WO2022091357A1 - Guiding device, treatment system, and treatment method

Info

Publication number: WO2022091357A1
Application number: PCT/JP2020/040865
Authority: WO
Inventors: 健藤崎; 宜瑞坂本; 嘉郎有働
Original assignee: オリンパス株式会社
Priority date: 2020-10-30
Filing date: 2020-10-30
Publication date: 2022-05-05
Also published as: JPWO2022091357A1

Abstract

In order to perform low-invasive treatment with three portals - for an endoscope, for a suction tool of a shaver or the like, and for an ultrasonic probe - when perfusate is being sent out and discharged, a guiding device (4) is provided with a cylindrical guide body (41) that has a through hole (411) where a cutting treatment tool that is used in a liquid is inserted, wherein an inner peripheral surface of the guide body has provided thereto: a protrusion (415) that protrudes toward a central axis (Ax) of the guide body, extends along said central axis, and guides movement of the cutting treatment tool along said central axis; and a groove (416) that is recessed toward an outer peripheral surface of the guide body, extends along the abovementioned central axis, and serves as a flow channel through which liquid circulates.

Description

Guiding device, treatment system, and treatment method

The present invention relates to a guiding device, a treatment system, and a treatment method.

Conventionally, in anterior cruciate ligament reconstruction by the BTB (Bone Tendon Bone) method, an ultrasonic probe is used to form a bone hole with a rectangular cross section in the bone to be a fixation site for transplanting a new ligament. The technique is known (see, for example, Patent Document 1).
In the technique described in Patent Document 1, first, two bone holes having a rectangular cross section smaller than a desired bone hole having a rectangular cross section are formed side by side. Then, after that, the two bone holes are connected to form one bone hole.

International Publication No. 2018/078831

However, in the technique described in Patent Document 1, the operator advances the ultrasonic probe to the bone by freehand. Therefore, there is a problem that it is difficult to accurately direct the axis of the ultrasonic probe to the direction or position where the bone hole should be formed, and it is difficult to perform a desired cutting (treatment).

By the way, the anterior cruciate ligament reconstruction is generally performed in a state where the joint cavity is filled with a perfusate such as physiological saline. Specifically, the perfusate is delivered into the joint cavity through an endoscope inserted into the joint cavity. In addition, the perfusate in the joint cavity is discharged through a suction tool such as a shaver inserted in the joint cavity.
However, when the perfusate is delivered and discharged as described above, the portal that communicates between the inside of the joint cavity and the outside of the skin is for an endoscope, a suction tool such as a shaver, and an ultrasonic probe. There will be three. That is, there is a problem that the number of portals is three and it is difficult to perform treatment with minimal invasiveness.

The present invention has been made in view of the above, and an object of the present invention is to provide a guiding device, a treatment system, and a treatment method capable of performing a desired treatment with minimal invasiveness.

In order to solve the above-mentioned problems and achieve the object, the guiding device according to the present invention includes a tubular guide body having a through hole through which a cutting treatment tool used in a liquid is inserted, and the guide body is provided. On the inner peripheral surface of the guide body, a convex portion that protrudes toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting treatment tool along the central axis, and the guide body. There is provided a groove portion that is recessed toward the outer peripheral surface of the surface and extends along the central axis to serve as a flow path through which the liquid flows.

The treatment system according to the present invention includes an endoscope, a cutting treatment tool used in a liquid, and a guiding device having a tubular guide body having a through hole through which the cutting treatment tool is inserted. On the inner peripheral surface of the guide body, a convex portion that protrudes toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting treatment tool along the central axis. A groove portion that is recessed toward the outer peripheral surface of the guide body and extends along the central axis to serve as a flow path for the liquid to flow is provided.

The treatment method according to the present invention is a treatment using an endoscope, a cutting treatment tool used in a liquid, and a guiding device having a tubular guide body having a through hole through which the cutting treatment tool is inserted. In this method, the inner peripheral surface of the guide body projects toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting tool along the central axis. It becomes a flow path that is recessed toward the outer peripheral surface of the guide body and extends along the central axis to discharge the liquid from the tip of the guide body toward the base end of the guide body. A groove portion is provided, and in the treatment method, the guiding device is positioned in the field of view of the endoscope in the joint cavity, the cutting treatment tool is inserted into the through hole, and the cutting treatment tool is continuously inserted. The living body is cut by driving it.

According to the guiding device, treatment system, and treatment method according to the present invention, the desired treatment can be performed with minimal invasiveness.

FIG. 1 is a diagram showing a schematic configuration of a treatment system according to an embodiment. FIG. 2 is a diagram illustrating an ultrasonic probe. FIG. 3 is a diagram illustrating an ultrasonic probe. FIG. 4 is a diagram illustrating a guiding device. FIG. 5 is a diagram illustrating a guiding device. FIG. 6 is a diagram illustrating a guiding device. FIG. 7 is a diagram illustrating a treatment method. FIG. 8 is a diagram illustrating a treatment method. FIG. 9 is a diagram illustrating a treatment method. FIG. 10 is a diagram illustrating a treatment method. FIG. 11 is a diagram illustrating a treatment method. FIG. 12 is a diagram illustrating a treatment method. FIG. 13A is a diagram illustrating a treatment method. FIG. 13B is a diagram illustrating a treatment method. FIG. 13C is a diagram illustrating a treatment method. FIG. 14 is a diagram illustrating a treatment method. FIG. 15 is a diagram illustrating a treatment method. FIG. 16 is a diagram illustrating a treatment method. FIG. 17 is a diagram illustrating a treatment method. FIG. 18 is a diagram illustrating a treatment method. FIG. 19 is a diagram illustrating a treatment method. FIG. 20 is a diagram illustrating a treatment method. FIG. 21 is a diagram illustrating a treatment method. FIG. 22 is a diagram illustrating a treatment method. FIG. 23 is a diagram illustrating a treatment method. FIG. 24 is a diagram illustrating a treatment method. FIG. 25A is a diagram showing a modification 1 of the embodiment. FIG. 25B is a diagram showing a modification 1 of the embodiment. FIG. 26A is a diagram showing a modification 2 of the embodiment. FIG. 26B is a diagram showing a modified example 3 of the embodiment. FIG. 26C is a diagram showing a modified example 4 of the embodiment. FIG. 27 is a diagram showing a modified example 5 of the embodiment. FIG. 28 is a diagram showing a modified example 6 of the embodiment.

