JP4424876B2 - Bone plug forming instrument - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a bone plug forming device for forming a bone plug of a predetermined shape from a bone piece or a bone filling material or a mixture of a bone piece and a bone filling material.
[0002]
[Prior art]
In recent years, in anterior cruciate ligament reconstruction, a bone hole is formed across the tibia and femur, the graft ligament is retracted and fixed in the bone hole, and then a bone plug is inserted from the end of the bone hole to insert the graft ligament into the bone hole inner wall. An operation for tightly fixing is performed. Further, in bone transplantation for fractures, after removing the fracture pieces, an operation is performed in which bones collected from other locations are processed to produce bone plugs and embedded in the pulverized locations.
[0003]
[Problems to be solved by the invention]
However, bone plugs used in anterior cruciate ligament reconstruction are usually obtained by processing bone fragments extracted into a cylindrical shape or the like with a hollow drill or the like into a predetermined shape with a chisel or the like when forming a bone hole. Have been made. For this reason, it is difficult to always make the same shape, and since the shape of the bone plug to be transplanted is not determined in advance, the selection of tools is not uniform and the machining operation becomes complicated.
Also, in bone transplantation for fractures, bone plugs are produced by processing the collected bone fragments with a chisel, etc., but the shape of the bone plug to be implanted is not determined, so it is the same as the anterior cruciate ligament reconstruction The processing operation is complicated.
Therefore, the present invention solves the above-mentioned problems, and a bone plug capable of forming a bone plug of a predetermined shape from a collected bone fragment or bone filler or a mixture of bone fragment and bone filler by a simple operation. A plug forming device is provided.
[0004]
[Means for Solving the Problems]
To achieve the above purpose,
(1) A bone plug forming device for forming a bone fragment or a bone filling material or a mixture of a bone piece and a bone filling material into a bone plug of a predetermined shape, wherein the bone plug forming device has an upper end opened, and A cylindrical member whose lower end is closed, a die member for forming a bone plug forming space which is housed in the cylindrical member so as to be able to be inserted and removed and extends from the upper end toward the lower end side, and the bone plug of the die member A pressing member for compressing and filling a bone fragment thrown into the forming space into the lower side of the bone plug forming space, and a pressing mechanism for pressing the pressing member downward. Further, the die member is formed so as to be split in the axial direction in the bone plug forming space forming portion, and the bone plug forming space of the die member has a wedge shape whose width becomes narrower toward the lower end. The pushing member has a trapezoidal pushing portion made in a shape and a size that can be intruded partway through the wedge-shaped bone plug forming space forming portion. Bone plug forming instrument.
[0005]
( 2 In the above (1), it is preferable that the die member has a movement path that communicates with the upper end side of the bone plug forming space and that allows the pushing member to move up and down.
( 3 ) the above( 2 ), The die member is mounted on the bone plug forming space forming die member that forms the bone plug forming space, and the moving path that is placed on the bone plug forming space forming die member and forms the moving path It preferably comprises a forming die member.
( 4 ) Above (1) to ( 3 ), The pressing mechanism includes a support plate that is detachably fixed to the opening on the upper end side of the cylindrical member, and passes through the support plate in a substantially vertical direction, and is screwed into the support plate. And a shaft portion whose lower end portion can be brought into contact with the upper end portion of the pushing member, and a pressing member provided on the upper end side of the shaft portion and provided with a gripping portion for rotating the shaft portion, The pressing mechanism is capable of pressing down the pushing member by advancing toward the lower end side of the shaft portion by rotating the gripping portion in a state where the support plate is fixed to the cylindrical member. Is preferred.
( 5 ) Above (1) to ( 4 ), The cylindrical member preferably has a cylindrical member main body having an open upper end and a lower end, and a lower lid detachably attached to the lower end surface of the cylindrical member main body.
( 6 ) Above (1) to ( 5 ), The cylindrical member and the die member preferably include an engagement mechanism for positioning the die member disposed in the cylindrical member.
