WO2022191259A1 - 姿勢確認装置及び姿勢調節方法 - Google Patents

姿勢確認装置及び姿勢調節方法 Download PDF

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Publication number
WO2022191259A1
WO2022191259A1 PCT/JP2022/010436 JP2022010436W WO2022191259A1 WO 2022191259 A1 WO2022191259 A1 WO 2022191259A1 JP 2022010436 W JP2022010436 W JP 2022010436W WO 2022191259 A1 WO2022191259 A1 WO 2022191259A1
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WO
WIPO (PCT)
Prior art keywords
posture
body cavity
affected part
pointer
affected
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2022/010436
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English (en)
French (fr)
Japanese (ja)
Inventor
均 水野
望 渡邊
倫政 岩崎
智洋 小野寺
浩司 岩崎
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Hokkaido University NUC
Mochida Pharmaceutical Co Ltd
Original Assignee
Hokkaido University NUC
Mochida Pharmaceutical Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Hokkaido University NUC, Mochida Pharmaceutical Co Ltd filed Critical Hokkaido University NUC
Priority to JP2023505619A priority Critical patent/JPWO2022191259A1/ja
Publication of WO2022191259A1 publication Critical patent/WO2022191259A1/ja
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor

Definitions

  • the present invention provides a posture confirmation device for confirming the direction of an affected area in a body cavity, a posture adjustment method using the posture confirmation device, a horizontal confirmation method using the posture confirmation device, and a liquid using the posture confirmation device.
  • the present invention relates to a method for implanting a sexual therapeutic material.
  • joint endoscopic surgery is widely used, which is advantageous for reducing the physical burden on patients and for early recovery after surgery.
  • arthroscopic surgery a small hole is made from the outside without making a large incision in the epidermis of the knee or elbow, and special surgical instruments and an endoscope are inserted through this hole to treat the affected area. is.
  • the inventors attempted to repair the affected area by embedding a liquid therapeutic material into the concavely defective affected area in the joint cavity as a treatment by arthroscopic endoscopic surgery. In this type of treatment, it has been found necessary to keep the implanted site horizontal in order to prevent leakage of the liquid therapeutic material from the implanted site (affected area surface).
  • the present invention provides an apparatus for confirming the posture of an affected part in a body cavity, which is suitable for arthroscopic surgery and the like, and which can easily check the posture of the affected part in a relatively narrow body cavity. It is an object of the present invention to provide a posture adjusting method using a posture confirming device, a horizontal state confirming method using a posture confirming device, and a liquid therapeutic material implanting method using a posture confirming device.
  • the present invention provides an apparatus for confirming the posture of an affected area in a body cavity, which is used for confirming the orientation of the affected area in the body cavity, a part of which is positioned in the body cavity and the other part of which is positioned inside the body cavity. is exposed to the outside of the body cavity; and a contact surface-shaped portion that is pivotably connected to the side of the body that is positioned inside the body cavity, and that is oriented in the same direction as the affected part surface by coming into contact with the affected part surface.
  • the orientation of the abutting surface portion is reflected on the pointer exposed outside the body cavity by the transmission means.
  • the posture of the affected part can be easily confirmed from the state of the pointer part.
  • the main body portion is formed in a hollow rod shape, and the contact surface portion is pivotably connected to one end in the longitudinal direction of the main body portion to form the corresponding contact surface shape.
  • the pointer portion includes a second support member that is swingably connected to one longitudinal end of the main body portion and supports the pointer portion; and the transmission means includes: A link member is provided that connects the first support member and the second support member through the inside of the main body portion and interlocks the rocking movements of the first support member and the second support member. do.
  • the transmission means has a simple structure in which the first support member provided at one end of the body portion and the second support member provided at the other end of the body portion are simply connected by the link member.
  • the orientation of the shaped portion can be reflected in the orientation of the pointer portion. Therefore, the device can be constructed in a small size and can be easily inserted into a relatively narrow body cavity.
  • the posture confirmation device of the present invention includes a determining means capable of determining the levelness of the affected part surface with which the contact surface portion contacts, via the pointer portion.
  • a determining means capable of determining the levelness of the affected part surface with which the contact surface portion contacts, via the pointer portion. Examples of the determining means that can be used in the present invention include a vertical measuring instrument, a protractor-type level, a round vial-type level, and a pendulum-type level.
  • the contact surface-shaped portion is formed so as to be diameter-reduced and deformable at least in a direction perpendicular to the swinging direction of the contact surface-shaped portion.