Hereinafter, embodiments for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. The present invention is not limited to the embodiments described below. Further, in the description of the drawings, the same parts are designated by the same reference numerals.

[Outline configuration of treatment system]
FIG. 1 is a diagram showing a schematic configuration of a treatment system 1 according to an embodiment.
The treatment system 1 treats a living tissue such as bone by applying ultrasonic vibration to the living tissue. Here, the treatment means, for example, removal or cutting of a living tissue such as bone. Note that FIG. 1 illustrates a treatment system for performing anterior cruciate ligament reconstruction as the treatment system 1.
As shown in FIG. 1, the treatment system 1 includes an endoscope device 2, a treatment device 3, a guiding device 4, and a perfusion device 6. The guiding device 4 will be described later.

As shown in FIG. 1, the endoscope device 2 includes an endoscope 21 and a first control device 22.
As shown in FIG. 1, in the endoscope 21, the tip portion of the insertion portion 211 is inserted into the joint cavity C1 through the first portal P1 that communicates the inside of the joint cavity C1 of the knee joint J1 and the outside of the skin. To. Then, the endoscope 21 irradiates the inside of the joint cavity C1 and captures the illumination light (subject image) reflected in the joint cavity C1 to image the subject image.
The first control device 22 performs various image processing on the captured image captured by the endoscope 21, and displays the captured image after the image processing on a display device (not shown).

As shown in FIG. 1, the treatment device 3 includes a cutting treatment tool 31, a second control device 32, and a foot switch 33.
As shown in FIG. 1, the cutting treatment tool 31 includes a treatment tool main body 311, an ultrasonic probe 312 (see FIG. 2), and a sheath 313.
The treatment tool main body 311 is formed in a cylindrical shape. An ultrasonic transducer 311a (Bolt-clamped Langevin-type transducer) that generates ultrasonic vibration according to the supplied drive power is configured inside the treatment tool main body 311. Figure 1) is stored.
Here, the second control device 32 supplies the driving power to the ultrasonic vibrator 311a in response to the operation of the foot switch 33 by the operator. The supply of the driving power is not limited to the operation to the foot switch 33, and may be performed, for example, in response to the operation to the operation unit (not shown) provided on the cutting treatment tool 31.

2 and 3 are views illustrating the ultrasonic probe 312. Specifically, FIG. 2 is a perspective view of the ultrasonic probe 312 as viewed from the tip side. FIG. 3 is a diagram showing how the ultrasonic probe 312 forms the bone hole 101.
The ultrasonic probe 312 is made of, for example, a titanium alloy or the like, and has a substantially cylindrical shape. The base end portion of the ultrasonic probe 312 is connected to the ultrasonic transducer 311a in the treatment tool main body 311. Then, the ultrasonic probe 312 transmits the ultrasonic vibration generated by the ultrasonic vibrator 311a from the base end to the tip end. In the present embodiment, the ultrasonic vibration is longitudinal vibration along the longitudinal direction (vertical direction in FIGS. 2 and 3) of the ultrasonic probe 312. Further, as shown in FIG. 2 or 3, a tip treatment portion 312a is provided at the tip portion of the ultrasonic probe 312.
The tip treatment portion 312a includes a base portion 312b and a tip portion 312c, as shown in FIG. 2 or FIG.
The substrate portion 312b has a shape that defines the contour shape of the bone hole formed in the bone by the ultrasonic probe 312. Specifically, in the substrate portion 312b, the cross-sectional shape orthogonal to the axis extending along the longitudinal direction of the ultrasonic probe 312 has a side length of a1 and another side length of b1 (as shown in FIG. 2). It is a rectangle of <a1). In the following, for convenience of explanation, the surface including the side of the length a1 is referred to as the surface 312d (FIG. 2) and the surface including the side of the length b1 is described as the surface 312e (FIG. 2) in the substrate portion 312b. do.
The tip portion 312c has a shape in which the cross-sectional area decreases toward the tip. The tip surface of the tip portion 312c is a flat surface.

The sheath 313 is formed in a cylindrical shape elongated from the treatment tool main body 311 and covers a part of the outer circumference of the ultrasonic probe 312 from the treatment tool main body 311 to an arbitrary length.

The tip portion of the ultrasonic probe 312 in the cutting treatment tool 31 described above is guided by the guiding device 4 inserted into the joint cavity C1 through the second portal P2 that communicates the inside of the joint cavity C1 and the outside of the skin. At the same time, it is inserted into the joint cavity C1.
Then, as shown in FIG. 3, when ultrasonic vibration is generated in a state where the tip treatment portion 312a is in contact with the bone treatment target portion 100, the hammer ring action mechanically causes the tip treatment portion 312a and the tip treatment portion 312a. The part of the bone that collided is crushed into fine particles. Then, when the tip treatment portion 312a is pushed into the treatment target site 100 by the operator, the tip treatment portion 312a enters the inside of the treatment target site 100 while crushing the bone. As a result, a bone hole 101 having a rectangular cross section having the same cross-sectional shape as that of the base portion 312b is formed in the treatment target site 100.

