WO2024122932A1 - Dispositif d'insertion d'une plaque de base glénoïde, et procédé associé - Google Patents

Dispositif d'insertion d'une plaque de base glénoïde, et procédé associé Download PDF

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Publication number
WO2024122932A1
WO2024122932A1 PCT/KR2023/018714 KR2023018714W WO2024122932A1 WO 2024122932 A1 WO2024122932 A1 WO 2024122932A1 KR 2023018714 W KR2023018714 W KR 2023018714W WO 2024122932 A1 WO2024122932 A1 WO 2024122932A1
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WIPO (PCT)
Prior art keywords
glenoid
guide
reaming
base plate
axis
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PCT/KR2023/018714
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English (en)
Korean (ko)
Inventor
김정성
김재원
정성욱
이상길
허연범
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주식회사 코렌텍
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Application filed by 주식회사 코렌텍 filed Critical 주식회사 코렌텍
Publication of WO2024122932A1 publication Critical patent/WO2024122932A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor

Definitions

  • the present invention relates to a device and method for inserting a glenoid base plate, and more specifically, to a stem having a hollow body extending in the direction of a first axis, and a guide rod extending in the direction of a second axis having a predetermined angle with the first axis. It includes, wherein at least a portion of the stem is inserted into the glenoid and the guide rod guides the cutting direction of the glenoid, so that the cutting guide can be accurately guided when cutting the non-escaped second surface of the glenoid for insertion of a partially reinforced base plate.
  • An artificial shoulder joint is a type of artificial prosthesis that replaces the human shoulder joint when it does not function properly. It mainly consists of a stem implanted in the humerus, a glenoid base plate connected to the scapula (scapula), and the stem. It consists of an artificial bone head and an insert that implement rotational movement between the condyle and the base plate.
  • the artificial bone head may be coupled to the stem side like a human shoulder joint, or conversely, it may be coupled to the glenoid base plate side. Accordingly, the insert is coupled to the glenoid base plate and stem, respectively.
  • the scapula 91 has an overall inverted triangular structure with the infrascapular fossa 913 (subscapular fossa), which is the front of the body facing anterior, and the posterior scapula.
  • the infraspinal fossa (not shown, infraspinatus fossa), which is the rear of the body facing the body, the coracoid process (917, beak process) protruding forward from the upper side, the acromion (919, acromion) protruding backward from the upper side, and the above It faces laterally between the coracoid process (917) and the acromion (919) and includes a glenoid (911, glenoid) that contacts the humeral head and implements joint movement.
  • the glenoid base plate (8) When total shoulder replacement surgery is performed, the glenoid base plate (8) is generally coupled to the glenoid (911) to replace the function of the glenoid (911). At this time, fixing means such as screws are used to firmly couple the glenoid base plate (8) to the glenoid (911).
  • the lower surface 81 in the direction in which the hollow stem extends is formed flat, as can be seen in FIG. 2.
  • This conventional base plate has the disadvantage of not being able to be seated or inserted stably when a bone defect occurs in the glenoid region.
  • a portion where the defect does not occur (R1) is used to secure the glenoid base plate, as shown in FIG. ) must be cut.
  • the contact surface formed by the plate B31 and the wedge B33 extends flat along the first surface B31a on the plate formed at one end of the base, passes through the central axis of the stem, and is spaced a first length D1 from the central axis. It is formed to form a convex curve from the point where it approaches the base (B1).
  • the first length D1 is formed to be smaller than the distance r from the central axis corresponding to the radius of the stem to the outer peripheral surface of the stem.
  • a contact surface In order to insert the partially reinforced glenoid base plate (B) into the glenoid (911), a contact surface must be formed in the glenoid to contact the plate (B31) and the wedge (B33), respectively. At this time, the contact surface in contact with the plate (B31) must be cut to a flat surface, and the surface in contact with the wedge (B33) must be formed as a curved surface, but there is a problem in that it is difficult to form a flat and curved surface in the glenoid.
  • a surgical instrument capable of cutting the glenoid, a reaming guide for accurate cutting when cutting the glenoid, and an accurate size and insertion direction of the implant are required.
  • a guiding method is required.
  • the present invention was devised to solve the above problems,
  • the object of the present invention is to include a stem that is hollow and extends in the direction of a first axis, and a limit guide protruding from the stem to one side and the other, wherein the limit guide is symmetrical with respect to the first axis at a predetermined height of the stem.
  • the aim is to provide a reaming guide that can accurately guide the cutting range when cutting the glenoid by protruding at least a portion of the stem into the glenoid and having the limit guide guide the cutting range of the glenoid.
  • the stem includes a first plane substantially flat extending along the first axis, a second plane opposing the first plane and extending along the first axis, and the limit guide includes a first plane. It provides a reaming guide that protrudes from one edge of the plane and the second plane to limit the cutting range of the plane on the glenoid.
  • the stem includes a connection surface that is at least partially curved and extends between a first plane and an opposing second plane, and the connection surface on the side where the limit guide is formed is on one side of the limit guide.
  • the object of the present invention further includes a fixing part on one side of the stem or guide rod for at least temporarily fixing the reaming guide on the glenoid, and the fixing part includes a branch extending from the stem or guide rod to one side, and a branch extending from the branch to the glenoid side.
  • the aim is to provide a reaming guide that includes an extending spike and increases fixation force when the reaming guide is temporarily fixed to the glenoid.
  • the purpose of the present invention is to provide a reaming guide in which the fixing part includes a slot through which a portion of the branch is formed so that a surgeon can easily hold the insertion position of the reaming guide.
  • An object of the present invention further includes a screw that penetrates the stem and is inserted into the glenoid, wherein the screw has a groove extending to at least one side on the surface of the head and a screw thread is formed on the outer peripheral surface of the head to perform glenoid reaming.
  • the aim is to provide a reaming guide that can be strongly fixed to the glenoid fossa.
  • An object of the present invention includes an insertion rod extending in a first axis direction, a striking portion spaced apart from the insertion rod at a predetermined distance to strike and chamfer at least a portion of the glenoid fossa, the striking portion having a convex curved surface in the distal direction, and a striking portion located on the curved surface.
  • the aim is to provide a glenoid chamfering device that allows the surgeon to chamfer the glenoid according to the shape of the base plate by forming a plurality of irregularities on the glenoid.
  • the object of the present invention is that at least a portion of the striking portion extends uniformly in thickness in a first direction perpendicular to the first axis, and has a thickness as it moves away from the insertion rod in a second direction perpendicular to the first axis.
  • the aim is to provide a glenoid chamfering device that can form a glenoid of a shape complementary to the augmentation of a partially reinforced base plate by forming it to gradually decrease.
  • the purpose of the present invention is to provide a glenoid chamfering mechanism capable of chamfering the glenoid at a planned position, including a first indentation guide in which the striking portion has a predetermined width and is recessed in the second direction.
  • the object of the present invention is to provide a glenoid chamfering mechanism capable of guiding reaming guides of various shapes by having the striking portion further include a second indentation guide that has a smaller width than the first indentation guide and is recessed in the second direction. will be.
  • the purpose of the present invention is to include a guide pin insertion step of inserting a guide pin into the glenoid along a first axis, a first reaming step of reaming a curved surface having a predetermined curvature along the guide pin, and a glenoid fossa based on the curved surface formed in the first reaming step.
  • a defect measurement step of checking the direction and amount of the defect a reaming guide insertion step of inserting a reaming guide that guides the cutting range of the glenoid into the glenoid to form a horizontal plane perpendicular to the first axis, the reaming
  • a second reaming step of forming a horizontal surface perpendicular to the first axis according to the guidance of the guide cutting of the glenoid fossa for insertion of a partially reinforced base plate can be accurately performed through the reaming guide inserted into the glenoid fossa. It provides a method of inserting a glenoid base plate.
  • the purpose of the present invention is to measure the distance in the first axis direction from the first surface to the lowest point of the glenoid defect through an augment sizer provided to measure the depth of the defect. It provides a glenoid base plate insertion method that can determine the amount and direction of bone defect in the defect area with a single surgical instrument, including a placement step and a defect direction checking step of measuring the direction in which the lowest point is formed based on the central part of the glenoid fossa. .
  • the defect measuring step includes a dial checker placement step of disposing a dial checker indicating a direction based on the central portion of the glenoid fossa on the glenoid before the augment sizer placement step, and the defect direction.
  • the checking step determines the direction in which the lowest point was formed through the direction measured by a dial checker, providing a glenoid base plate insertion method that allows the surgeon to quickly and clearly recognize in which direction the lowest point of the glenoid is formed from the center of the glenoid. .
  • the purpose of the present invention is to determine the direction in which the part of the augmentation sizer in contact with the lowest point faces on the dial checker as the direction in which the lowest point is formed, so that the defect direction checking step determines the direction in which the lowest point is formed, so that the glenoid base can easily guide the glenoid cutting direction and base plate insertion position.
  • a plate insertion method is provided.
  • the purpose of the present invention is to place the augment sizer in such a way that a portion of the augment sizer is in contact with the lowest point and at the same time, one surface of the augment sizer is in contact with one surface of the dial checker. It provides a glenoid base plate insertion method that allows the use of an appropriate augment sizer according to the amount of bone defect by placing it on the bone defect.
  • the purpose of the present invention is to include the reaming guide insertion step, a reaming guide fastening step of fastening the reaming guide to the reaming guide holder, a reference indicator fastening step of connecting a reference indicator to one side of the reaming guide holder, and the reference indicator being connected to a first A direction alignment step of aligning the insertion position of the reaming guide fastened to the reaming guide holder by moving it to a position, and approaching the reaming guide to the glenoid along the first axis and fixing the reaming guide on the glenoid according to the aligned insertion position.
  • the aim is to provide a glenoid base plate insertion method that can clearly guide the cutting of the glenoid fossa, including the reaming guide fixation step.
  • the object of the present invention further includes a post drill step of forming a recess having a cross section larger than the guide pin in the first axis direction in the glenoid fossa, wherein at least a portion of the boss cutter having a predetermined diameter is formed on one side.
  • the first reaming step includes a defect size checking step of placing a size checker provided on the glenoid to check the amount of bone defect in the glenoid fossa, and allowing at least a portion of the size checker to contact the lowest point of the glenoid fossa; Including a curved surface reaming step of reaming a curved surface that has a predetermined curvature determined according to the amount of defect measured in the defect size checking step and is concavely formed with respect to the first axis, a concave curved surface with a different curvature depending on the amount of bone defect in the glenoid fossa is formed.
  • the aim is to provide a method of inserting a glenoid base plate that can be formed.
  • the object of the present invention further includes a chamfering step of chamfering the curved surface that was not reamed in the second reaming step, and the chamfering step is such that a portion of the joint condyle has a constant indentation depth in a first direction perpendicular to the first axis. It extends in a second direction perpendicular to the first axis and chamfers the curved surface so that the depth of indentation gradually decreases as it moves away from the center of the glenoid, so that it is complementary to the augment shape of the partially reinforced base plate. It provides a method of inserting a glenoid base plate that chamfers the glenoid into a shape.
  • An object of the present invention further includes a base plate insertion step of inserting a partially reinforced base plate into the glenoid, wherein the base plate insertion step includes a base plate fastening step of fastening the partially reinforced base plate to a base plate holder, A reference indicator fastening step of connecting a reference indicator to one side of the base plate holder, an alignment insertion step of aligning the insertion position of the base plate fastened to the base plate holder and inserting the base plate by moving the reference indicator to a first position.
  • the aim is to provide a glenoid base plate insertion method that can simply and accurately insert a partially reinforced base plate into the glenoid.
  • the present invention is implemented by an embodiment having the following configuration.
  • the present invention includes a stem that has a hollow body and extends in the first axis direction, and a limit guide protrudes from the stem to one side and the other, and the limit guide is installed at a predetermined height of the stem. At least a portion of the stem is inserted into the glenoid by protruding in a direction symmetrical about one axis, and the limit guide guides the cutting range of the glenoid.