  • the contact surface-like portion when inserting the contact surface-like portion into the body cavity, even if the hole made in the epidermis of the patient is smaller than the outer diameter of the contact surface-like portion, the diameter of the contact surface-like portion is reduced and deformed so that the contact surface-like portion can be inserted smoothly. can. Therefore, it is possible to improve workability for the practitioner and reduce the burden on the patient.
  • the present invention also provides a method for adjusting the posture of an affected part in a body cavity using the posture confirmation device having the above configuration, wherein a part of the main body is inserted into the body cavity and the other part of the main body is pushed out of the body cavity.
  • the present invention also provides a method for confirming the horizontal state of an affected area in a body cavity using the posture confirmation device configured as described above, wherein a part of the main body is inserted into the body cavity, and the other part of the main body is inserted into the body cavity.
  • the present invention by sequentially performing the above steps, it is possible to reliably grasp the direction of the affected area using the posture confirmation device. Therefore, for example, it is possible to easily and accurately perform an operation such as changing a patient's posture in order to maintain the affected area in a horizontal posture in arthroscopic surgery.
  • the present invention is a method of implanting a liquid therapeutic material using the posture confirmation device having the above configuration, wherein a part of the main body is inserted into a body cavity, and the other part of the main body is inserted into the body cavity.
  • FIG. 2 is a diagram showing the configuration and operation of the posture confirmation device of the first embodiment with a part cut away;
  • FIG. 2 is a diagram showing the configuration and operation of the posture confirmation device of the first embodiment with a part cut away;
  • the figure which shows a contact surface-shaped part The figure which shows a contact surface-shaped part.
  • FIG. 4C is a diagram showing a process following FIG. 4A when using the posture confirmation device;
  • FIG. 10 is a view showing a round vial level as another example of the discriminating means;
  • FIG. 10 is a view showing a round vial level as another example of the discriminating means;
  • FIG. 12 is a diagram showing the configuration and operation of the posture confirmation device of the third embodiment with a part broken away;
  • FIG. 12 is a diagram showing the configuration and operation of the posture confirmation device of the third embodiment with a part broken away;
  • the posture confirmation device 1 includes a rod-shaped hollow body portion 2 and a contact surface portion 3 that is swingable at one end of the body portion 2. , and a pointer portion 4 which is swingable at the other end of the main body portion 2 .
  • the contact surface portion 3 is provided on the first pulley 5 (first support member).
  • the first pulley 5 is supported by the body portion 2 via the first rotating shaft 6 .
  • the first rotation shaft 6 of the first pulley 5 functions as a swing shaft that allows the contact surface portion 3 to swing relative to the body portion 2 .
  • the pointer portion 4 is provided integrally with the second pulley 7 (second support member).
  • the second pulley 7 is supported by the body portion 2 via a second rotating shaft 8 .
  • a second rotation shaft 8 of the second pulley 7 functions as a swing shaft that allows the pointer portion 4 to swing relative to the body portion 2 .
  • the first pulley 5 and the second pulley 7 have the same diameter, and a transmission wire 9 (link member) is stretched between the first pulley 5 and the second pulley 7 .
  • a transmission wire 9 between the first pulley 5 and the second pulley 7 is housed inside the body portion 2 .
  • the first pulley 5 rotates by the same angle as the swing angle of the contact surface portion 3, and the rotation is transmitted to the second pulley 7 via the transmission wire 9. .
  • the second pulley 7 rotates by the same angle as the rotation angle of the first pulley 5 transmitted by the transmission wire 9, and the pointer portion 4 swings accordingly.
  • the direction in which the contact surface portion 3 faces (the direction in which the axis a extends) and the axis b (imaginary line) of the pointer portion 4 are set so as to be parallel to each other.
  • the first pulley 5, the second pulley 7, and the transmission wire 9 constitute the transmission means of the present invention.
  • the contact surface portion 3 includes a contact member 10 made of an annular wire formed into a circular contour shape, and a frame portion 11 extending in the radial direction of the contact member 10.
  • the frame portion 11 is connected to the first pulley 5 .
  • the frame portion 11 is rotatable around an axis line a shown in FIG. 2A.
  • the contact member 10 is elastically deformable in a diameter-reducing direction in a direction perpendicular to the swinging direction of the contact surface portion 3 .
  • the abutment member 10 does not have a substantial surface because it uses a ring-shaped wire, but has a substantial surface as a virtual surface inside the wire contour.
  • the contact member 10 is not limited to a ring-shaped wire, and may be formed of a disk-shaped or dish-shaped flexible plate material.
  • a ring-shaped superelastic alloy wire, a wire rope, a synthetic resin, an elastomer, or the like may be used as the contact member 10.