In the anterior cruciate ligament reconstruction using the treatment system 1 according to the present embodiment, the first and second bone holes 511 with respect to the anterior cruciate ligament attachment portion on the lateral surface of the lateral condyle of the femur as the treatment target site 100. , 512 (see FIG. 18). Here, the first and second bone holes 511, 512 each have a rectangular cross section of vertical a1 × horizontal b1, and are formed side by side with a certain interval d1. Then, by connecting the first and second bone holes 511, 512, a bone hole 510 having a rectangular cross section (see FIG. 24) having a side length of a1 and a other side length of 2b1 + d1 is finally formed. Will be done.

The guiding device 4 is inserted into the joint cavity C1 through the second portal P2, and guides the insertion of the tip portion of the ultrasonic probe 312 in the cutting treatment tool 31 into the joint cavity C1.
The detailed configuration of the guiding device 4 will be described later.

Here, the inside of the joint cavity C1 is filled with a perfusate such as physiological saline. Then, the perfusate is sent out into the joint cavity C1 by the perfusion device 6 and discharged out of the joint cavity C1. As shown in FIG. 1, the perfusion device 6 includes a liquid source 61, a liquid feed tube 62, a liquid feed pump 63, a liquid drain bottle 64, a liquid drain tube 65, and a liquid drain pump 66.
The liquid source 61 houses the perfusate.
One end of the liquid feeding tube 62 is connected to the liquid source 61, and the other end is connected to the endoscope 21.
The liquid feed pump 63 delivers the perfusate from the liquid source 61 toward the endoscope 21 through the liquid feed tube 62. Then, the perfusate delivered to the endoscope 21 is delivered into the joint cavity C1 from the liquid feeding hole 211a (see FIG. 12) formed in the tip portion of the insertion portion 211.

The drainage bottle 64 contains the perfusate drained out of the joint cavity C1.
One end of the drainage tube 65 is connected to the guiding device 4, and the other end is connected to the drainage bottle 64.
The drainage pump 66 follows the flow path of the guiding device 4 to the drainage tube 65 inserted into the joint cavity C1 and discharges the perfusate in the joint cavity C1 to the drainage bottle 64. In this embodiment, the drainage pump 66 will be described, but the present invention is not limited to this, and a suction device provided in the facility may be used.

[Guiding device configuration]
4 to 6 are diagrams illustrating the guiding device 4. Specifically, FIG. 4 is a perspective view showing the appearance of the guiding device 4. FIG. 5 is a view of the guiding device 4 as viewed from the tip side (left side in FIG. 4). FIG. 6 is a cross-sectional view showing a state in which the ultrasonic probe 312 is inserted through the guiding device 4.
The guiding device 4 includes a guide main body 41, a protrusion 42, a handle portion 43 (FIGS. 4 and 6), and a cocked drainage portion 44 (FIGS. 4 and 6).

As shown in FIG. 1, the guide main body 41 has a tubular shape having a through hole 411 through which the ultrasonic probe 312 is inserted. Then, the guide main body 41 regulates the progress of the ultrasonic probe 312 inserted through the through hole 411 in a certain direction, and guides the movement of the ultrasonic probe 312. In the present embodiment, the cross-sectional shapes of the outer peripheral surface and the inner peripheral surface of the guide main body 41 orthogonal to the central axis Ax (FIG. 6) are substantially circular, respectively.

As shown in FIG. 4 or 6, the guide main body 41 becomes thinner toward the tip (left side in FIGS. 4 and 6). That is, the tip surface of the guide main body 41 is not a plane orthogonal to the central axis Ax, but a slope 412 diagonally intersecting the plane. As a result, a space is created in the vicinity of the protrusion 42 in the guide main body 41, so that the visibility of the tip treatment portion 312a in the ultrasonic probe 312 inserted through the through hole 411 can be improved.
In the following, for convenience of explanation, the base end portion (the right side portion in FIGS. 4 and 6) is referred to as the slope base end portion 412a (FIGS. 4 to 6) on the slope 412, and the tip portion (FIG. 4). And in FIG. 6, the left side portion) is referred to as a slope tip portion 412b (FIGS. 4 to 6).

Further, the guide main body 41 is provided with a notch portion 413 (FIGS. 4 to 6) which is linearly cut out from the slope base end portion 412a toward the base end side.
Further, as shown in FIG. 6, the guide main body 41 is provided with a slit 414 that penetrates the inside and outside of the guide main body 41. The slit 414 extends linearly from the position on the proximal end side toward the proximal end side by a predetermined dimension from the slope tip portion 412b. That is, the slit 414 is provided on the side facing the notch 413.

Further, as shown in FIG. 5, a convex portion 415 and a groove portion 416 are provided on the inner peripheral surface of the guide main body 41.
As shown in FIG. 5, the convex portion 415 projects toward the central axis Ax and extends along the central axis Ax. Then, the convex portion 415 guides the movement of the ultrasonic probe 312 inserted through the through hole 411 along the central axis Ax. In this embodiment, a plurality of convex portions 415 are provided. The plurality of convex portions 415 are provided in a state of rotational symmetry about the central axis Ax. The number of convex portions 415 is not limited to the number shown in FIG. 5, and other numbers may be provided. The same applies to the number of grooves 416.