  • the stem includes a first plane extending along the first axis substantially flat, a second plane extending along the first axis opposite the first plane, and the limit
  • the guide is characterized in that it protrudes from one edge of the first and second planes.
  • the stem includes a connection surface that extends between a first plane and an opposing second plane, and at least a portion of the connection surface is curved, and the connection surface on the side where the limit guide is formed is the limit guide. It is characterized by forming a substantially flat guide surface on one side and having a curved surface on the other side of the limit guide.
  • the present invention further includes a fixing part for at least temporarily fixing the reaming guide on the glenoid on the guide surface or a lower side of the guide surface, and the fixing part includes a branch extending from the stem to one side, the branch It is characterized in that it includes a spike extending from the glenoid side.
  • the fixing part is characterized in that it includes a slot formed as a groove formed through a portion of the branch or recessed on the branch.
  • the present invention further includes a screw that penetrates the stem and is inserted into the glenoid, wherein the stem has a thread on at least one side of the inner peripheral surface, and the screw extends at least on one side on the surface of the head. It is characterized in that a groove is formed and a screw thread is formed on the outer peripheral surface of the head.
  • the present invention includes an insertion rod extending in a first axis direction, a striking portion spaced a predetermined distance from the insertion rod to strike and chamfer at least a portion of the glenoid fossa, and the striking portion moves in a distal direction. It is characterized in that it has a convex curved surface and a plurality of irregularities are formed on the curved surface.
  • At least a portion of the striking portion extends uniformly in thickness in a first direction perpendicular to the first axis, and extends from the insertion rod in a second direction perpendicular to the first axis. It is characterized by being formed so that the thickness gradually decreases as it moves away.
  • the striking portion includes a first recessed guide having a predetermined width and recessed in the second direction.
  • the striking portion further includes a second retraction guide that has a smaller width than the first retraction guide and is recessed in the second direction.
  • the defect measuring step measures the distance in the first axis direction from the central part of the glenoid to the lowest point of the glenoid defect through an augment sizer provided to measure the depth of the defect. It is characterized by comprising an augmentation sizer placement step and a defect direction checking step of measuring the direction in which the lowest point is formed based on the central portion of the glenoid fossa.
  • the defect measuring step includes a dial checker placement step of placing a dial checker indicating a direction based on the central portion of the glenoid fossa on the glenoid before the augmentation sizer placement step; ,
  • the defect direction checking step is characterized by determining the direction in which the lowest point was formed through the direction measured by a dial checker.
  • the defect direction checking step is characterized in that the direction in which the portion of the augmentation sizer in contact with the lowest point faces on the dial checker is determined as the direction in which the lowest point is formed.
  • a portion of the augmentation sizer is in contact with the lowest point, and at the same time, one surface of the augmentation sizer is in contact with one surface of the dial checker. characterized in that it is disposed on the dial checker.
  • the reaming guide insertion step includes a reaming guide fastening step of fastening the reaming guide to the reaming guide holder, a reference indicator fastening step of connecting a reference indicator to one side of the reaming guide holder, and the reference A direction alignment step of aligning the insertion position of the reaming guide fastened to the reaming guide holder by moving the indicator to the first position, and approaching the reaming guide to the glenoid fossa along the first axis and adjusting the reaming guide according to the aligned insertion position. It is characterized by comprising a reaming guide fixation step for fixing on the glenoid.
  • it further includes a post drill step of forming a recess having a cross section larger than the guide pin in the first axis direction in the glenoid fossa, wherein the post drill step is performed by using a boss cutter having a predetermined diameter. It is characterized by reaming the glenoid fossa along the guide pin after allowing at least a portion of the stopper to protrude to one side of a stopper formed with a convex curved surface.
  • the first reaming step includes placing a size checker provided to check the amount of bone defect in the glenoid fossa on the glenoid, and allowing at least a portion of the size checker to contact the lowest point of the glenoid fossa. It is characterized in that it includes a size checking step and a curved surface reaming step of reaming a curved surface that has a predetermined curvature determined according to the amount of defects measured in the defect size checking step and is concavely formed with respect to the first axis.
  • it further includes a chamfering step of chamfering the curved surface that is not reamed in the second reaming step, and the chamfering step is performed so that a portion of the joint condyle is tilted in a first direction perpendicular to the first axis.
  • the indentation depth extends uniformly, and the curved surface is chamfered in a second direction perpendicular to the first axis so that the indentation depth gradually decreases as the distance from the center of the glenoid fossa increases.
  • the present invention further includes a base plate insertion step of inserting the partially reinforced base plate into the glenoid, and the base plate insertion step includes fastening the partially reinforced base plate to the base plate holder.
  • the present invention can achieve the following effects by combining the above-mentioned embodiment with the configuration, combination, and use relationship described below.
  • the object of the present invention is to include a stem that is hollow and extends in the direction of a first axis, and a limit guide protruding from the stem to one side and the other, wherein the limit guide is symmetrical with respect to the first axis at a predetermined height of the stem. It has the effect of providing a reaming guide that can accurately guide the cutting range when cutting the glenoid by protruding at least a portion of the stem into the glenoid and allowing the limit guide to guide the cutting range of the glenoid.
  • the stem includes a first plane extending along the first axis substantially flat, a second plane opposing the first plane and extending along the first axis, and the limit guide is formed on the first plane. And it may be formed to protrude from one edge of the second plane to limit the cutting range of the plane on the glenoid.
  • the stem includes a connection surface extending between a first plane and an opposing second plane, and at least a portion of the connection surface is curved, and the connection surface on the side where the limit guide is formed is substantially on one side of the limit guide.
  • the present invention further includes a fixing part for at least temporarily fixing the reaming guide on the glenoid on one side of the stem or guide rod, and the fixing part includes a branch extending to one side from the stem or guide rod, and extending from the branch to the glenoid side. Including spikes that increase the fixing force when the reaming guide is temporarily fixed to the glenoid fossa.
  • the fixing part includes a slot through which a portion of the branch is formed, so that the surgeon can easily hold the insertion position of the reaming guide.
  • the present invention further includes a screw that penetrates the stem and is inserted into the glenoid, wherein the screw has a groove extending to at least one side on the surface of the head and a screw thread is formed on the outer peripheral surface of the head to perform glenoid reaming. It has the effect of providing a reaming guide that can be strongly fixed to the.
  • the present invention includes an insertion rod extending in a first axis direction, a striking portion spaced apart from the insertion rod at a predetermined distance to strike and chamfer at least a portion of the glenoid fossa, the striking portion having a convex curved surface in the distal direction and positioned on the curved surface.
  • At least a portion of the striking portion extends uniformly in thickness in a first direction perpendicular to the first axis, and increases in thickness as it moves away from the insertion rod in a second direction perpendicular to the first axis. By forming it to gradually decrease, it forms a glenoid of a shape complementary to the augmentation of the partially reinforced base plate.
  • the striking portion has a predetermined width and includes a first indentation guide that is indented in the second direction, so that the glenoid fossa can be chamfered at a planned position.
  • the striking portion can guide reaming guides of various shapes by further including a second recessed guide that has a smaller width than the first retracted guide and is recessed in the second direction.
  • the present invention includes a guide pin insertion step of inserting a guide pin into the glenoid along a first axis, a first reaming step of reaming a curved surface having a predetermined curvature along the guide pin, and a glenoid fossa based on the curved surface formed in the first reaming step.
  • a defect measurement step of checking the direction and amount of the defect a reaming guide insertion step of inserting a reaming guide that guides the cutting range of the glenoid fossa into the glenoid fossa to form a horizontal plane perpendicular to the first axis, the reaming guide
  • a second reaming step of forming a horizontal surface perpendicular to the first axis according to the guide cutting of the glenoid fossa for insertion of a partially reinforced base plate can be accurately performed through the reaming guide inserted into the glenoid fossa.
  • the defect measuring step includes arranging an augment sizer to measure the distance in the first axis direction from the first surface to the lowest point of the glenoid defect through an augment sizer provided to measure the depth of the defect.
  • the defect measurement step includes a dial checker placement step of placing a dial checker indicating a direction based on the central portion of the glenoid fossa on the glenoid before the augment sizer placement step, and checking the defect direction.
  • the step has the advantage of determining the direction in which the lowest point was formed through the direction measured by the dial checker, so that the surgeon can quickly and clearly recognize in which direction the lowest point of the glenoid fossa was formed from the center of the glenoid fossa.
  • the defect direction checking step determines the direction in which the part of the augmentation sizer in contact with the lowest point faces on the dial checker as the direction in which the lowest point was formed, providing the effect of simple guidance of the joint cutting direction and base plate insertion position. do.
  • the augmentation sizer arrangement step includes placing the augmentation sizer in which a portion of the augmentation sizer is in contact with the lowest point and at the same time, one surface of the augmentation sizer is in contact with one surface of the dial checker. By placing it in , it is possible to use an appropriate augment sizer depending on the amount of bone defect.
  • the reaming guide insertion step includes a reaming guide fastening step of fastening the reaming guide to the reaming guide holder, a reference indicator fastening step of connecting a reference indicator to one side of the reaming guide holder, and positioning the reference indicator at a first position.
  • a direction alignment step of aligning the insertion position of the reaming guide fastened to the reaming guide holder by moving and approaching the reaming guide to the glenoid along the first axis and fixing the reaming guide on the glenoid according to the aligned insertion position.
  • Including the reaming guide fixation step cutting of the glenoid fossa can be clearly guided.
  • the present invention further includes a post drill step of forming a recess having a cross section larger than the guide pin in the first axis direction in the glenoid fossa, wherein at least a portion of the boss cutter having a predetermined diameter has one side.
  • the effect of forming a recess within the glenoid can be obtained by protruding from one side of the stopper formed with a convex curved surface and then reaming the glenoid along the guide pin.
  • the first reaming step includes a defect size checking step of placing a size checker provided on the glenoid fossa to check the amount of bone defect in the glenoid fossa, and allowing at least a portion of the size checker to contact the lowest point of the glenoid fossa.
  • Forming a concave curved surface with a different curvature depending on the amount of bone defect in the joint fossa including a curved surface reaming step of reaming a curved surface formed concavely with respect to the first axis and having a predetermined curvature determined according to the amount of defect measured in the defect size checking step. can do.
  • the present invention further includes a chamfering step of chamfering the curved surface that was not reamed in the second reaming step, and the chamfering step is such that a portion of the joint condyle has a constant indentation depth in a first direction perpendicular to the first axis.
  • the curved surface is chamfered so that the depth of indentation gradually decreases as it moves away from the center of the glenoid, thereby forming a shape complementary to the augmentation shape of the partially reinforced base plate. This produces the effect of chamfering the glenoid fossa.
  • the present invention further includes a base plate insertion step of inserting the partially reinforced base plate into the glenoid, wherein the base plate insertion step includes a base plate fastening step of fastening the partially reinforced base plate to the base plate holder, the base A reference indicator fastening step of connecting a reference indicator to one side of the plate holder, an alignment insertion step of aligning the insertion position of the base plate fastened to the base plate holder and inserting the base plate by moving the reference indicator to the first position. It has the effect of providing a glenoid base plate insertion method that can simply and accurately insert a partially reinforced base plate into the glenoid.
  • Figure 1 is a perspective view showing the glenoid base plate being inserted into the scapula.
  • Figure 2 is a view showing a glenoid base plate according to the prior art.
  • Figures 3 and 4 are diagrams illustrating seating the glenoid base plate according to the prior art into the glenoid where a bone defect has occurred.
  • Figure 5 is a perspective view of a partially reinforced glenoid base plate (B)
  • Figure 6 is a cross-sectional view of the partially reinforced glenoid base plate (B)
  • Figure 7 is a view showing landmarks displayed in the shape of a cross on the glenoid according to an embodiment of the present invention.
  • Figures 8 and 9 are views showing the insertion of the guide pin 110 into the glenoid fossa according to an embodiment of the present invention.
  • Figure 10 is a perspective view of a center guide according to an embodiment of the present invention.
  • Figure 11 is a rear perspective view of the center guide according to an embodiment of the present invention.
  • Figure 12 is a perspective view of a center guide according to another embodiment of the present invention.