( 7 ) the above( 6 ), The engagement mechanism includes a die member positioning protrusion that extends substantially vertically from the inner surface of the lower lid of the tubular member to the upper end side, and a positioning protrusion housing portion provided on the die member. It is preferable.
[0008]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, the bone plug forming instrument of the present invention will be described in detail with reference to the accompanying drawings.
1 is an external view of a bone plug forming instrument that is an embodiment of the present invention, FIG. 2 is an exploded view of the bone plug forming instrument that is an embodiment of the present invention, and FIG. 3 is a bone plug forming instrument shown in FIG. FIG. 4 is an external view of the bottom cover of the tubular member shown in FIG. 3, and FIG. 5 is used in the bone plug forming instrument shown in FIG. FIG. 6 is a plan view of the bone plug forming space forming die member shown in FIG. 5, and FIG. 7 is a movement used for the bone plug forming instrument shown in FIG. FIG. 8 is an external view of a pressing member used in the bone plug forming device shown in FIG. 1, and FIG. 9 is used in the bone plug forming device shown in FIG. FIG. 10 is an external view of a support plate (upper lid) of the pressing mechanism, and FIG. 10 is a pressing member used in the bone plug forming instrument shown in FIG. It is a front view.
[0009]
A bone plug forming device 1 of the present invention is a bone plug forming device for forming a bone piece 5 or a bone filling material or a mixture of bone pieces and a bone filling material (not shown) into a bone plug 17 having a predetermined shape. The bone plug forming instrument 1 has a cylindrical member 2 whose upper end is open and whose lower end is closed, and a bone plug forming space 3 that is housed in and out of the cylindrical member 2 and extends from the upper end toward the lower end side. A pressing member 6 for compressing and filling the bone piece 5 put into the bone plug forming space of the die member 4 into the lower side of the bone plug forming space 3, and the cylindrical member 2 Is provided with a pressing mechanism 7 for pressing the pushing member 6 downward.
[0010]
For example, the bone plug forming device 1 has a shape in which a bone piece 5 or a bone filling material extracted by a hollow drill or the like or a mixture of a bone piece and a bone filling material is filled inside and strongly pressed during ACL reconstruction. A bone plug is produced. As shown in FIGS. 1 and 2, the bone plug forming instrument 1 of the present invention includes a cylindrical member 2, a die member 4 having a recess 33 that forms a bone plug forming space 3, a pushing member 6, and a pushing member. A pressing mechanism 7 is provided.
[0011]
As shown in FIG. 2, the cylindrical member 2 has an upper end opened and a lower end closed. In the embodiment, the cylindrical member 2 includes a cylindrical member main body portion 20 having substantially the same inner diameter from the upper end to the lower end, as shown in FIGS. 3 and 4, and a lower lid 21 that forms a lower end closing surface. . The lower lid 21 is detachably attached from the lower side of the cylindrical member main body 20 with screws or the like. With such a configuration, when the lower lid 21 is removed from the tubular member 2 and the die member 4 (the die member 41 for forming the bone plug forming space) is pressed from the lower side, the die member 4 (the die member 41) is moved to the tubular member main body. It can be easily taken out from the part 20.
Further, the cylindrical member 2 and the die member 4 are provided with an engaging mechanism for positioning the die member 4 disposed in the cylindrical member 2. Specifically, the engaging mechanism includes a die member positioning protrusion 8 extending substantially perpendicularly to the upper end side from the inner surface (upper surface) of the lower lid 21 of the cylindrical member 2 and a positioning protrusion provided on the die member 4. 8 is configured by positioning protrusion housing portions (penetrating holes) 43 and 44 for housing 8. The die member positioning protrusions 8 are two rod-shaped bodies (positioning guide bars) provided on the upper surface of the lower lid 21. In the embodiment, the positioning protrusion 8 is a positioning member when the moving path forming dice member 42 constituting the dice member 4 is arranged at an appropriate position in the cylindrical member 2. In the embodiment of the present invention, since the bone plug forming space forming die member 41 is accommodated in the tubular member 2 without any gap, positioning is not particularly required, but positioning is required when it is not accommodated with no gap. In some cases, the positioning protrusion can be used for positioning. In the embodiment, the positioning protrusion 8 is manufactured as a separate member from the lower lid 21 and is fixed to the lower lid 21 by screwing, but may be manufactured integrally with the lower lid.