As shown in FIG. 5, the groove portion 416 is recessed toward the outer peripheral surface of the guide main body 41 and extends along the central axis Ax. The groove 416 serves as a flow path through which the perfusate flows. In the present embodiment, the groove portions 416 are provided between the adjacent convex portions 415, respectively. The plurality of groove portions 416 are provided in a state of rotational symmetry about the central axis Ax. Further, the plurality of groove portions 416 serve as a flow path for discharging the perfusate liquid from the tip end to the base end of the guide main body 41. In the case of the present embodiment, the plurality of groove portions 416 are extended to the positions where they are guided to the flow path of the drainage portion 44 with a cock. Further, by preventing the groove portion 416 from having the groove portion 416 on the proximal end side of the drainage portion 44 with a cock on the inner peripheral surface of the guide main body 41, the liquid can be drained only from the inside of the body. Further, the depth of the groove portion 416 is 0.1 mm or more and 1.0 mm or less. Further, the width of the groove portion 416 is 0.1 mm or more, and is 1/3 or less of the entire circumference centered on the central axis Ax.

The protrusion 42 has a plate shape that linearly protrudes from the outer peripheral surface of the slope tip portion 412b side of the guide main body 41 toward the tip side. That is, the protrusion 42 is provided at a position avoiding the projection region in which the through hole 411 is projected along the central axis Ax.
In the following, for convenience of explanation, a flat plate surface located on the central axis Ax side and parallel to the central axis Ax is referred to as a first surface 421 (FIGS. 4 to 6). do. Further, in the protrusion 42, the surface on the side separated from the central axis Ax and forming the front and back surfaces with the first surface 421 is referred to as a second surface 422 (FIGS. 4 to 6).

As shown in FIGS. 4 to 6, the second surface 422 is formed in a stepped shape in which the region on the distal end side is located closer to the central axis Ax than the region on the proximal end side. In the following, for convenience of explanation, in the second surface 422, the region on the distal end side is described as the second distal end side surface 422a, and the region on the proximal end side is described as the second proximal end side surface 422b. The stepped portion that is the boundary between the tip side surface 422a and the second base end side surface 422b is referred to as a stepped portion 422c. Here, the second tip end side surface 422a and the second base end side surface 422b are flat surfaces parallel to the first surface 421, respectively. Further, the stepped portion 422c is a surface substantially orthogonal to the second tip end side surface 422a and the second base end side surface 422b.

In the protrusion 42 described above, the cross-sectional shape cut by the plane passing through the second base end side surface 422b and orthogonal to the central axis Ax has a plurality of protrusions when the through hole 411 is viewed along the central axis Ax. It has a rectangular shape slightly smaller than the rectangular shape 411a (FIG. 5) inscribed in the circle (shown by the alternate long and short dash line in FIG. 5) formed by the tip of the portion 415. In the present embodiment, the diameter of the through hole 411 is set to be between 3 mm and 10 mm. Further, the cross-sectional shape is substantially the same as the cross-sectional shape cut in a plane orthogonal to the central axis Ax in the tip treatment portion 312a. That is, the protrusion 42 is set to a size that can be inserted into the bone hole formed by the tip treatment portion 312a.

The handle portion 43 has a plate shape connected to the base end of the guide main body 41 and is a portion held by the operator. The shape of the handle portion 43 is not limited to the plate body shape, and may be any other shape. Further, the handle portion 43 is arranged on the same side as the side on which the protrusion 42 is arranged with respect to the central axis Ax of the guide main body 41. That is, when the handle portion 43 is gripped, the protrusion portion 42 is located on the same side as the handle portion 43. On the other hand, the notch 413 is located on the opposite side.

The drainage portion 44 with a cock is provided on the outer peripheral surface of the guide main body 41 and has a tubular shape that communicates with the inside of the guide main body 41. Then, one end of the drainage tube 65 is connected to the drainage portion 44 with a cock. That is, the drainage portion 44 with a cock serves as a flow path for communicating the groove portion 416 and the drainage tube 65. Hereinafter, the flow path is referred to as a drainage flow path. The drainage unit 44 with a cock is configured to be able to open and close the drainage flow path by operating the cock (not shown).

[Treatment method]
Next, a treatment method using the treatment system 1 will be described.
7 to 24 are views illustrating a treatment method.
First, the operator closes the drainage flow path by operating the cock (not shown) of the drainage unit 44 with a cock. In addition, the operator inserts the guiding device 4 into the joint cavity C1 through the second portal P2. Further, the operator operates the guiding device 4 while checking the captured image captured by the endoscope 21 and displayed on the display device (not shown). Specifically, the surgeon aligns the central axis Ax of the guiding device 4 with respect to the femoral lateral condyle 500 in the direction in which the bone hole should be formed, and as shown in FIG. 7, the femoral lateral condyle 500 and the like. The protrusion 42 is inserted between the bones of the knee joint. Here, the guiding device 4 is in a posture in which the notch portion 413 side faces the arrangement side of the endoscope 21. In other words, the guiding device 4 is in a posture in which the slit 414 side faces the side opposite to the arrangement side of the endoscope 21. Then, as shown in FIG. 8, the operator abuts the first surface 421 against the posterior wall 501 of the femoral lateral condyle 500.

Next, the surgeon inserts the ultrasonic probe 312 through the through hole 411, images the ultrasonic probe 312 by the endoscope 21, and confirms the captured image displayed on the display device (not shown). It is projected from the tip (slope 412) of the guide body 41. Further, the operator sets the rotation position of the ultrasonic probe 312 about the central axis Ax to the rotation position where the surface 312d is parallel to the first surface 421 (FIG. 9). Then, the operator brings the tip treatment portion 312a of the ultrasonic probe 312 set at the rotation position into contact with the surface of the femoral lateral condyle 500. At this time, the ultrasonic probe 312 is guided by the tips of the plurality of protrusions 415 so that it can proceed in the direction in which the bone hole should be formed with respect to the femoral lateral condyle 500.