  • Figure 13 is a perspective view of the guide handle 200 according to an embodiment of the present invention.
  • Figure 14 is a perspective view of the first reamer 310 according to an embodiment of the present invention.
  • Figure 15 is a view showing a structure in which the boss cutter 320 and the stopper 330 are fastened to form a recess (H) along the guide pin 110 according to an embodiment of the present invention.
  • Figure 16 is an exploded perspective view of the boss cutter 320 and the stopper 330.
  • Figure 17 is a perspective view of a defect measuring instrument 400 according to an embodiment of the present invention.
  • Figure 18 is an exploded perspective view of the defect measuring instrument 400 according to an embodiment of the present invention.
  • Figure 19 is a view showing that the augmentation sizer 430 according to an embodiment of the present invention is in contact with the lowest point (L) of the glenoid fossa.
  • Figure 20 is a view showing a state in which the dial checker 410 according to an embodiment of the present invention is at least temporarily fixed on the glenoid.
  • Figure 21 is a view showing the size checker 470 according to an embodiment of the present invention approaching the glenoid fossa (G) and contacting the lowest point (L).
  • Figure 22 is an exploded perspective view of the size checker 470 and the sizer handle 450 according to an embodiment of the present invention.
  • Figure 23 is a view showing inserting the reaming guide 500 into the glenoid while the reference indicator (guide handle, 200) is fastened to the reaming guide holder 600 according to a preferred embodiment of the present invention.
  • Figure 24 is an exploded perspective view of the reaming guide holder 600 and the reaming guide 500 according to an embodiment of the present invention.
  • Figure 25 is a cross-sectional view of the reaming guide 500 according to an embodiment of the present invention.
  • Figure 26 is a view showing the reaming guide inserted into the glenoid
  • Figure 27 is a perspective view of the reaming guide 500 according to an embodiment of the present invention.
  • Figure 28 is a perspective view of the reaming guide 500 according to another embodiment of the present invention.
  • Figure 29 is a view showing the screw driver 700 being fastened to the reaming guide 500 according to an embodiment of the present invention.
  • Figure 30 is an exploded perspective view of the screw driver 700 and the reaming guide 500
  • Figure 31 is a perspective view of the reaming guide holder 800 and the reaming guide 500 according to another embodiment of the present invention.
  • Figure 32 is an exploded perspective view of the reaming guide holder 800
  • Figure 33 shows that the screw driver 850 of the reaming guide holder 800 moves forward and backward within the fastening part 830 so that the tip 853 of the screw driver 850 is hidden or exposed within the fastening end 833.
  • Figure 34 is an exploded perspective view of the reaming guide holder 900 and the reaming guide 500 according to another embodiment of the present invention.
  • Figure 35 is a view showing the second reamer 1000 fastened to the reaming guide 500 according to an embodiment of the present invention.
  • Figure 36 is a perspective view of the second reamer 1000 and the reaming guide according to an embodiment of the present invention.
  • Figure 37 is a view showing that the joint cutting range of the second reamer 1000 according to an embodiment of the present invention is limited by the limit guide 530.
  • Figure 38 is a view showing the glenoid chamfer 1100 approaching the reaming guide 500 according to an embodiment of the present invention.
  • Figure 39 is a perspective view of the glenoid chamfering device 1100 according to an embodiment of the present invention.
  • Figure 40 is a view showing inserting the partially reinforced base plate (B) into the glenoid while the reference indicator (guide handle, 200) is fastened to the base plate holder 1200 according to an embodiment of the present invention.
  • 41 is an enlarged view of a portion of the base plate holder 1200.
  • Figure 42 is a flow chart of the glenoid base plate insertion method (S) according to an embodiment of the present invention.
  • Figure 43 is a flow chart of the first reaming step (S20) according to an embodiment of the present invention.
  • Figure 44 is a flow chart of the defect measurement step (S40) according to an embodiment of the present invention.
  • Figure 45 is a flow chart of the reaming guide insertion step (S50) according to an embodiment of the present invention.
  • Figure 46 is a flow chart of the base plate insertion step (S80) according to an embodiment of the present invention.
  • the base plate (B) refers to a glenoid base plate that is partially reinforced (wedged) as described above, and an augmentation to compensate for bone defects in the glenoid is formed in a portion.
  • landmarks may be displayed in the shape of a cross on the glenoid (G) along the anterior and posterior and superior and inferior directions.
  • the guide pin 110 is inserted into the central part of the landmark.
  • the center guide 120 can be used to insert the guide pin 110, and the guide handle 200 After supporting the center guide 120, the guide pin 110 may be inserted through the hole formed in the center guide 120.
  • the guide pin 110 has a pin 111 extending in one direction and a sharply formed end 113, and the end 113 is inserted into the center of the glenoid fossa (G).
  • the direction in which the guide pin 110 is inserted may be defined as the first axis.
  • the center guide 120 is provided with a central portion 121 that penetrates and accommodates the guide pin 110 and a portion of the guide handle 200. It may include a plurality of receiving portions 123. In one embodiment, the receiving portion 123 may be provided on the upper, lower, left, and right sides with respect to the central portion 121. A through hole 121a is formed in the central portion 121 to allow the guide pin 110 to penetrate the center guide, and the receiving portion 123 is accommodated in a shape corresponding to or complementary to the end shape of the guide handle 200. A groove 123a is formed. To enable the surgeon to easily insert the guide handle 200, one side of the receiving portion 123 where the receiving groove 123a is formed may form a predetermined angle with one side of the central portion 121.
  • the central portion 121 and the receiving portion 123 may form a single contact surface 125 in contact with the glenoid (G).
  • the contact surface may be formed substantially flat, and a spike 123b may be formed on the joint surface to at least temporarily fix the center guide 120 on the glenoid.
  • the spike 123b is formed on the receiving portion side.
  • the center guide 120 may further include a loss compensation unit 127.
  • the loss compensation part 127 is a part extending from the end of one receiving part 123 toward the glenoid side, and one end of the loss compensation part 127 can support a portion of the defective glenoid by touching the defective glenoid. Since the amount of bone defect in the glenoid fossa may vary depending on the patient, a plurality of center guides 120 with different lengths of the defect compensation portion 127 extending toward the glenoid may be prepared.
  • Figure 12 shows a center guide according to another embodiment of the present invention.
  • the central portion 121 may have a through hole 121b formed by slanting downward. At this time, one end of the through hole 121b on the contact surface 125 may be formed in the center without being deviated downward. Accordingly, the guide pin 110 can be inserted into the glenoid from the bottom to the top.
  • the inclination angle of the first axis is preferably around 10 degrees, and it is preferable to have an inclination of 10 degrees.
  • the center guide 120 may have at least one indicating portion 129 instead of the receiving portion 123.
  • the indicating part 129 can indicate in which direction the defect compensation part 127 is formed based on the central part 121, and in addition, the length of the defect compensation part and the degree of inclination of the through hole are determined by the indicating part ( 129) or may be indicated.
  • the guide handle 200 is a device that assists in supporting or manipulating the center guide 120 and/or other surgical instruments, and the end is received and fastened to a groove or receiving portion of another surgical instrument. As a result, the surgeon can manipulate and move the surgical instrument coupled to the guide handle 200.
  • the guide handle 200 may have substantially the same configuration as the reference indicator described later.
  • the guide handle 200 may include a body 210 extending to one side and a receiving portion 230 accommodated in a surgical instrument.
  • the body 210 is preferably extended to a predetermined length so that it is easy for the surgeon to hold, and the end opposite to the receiving portion 230 is formed flat to facilitate impacting.
  • the body 210 is formed with a long hole 210a penetrating from one side to the other side along an extending axis, and landmarks displayed on the glenoid can be confirmed through the long hole 210a.
  • the receiving portion 230 is configured to be accommodated in a groove of a surgical instrument, etc. at one end of the body 210 and then fastened.
  • the receiving portion 230 may be formed with a smaller diameter than the body 210 .
  • the receiving portion 230 has an overall cylindrical shape, but has a substantially circular shape, and a protrusion 231a protruding to one side is provided at the tip portion 231, which constitutes the endpoint of the receiving portion with the gap 233 interposed therebetween.
  • the gap 233 is formed along an axis along which the body extends from the distal end 231, so that the gap 233 between the distal ends 231 can be reduced and then increased by an external force.
  • a protruding step 235 may be formed along the outer circumferential surface at a predetermined distance away from the distal end, and a portion of the step 235 may be provided with a protrusion 235a protruding toward the other side.
  • the protrusion 231a formed on the tip 231 and the protrusion 235a formed on the step 235 may protrude in opposite directions.
  • the first reamer 310 is a surgical instrument for reaming the first surface as a curved surface with a predetermined curvature along the guide pin 110 inserted into the glenoid fossa (G).
  • the curved surface is a concave curved surface centered on the first axis, and the curvature of the curved surface may be determined according to the amount of bone defect in the joint fossa measured by the defect measuring device 400, which will be described later.
  • the size checker 470 is fastened to the defect measuring device 400 to measure the amount of bone defect in the glenoid fossa, and then cutting of the glenoid fossa can be performed using the first reamer 310.
  • the first reamer 310 can adjust the curvature to be reamed, or a plurality of first reamers 310 can be prepared according to the curvature of the curved surface.
  • the first reamer 310 may ream at least a portion of the glenoid (G) into a curved shape centered on the first axis, which is the insertion direction of the guide pin, and the body 311 extending to one side ), a shell 313 provided to surround at least a portion of the body 311, and a cutting portion 315 that substantially cuts the glenoid fossa.
  • the body 311 extends to one side, has a predetermined length to facilitate the surgeon's grip, and preferably has a hollow hole to accommodate the guide pin 110 for cutting the glenoid along the guide pin 110.
  • the outer shell 313 surrounds at least a portion of the body and may have a plurality of through holes 313a to facilitate cleaning.
  • the cutting part 315 includes a blade 3151, at least a portion of which extends radially to cut bone, a rim 3153 connecting the blades on the outside of the cutting part 315, and a receiving hole 3155 for receiving a guide pin. ) may include.
  • the surgeon may approach the glenoid so that the reamer 310 penetrates and accommodates the guide pin 110, and then rotate the reamer to ream and/or form a curved surface with a predetermined curvature around the first axis, which is the insertion axis of the guide pin. there is.
  • the blade 3151 may gradually protrude in a distal direction toward the center of the cutting portion 315.
  • a recess with a larger diameter than the guide pin may be formed in the glenoid.
  • the glenoid can be reamed along the guide pin (110), and a surgical instrument consisting of the boss cutter (320) and stopper (330) can be used. It may be possible.
  • the boss cutter 320 is configured to form a recess (H) centered on the first axis into which the guide pin is inserted into the glenoid, and has a hollow body 321 extending to one side to accommodate the guide pin, a boss It may include a cutting portion 323 that reams the bone when the cutter rotates to form a recess (H) with a larger diameter than the guide pin, and a seating portion 325 that protrudes outward for seating the stopper.
  • the stopper 330 is configured to be seated or fastened to the boss cutter to adjust the approach distance of the boss cutter.
  • the stopper 331 is a tube 331 that has a hollow portion 331a so that it can be seated on the seating portion 325 while penetrating at least a portion of the boss cutter.
  • the boss cutter 320 is positioned in the joint fossa. When approaching, it includes an blocking surface 333 that at least partially touches the curved surface formed in the glenoid fossa.
  • the blocking surface 333 may have a predetermined curvature corresponding to the curved surface formed on the glenoid and may be formed to have a convex curved surface. As the curvature of the curved surface formed in the glenoid fossa is plural, the blocking surface 333 may have a plurality of curvatures correspondingly, and therefore, a plurality of stoppers 330 can be prepared.
  • a part of the boss cutter 320 including the cutting part 323, protrudes to one side of the stopper, and the boss cutter 320 uses the guide pin 110. It is brought close to the glenoid to receive penetration and then rotated to form a recess (H) in the glenoid. The rotation of the boss cutter 320 may be stopped when the stopping surface 333, which is a curved surface of the stopper, contacts the first surface of the glenoid fossa.