[0012]
Further, as the engaging mechanism, a ridge formed perpendicularly from the upper end to the lower end on the inner surface of the cylindrical member main body, and a recess formed on the outer surface of the die member so as to engage with the ridge. It may consist of strips. Further, the engagement mechanism may be composed of a concave strip portion formed on the inner side surface of the cylindrical member main body portion and a ridge portion formed on the outer side surface of the die member.
The engagement mechanism is composed of a convex portion formed on the upper surface of the lower lid of the cylindrical member and a concave portion formed on the bottom surface of the die member (die member 41) so as to engage with the convex portion. There may be. Moreover, it may consist of a concave portion formed on the upper surface of the lower lid of the cylindrical member and a convex portion formed on the bottom surface of the die member (die member 41) so as to engage with the concave portion.
[0013]
Moreover, you may provide the bone plug extrusion hole (not shown) which penetrates a lower cover near the center of a lower cover. The bone plug extrusion hole is formed to communicate with an extrusion hole penetrating from the inner surface of the bone plug formation space of the die member 4 (bone plug formation space formation die member 41) to the lower surface of the bone plug formation space formation die member. ing. With such a configuration, the bone plug can be pushed out of the bone plug forming space by inserting the push rod from the lower surface of the lower lid. In addition, when the bone plug forming instrument is used, the extrusion hole formed in the lower lid is preferably closed by a closing member produced by another member together with the extrusion hole formed in the bone plug forming space forming die member. .
Moreover, in order to reduce friction with the die member accommodated in the inner surface of the cylindrical member main body 20, a groove that does not contact the outer surface of the die member may be provided along the axial direction.
[0014]
The die member 4 has a recess 33 formed on the upper end side toward the lower end side. The concave portion 33, together with the cylindrical member inner surface 27, forms a bone plug forming space 3 that is a form part when forming the bone piece 5 or the bone filling material or the mixture of the bone piece and the bone filling material into the bone plug 17 having a predetermined shape. Forming. Further, as shown in FIGS. 1, 13, and 14, the die member 4 has a movement path forming space 39 that communicates with the recess 33 above the recess 33. The movement path forming space 39, together with the cylindrical member inner surface 27, forms a movement path 9 in which the pushing member 6 can move up and down.
In this embodiment, the die member 4 is manufactured as a member separate from the bone plug forming space forming die member 41 forming the bone plug forming space 3 and the bone plug forming space forming die member 41. And a dicing member 42 for forming a moving path. Thereby, it becomes easy to take out the die member from the cylindrical member. Note that the bone plug forming space forming die member 41 and the moving path forming die member 42 of the embodiment form the bone plug forming space 3 and the moving path 9 together with the cylindrical member inner surface 27, respectively.
[0015]
In the embodiment, the recess 33 is a notch that is cut from the front surface to the back surface of the bone plug forming space forming die member 41 from the upper end to the vicinity of the lower end of the bone plug forming space forming die member 41. Specifically, the concave portion (notch portion) 33 (bone plug forming space) has a wedge shape whose width becomes narrower toward the lower end. By producing the concave portion 33 in such a shape, the bone fragment 5 or the bone filling agent or a mixture of the bone piece and the bone filling agent is charged into the concave portion 33 and filled with the pushing member 6 from the upper side and strongly pressed. 5 or a bone filler or a mixture of bone fragments and bone filler is compressed and filled in the lower part of the space (bone plug formation space 3) between the concave portion 33 and the inner surface 27 of the tubular member to form a wedge-shaped bone plug 17. The Further, as in the embodiment of the present invention, if the recess is made by cutting out all or part of the bone plug forming space forming die member from the upper end to the vicinity of the lower end, the outer surface of the die member and the inside of the cylindrical member are formed. The contact area with the surface is reduced, and the die member can be easily taken out from the cylindrical member. Note that the shape of the notch is not limited to the wedge shape described above, and may be prepared according to the shape of the bone hole formed in ACL reconstruction or the like. If a die member having several types of cutouts with different shapes (a die member for forming a bone plug forming space) is prepared, a bone plug having a predetermined shape can be formed simply by replacing the die member in the cylindrical member. be able to.