Next, the operator opens the drainage flow path by operating the cock (not shown) of the drainage unit 44 with a cock. That is, the drainage of the perfusate in the joint cavity C1 is started. Specifically, the perfusate in the joint cavity C1 sent out from the liquid feeding hole 211a (see FIG. 12) of the endoscope 21 is sucked to the tip portion (notch portion 413 and slit) of the guide main body 41. 414) -Groove portion 416-Drainage flow path-Drainage tube 65-Drainage is discharged by following the flow path of the drainage bottle 64.

Next, the operator makes the ultrasonic probe 312 ultrasonically vibrate by operating the foot switch 33. As a result, the tip treatment portion 312a cuts the femoral lateral condyle 500 as shown in FIG. Then, as shown in FIG. 11, the femoral lateral condyle 500 has a first rectangular cross-sectional shape having a side length of a1 and another side length of b1 at a position separated from the posterior wall 501 by a distance d1. Bone hole 511 is formed. The operator forms the first bone hole 511 without penetrating the femoral lateral condyle 500.

Here, when forming the first bone hole 511, the granular fine bone crushed by the ultrasonic probe 312 is released into the perfusate in the joint cavity C1. Then, the fine bone released into the perfusate follows the flow of the perfusate, as shown by the arrow in FIG. 12, from the tip of the guide body 41, the position of the notch 413, and the position of the slit 414 to the groove 416. Is sucked into. As a result, the turbidity of the visual field of the endoscope 21 is eliminated. By driving the ultrasonic probe 312 as described above, the first bone hole 511 is formed.
When the field of view of the endoscope 21 is obscured by the fine bone when the first bone hole 511 is formed, the ultrasonic probe 312 becomes invisible (the state shown in FIGS. 13A to 13B). In the case of), the operator operates the foot switch 33 to intermittently drive the ultrasonic probe 312 to temporarily stop the operation. In FIG. 13B, fine bones are represented by dots. Then, when the fine bone is sucked into the groove 416, the turbidity of the visual field of the endoscope 21 is eliminated, and the ultrasonic probe 312 becomes visible (when the state shown in FIGS. 13B to 13C is obtained). ), The operator drives the ultrasonic probe 312 again. By driving the ultrasonic probe 312 as described above, the first bone hole 511 is formed.

Next, the operator pulls out the ultrasonic probe 312 from the through hole 411 and separates the first surface 421 from the rear wall 501. After that, the operator confirms the image captured by the endoscope 21 and displayed on the display device (not shown), and as shown in FIGS. 14 and 15, the protrusion 42 is the first bone. Fit into the hole 511. More specifically, the surgeon abuts the second proximal side surface 422b on the first inner wall surface 511a on the posterior wall 501 side in the first bone hole 511, and the operator makes a second in the first bone hole 511. The first surface 421 is set to be in contact with the second inner wall surface 511b facing the inner wall surface 511a of 1. As a result, the guiding device 4 is positioned with respect to the lateral femoral condyle 500.

Next, the surgeon inserts the ultrasonic probe 312 through the through hole 411, images the ultrasonic probe 312 by the endoscope 21, and confirms the captured image displayed on the display device (not shown). It is projected from the tip (slope 412) of the guide body 41. Further, the operator sets the rotation position of the ultrasonic probe 312 about the central axis Ax to the rotation position where the surface 312d is parallel to the first surface 421 (FIG. 16). Then, the operator brings the tip treatment portion 312a of the ultrasonic probe 312 set at the rotation position into contact with the surface of the femoral lateral condyle 500. At this time, the ultrasonic probe 312 is guided by the tips of the plurality of protrusions 415 so that it can proceed in the direction in which the bone hole should be formed with respect to the femoral lateral condyle 500. Then, the operator makes the ultrasonic probe 312 ultrasonically vibrate by operating the foot switch 33. As a result, the tip treatment portion 312a cuts the femoral lateral condyle 500 as shown in FIG. Then, as shown in FIG. 18, the femoral lateral condyle 500 has a rectangular cross-section with a side length of a1 and another side length of b1 at a position separated from the first bone hole 511 by a distance d1. The second bone hole 512 is formed. The surgeon forms the second bone hole 512 without penetrating the femoral lateral condyle 500. Further, as described with reference to FIGS. 13A to 13C, when the operator forms the second bone hole 512, the field of view of the endoscope 21 is obscured by the fine bone, and the ultrasonic probe 312 is invisible. If this happens, the foot switch 33 is operated to intermittently drive the ultrasonic probe 312 to temporarily stop the operation. Further, when the turbidity of the visual field of the endoscope 21 is eliminated and the ultrasonic probe 312 becomes visible, the operator drives the ultrasonic probe 312 again.
By forming the second bone hole 512 as described above, the perforation direction of the second bone hole 512 becomes parallel to the perforation direction of the first bone hole 511. Further, as shown in FIG. 18, the femoral lateral condyle 500 is left with a partition wall 513, which is a bone portion having a thickness of a distance d1 between the first and second bone holes 511, 512, and the first and second bone holes are left. The second bone holes 511, 512 are formed adjacent to each other.

Next, the operator pulls out the ultrasonic probe 312 from the through hole 411. After that, the surgeon pulls out the proximal end portion of the protrusion 42 from the first bone hole 511 while checking the captured image imaged by the endoscope 21 and displayed on the display device (not shown). It is assumed that the tip portion of the protrusion 42 is inserted into the first bone hole 511. Then, the surgeon abuts at least a part of the stepped portion 422c on the edge of the first bone hole 511, and abuts the second tip side surface 422a on the first inner wall surface 511a (FIGS. 19 and 20). ). As a result, the guiding device 4 is positioned with respect to the lateral femoral condyle 500. More specifically, it is desirable that the guiding device 4 is in close contact with the bone wall of the first bone hole 511 in the direction of the width a1 of the protrusion 42 up to the depth inserted into the first bone hole 511. At this time, the guiding device 4 can be stably fixed and positioned in the first bone hole 511.