  • the defect measuring device 400 is an instrument that measures the amount of bone defect in the glenoid fossa and in what direction the defect is located, preferably the first surface as a reamed curved surface or the center portion of the glenoid fossa. As a standard, you can check the direction and amount of the defect. If a portion of the glenoid fossa is missing, the lowest point (L) may exist in a predetermined direction based on the center of the glenoid even after reaming to form a curved surface on the glenoid. The defect measuring device 400 can check the amount of bone defect in the glenoid fossa and the direction of the defected part based on the lowest point (L).
  • the insertion position which is the direction in which the augment of the base plate will be inserted, can be determined based on the amount and direction of the defect measured by the defect measuring device 400.
  • the defect measuring device 400 can check the amount of defect based on how much the lowest point (L) is indented, and the direction in which the lowest point (L) is formed based on the central part of the glenoid fossa ( direction of the defect) can be confirmed, and the direction of the defect is clearly indicated so that a second horizontal surface on the glenoid can be formed in the correct direction.
  • the defect measuring device 400 may include a dial checker 410, an augmentation sizer 430, and a sizer handle 450.
  • the dial checker 410 is a component that can indicate the direction of another component seated or overlapping on the dial checker, and is at least temporarily fixed to the glenoid (G) so that the direction of a portion of the augment sizer, which will be described later, is clearly known. make it possible
  • the dial checker 410 has a hollow 410a to penetrate and receive the guide pin 110, approaches the curved surface of the glenoid G, and is aligned as described later. It can be temporarily fixed.
  • the dial checker 410 may include a rod 411 extending to at least one side, a disk 413 extending at least radially from one side of the rod, and an insertion portion 415 inserted into a recess (H) formed in the glenoid. You can.
  • the rod 411 preferably extends in the first axis direction to penetrate and accommodate the guide pin 110.
  • the disk 413 is a configuration that substantially has a direction.
  • 'having a direction' means that it is not a rotating body with the first axis as the rotation axis, and has the shape of a rotating body with the first axis as the rotation axis. This means that even if it has a symmetrical shape with respect to the first axis, the direction in which at least part of the structure faces is substantially distinct. That is, the actual direction of the disk 413 can be determined according to rotation about the first axis, and a predetermined insertion position can be determined or recognized.
  • the disk 413 allows recognition and/or confirmation of the direction of components seated or overlapping on the disk.
  • the disk 413 may include a disk body 4131, an indicator 4133, a spike 4135, and an alignment hole 4137.
  • the disk body 4131 is a portion that extends radially at least in part with respect to the rod 411, and may have a substantially flat one side and a convex curved surface on the other side.
  • the disk body 4131 may have a flat surface on the rod 411 side and a convex curved surface on the insertion portion 415 side.
  • the convex curved surface of the disk body 4131 may protrude around the first axis, which is the extending direction of the rod. Since the curvature of the curved surface formed in the glenoid fossa may vary depending on the amount of bone defect in the glenoid fossa, the curvature of the convex surface of the disc body 4131 may also vary. Accordingly, a plurality of dial checkers 410 including disk bodies 4131 having different curvatures may be prepared.
  • the spikes 4135 are provided so that the dial checker 410 can be temporarily fixed on the first surface of the glenoid, and at least one spike 4135 is provided on one surface facing the glenoid of the disc body 4133.
  • a protrusion may be formed on the top.
  • the alignment hole 4137 is at least one through hole penetrating the disk body 4131, and may preferably be a long hole extending up and down.
  • the alignment of the disk 413 or dial checker 410 can be checked through the alignment hole 4137. After the surgeon approaches the dial checker 410 to the glenoid, the surgeon can align the dial checker 410 by aligning the alignment hole 4137 with a cross-shaped landmark displayed on the glenoid. In one embodiment, the insertion position of the dial checker 410 can be aligned so that the landmark displayed in the superior-inferior direction is at the center of the alignment hole 4137.
  • the augmentation sizer 430 is configured to measure the depth and direction of the defect. It is coaxially aligned with the dial checker 410 and rotates about the first axis while rotating about the first axis or the central part of the glenoid. Makes it possible to recognize the direction of the lowest point.
  • the augmentation sizer 430 has a through hole 430a that penetrates and accommodates the rod 411 so that it can rotate about the first axis, and can rotate on the disk 413.
  • the augmentation sizer 430 may include a rotor 431, legs 433, and a receiving head 435.
  • the rotor 431 is configured to rotate relative to the rod 411 on the disk 413, has a substantially flat contact surface on one surface, and can contact the disk body 4131 in a preferred embodiment. As the rotor 431 rotates on the disk, the disk body 4131 faces the glenoid on one side and the rotor 431 on the other side.
  • the leg 433 extends from one side of the rotor 431 to the glenoid side, and in a preferred embodiment, the endpoint 433a of the leg may reach the lowest point. Since the amount of bone defect in the glenoid fossa varies depending on the patient, the distance from the lowest point (L) to the first surface or the distance from the lowest point (L) to the rotor may vary, so a plurality of augmentation sizers with different leg lengths may be provided. there is. The surgeon can rotate the augmentation sizer 430 on the dial checker 410 to check whether the endpoint 433a of the leg reaches the lowest point L.
  • the depth of the lowest point (L) that is, the distance along the first axis direction from the first surface as a curved surface formed on the glenoid to the lowest point (L), can be measured according to the leg length of the augmentation sizer.
  • the receiving head 435 is a part accommodated in the sizer handle 450, and may have a shape corresponding to the receiving space of the sizer handle, which will be described later.
  • the receiving head 435 extends a predetermined length from the rotor 431 to one side, and a portion of the outer peripheral surface may have a curved surface and the other portion may have a flat surface.
  • the central portion of the receiving head 435 may have an extended through hole 430a to accommodate the rod 411.
  • the direction of the defect which is the direction in which the lowest point is formed based on the central part of the glenoid
  • the dial checker 410 may be fixed at least temporarily after approaching the glenoid at a predetermined insertion position, that is, in the direction in which the alignment hole 4137 and the landmark are aligned as described above.
  • the augmentation sizer 430 rotates so that the endpoint 433a of the leg comes into contact with the lowest point L. At this time, the direction the leg 433 is facing can be recognized by the indicator 4133.
  • the sizer handle 450 is configured to easily rotate the augment sizer 430 on the dial checker 410, and accommodates at least a portion of the augment sizer 430 to create an augment sizer ( 430) and the sizer handle 450 may rotate together around the first axis. That is, the sizer handle 450 has a through hole 450a that penetrates and accommodates the rod 411 of the dial checker and can rotate around the rod 411.
  • the sizer handle 450 may include a handle 451, a receiving portion 453, and a receiving cap 455.
  • the handle 451 is hollow and extends to one side, and extends to a length that is easy for the surgeon to grip.
  • the receiving portion 453 can accommodate the receiving head 435 of the augmentation sizer while forming a receiving space 453a therein.
  • the receiving space 453a for accommodating the receiving head 435 of the augmentation sizer 430 is preferably formed so that the augmentation sizer 430 does not rotate independently of the sizer handle 450.
  • the accommodating cap 455 is configured to open and close the accommodating space 453a while slidingly moving to at least one side with respect to the accommodating portion 453.
  • the receiving cap 455 can move forward or backward by sliding in the direction of the first axis. In the forward state, the receiving space is closed to fix the augment sizer 430, and in the backward state, the augment sizer 430 is moved. ) can be removed or replaced.
  • the surgeon When the dial checker 410 is temporarily fixed on the glenoid according to a predetermined insertion position, the surgeon first inserts the receiving head 435 into the receiving space 453a and advances the receiving cap 455 to form the augment sizer 430. ) is fixed to the sizer handle 450 and then approached to the glenoid in the first axis direction. At this time, the rod 411 of the dial checker is received through the sizer handle 450 and the augmentation sizer 430. Afterwards, while rotating the augment sizer 430, it is checked whether the end point (433a) of the leg touches the lowest point (L). At this time, one side of the augment sizer (430) and the rotor (431) is connected to the disk (413).
  • the size checker 470 may be coaxially aligned with the guide pin 110 and may have a through hole for receiving the guide pin 110 so that it can rotate about the first axis.
  • the size checker 470 may include a rotor 471, a first leg 473, a second leg 475, and a receiving head 477.
  • the rotor 471 is configured to rotate based on the guide pin 110, and one surface may be formed to be substantially flat.
  • the first leg 473 is configured to extend from one side of the rotor 471 to the glenoid side.
  • the endpoint 273a of the first leg can reach an outer part of the curved surface formed on the glenoid. there is.
  • the second leg 475 extends from the other side of the rotor 471 to the glenoid side, and in a preferred embodiment, the endpoint 475a of the second leg can reach the lowest point (L) of the glenoid. Since the amount of bone defect in the glenoid fossa varies depending on the patient, the distance from the lowest point (L) to the center of the glenoid or the distance from the lowest point (L) to the rotor may vary, so a plurality of size checkers with different leg lengths may be provided. .
  • the surgeon rotates the size checker 470 on the glenoid so that the endpoint (473a) of the first leg touches the outer part of the curved surface (F1) formed on the glenoid, and the endpoint (475a) of the second leg touches the lowest point (L). You can check whether it reaches.
  • a size checker with a desirable leg length is used. It can be recognized. Therefore, the depth of the lowest point (L), that is, the amount of bone defect in the glenoid fossa, can be measured according to the leg length of the size checker.
  • the receiving head 477 is a part accommodated in the sizer handle 450, and may have a shape corresponding to the receiving space of the sizer handle described above. In one embodiment, the receiving head 477 extends a predetermined length from the rotor 471 to one side, and a portion of the outer peripheral surface may have a curved surface and the other portion may have a flat surface. The central portion of the receiving head 477 may have an extended through hole to accommodate the guide pin 110.
  • the reaming guide 500 is configured to guide the formation of a second surface (F2) as a horizontal surface perpendicular to the first axis on the curved surface of the glenoid (G), and the amount and direction of bone defect in the glenoid (G). Provides guidance for appropriate horizontal surface reaming.
  • the amount of defect in the glenoid (G) may correspond to the distance along the first axis direction from the center of the glenoid to the lowest point (L), and the horizontal plane is based on the direction from the center of the glenoid to the lowest point (L). Can be reamed.
  • a plurality of reaming guides 500 may be provided according to the amount of glenoid defect measured or confirmed by the defect measuring device 400.
  • the reaming guide 500 can be inserted into the glenoid fossa (G) along the first axis and guides reaming of the second surface (F2) as a horizontal plane perpendicular to the first axis.
  • the reaming guide 500 may include a stem 510 extending in the first axis direction, a limit guide 530 protruding from the stem, and a fixing part 550 that at least temporarily fixes the reaming guide on the glenoid. You can.
  • the stem 510 has a hollow portion 510a and extends in the direction of the first axis
  • the central portion of the glenoid has a recess (H) formed by a boss cutter (220) centered on the guide pin (110), and at least part or all of the stem (510) is to be inserted into the recess (H).
  • the stem 510 has a hollow 510a formed on the inner peripheral surface, and the hollow 510a may be a cylindrical hole. Parts of the reaming guide holders 600 and 800 and the screw driver 700, which will be described later, can be accommodated in the reaming guide 500 through the hollow.
  • the stem 510 may have a thread 510b formed on the inner peripheral surface of the glenoid side.
  • the head of a screw 580 which will be described later, is fastened to the thread 510b formed on the inner peripheral surface, or a part of the reaming guide holder 600, 800. can be concluded.
  • the stem 510 can be divided into an upper part 510c and a lower part 510d by a limit guide 530, which will be described later. At least a portion of the upper part 510c is accommodated in the reaming guide holder 600 to at least temporarily fix the reaming guide 500 to the glenoid or to guide the glenoid chamfering device 1100, which will be described later, and the lower part 510d At least a portion may be inserted into the recess (H) formed in the glenoid fossa.
  • the stem 510 includes a first plane 511 extending substantially flat along the first axis, and a second plane 512 opposing the first plane and extending substantially flat along the first axis. do.