[0016]
Further, the bone plug forming space forming die member 41 includes an engaging mechanism for positioning the die member 41 in the cylindrical member. Specifically, the die member 41 is provided with a positioning protrusion housing portion 43 that engages with the positioning protrusion 8 described above. The positioning protrusion accommodating portion 43 is two penetration holes 43 provided so as to penetrate from the upper end to the lower end of the concave portion forming portion of the die member 41. The penetration hole 43 is provided at a position corresponding to the rod-shaped body that is the positioning protrusion. With this configuration, when the bone plug forming space forming die member 41 is housed in the tubular member 2, the bone plug forming space forming die member 41 is housed in the tubular member along the positioning protrusion 8. The
[0017]
Further, the bone plug forming space forming die member may have an extrusion hole (not shown) penetrating from the inner surface of the notch portion to the lower surface of the bone plug forming space forming die member. This extrusion hole is formed so as to communicate with the extrusion hole provided from the upper surface to the lower surface of the lower lid in the vicinity of the center of the lower lid. With such a configuration, when the push rod is inserted from the lower side of the lower lid, the bone plug can be pushed out of the forming space from the forming space. In addition, when using a bone plug forming instrument, it is preferable that the extrusion hole formed in the die member for forming the bone plug formation space is closed with a closing member made of a separate member together with the extrusion hole formed in the lower lid.
[0018]
Further, the lower surface of the bone plug forming space forming die member 41 is made flat, and the outer surface shape (side surface shape) is made to substantially match the inner surface shape of the tubular member 2. Therefore, the bone plug forming space forming die member 41 is accommodated in the tubular member 2 with almost no gap. Further, the upper surface of the bone plug forming space forming die member 41 is formed to be flat and is in surface contact with the lower surface of a moving path forming die member 42 described later. For this reason, the upper surface of the bone plug forming space forming die member 41 and the lower surface of the moving path forming die member 42 are in contact with each other without any gap.
[0019]
Further, the bone plug forming space forming die member 41 is fabricated so as to be capable of being divided in the axial direction in the recess 33 portion (bone plug forming space forming portion). Specifically, as shown in FIG. 5, the bone plug forming space forming die member 41 is formed so as to be divided into two at the center in the substantially vertical direction of the recess 33. For this reason, if the bone plug forming space forming die member 41 containing the bone plug is taken out from the cylindrical member 2 and then divided, the formed bone plug can be easily taken out.
[0020]
The moving path 9 is a portion where a pushing member 6 described later moves up and down, and forms a portion that accommodates the bulky bone piece 5 together with the recess 33 when the bone piece is inserted. Further, as shown in FIG. 1, the moving path 9 is formed by two members 42 a and 42 b constituting the moving path forming dice member 42 and an inner surface 27 of the cylindrical member 2.