Next, the surgeon inserts the ultrasonic probe 312 through the through hole 411, images the ultrasonic probe 312 by the endoscope 21, and confirms the captured image displayed on the display device (not shown). It is projected from the tip (slope 412) of the guide body 41. Further, the operator sets the rotation position of the ultrasonic probe 312 about the central axis Ax to the rotation position where the surface 312d is parallel to the first surface 421 (FIG. 21). Then, the operator brings the tip treatment portion 312a of the ultrasonic probe 312 set at the rotation position into contact with the surface of the partition wall 513. At this time, the ultrasonic probe 312 is guided by the tips of the plurality of protrusions 415 so that it can proceed in the direction in which the bone hole should be formed with respect to the femoral lateral condyle 500. Then, the operator makes the ultrasonic probe 312 ultrasonically vibrate by operating the foot switch 33. As a result, the tip treatment portion 312a cuts the partition wall 513 as shown in FIG. 22. Then, as shown in FIGS. 23 and 24, the first and second bone holes 511, 512 communicate with each other, and the femoral lateral condyle 500 has a side length of a1 and a side length of 2b1 + d1. A bone hole 510 having a rectangular cross section is formed. As described with reference to FIGS. 13A to 13C, when the surgeon forms the partition wall 513, the field of view of the endoscope 21 is obscured by fine bones, and the ultrasonic probe 312 becomes invisible. Operates the foot switch 33 to intermittently drive the ultrasonic probe 312 to temporarily stop. Further, when the turbidity of the visual field of the endoscope 21 is eliminated and the ultrasonic probe 312 becomes visible, the operator drives the ultrasonic probe 312 again.

In the above-described embodiment, the first bone hole 511 is formed at a position separated from the rear wall 501 by a distance d1, but the present invention is not limited to this, and the distance d1'is different from the distance d1 from the rear wall 501. The first bone hole 511 may be formed at a position only distant from each other. In this case, when forming the first bone hole 511, for example, another guiding device different from the guiding device 4 is used.

According to the present embodiment described above, the following effects are obtained.
The treatment system 1 according to the present embodiment includes the guiding device 4 described above. Therefore, by using the guiding device 4, the axis of the ultrasonic probe 312 can be accurately directed to the direction and position where the bone hole should be formed, and the desired cutting (treatment) can be performed.
Further, in the guiding device 4 according to the present embodiment, a groove portion 416 that serves as a flow path for the perfusate is provided on the inner peripheral surface of the guide main body 41. Therefore, there are two portals for communicating the inside of the joint cavity C1 and the outside of the skin for the endoscope 21 and the ultrasonic probe 312 (guiding device 4) for sending and discharging the perfusate. That is, the number of portals is two, and treatment can be performed with minimal invasiveness.
From the above, according to the treatment system 1 according to the present embodiment, the desired treatment can be performed with minimal invasiveness.

Further, in the guiding device 4 according to the present embodiment, the protrusion 42 is provided at a position avoiding the projection region where the through hole 411 is projected along the central axis Ax.
Therefore, by using the protrusion 42, the guiding device 4 can be easily positioned, and the movement of the ultrasonic probe 312 along the central axis Ax can be satisfactorily guided.

Further, in the guiding device 4 according to the present embodiment, the groove portion 416 is a flow path for discharging the perfusate from the tip end to the base end of the guide main body 41.
Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 can be discharged to the outside of the joint cavity C1 together with the perfusate through the groove 416. That is, the turbidity of the visual field of the endoscope 21 can be satisfactorily eliminated, and the desired treatment can be satisfactorily performed.

Further, in the guiding device 4 according to the present embodiment, the depth and width of the groove portion 416 are each 0.1 mm or more.
Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 can be satisfactorily sucked into the groove 416 together with the perfusate.

Further, in the guiding device 4 according to the present embodiment, the depth of the groove portion 416 is 1.0 mm or less.
Therefore, the wall thickness of the guide main body 41 does not become unnecessarily thin, and the strength of the guide main body 41 can be sufficiently maintained.

Further, in the guiding device 4 according to the present embodiment, the width of the groove portion 416 is 1/3 or less of the entire circumference centered on the central axis Ax. That is, by setting the width of the groove portion 416 to 1/3 or less of the entire circumference centered on the central axis Ax, three or more convex portions 415 are provided, and the ultrasonic probe 312 is provided by the three or more convex portions 415. Can be stably supported.

Further, in the guiding device 4 according to the present embodiment, the groove portion 416 is provided in a state of rotational symmetry about the central axis Ax.
Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 together with the perfusate is evenly distributed in the circumferential direction centered on the central axis Ax from the tip of the guide body 41. It can be sucked into the groove 416.

Further, in the guiding device 4 according to the present embodiment, the guide main body 41 is provided with the notch portion 413 described above on the arrangement side of the endoscope 21.
Therefore, among the fine bones crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1, the fine bones located between the ultrasonic probe 312 and the endoscope 21 are cut out. It can be effectively sucked from the portion 413 to the groove portion 416. That is, the turbidity of the visual field of the endoscope 21 can be effectively eliminated.