  • the stem 510 extends between the first plane and the opposing second plane and further includes a first connection surface 513 and a second connection surface 515, at least partially formed as a curved surface.
  • the first plane 511 and the second plane 512 face each other on both sides of the stem 510 and extend in parallel. As at least a portion of the first plane 511 and the second plane 512 extends flat, a portion of the stem may be guided into the alignment leg 613 of the reaming guide 600, which will be described later.
  • the first connection surface 513 and the second connection surface 515 extend between the opposing first and second planes and connect the first and second planes.
  • the first connection surface 513 may be a curved surface that is convex outward and extends along the first axis direction.
  • a portion of the second connection surface 515 located on the side where the limit guide 530, which will be described later, is formed may be formed as a curved surface that is partially convex outward and extends along the first axis direction, and the other portion may be formed as a flat surface.
  • the second connection surface 515 includes a guide surface 515a and a curved portion 515b.
  • the guide surface 515a may be formed at least partially as a flat plane for interaction with the chamfering mechanism 1100 described later at the upper part 510c, which is the upper part of the limit guide, including a portion of the limit guide 530.
  • the curved portion 515b may extend outward from the lower portion 510d as a convex curved surface.
  • the limit guide 530 protrudes from a predetermined height of the stem 510 and is provided to guide the cutting range of the joint fossa. As shown in FIGS. 24 and 25, the limit guide 530 may be formed to protrude in a direction symmetrical about the first axis at a predetermined height of the stem. Additionally, the limit guide protrudes from one edge of the first and second planes. In one embodiment, the limit guide may be formed to protrude from an edge of one connection surface 515 at a predetermined height of the first and second planes.
  • the stem 510 can be divided into an upper part 510c and a lower part 510d by the limit guide 530, and as described above, the connection surface 515 on the side where the limit guide is formed is substantially flat on the upper side. It forms a guide surface 515a and may have a curved portion 515b on the lower side. That is, the limit guide 530 may extend on both sides along the guide surface 515a.
  • the fixing unit 550 is configured to at least temporarily fix the reaming guide to the glenoid on the guide surface or one lower side of the guide surface. A portion of the fixing portion 550 may contact the first surface of the glenoid, or at least a portion may be inserted into the first surface, thereby preventing the reaming guide 500 from rotating within the recess (H). You can.
  • the fixing part 550 has a branch 551 extending from the stem 510 to one side, and is provided with a spike 553 extending from the branch 551 to the glenoid side, so that the end of the spike is connected to the first surface of the glenoid or It can be touched or inserted into the surrounding area of the joint fossa to increase friction.
  • the fixing portion 550 may have a slot 555 formed to receive a part of another mechanism.
  • the slot 555 may have a portion of a branch formed through a hole.
  • the slot 555 may be a groove formed on a branch.
  • the branch 551 may extend from the surface on which the guide surface 515a is formed. That is, the branch 551 may extend perpendicular to the stem 510 while extending from the guide surface 515a.
  • the reaming guide 500 without the fixing part 550 may be used.
  • the reaming guide 500 is at least partially accommodated through the stem 510, and a portion may further include a screw 580 inserted into the glenoid fossa.
  • the screw 580 has a thread formed on a portion extending to one side, and a thread is formed on the outer peripheral surface of the head portion so that it can be fastened to a portion of the inner peripheral surface of the stem.
  • the head of the screw 580 may be screwed with a thread 510b formed on the inner peripheral surface of the stem.
  • the screw 580 is not excluded from being provided integrally with the reaming guide 500.
  • the screw 580 has a groove 581 extending to at least one side on the surface of the head, so that the screw 580 can be rotated using a mechanism.
  • the reaming guide holder 600 holds the reaming guide 500 and aligns its direction to approach and insert the reaming guide 500 into the glenoid. It is a configuration that can be done.
  • the reaming guide holder 600 approaches the glenoid with the reaming guide 500 fastened, and the insertion position of the reaming guide 500 can be determined for reaming the second surface as an accurate horizontal plane.
  • the reaming guide holder 600 may include an insertion position determination part 610 that determines the insertion position of the reaming guide 500, and a fastening part 630 that is at least partially fastened to the reaming guide.
  • the insertion position determination unit 610 can determine the insertion position of the reaming guide 500, that is, which direction the guide surface 515a faces when the reaming guide 500 is inserted into the glenoid. As described above, the reaming guide 500 is inserted into the glenoid along the first axis, but if the direction of the reaming guide 500 is not determined, the guide surface 515a may face all directions within a 360-degree range based on the first axis. You can.
  • the guide surface 515a of the reaming guide 500 or the limit guide 530 extending on both sides along the guide surface guides the second surface reaming as a horizontal plane, so when inserted into the glenoid, the direction of the limit guide 530 is changed.
  • the insertion position determination unit 610 can determine the insertion position of the reaming guide 500 along the defect direction recognized by the defect measuring device 400 described above.
  • the insertion position of the reaming guide may be determined so that the guide surface 515a faces in the opposite direction to the lowest point L, as shown in FIG. 26. That is, the insertion position may be determined so that the limit guides 530 protruding on both sides of the stem are symmetrical with respect to the line from the glenoid center or recess to the lowest point (L).
  • the insertion position determination unit 610 can approach the glenoid (G) with at least a portion of it at least temporarily fastened to the reaming guide 500, and rotates about the first axis to determine the insertion position of the reaming guide 500. It can be adjusted or specified.
  • the insertion position determination unit 610 includes a body 611 at least partially extending in the first axis direction, an alignment leg 613 extending from one side of the body 611, and connecting the body 611 and the alignment portion 617. It includes a connecting portion 615 that is connected to the body 611 and an alignment portion 617 provided on the other side of the body 611.
  • the body 611 extends to at least one side to form the outer shape of the insertion position determining part 610, and may have a hollow interior to accommodate a fastening part 630, which will be described later.
  • the body 611 preferably extends in the first axis direction.
  • the alignment leg 613 is provided to accommodate at least a portion of the reaming guide in the gap 613a and align the direction of the reaming guide.
  • the alignment leg 613 includes a leg 6131 that is divided into two while forming a gap 613a in the middle, and a bent portion 6133 that is bent and extended from one end of the leg 6131.
  • the pair of bent portions 6133 are parallel and accommodate a portion of the reaming guide in the gap 613a between the bent portions 6133.
  • the upper portion 510c of the stem may occupy the gap formed by the alignment leg 613.
  • the first plane 511 and the second plane 512 opposing each other are accommodated between the alignment legs 613 to grip the stem 510 to align the direction of the reaming guide 500.
  • a reaming guide lacking the fixing portion 550 as described above may be used with the reaming guide holder 600 having the alignment leg 613 in one embodiment.
  • the connecting portion 615 connects the body 611 and the alignment portion 617 formed at the other end of the body, and may form a predetermined space therein for smooth rotation of the fastening portion 630, which will be described later.
  • the alignment portion 617 is formed to align the insertion position of the reaming guide 500, allowing the surgeon to check the alignment portion 617 and rotate the insertion position determination portion 610 about the first axis. there is.
  • the alignment unit 617 may include a disk 6171, a receiving groove 6173, and a corresponding indicator 6175.
  • the disk 6171 is provided in the shape of a plate with a predetermined thickness, and the surface opposite to the joint, that is, the lateral surface, is formed to be substantially flat, so that impacting, etc. can be easily performed.
  • the disk 6171 may be a circular plate or a polygonal plate with a plurality of receiving grooves 6173 formed on the outer peripheral surface.
  • the receiving groove 6173 is a groove provided to accommodate one end of the reference indicator, and is formed recessed into the outer peripheral surface of the disk 6171, so that the reference indicator and the reaming guide holder 600 can be substantially perpendicular.
  • the receiving groove 6173 receives the reference indicator and then determines the insertion position of the reaming guide 500 together with the reference indicator.
  • the reference indicator may have substantially the same configuration as the guide handle 200.
  • a protruding groove 6173a is formed on one side of the receiving groove 6173 to prevent rotation or falling off, and the protrusion 231a of the guide handle 200 can be accommodated as a reference indicator.
  • the corresponding indicator 6175 is an indicator displayed or formed on one side of the disk 6171, and is displayed corresponding to the indicator 4133 formed on one side of the disk body 4131 described above. That is, a corresponding indicator such as the indicator 4133 displayed on the disk checker 410 to identify the direction of the lowest point (L) is displayed radially.
  • the corresponding indicator 6175 may be displayed to correspond to the portion where the receiving groove 6173 is formed, and the number corresponding to the number of receiving grooves 6173 formed on the outer peripheral surface of the disk may be displayed. That is, when 12 corresponding indicators 6175 are displayed at an angle of 30 degrees on one side of the disk 6171, a receiving groove 6173 is formed on the outer peripheral surface corresponding to the portion where the corresponding indicators 6175 are displayed.
  • the surgeon can check the direction of the defect through the defect measuring device 400.
  • the augmentation sizer 430 is placed toward the lowest point on the dial checker 410, it is possible to check which direction the lowest point (L) is by checking the indicator 4133 where the legs 433 overlap.
  • the insertion position determination unit 610 according to an embodiment of the present invention inserts the reference indicator into the receiving groove 6173 where the corresponding indicator 6175 corresponding to the indicator 4133 is displayed and then moves the reference indicator to the first position.
  • the insertion position of the reaming guide fastened to the reaming guide holder is provided to be aligned.
  • the guide surface 515a of the reaming guide fastened to the reaming guide holder 600 is The facing direction and the lowest point (L) are located in the opposite direction from the center of the glenoid.
  • the surgeon fastens the reference indicator (guide handle, 200) to the receiving groove 6173 marked with the corresponding indicator 6175 corresponding to the direction of the lowest point (L), and then directs the reference indicator in the inferior direction. Move or rotate to position 1. Through this, the insertion position of the reaming guide 500 can be aligned.
  • the reference indicator or guide handle 200 and the reaming guide holders 600 and 800 may be rotated around the first axis.
  • indicators 4133 from 1 to 12 may be displayed on the disk 413 of the dial checker, and 12 or an indicator corresponding to the superior direction is a landmark indicated in the superior direction of the glenoid fossa.
  • the dial checker 410 is arranged so that it corresponds to .
  • the direction of the lowest point (L) is confirmed by a predetermined number or an indicator corresponding to the direction.
  • Corresponding indicators 6175 from 1 to 12 may also be displayed on the disk 617 of the reaming guide holder 600.
  • the fastening part 630 is fastened with at least a portion of the reaming guide 500, and preferably, one end of the fastening part 630 is fastened with the screw thread 510b formed on the inner peripheral surface of the stem 510 to secure the reaming guide 500. Can be at least temporarily fastened to the reaming guide holder 600.
  • the fastening part 630 may be coaxially aligned with the insertion position determining part 610.
  • the fastening part 630 has a rod 631 extending to one side, and the rod 631 may be at least partially surrounded by the body 611.
  • the fastening end 633 provided at one end of the glenoid side of the rod 631 is inserted into the stem and mediates fastening with the reaming guide 500, and a thread is formed on the outer peripheral surface of the fastening end 633.
  • a rotating body 635 capable of rotating the fastening part 630 is formed on the other side of the rod 631.
  • the rod 631 and the fastening end 633 may protrude toward the end through the gap 613a between the alignment legs 613. In one embodiment, the fastening end 633 may extend further toward the glenoid than the alignment leg 613.
  • the screw driver 700 is configured to rotate the screw 580 in the reaming guide 500 to insert the screw 580 into the glenoid, and includes a driver 710 and a holder (710) that are coaxially aligned. 730).
  • the driver 710 includes a rod 711 extending along the first axis, a tip 713 that is inserted into the groove 581 formed on the head surface of the above-described screw at one end of the rod to transmit a rotational force, and a circuit that rotates the driver. Includes total (715).
  • the holder 730 constitutes the outer shell of the driver 710 and may have a plurality of through holes to facilitate cleaning.
  • a reaming guide holder 800 according to another embodiment of the present invention is shown.