  • an arthroscope u is inserted into the joint cavity x (inside the body cavity) through a hole y formed in the patient's epidermis z, and the defect portion of the joint to be treated (affected surface w ) is placed in the field of view of the arthroscope u.
  • the inside of the joint cavity x (inside the body cavity) is inserted into the joint cavity x from the hole v formed in the epidermis z at a position different from the hole y formed in the patient's epidermis z for inserting the arthroscope u.
  • the abutment surface portion 3 and one end portion of the main body portion 2 of the posture confirmation device 1 are inserted into the posture confirmation device 1 (insertion step).
  • the posture confirmation device 1 brings the contact surface portion 3 close to one end of the body portion 2 and inserts it into the hole v of the skin z.
  • the contact member 10 of the contact surface-shaped portion 3 is deformed in the direction of diameter reduction as shown in FIG. 3B (The wire, which is the contact member 10, is bent in a substantially elliptical shape and passes through the hole v. After passing through the hole v, the abutment member 10 elastically returns to its original shape shown in FIG. 3A when it enters the joint cavity x.
  • the contact member 10 of the contact surface-shaped portion 3 is brought into contact with the affected portion surface w so as to face each other, and the contact surface-shaped portion 3 is moved toward the direction of the affected portion surface w. to correspond to each other (affected part surface contacting step).
  • the abutting member 10 abuts against the diseased part surface w with the inner side having a wire contour as a virtual surface.
  • the contact surface portion 3 swings with respect to the main body portion 2 .
  • the abutting surface portion 3 can rotate around the axis in the longitudinal direction of the body portion 2 in addition to swinging with respect to the body portion 2 described above. can be rotated to
  • the direction of the affected part surface w can be easily confirmed by the posture of the pointer part 4 (the direction of the axis b) without being affected by the insertion angle of the body part 2 into the joint cavity x.
  • the affected part surface w is to be in a horizontal posture, as shown in FIG. 4D , the posture (body position, etc.) of the relevant part of the patient having the affected part surface w is adjusted while checking the pointer part 4 (adjustment step). .
  • the pointer part 4 is formed in a rod shape, and its posture can be easily visually recognized. That is, as shown in FIGS. 2A and 2B, the direction in which the contact surface portion 3 faces (the direction in which the axis a extends) and the axis b of the pointer portion 4 are set so as to be parallel to each other. When the axis b of the pointer portion 4 points in the vertical direction, it can be determined that the affected part surface w with which the contact surface-shaped portion 3 is in contact is horizontal.
  • attitude determination member 12 corresponds to determination means in the present invention.
  • the posture determining member 12 is formed in the shape of a square frame, and the upper end of the pointer portion 4 in the standing posture abuts against the inside of one corner portion 13 thereof, thereby supporting the pointer portion 4 . At this time, the attitude determination member 12 is in a state of being able to move freely in a pendulum shape with the upper end of the pointer portion 4 as a fulcrum, and the corner tip 14 in the diagonal direction of the corner portion 13 with which the pointer portion 4 abuts and supports. is balanced so that it points vertically downward.
  • the posture determination member 12 By attaching the posture determination member 12 to the pointer portion 4, the vertical degree of the posture of the pointer portion 4 can be easily grasped. Then, for example, if the patient's posture is changed so that the pointing direction of the corner tip 14 of the posture determining member 12 and the axis b of the pointer portion 4 are aligned, the affected area surface w can be easily made horizontal. can.
  • the determination means in the present invention is not limited to the posture determination member 12, and can be a determination means having a structure generally called a level or spirit level. For example, as shown in FIG. 7, by attaching a protractor-type level 15 having an angular scale to the indicator 4, the posture (inclination) of the indicator 4 with respect to the vertical can be measured.
  • a pendulum-type level 18 is attached to the pointer portion 4, and the plane where the axis b of the pointer portion 4 intersects perpendicularly due to the displacement of the indicated position of the tip of the pendulum 18b with respect to the center of the measuring plate 18a. (ie, the levelness of the affected part surface w) can be easily determined.
  • the posture confirmation device 20 includes a hollow rod-shaped body portion 21, a contact surface portion 22 provided at one end of the body portion 21, and a body portion 21. and a pointer portion 23 provided at the other end of the.
  • the contact surface portion 22 is integrally connected to and held by a substantially triangular first swing member 24 (first support member).
  • a first connecting member 25 is fixed to the inner surface of the body portion 21 on the one end side.
  • the first swinging member 24 is swingably connected to the first connecting member 25 via a first swing shaft 26 .