Further, in the guiding device 4 according to the present embodiment, the guide main body 41 is provided with the slit 414 described above on the side opposite to the arrangement side of the endoscope 21.
Therefore, among the fine bones crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1, the fine bones that wrap around to the side opposite to the placement side of the endoscope 21 are removed from the slit 414. It can be effectively sucked into the groove 416. That is, the fine bone that wraps around to the side opposite to the placement side of the endoscope 21 does not move between the ultrasonic probe 312 and the endoscope 21, and the field of view of the endoscope 21 can be seen. Can be maintained well.

Further, in the treatment system 1 according to the present embodiment, the perfusion device 6 includes a drainage pump 66.
Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 can be positively sucked into the groove 416. That is, the turbidity of the visual field of the endoscope 21 can be effectively eliminated.

(Other embodiments)
Although the embodiments for carrying out the present invention have been described so far, the present invention should not be limited only to the above-described embodiments.
In the above-described embodiment, the flow path for sending the perfusate into the joint cavity C1 is set on the endoscope 21 side, and the flow path for discharging the perfusate to the outside of the joint cavity C1 is set in the groove 416. However, the flow path of transmission and discharge may be set in reverse.
In the above-described embodiment, the guide main body 41 is formed in a cylindrical shape, but the guide body 41 is not limited to this, and may have any other shape as long as it is a cylindrical shape.
In the above-described embodiment, the ultrasonic probe 312 is used as the cutting treatment tool according to the present invention, but the present invention is not limited to this, and other cutting treatment tools such as a drill may be used.
In the above-described embodiment, the cross-sectional shape of the tip treatment portion 312a is not limited to a rectangular shape, but may be another polygonal shape, a circular shape, or an elliptical shape.
In the above-described embodiment, the cross-sectional shape of the inner peripheral surface of the guide main body 41 is not limited to a circular shape, and may be, for example, any other shape capable of defining the orientation of the cutting treatment tool.

25A and 25B are diagrams showing a modification 1 of the embodiment. Specifically, FIG. 25A is a perspective view showing a tip portion of the guiding device 4A according to the first modification. In FIG. 25A, the protrusion 42 is not shown for convenience of explanation. FIG. 25B is a cross-sectional view of the guiding device 4A cut through the notch 413 and at a plane orthogonal to the central axis Ax (the plane at position S shown by the alternate long and short dash line in FIG. 25A).
In the above-described embodiment, the groove portion 416 is provided in a state of rotational symmetry about the central axis Ax.
On the other hand, in the present modification 1, as shown in FIGS. 25A and 25B, only one groove portion 416 is provided, and the groove portion 416 is provided in a state of not being rotationally symmetric with respect to the central axis Ax. More specifically, the groove portion 416 is provided on the notch portion 413 side. That is, the groove portion 416 is provided on the arrangement side of the endoscope 21.
Even when the present modification 1 is adopted, the same effect as that of the above-described embodiment is obtained.

26A to 26C are diagrams showing modified examples 2 to 4 of the embodiment. Specifically, FIGS. 26A to 26C are cross-sectional views corresponding to FIG. 25B.
In the above-described embodiment, the number of groove portions 416 is 5 or more, but the number is not limited to this.
For example, as in the guiding device 4B according to the second modification of FIG. 26A, the number of the groove portions 416 may be four. At this time, the four groove portions 416 are provided at positions that are rotationally symmetric at 90 ° with respect to the central axis Ax. One of the four groove portions 416 is provided at the same position as the notch portion 413 when viewed along the central axis Ax.

Further, for example, as in the guiding device 4C according to the modification 3 of FIG. 26B, the number of the groove portions 416 may be three. At this time, the three groove portions 416 are provided at positions that are not rotationally symmetric with respect to the central axis Ax. Further, the three groove portions 416 are provided at positions avoiding the notch portion 413 when viewed along the central axis Ax. It should be noted that a configuration may be adopted in which any of the three groove portions 416 is provided at the same position as the notch portion 413 when viewed along the central axis Ax.

Further, for example, as in the guiding device 4D according to the modified example 4 of FIG. 26C, the number of the groove portions 416 may be two. At this time, the two groove portions 416 are provided at positions that are rotationally symmetric at 180 ° with respect to the central axis Ax. Further, the two groove portions 416 are provided at positions avoiding the notch portion 413 when viewed along the central axis Ax. When either of the two groove portions 416 is viewed along the central axis Ax, a configuration provided at the same position as the notch portion 413 may be adopted.

FIG. 27 is a diagram showing a modified example 5 of the embodiment. Specifically, FIG. 27 is a cross-sectional view of the guiding device 4E according to the present modification 5 cut along a plane orthogonal to the central axis Ax.
In the present modification 5, as shown in FIG. 27, the flow path 416E through which the perfusate is circulated is provided within the wall thickness of the guide main body 41 instead of the groove portion 416.
Even when the present modification 5 is adopted, the same effect as that of the above-described embodiment is obtained.

FIG. 28 is a diagram showing a modified example 6 of the embodiment. Specifically, FIG. 28 is a perspective view showing the guiding device 4F according to the present modification 3.
As shown in FIG. 28, in the guiding device 4F according to the present modification 6, the drain portion 44 with a cock is omitted from the guiding device 4 described in the above-described embodiment. That is, when the guiding device 4F according to the present modification 3 is adopted, the drainage bottle 64, the drainage tube 65, and the drainage pump 66 are also omitted. The groove portion 416 according to the present modification 6 is provided so as to extend from the tip end to the base end of the guide main body 41. Then, the perfusate in the joint cavity C1 is not discharged to the outside of the joint cavity C1 by being sucked, but is discharged in a state of being drained from the base end of the guide main body 41 through the groove portion 416.
Then, in the treatment method according to the present modification F, the guiding device 4F is positioned in the field of view of the endoscope 21 in the joint cavity C1, the ultrasonic probe 312 is inserted into the through hole 411, and the ultrasonic probe 312 is inserted. When the living body is cut by driving and the ultrasonic probe 312 becomes invisible due to the turbidity of the field of view of the endoscope 21, the foot switch 33 is operated to intermittently drive the ultrasonic probe 312. By driving, the ultrasonic probe 312 is temporarily stopped, and when the ultrasonic probe 312 becomes visible, the ultrasonic probe 312 is driven again, and when the cutting of the living body is completed, the ultrasonic probe 312 is driven. Stop.