  • the reaming guide holder 800 has an insertion position determining part 810, a fastening part 830, and a screw driver 850 aligned coaxially, so that the reaming guide 500 approaches the glenoid side using a single device and turns the screw to at least It can be temporarily fixed.
  • the insertion position determination unit 810 has the same function as the insertion position determination unit 610 described above, and substantially the same configuration is replaced with the description of the insertion position determination unit 610.
  • the insertion position determination unit 810 includes a body 811 at least partially extending in the first axis direction, an alignment leg 813 extending from one side of the body 811, and an alignment portion provided on the other side of the body 811. Includes (815).
  • the alignment unit 815 may include a disk 8151, a receiving groove 8153, and a corresponding indicator 8155, and the fastening portion 830 or the screw driver 850 can be turned on one side of the disk 8151. It is the same as the above description except that the rotating body provided so as to be formed is formed.
  • the fastening part 830 is coaxially aligned with the insertion position determining part 810, and includes a rod 831 extending to one side, a fastening end 833 provided on one end of the rod 831, and a fastening end 833 on the other side of the rod 831. It includes a rotating body 835 provided.
  • the fastening part 830 may have a hollow 830a to accommodate the screw driver 850.
  • the screw driver 850 includes a rod 851 extending along the first axis, a tip 853 that is inserted into the groove 581 formed on the head surface of the above-described screw at one end of the rod to transmit rotational force, and a screw driver that rotates. It includes a rotating body 855.
  • the screw driver 850 is coaxially aligned with the insertion position determining part 810 and the fastening part 830, and is slidably provided within the fastening part 830, so that one end can be exposed or hidden at the end near the glenoid.
  • the tip 853 protrudes beyond the fastening end 833 when the screw driver 850 moves forward, and is accommodated in the hollow 830a of the fastening part 830 when the screw driver 850 moves backward.
  • the reaming guide holder 800 in which the insertion position determination part 810, the fastening part 830, and the screw driver 850 are coaxially aligned, has a fixing leg (described later) instead of the alignment leg 813. 913) can be provided.
  • a reaming guide holder 900 according to another embodiment of the present invention may be provided.
  • the reaming guide holder 900 includes an insertion position determination part 910 and a fastening part 930 and can perform a substantially similar function to the reaming guide holder 600, but instead of the alignment leg 613, it has a fixing leg ( There is a difference in that 913) is formed, and the configuration that is substantially the same as that of the reaming guide holder 600 according to an embodiment of the present invention will be replaced by the above description.
  • the insertion position determination part 910 includes a body 911 at least partially extending in the first axis direction, a fixing leg 913 extending from one side of the body, a connection part 915 connecting the body and the alignment part, and a body 911 extending on the other side of the body. It includes an alignment unit 917 that is provided.
  • the fixing leg 913 is configured to prevent the reaming guide 500 from rotating with respect to the reaming guide holder 900, and at least a portion of the fixing leg 913 may extend toward the reaming guide 500 from one end of the glenoid side of the body 911. .
  • the fixing leg 913 allows the reaming guide 500 to determine or designate an insertion position without rotating.
  • the pin 913a formed at the end of the fixing leg can be accommodated in the slot 555 of the fixing part.
  • the alignment portion 917 may include a disk 9171, a receiving groove 9173, and a corresponding indicator 9175, and a protruding groove 9173a is formed on one side of the receiving groove 9173 to prevent rotation or falling off. can be formed.
  • the fastening part 930 includes a rod 931 extending to one side, a fastening end 933 provided at one end of the joint fossa side of the rod, and a rotating body 935 capable of rotating the fastening part 930 on the other side of the rod. It can be included.
  • the second reamer 1000 is a surgical procedure to form a second surface (F2) as a horizontal surface perpendicular to the first axis (X1) following the guidance of the reaming guide 500 inserted into the glenoid fossa. It is an instrument.
  • the cutting range of the second reamer 1000 may be guided by the limiting guide 530 of the reaming guide 500 so as to cut only a predetermined range on the glenoid fossa (G).
  • the second reamer 1000 includes a body 1010 extending to one side, a shell 1030 provided to surround at least a portion of the body, and a cutting portion 1050 that substantially cuts the glenoid fossa.
  • the body 1010 extends to one side, has a predetermined length to facilitate the surgeon's grip, and preferably has an insertion portion 1010a so that at least part of the body 1010 is inserted into the stem 510 of the reaming guide 500.
  • the outer shell 1030 surrounds at least a portion of the body and may have a plurality of through holes 1030a to facilitate cleaning.
  • the cutting unit 1050 is provided to rotate with the body 1010 as the center, and extends radially at least in part to cut a portion of the glenoid fossa.
  • the cutting portion 1050 includes a tube 1051 surrounding the body 1010, an extension portion 1052 extending distally from the tube, and a second surface forming portion extending radially with a predetermined central angle at one end of the extension portion ( 1053).
  • the second surface forming portion 1053 may include blades 1053a, at least a portion of which extends radially to cut bone, and a rim 1053b connecting the blades.
  • the second surface forming portion 1053 preferably has a central angle smaller than the angle (180 degrees) between the limit guides 530 extending on both sides. As shown in FIG. 37 , the second surface forming portion 1053b rotates with or around the body 1010, but the rotation range may be limited by the limit guide 530.
  • the extension portion 1052 extending distally from the tube 1051 may have a predetermined center angle, but one end of the extension portion 1052 or the cutting portion 1053 is blocked by the limiting guide, thereby limiting the cutting range.
  • the cutting unit 1053 cuts the portion on the glenoid excluding the portion toward which the guide surface faces. That is, the second reamer 1000 has a first plane 511, a first connection surface 513 on which no guide surface is formed, and a second plane 512 centered on the center of the joint fossa or the recess H. The cutting direction is perpendicular to the first axis ( can be formed.
  • the glenoid chamfering device 1100 is provided to chamfer the first surface (F1) as the curved surface of the glenoid fossa.
  • the augmentation (B3) of the partially reinforced base plate (B) includes a plate (B31) extending substantially flatly perpendicular to the central axis of the stem and a wedge (B33) extending from one end of the plate. It includes a thickness of the wedge that gradually decreases in the first direction (A1), while the thickness of the wedge extends uniformly in the second direction (A2).
  • the glenoid chamfering device 1100 can chamfer the curved surface of the glenoid to form a curved surface in contact with the wedge (B33) on the glenoid.
  • the glenoid chamfer 1100 may include a body 1110, an insertion rod 1130, a hitting portion 1150, and an impacting portion 1170.
  • the body 1110 extends to one side and has a predetermined length to facilitate the surgeon's grip.
  • An insertion rod 1130 and an impact portion 1150 may be provided on one side of the body, and an impact portion 1170 may be provided on the other side.
  • the insertion rod 1130 is configured to extend from the body 1110 in the first axis direction and is inserted into the stem 510 of the reaming guide to prevent the chamfered portion from deviating when the glenoid chamfering device 1100 hits the glenoid. can do.
  • the striking portion 1150 is formed on one side of the body 1110, and is spaced a predetermined distance apart from the insertion rod 1130 and may be provided to strike and chamfer at least a portion of the glenoid fossa.
  • the striking portion 1150 has a curved surface 1150a that is convex in the distal direction, and a plurality of irregularities are formed on the curved surface, so that when striking the glenoid fossa, the bones of the glenoid are chamfered by the irregularities.
  • a plurality of striking portions 1150 may be prepared depending on the amount of bone defect in the joint fossa, and the striking portion 1150 may have a shape corresponding to the amount of bone defect measured by the augmentation sizer 430 or the size checker 470. ) can be prepared.
  • the striking portion 1150 may be detachably fastened to the body 1110.
  • a plurality of glenoid chamfering mechanisms 1100 may be prepared.
  • the striking unit 1150 may include a striking body 1151, a first insertion guide 1153, and may further include a second insertion guide 1155.
  • the striking body 1151 has a predetermined volume and thickness and strikes the first surface F1 as a curved surface when the glenoid chamfer 1100 is struck.
  • the striking body 1151 has a shape corresponding to the wedge B33 of the base plate B and may have a curved surface that is convex in the distal direction. Referring to FIG. 39, the striking body 1151 extends uniformly in thickness in a first direction (X2) perpendicular to the first axis, and is inserted into the second direction (X3) perpendicular to the first axis. It may be formed so that the thickness gradually decreases as one moves away from the rod. At this time, the first direction (X2) and the second direction (X3) may be perpendicular. Furthermore, the striking body 1151 or the striking portion 1150 has a convex curved surface in the distal direction, which means that when the striking body 1151 extends in a direction away from the insertion rod along the second direction It can be explained as increasing.
  • the first recessed guide 1153 has a predetermined width and is a part that is recessed in the second direction (X3).
  • the guide surface 515a and the limit guide 530 are guided toward the first recessed guide 1153, or It can be accepted. That is, the first retraction guide 1153 extends along the first axis with a portion of the insertion rod 1130 side of the striking body 1151 recessed in the second direction (X3).
  • the width into which the first recessed guide 1153 is recessed may be the length from the end of one limit guide 530 to the end of the other limit guide 530.
  • the guide surface 515a and the limit guide 530 are flat, when the insertion rod 1110 is inserted into the stem 510 of the reaming guide, the guide surface 515a and the limit guide 530 are It is accommodated inside the first entrapment guide (1153). Accordingly, when a part of the reaming guide is inserted and fixed into the glenoid, the glenoid chamfering device 1100 chamfers the first surface F1 as a curved surface centered on the direction in which the guide surface 515a faces.
  • the second recessed guide 1155 has a smaller width than the first recessed guide and is a part recessed in the second direction, where the fixing part 550 of the reaming guide is guided or accommodated toward the second recessed guide 1155. You can.
  • the width of the second insertion guide 1155 may be the same as or slightly wider than the width of the branch 551 of the fixing part 550.
  • the glenoid chamfering device 1100 lacking the second retraction guide 1155 can be used.
  • the hitting portion 1150 may be formed symmetrically with respect to a plane perpendicular to the first direction that bisects the central portion.
  • a guide gap 1160 may be formed between the insertion rod 1130 and the hitting portion 1150.
  • the insertion rod 1130 is inserted into the stem 510 of the reaming guide, and the retraction guides 1153 and 1155 of the striking part guide the guide surface 515a and the fixing part 550, so the guide gap 1160 contains a stem ( A portion of the guide surface 515a side of 510) is accommodated.
  • the size of the guide gap 1160 may correspond to the distance from the inner peripheral surface of the stem 510 to the guide surface 515a and the limit guides 530 on both sides.
  • the glenoid chamfering device 1100 which accommodates a portion of the guide surface 515a side of the stem 510 between the guide gap 1160, does not rotate based on the reaming guide, but the chamfered portion on the glenoid is fixed.
  • the impacting portion 1170 may extend flatly over a predetermined area from the other end of the body to facilitate the surgeon's impact.
  • the base plate holder 1200 is a device for inserting a partially reinforced glenoid base plate (B) into the glenoid, and after being at least temporarily fastened to the base plate (B), the base plate ( Determine the insertion position of B) and insert the base plate into the recess (H) of the glenoid (H). At this time, it is preferable that the base plate holder 1200 approaches the glenoid along the first axis while being fastened to the base plate.
  • the base plate holder 1200 can determine which direction the augment faces when the base plate (B) is inserted into the glenoid.
  • the plate (B31) corresponds to the second surface as the horizontal surface of the glenoid
  • the wedge (B33) corresponds to the chamfered portion of the first surface as the curved surface of the glenoid, so it is inserted into the glenoid.
  • the insertion position of the augment must be determined.
  • the base plate holder 1200 can determine the insertion position of the base plate (B) according to the defect direction recognized by the defect measuring device 400 described above and/or the insertion position determined by the reaming guide holder 600. .
  • the base plate holder 1200 can rotate about the first axis to adjust or designate the insertion position of the base plate.
  • the base plate holder 1200 includes a body 1210 at least partially extending in the first axis direction, a fastening auxiliary part 1230 that assists fastening between the base plate and the base plate holder, and a base plate ( It includes an insertion end 1250 that is at least partially inserted into B) and an alignment portion 1270 provided on the other side of the body 1210.