  • the contact surface portion 22 is configured in the same manner as the contact surface portion 3 in the first embodiment.
  • the pointer portion 23 is integrally connected to and held by a substantially triangular second swing member 27 (second support member).
  • a second connecting member 28 is fixed to the inner surface of the body portion 21 on the other end side.
  • the second swinging member 27 is swingably connected to the second connecting member 28 via a second swing shaft 29 .
  • the pointer portion 23 has the same shape as the pointer portion 4 in the first embodiment.
  • the first swinging member 24 and the second swinging member 27 are connected by a rod-shaped link member 30 housed inside the body portion 21 .
  • One end of the link member 30 in the longitudinal direction is connected to the first rocking member 24 via a rotatable first connecting shaft 31
  • the other end in the longitudinal direction is connected to a second connecting shaft 32 via a rotatable second connecting shaft 32 . It is connected to the swing member 27 .
  • the distance from the center of the first swing shaft 26 to the center of the second swing shaft 29 is equal to the distance from the center of the first connecting shaft 31 to the center of the second connecting shaft 32 .
  • the distance from the axis of the first swing shaft 26 to the axis of the first connecting shaft 31 is equal to the distance from the axis of the second swing shaft 29 to the axis of the second connecting shaft 32 .
  • the swing at this time is the second swing via the link member 30 . It is transmitted to the moving member 27 .
  • the second oscillating member 27 oscillates the pointer portion 23 by the same angle as the oscillating angle of the contact surface portion 22 transmitted via the link member 30 . Thereby, the posture of the contact surface portion 22 is reflected in the posture of the pointer portion 23 .
  • the link member 30 and the body portion 21 that connect the first swing member 24 and the second swing member 27 constitute a so-called parallel link mechanism.
  • the first swing member 24, the second swing member 27, the link member 30, and the body portion 21 constitute the transmission means of the present invention. Accordingly, the posture confirmation device 20 of the second embodiment can also obtain the same effect as the posture confirmation device 1 of the first embodiment described above.
  • the posture confirmation device 33 includes a hollow rod-shaped body portion 34, a contact surface portion 35 provided at one end of the body portion 34, and a body portion 34. and a pointer portion 36 provided at the other end of the.
  • the contact surface portion 35 is integrally connected to and held by a substantially triangular first swing member 37 (first support member).
  • a first connecting member 38 is fixed to the inner surface of the body portion 34 on the one end side.
  • the first swinging member 37 is swingably connected to the first connecting member 38 via a first swing shaft 39 .
  • the contact surface portion 35 is configured in the same manner as the contact surface portion 3 in the first embodiment.
  • the pointer portion 36 is integrally connected to and held by a substantially triangular second swinging member 40 (second supporting member).
  • a second connecting member 41 is fixed to the inner surface of the body portion 34 on the other end side.
  • the second swinging member 40 is swingably connected to the second connecting member 41 via a second swing shaft 42 .
  • the pointer portion 36 has the same shape as the pointer portion 4 in the first embodiment.
  • the first swinging member 37 and the second swinging member 40 are connected by a rod-shaped link member 43 housed inside the body portion 34 .
  • the link member 43 has a rotatable first connecting pin 44 at one longitudinal end and a rotatable second connecting pin 45 at the other longitudinal end.
  • the first connecting pin 44 is movably connected to a first elongated hole 46 formed in the first swinging member 37
  • the second connecting pin 45 is a second connecting pin 45 formed in the second swinging member 40 . It is movably connected to the long hole 47 .
  • the swing at this time is the second swing via the link member 43 . It is transmitted to the moving member 40 .
  • the second oscillating member 40 oscillates the pointer portion 36 by the same angle as the oscillating angle of the contact surface portion 35 transmitted via the link member 43 .
  • the posture of the contact surface portion 35 is reflected in the posture of the pointer portion 36 .
  • the link member 43 has a first connecting pin 44 and a second connecting pin 45 at both ends that are connected to the first elongated hole 46 of the first swinging member 37 and the second elongated hole 47 of the second swinging member 40, respectively. is connected to
  • the link member 43 interlocks the first swinging member 37 and the second swinging member 40, the first connecting pin 44 and the second connecting pin 45 are aligned with the first long hole 46, respectively. It moves in the longitudinal direction with respect to the second elongated hole 47 . Therefore, the link member 43 is not affected by the movement of the first rocking member 37 and the second rocking member 40, and the link member 43 moves linearly in its longitudinal direction.
  • the link member 43 and the body portion 34 that connect the first swing member 37 and the second swing member 40 constitute a so-called slide mechanism.