1 Treatment system 2 Endoscope device 3

Treatment device

4, 4A-4F Guiding device 6 Perfusion device 21 Endoscope 22 First control device 31 Cutting treatment tool 32 Second control device 33 Foot switch 41 Guide body 42 Protrusion Part 43 Handle part 44 Drainage part with cock 61 Liquid source 62 Liquid supply tube 63 Liquid supply pump 64 Drainage bottle 65 Drainage tube 66 Drainage pump 100 Treatment target part 101 Bone hole 211 Insertion part 211a Liquid supply hole 311 Treatment tool Main body 311a Ultrasonic transducer 312 Ultrasonic probe 312a Tip treatment part

312b Base part

312c Tip part

312d, 312e Surface 313 Sheath 411 Through hole 411a Rectangular 412 Slope 412a Slope base end 412b Slope tip 4 13 Notch Part 416 Groove 416E Flow path 421 First surface 422 Second surface 422a Second tip side surface 422b Second base end side surface 422c Stepped part 500 Femoral lateral condyle 501 Posterior wall 510 Bone hole 511 First bone hole 511a 1st inner wall surface 511b 2nd inner wall surface 512 2nd bone hole 513 partition wall Ax central axis C1 joint cavity J1 knee joint P1 1st portal P2 2nd portal

Claims

It has a cylindrical guide body with a through hole through which a cutting tool used in liquids is inserted.
On the inner peripheral surface of the guide body,
A convex portion that protrudes toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting tool along the central axis.
A guiding device provided with a groove portion that is recessed toward the outer peripheral surface of the guide body and extends along the central axis to serve as a flow path through which the liquid flows.
Further provided with a protrusion that protrudes from the tip of the guide body and positions the guiding device with respect to the treatment target portion to be cut by the cutting treatment tool.
The protrusion is
The guiding device according to claim 1, wherein the through hole is provided at a position avoiding a projection region projected along the central axis.
The depth of the groove is
The guiding device according to claim 1, which is 0.1 mm or more.
The depth of the groove is
The guiding device according to claim 1, which is 1.0 mm or less.
The width of the groove is
The guiding device according to claim 1, which is 0.1 mm or more.
The width of the groove is
The guiding device according to claim 1, which is 1/3 or less of the entire circumference centered on the central axis.
The groove is
The guiding device according to claim 1, which is a flow path for discharging the liquid from the tip of the guide body toward the base end of the guide body.
The groove is
The guiding device according to claim 1, which is provided in a state of rotational symmetry about the central axis.
The groove is
The guiding device according to claim 1, which is provided in a state of not being rotationally symmetric with respect to the central axis.
The guiding device is
Used in the field of view of the endoscope,
The groove is
The guiding device according to claim 9, which is provided on the side where the endoscope is arranged.
The guide body
The guiding device according to claim 1, wherein a notch is provided from the tip of the guide body toward the base end of the guide body.
The guiding device is
Used in the field of view of the endoscope,
The notch is
The guiding device according to claim 11, which is provided on the side where the endoscope is arranged.
The tip side part of the guide body
The guiding device according to claim 1, wherein an opening is provided so as to penetrate the inside and outside of the guide body.
The guiding device is
Used in the field of view of the endoscope,
The opening is
The guiding device according to claim 13, which is provided on the side opposite to the side on which the endoscope is arranged.
Further provided with a handle portion provided at the base end of the guide body,
The handle portion is
The guiding device according to claim 2, wherein the protrusion is arranged on the same side as the central axis of the guide body.
With an endoscope,
Cutting tools used in liquids and
A guiding device having a cylindrical guide body having a through hole through which the cutting tool is inserted.
On the inner peripheral surface of the guide body,
A convex portion that protrudes toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting tool along the central axis.
A treatment system provided with a groove portion that is recessed toward the outer peripheral surface of the guide body and extends along the central axis to serve as a flow path through which the liquid flows.
A treatment method using an endoscope, a cutting treatment tool used in a liquid, and a guiding device having a cylindrical guide body having a through hole through which the cutting treatment tool is inserted.
On the inner peripheral surface of the guide body,
A convex portion that protrudes toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting tool along the central axis.
A groove portion that is recessed toward the outer peripheral surface of the guide body and extends along the central axis to serve as a flow path for discharging the liquid from the tip of the guide body toward the base end of the guide body is provided. Be,
The treatment method is
Positioning the guiding device within the field of view of the endoscope in the joint cavity,
Insert the cutting treatment tool into the through hole and insert it.
A treatment method for cutting a living body by continuously driving the cutting treatment tool.
When the cutting treatment tool becomes invisible due to the turbidity of the field of view of the endoscope, the driving of the cutting treatment tool is further intermittently driven and temporarily stopped.
When the cutting tool becomes visible, the cutting tool is continuously driven again.
The treatment method according to claim 17, wherein when the cutting of the living body is completed, the driving of the cutting treatment tool is stopped.
After inserting the cutting treatment tool into the through hole and before cutting the living body by driving the cutting treatment tool, the liquid is discharged by sucking the liquid in the joint cavity through the groove. The treatment method according to claim 17, which is started.