  • the body 1210 preferably extends along the first axis (X1) and surrounds at least a portion of the fastening auxiliary part 1230.
  • a plurality of through holes or long holes may be formed in the body 1210.
  • the fastening auxiliary part 1230 assists fastening between the base plate (B) and the base plate holder 1200, and can prevent the base plate (B) from falling off from the base plate holder 1200.
  • the fastening auxiliary part 1230 includes a connecting rod 1231 that transmits rotational force, a rotating body 1233 that can be rotated by the surgeon, and an auxiliary protrusion inserted into the base plate (B) along with an insertion protrusion 1251 to be described later. Includes (1235).
  • the connecting rod 1231 connects the rotating body 1233 and the auxiliary protrusion 1235 to transmit rotational force to the auxiliary protrusion 1235, and the auxiliary protrusion 1235 moves forward or backward by the rotational force to the base plate (B). It can be inserted into the formed through hole or insertion hole.
  • a screw thread 1235a may be formed on the outer peripheral surface of the auxiliary protrusion 1235.
  • the insertion end 1250 is a part that is substantially fastened to the base plate (B) and is formed at one end of the glenoid side of the body.
  • the insertion end 1250 may include an insertion protrusion 1251 and an insertion indicator 1253.
  • the insertion protrusion 1251 is a protrusion that protrudes from the insertion end 1250 toward the glenoid and can be inserted into the hollow of the base plate (B). Therefore, the insertion protrusion 1251 can be fastened to the base plate (B) on the first axis (X1), which is the central axis of the base plate.
  • the insertion indicator 1253 is displayed on the insertion end 1250 or the body 1210 to indicate the fastening direction of the base plate and the base plate holder 1200. Since the partially reinforced base plate (B) does not have a symmetrical shape because the augment is formed in a portion, the base plate and the base plate holder 1200 must be fastened in a predetermined manner so that the augment is connected to the first curved surface of the joint fossa.
  • the chamfered surface may correspond to the second surface, which is a horizontal surface.
  • the auxiliary protrusion 1235 is engaged with the through hole of the portion of the augmentation of the base plate where the plate B31 is formed, and the insertion protrusion 1251 is engaged with the through hole formed in the center of the base plate.
  • the approach direction of the plate (B) and/or the base plate holder 1200 can be indicated.
  • the insertion indicator 1253 displays the cross-sectional shape of the partially reinforced base plate (B), and the augmentation portion is displayed on the side of the auxiliary protrusion 1235 so that the surgeon can look at the insertion indicator 1253 and insert the portion of the base plate (B).
  • This reinforced base plate (B) can be fastened in a specified direction.
  • the alignment unit 1270 is formed to align the insertion position of the base plate (B), and the surgeon can check the alignment unit 1270 and rotate the base plate holder 1200 about the first axis.
  • the alignment unit 1270 may include a disk 1271, a receiving groove 1273, and a corresponding indicator 1275.
  • the disk 1271 is provided in the shape of a plate with a predetermined thickness, and the surface opposite to the joint, that is, the lateral surface, is formed to be substantially flat, so that impacting, etc. can be easily performed.
  • the disk 1271 may be a circular plate or a polygonal plate with a plurality of receiving grooves 1273 formed on the outer peripheral surface.
  • the receiving groove 1273 is a groove provided to accommodate one end of the reference indicator, and is formed recessed into the outer peripheral surface of the disk 1271, so that the reference indicator and the base plate holder 1200 can be substantially perpendicular.
  • the receiving groove 1273 receives the reference indicator and then determines the insertion position of the base plate (B) together with the reference indicator.
  • the reference indicator may have substantially the same configuration as the guide handle 200.
  • a protruding groove 1273a is formed on one side of the receiving groove 1273 to prevent rotation or falling off, and the protrusion 231a of the guide handle 200 can be accommodated as a reference indicator.
  • the corresponding indicator 1275 is an indicator displayed or formed on one side of the disk 1271, and is displayed corresponding to the indicator 4133 formed on one side of the disk body 4131 described above. That is, a corresponding indicator such as the indicator 4133 displayed on the disk checker 410 to identify the direction of the lowest point (L) is displayed radially.
  • the corresponding indicator 1275 may be displayed to correspond to the portion where the receiving groove 1273 is formed, and the number corresponding to the number of receiving grooves 1273 formed on the outer peripheral surface of the disk may be displayed. That is, when 12 corresponding indicators 1275 are displayed at an angle of 30 degrees on one side of the disk 1271, a receiving groove 1273 is formed on the outer peripheral surface corresponding to the portion where the corresponding indicators 6175 are displayed.
  • the corresponding indicator 1275 of the base plate holder 1200 may be substantially the same as the corresponding indicator 6175 of the reaming guide holder 600, and the alignment portion 1270 of the base plate holder 1200 is the reaming guide holder. It may be substantially the same as the alignment portion 617 of 600.
  • the surgeon can check the direction of the defect through the defect measuring device 400.
  • the augmentation sizer 430 is placed toward the lowest point on the dial checker 410, it is possible to check which direction the lowest point (L) is by checking the indicator 4133 where the legs 433 overlap.
  • the surgeon fastens the reference indicator (guide handle, 200) to the receiving groove 1273 marked with the corresponding indicator 1275 corresponding to the direction of the lowest point (L), and then Move or rotate to the first position so that it is facing downward. Through this, the insertion position of the base plate (B) can be aligned and inserted into the glenoid.
  • the device for inserting a glenoid base plate according to an embodiment of the present invention and the process of inserting a partially reinforced base plate into the glenoid through the device have been described.
  • the glenoid base plate insertion method (S) according to an embodiment of the present invention will be described.
  • the glenoid base plate insertion method (S) forms a curved first surface and a horizontal second surface on the glenoid in order to insert the partially reinforced base plate (B) into the glenoid (G). This is a process of aligning the insertion position of the base plate and inserting it into the glenoid. If a part of the glenoid is missing, the missing part can be compensated for through an augment formed in a part of the base plate.
  • the glenoid base plate insertion method (S) includes a guide pin insertion step (S10), a first reaming step (S20), a post drill step (S30), a dial checking step (S40), a reaming guide insertion step (S50), and a second reaming step. It may include a step (S60), a chamfering step (S70), and a base plate insertion step (S80).
  • the guide pin insertion step (S10) is a process of inserting the guide pin 110 into the glenoid (G).
  • the guide pin can be inserted along the first axis (X1), and the guide pin 110 is a center guide. It can be inserted into the glenoid fossa under the guidance of (120).
  • a guide pin 110 can be inserted into the central portion of the glenoid where each landmark intersects. .
  • a landmark other than a cross may be displayed to indicate the center of the glenoid, but it is preferable to include landmarks in the superior and inferior directions.
  • the center guide 120 used to insert the guide pin may have a shape suitable for being supported on the glenoid.
  • the first reaming step (S20) is a process of reaming the concave first surface around the first axis along the guide pin, and includes a defect size checking step (S21) and a curved surface reaming step (S23). do.
  • the defect size checking step (S21) is a process of measuring the amount of bone defect in the glenoid (G), and the curvature of the first surface as a curved surface can be determined according to the bone defect amount measured in the defect size checking step (S21). .
  • the amount of bone defect in the joint fossa can be measured by attaching the size checker 470 to the defect measuring device 400. The surgeon rotates the size checker 470 on the glenoid so that the endpoint (473a) of the first leg touches the outer part of the curved surface (F1) formed on the glenoid, and the endpoint (475a) of the second leg touches the lowest point (L). You can check whether it reaches.
  • the endpoint (475a) of the second leg touches the lowest point (L) and the endpoint (473a) of the first leg touches the outer part of the curved surface formed on the glenoid
  • a size checker with a desirable leg length is used. It can be recognized. Therefore, the depth of the lowest point (L), that is, the amount of bone defect in the glenoid fossa, can be measured according to the leg length of the size checker.
  • the curved surface reaming step (S23) may be performed by the first reamer 310 described above.
  • the surgeon operates the first reamer 310 while approaching the glenoid fossa along the first axis so that the first reamer 310 can accommodate the guide pin to form a first surface as a concave curved surface centered on the first axis (X1).
  • the post drill step (S30) is a process of forming a recess (H) with a cross-section larger than the guide pin based on the center portion of the glenoid into which the guide pin is inserted.
  • a reaming guide and a base are installed in the recess (H). At least a portion of the plate may be inserted.
  • the post drill step (S30) may be performed by the boss cutter 320 on which the stopper 330 is mounted or the boss cutter 320 provided integrally with the stopper 330.
  • the post drill step (S30) causes at least a portion of the boss cutter having a predetermined diameter to protrude to one side of the stopper whose one side is convexly protruding, and then the boss cutter 320 rotates the first axis to accommodate the guide pin 110. Accordingly, the glenoid can be reamed while approaching the glenoid.
  • the defect measurement step (S40) is a process of confirming the direction and amount of defects of the defect with respect to the first side, and can be performed by the defect measurement device 400.
  • the direction of the defect can be confirmed through an indicator, and the insertion position of the reaming guide 500 is determined to correspond to the indicator, and the reaming guide insertion step (S50) and the second reaming step (S50) to be described later ( S60) can be performed to accurately ream the second side.
  • the defect measurement step includes a dial checker placement step (S41), an augmentation sizer placement step (S43), and a defect direction checking step (S45).
  • the dial checker placement step (S41) is a process of placing a dial checker indicating the direction based on the central part of the glenoid fossa on the glenoid fossa.
  • the dial checker 410 described above is placed on the glenoid, and the surgeon approaches the glenoid with the dial checker 410 and then aligns the cross-shaped landmark marked on the glenoid with the alignment hole 4137 to place the dial checker 410 on the glenoid. ) can be sorted.
  • the insertion position of the dial checker 410 can be aligned so that the landmark displayed in the superior-inferior direction on the glenoid is at the center of the alignment hole 4137.
  • the dial checker 410 may be at least temporarily fixed to the glenoid by a spike 4135 protruding from one surface of the disc body 4133 facing the glenoid.
  • the augment sizer placement step (S43) measures the distance in the first axis direction from the first surface to the lowest point (L) of the glenoid defect through the augment sizer 430 provided to measure the depth of the defect. It's a process. A portion of the augmentation sizer 430 is in contact with the lowest point (L), and at the same time, one surface of the augmentation sizer 430 is in contact with one surface of the dial checker 410. It can be placed on the dial checker. As described above, since the depth of the lowest point (L) may vary depending on the amount of glenoid defect depending on the patient, a plurality of augmentation sizers 430 having different leg 433 lengths may be provided.
  • the ment sizer placement step (S43) can be performed. The surgeon can rotate the augment sizer 430 on the dial checker 410 to check whether the endpoint 433a of the leg touches the lowest point L. When the contact surface of the rotor 431 comes into contact with one surface of the disk body 4131, it can be recognized that an augment sizer having a desirable leg length has been used.
  • the defect direction checking step (S45) is a process of measuring the direction in which the lowest point is formed based on the central part of the glenoid fossa.
  • the direction in which the lowest point is formed is determined through the direction measured by the dial checker, and the direction in which the part of the augmentation sizer in contact with the lowest point (L) faces on the dial checker is the direction in which the lowest point is formed. direction can be determined.
  • the endpoint (433a) of the leg is in contact with the lowest point (L) and the contact surface of the rotor (431) is in contact with one surface of the disk body (4131), the direction in which the leg (433) faces is recognized by the indicator (4133).
  • the direction of the defect can be determined. Afterwards, the guide pin 110 can be removed.
  • the reaming guide insertion step (S50) is a process of inserting a reaming guide that guides reaming of the second surface, which is a horizontal plane perpendicular to the first axis, into the glenoid fossa.
  • the second surface (F2) can be formed by reaming the first surface (F1), which is a curved surface formed on the glenoid, to a certain portion to be flat.
  • the reaming guide 500 whose insertion position is aligned, may be inserted into the recess (H) through the reaming guide insertion step (S50).