  • the first swinging member 37, the second swinging member 40, the link member 43, and the body portion 34 constitute the transmission means of the present invention.
  • the posture confirmation device 33 of the third embodiment can also obtain the same effect as the posture confirmation device 1 of the first embodiment described above.
  • the posture confirmation device 48 includes a hollow rod-shaped body portion 49, a contact surface portion 50 provided at one end of the body portion 49, and a body portion 49. and a transmission means 52 provided inside the body portion 49 .
  • the transmission means 52 includes a first swinging portion 53 (first support member), a second swinging portion 54 (second support member), a link portion 55 (link member), and a fixing portion 56. These are integrally connected to each other via four hinge portions (first hinge portion 57, second hinge portion 58, third hinge portion 59, fourth hinge portion 60) which will be described later.
  • the transmission means 52 is made of synthetic resin, and the four hinge portions (first hinge portion 57, second hinge portion 58, third hinge portion 59, and fourth hinge portion 60) are It is formed thinner than each of the first swinging portion 53, the second swinging portion 54, the link portion 55, and the fixed portion 56, so that it can be easily bent.
  • the contact surface portion 50 is held integrally with the first swing portion 53 .
  • the contact surface portion 50 is held integrally with the second swing portion 54 .
  • the fixed portion 56 is fixed to the inner surface of the body portion 49, and the link portion 55 is movable inside the body portion 49 along its longitudinal direction.
  • a first hinge portion 57 provided between a fixed portion 56 located on one end side of the main body portion 49 and the first swinging portion 53 allows the first swinging portion 53 to swing relative to the main body portion 49 .
  • a second hinge portion 58 provided between a fixed portion 56 located on the other end side of the body portion 49 and the second swing portion 54 functions as a first swing shaft to On the other hand, it functions as a second swing shaft that allows the second swing portion 54 to swing freely.
  • a third hinge portion 59 provided between one longitudinal end of the link portion 55 and the first swing portion 53 has a function equivalent to that of the rotatable first connecting shaft.
  • a fourth hinge portion 60 provided between the other end in the longitudinal direction of 55 and the second swing portion 54 has the same function as a rotatable second connecting shaft.
  • the swinging motion at this time is the second swinging motion via the link portion 55 . It is transmitted to the unit 54 .
  • the second oscillating portion 54 oscillates the pointer portion 51 by the same angle as the oscillating angle of the contact surface portion 50 transmitted via the link portion 55 .
  • the posture of the contact surface portion 50 is reflected in the posture of the pointer portion 51 .
  • the link portion 55 connecting the first swing portion 53 and the second swing portion 54, the body portion 49, and the fixed portion 56 constitute a so-called parallel link mechanism.
  • the posture confirmation device 48 of the fourth embodiment can also obtain the same effect as the posture confirmation device 1 of the first embodiment described above.
  • the present invention enables easy confirmation of the orientation of the affected area in a relatively narrow body cavity and easy adjustment of the orientation of the affected area in the body cavity, despite its simple configuration. , and can be suitably used for joint endoscopic surgery, etc., in which the injured site cannot be directly seen.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
PCT/JP2022/010436 2021-03-11 2022-03-10 姿勢確認装置及び姿勢調節方法 Ceased WO2022191259A1 (ja)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2025013885A1 (ja) * 2023-07-11 2025-01-16 持田製薬株式会社 姿勢確認装置付きキュレット

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2010503446A (ja) * 2006-09-18 2010-02-04 テクレス・ソシエタ・ペル・アチオニ 流体セメントで骨空洞、特に寛骨臼空洞を充填するための装置
JP2020509870A (ja) * 2017-03-14 2020-04-02 オースアライン・インコーポレイテッド 軟部組織の測定およびバランシングを行うシステムおよび方法
CN210843057U (zh) * 2019-09-24 2020-06-26 北京蒙太因医疗器械有限公司 股骨髁ap测量器

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2010503446A (ja) * 2006-09-18 2010-02-04 テクレス・ソシエタ・ペル・アチオニ 流体セメントで骨空洞、特に寛骨臼空洞を充填するための装置
JP2020509870A (ja) * 2017-03-14 2020-04-02 オースアライン・インコーポレイテッド 軟部組織の測定およびバランシングを行うシステムおよび方法
CN210843057U (zh) * 2019-09-24 2020-06-26 北京蒙太因医疗器械有限公司 股骨髁ap测量器

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2025013885A1 (ja) * 2023-07-11 2025-01-16 持田製薬株式会社 姿勢確認装置付きキュレット

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