  • the reaming guide insertion step (S50) may be performed by the reaming guide holder 600 and the screw driver 700, or the reaming guide holder 800 accommodating the screw driver 850 therein.
  • the reaming guide insertion step (S50) includes a reaming guide fastening step (S51), a reference indicator fastening step (S53), a direction alignment step (S55), a reaming guide fixing step (S57), and a screw insertion step (S59).
  • the reaming guide fastening step (S51) is a process of fastening the reaming guide 500 to the reaming guide holder 600. At least a portion of the reaming guide holder 600 may be accommodated in the hollow 510a of the stem of the reaming guide. A suitable reaming guide 500 from among a plurality of reaming guides may be selected and used according to the amount of glenoid bone defect measured in the augmentation sizer placement step (S430).
  • the fastening end 633 rotates to form a thread formed on the outer peripheral surface of the fastening end 633 and the inner peripheral surface of the stem.
  • the formed thread 510b is fastened through screw coupling.
  • the reaming guide is fastened, the direction in which the guide surface 515a faces can be guided by the alignment legs 613 and 813 or the fixing leg 913.
  • the pin 913a formed at the end of the fixing leg is accommodated in the slot 555 of the fixing part of the reaming guide to guide the fastening of the reaming guide, and the gap formed by the alignment legs 613 and 813 ( The upper part 510c of the stem is accommodated between 613a and 813a so that fastening of the reaming guide can be guided.
  • the reference indicator fastening step (S53) is a process of connecting a reference indicator to one side of the reaming guide holder.
  • the reference indicator may be substantially the same as the guide handle 200.
  • the reference indicator and the reaming guide holder can form a predetermined angle.
  • the reference indicator and the reaming guide holder may form a right angle.
  • an angle other than a right angle may be formed depending on whether the first axis X1 is tilted.
  • the reference indicator is inserted into the receiving groove (6173) where the corresponding indicator (6175) corresponding to the indicator (4133) confirmed in the defect direction checking step (S45) is displayed.
  • the direction alignment step (S55) is a process of aligning the insertion position of the reaming guide fastened to the reaming guide holder by moving the reference indicator to the first position.
  • the reaming guide holder 600 is fastened to the reaming guide holder 600 by moving the reference indicator inserted into the receiving groove 6173 to the first position with one end facing downward.
  • the direction in which the guide surface (515a) of the guide faces is positioned so that the lowest point (L) of the glenoid fossa is in the opposite direction.
  • the reference indicator or guide handle 200 and the reaming guide holders 600 and 800 may be rotated around the first axis.
  • the reaming guide fixing step (S57) is a process of approaching the reaming guide to the glenoid along the first axis (X1) and fixing the reaming guide on the glenoid according to the aligned insertion position.
  • the surgeon approaches the aligned reaming guide holder 600 and reaming guide 500 to the glenoid along the first axis and inserts and fixes a part of the reaming guide into the glenoid.
  • the stem 510 of the reaming guide is inserted into the glenoid recess (H) and fixed at least temporarily.
  • the screw insertion step (S59) is a process of inserting the screw 580 into the glenoid by rotating the screw 580 in the reaming guide 500.
  • the screw insertion step (S59) may be performed by the screw driver 700 or the screw driver 850 accommodated in the reaming guide holder 800.
  • the screw 580 in the reaming guide 500 can be rotated using a screw driver 700 to insert it into the glenoid and at least temporarily fix it.
  • a screw driver ( 850) can be advanced so that the tip 853 is exposed to the glenoid side rather than the fastening end 833, and then the screw 580 can be rotated to insert it into the glenoid and at least temporarily fix it.
  • the second reaming step (S60) is a process of reaming the second surface perpendicular to at least a portion of the reaming guide, preferably a process of reaming the second surface as a plane perpendicular to the first axis.
  • the second reaming step (S60) may be performed by the second reamer (1000).
  • the second reamer 1000 reams the glenoid while receiving the upper part 510c of the reaming guide.
  • the rotation range may be limited by the limit guide 530.
  • the extension portion 1052 extending distally from the tube 1051 may have a predetermined center angle, but one end of the extension portion 1052 or the cutting portion 1053 is blocked by the limiting guide, thereby limiting the cutting range. Therefore, the cutting unit 1053 cuts the portion on the glenoid excluding the portion toward which the guide surface faces. That is, the second reamer 1000 has a first plane 511, a first connection surface 513 on which no guide surface is formed, and a second plane 512 centered on the center of the joint fossa or the recess H. The cutting direction is perpendicular to the first axis (X1) and is cut flat.
  • a second surface (F2) can be formed as a horizontal surface of the joint condyle that faces the plate (B31) of the base plate (B) in which the above-described portion is reinforced. At this time, the lowest point (L) may be included in the second side.
  • the chamfering step (S70) is a process of chamfering the curved surface that was not reamed in the second reaming step, and the portion of the first surface (F1) on which the second surface is not formed can be chamfered through the glenoid chamfering device (1100).
  • the remaining portion where the second surface is not formed among the curved surfaces formed on the glenoid is chamfered. This portion may be the direction in which the guide surface 515a faces.
  • a portion of the glenoid fossa is extended at a constant depth in a first direction perpendicular to the first axis, and indented as it moves away from the center of the glenoid in a second direction perpendicular to the first axis.
  • Chamfer so that the depth gradually decreases.
  • the curved portion of the joint fossa can be chamfered to have a shape complementary to the wedge (B33) of the base plate (B).
  • the base plate insertion step (S80) is a process of inserting a partially reinforced base plate (B) into the glenoid fossa.
  • the base plate (B) may be fastened to the base plate holder 1200 and inserted into the glenoid.
  • the base plate insertion step (S80) includes a base plate fastening step (S81), a reference indicator fastening step (S83), and an alignment insertion step (S85).
  • the base plate fastening step (S81) is a process of fastening the partially reinforced base plate to the base plate holder, in which the insertion protrusion 1251 of the base plate holder 1200 is inserted into the hollow formed in the center of the base plate (B). This is a process in which the auxiliary protrusion 1235 is inserted into a hole formed in a part other than the center of the base plate (B) and fastened at least temporarily.
  • the base plate may be fastened in the direction according to the insertion indicator 1253.
  • the insertion indicator 1253 is a base plate ( B) and/or indicates the approach direction of the base plate holder 1200.
  • the reference indicator fastening step (S83) is a process of connecting a reference indicator to one side of the base plate holder, and can be performed similarly to the reference indicator fastening step (S53) described in the reaming guide insertion step described above.
  • the reference indicator may be substantially the same as the guide handle 200.
  • the reference indicator and the base plate holder can form a predetermined angle.
  • the reference indicator and the base plate holder may form a right angle.
  • an angle other than a right angle may be formed depending on whether the first axis X1 is tilted.
  • the reference indicator is inserted into the receiving groove (1273) where the corresponding indicator (1275) corresponding to the indicator (4133) confirmed in the defect direction checking step (S45) is displayed.
  • the corresponding indicator 1275 which is the same as the corresponding indicator 6173 in the reference indicator fastening step (S53) described above, can be inserted into the receiving groove 1273 displayed.
  • the alignment and insertion step (S85) is a process of aligning the insertion position of the base plate fastened to the base plate holder and inserting the base plate by moving the reference indicator to the first position.
  • the base fastened to the base plate holder 1200 is moved by moving the reference indicator inserted in the receiving groove 1273 to the first position with one end facing downward.
  • the augmentation of the plate corresponds to the second surface, and by inserting the base plate into the glenoid, the base plate is inserted and fixed at the correct position and angle.
  • movement to the first position occurs when the base plate holder 1200, which accommodates the reference indicator or guide handle 200, is located on the first axis, and one end of the reference indicator or guide handle 200 is moved to the lower side. It may include rotating the reference indicator or guide handle 200 and the base plate holder 1200 about a first axis so that they face in the (inferior) direction. Accordingly, the augmentation of the base plate (B) can be seated on the glenoid.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Dentistry (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif d'insertion d'une plaque de base glénoïde, et un procédé associé, et, plus spécifiquement : un dispositif d'insertion d'une plaque de base glénoïde d'une articulation artificielle de l'épaule, le dispositif comprenant une tige, qui a une partie creuse et s'étend dans la direction d'un premier axe, et une tige de guidage, qui s'étend dans la direction d'un second axe ayant un angle prédéterminé avec le premier axe, au moins une partie de la tige étant insérée dans la cavité glénoïde et la tige de guidage guidant la direction de découpe de la cavité glénoïde de telle sorte que la découpe peut être guidée avec précision lorsque la cavité glénoïde est découpée pour former une seconde surface inclinée pour l'insertion d'une plaque de base partiellement renforcée ; et un procédé d'insertion de la plaque de base glénoïde de l'articulation artificielle de l'épaule, comprenant : une étape d'insertion de broche de guidage consistant à insérer une broche de guidage dans la cavité glénoïde le long du premier axe ; une première étape d'alésage consistant à effectuer un alésage, le long de la broche de guidage, pour former une surface incurvée ayant une courbure prédéterminée ; une étape de mesure de fracture consistant à vérifier la direction d'une partie fracturée et la quantité de fracture dans la cavité glénoïde par rapport à la surface incurvée formée dans la première étape d'alésage ; une étape d'insertion de guide d'alésage consistant à insérer, dans la cavité glénoïde, un guide d'alésage pour guider une plage de découpe de la cavité glénoïde afin de former une surface horizontale perpendiculaire au premier axe ; et une seconde étape d'alésage consistant à former la surface horizontale perpendiculaire au premier axe en fonction du guidage du guide d'alésage.
PCT/KR2023/018714 2022-12-08 2023-11-20 Dispositif d'insertion d'une plaque de base glénoïde, et procédé associé WO2024122932A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
KR10-2022-0170672 2022-12-08
KR1020220170672A KR20240085617A (ko) 2022-12-08 2022-12-08 관절와 베이스플레이트 삽입용 기구 및 그 방법

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2019521776A (ja) * 2016-07-08 2019-08-08 バイオメット マニュファクチャリング，リミティド ライアビリティ カンパニー 関節窩増大準備処理のためのリーマ及びガイド
JP6725492B2 (ja) * 2014-08-14 2020-07-22 バイオメット マニュファクチャリング，リミティド ライアビリティ カンパニー 可撓性を有する骨リーマ
US20210000605A1 (en) * 2015-04-24 2021-01-07 Biomet Manufacturing, Llc Patient-specific augmented glenoid systems and methods
JP2022044764A (ja) * 2016-05-18 2022-03-17 デピュイ・アイルランド・アンリミテッド・カンパニー 整形外科用関節置換術における患者の脛骨を準備するためのシステム及び方法
US20220110644A1 (en) * 2017-07-11 2022-04-14 Howmedica Osteonics Corp. Guides and instruments for improving accuracy of glenoid implant placement
WO2022109135A1 (fr) * 2020-11-18 2022-05-27 Stryker Corporation Systèmes chirurgicaux et procédés pour déterminer la profondeur de pénétration d'outils de coupe

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP6725492B2 (ja) * 2014-08-14 2020-07-22 バイオメット マニュファクチャリング，リミティド ライアビリティ カンパニー 可撓性を有する骨リーマ
US20210000605A1 (en) * 2015-04-24 2021-01-07 Biomet Manufacturing, Llc Patient-specific augmented glenoid systems and methods
JP2022044764A (ja) * 2016-05-18 2022-03-17 デピュイ・アイルランド・アンリミテッド・カンパニー 整形外科用関節置換術における患者の脛骨を準備するためのシステム及び方法
JP2019521776A (ja) * 2016-07-08 2019-08-08 バイオメット マニュファクチャリング，リミティド ライアビリティ カンパニー 関節窩増大準備処理のためのリーマ及びガイド
US20220110644A1 (en) * 2017-07-11 2022-04-14 Howmedica Osteonics Corp. Guides and instruments for improving accuracy of glenoid implant placement
WO2022109135A1 (fr) * 2020-11-18 2022-05-27 Stryker Corporation Systèmes chirurgicaux et procédés pour déterminer la profondeur de pénétration d'outils de coupe

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