The moving path forming die member 42 is composed of two members 42a and 42b which are formed in a substantially semi-cylindrical shape facing each other. Since the surfaces where the members 42a and 42b face each other are formed as vertical planes, the moving path 9 has substantially the same distance from the upper end to the lower end. The distance of the movement path 9 (the distance between the members 42a and 42b facing each other) is made to be substantially the same as the maximum portion (upper end portion) of the trapezoidal pushing portion 61 of the pushing member 6. For this reason, it is possible to fill the bone plug forming space 3 with almost all of the bone fragments introduced into the die member. Further, as shown in FIG. 7, the moving path forming dice member 42 is provided with positioning protrusion storing portions 44a and 44b which are penetration holes for storing the positioning protrusions from the upper surface to the lower surface, respectively. For this reason, the moving path forming die member 42 is accommodated in the cylindrical member 2 along the positioning protrusion 8 and positioned at an appropriate position. Further, the lower surface of the moving path forming die member 42 is made flat, and is made so as to be substantially in surface contact with the upper surface of the bone plug forming space forming die member 41. Therefore, in the cylindrical member 2, the lower surface of the moving path forming die member 42 and the upper surface of the bone plug forming space forming die member 41 are in contact with each other with almost no gap. Further, the upper surface of the moving path forming die member 42 is formed flat, and when stored in the cylindrical member 2, the upper surfaces of the members 42a and 42b are substantially the same height as the opening end of the cylindrical member. Is located. The moving path forming die member 42 is accommodated in the cylindrical member with almost no gap.
[0021]
In addition, the concave portion of the die member is not limited to the notch shape cut out to both side surfaces of the die member as described above, and any shape can be used as long as it can be filled with bone fragments or the like and can be strongly pressed. It may be. For example, as shown in FIGS. 11 and 12, the concave portion of the die member is not cut out to the outer surface of the die member, and is a hole from the outside of the die member toward the center (as it goes to the lower end side of the die member). May be narrowed. By producing in this way, the die member 51 having the recesses becomes a mold part that forms a bone plug forming space alone. Even when the die member 51 is used instead of the die member 41, the bone plug can be formed by the same operation as described above.
[0022]
Further, the bone plug forming space forming die member 51 is provided with a positioning protrusion storing portion 53 for storing the positioning protruding portion 8 in the same manner as the bone plug forming space forming die member 41. The positioning protrusion accommodating portion 53 is two penetration holes provided so as to penetrate from the upper end to the lower end of the recess-unformed portion. The penetration hole is provided at a position corresponding to a rod-like body (guide rod) which is a positioning protrusion. In addition, the die member 51 is formed in the recess 31 so as to be split in the axial direction. Specifically, as shown in FIG. 11, the dice member 51 is fabricated so as to be divided into two at substantially the center in the longitudinal direction of the recess 31. For this reason, if the die member 51 for accommodating the bone plug is taken out from the tubular member 2 and then divided, the formed bone plug can be taken out easily. Further, the upper and lower surfaces of the bone plug forming space forming die member 51 are made flat. The outer surface shape (side surface shape) of the die member 51 matches the inner surface shape of the cylindrical member 2 and is accommodated in the cylindrical member with almost no gap.
[0023]
Further, the moving path forming die member does not have to be made of two members as described above. For example, the moving path forming die member is made as one cylindrical body having a moving path in which the pushing member moves up and down. Also good.
In the embodiment of the present invention, the die member is divided into a portion for forming the bone plug forming space 3 (bone plug forming space forming die member 41) and a portion for forming the moving path 9 (moving path forming die member 42). Are formed as separate members, but may be formed integrally.
[0024]
The pushing member 6 includes a trapezoidal pushing portion 61 that decreases in a taper shape from the proximal end toward the distal end, and a connecting portion 62 that is provided on the proximal end side of the trapezoidal pushing portion 61 and is connected to the shaft portion 11.
As shown in FIGS. 2 and 10, the trapezoidal push-in portion 61 is formed in a shape and size that can enter partway through the recess 33. Further, since the maximum portion of the trapezoidal pushing portion 61 is made to be approximately the same size as the distance between the member 42a and the member 42b of the moving path 9 and the maximum portion of the recess 33, the moving path 9 and the bone plug forming space 3 are formed. Can be pushed into the lower part of the bone plug forming space 3 without leaving the bone piece 5 put into the bone. Moreover, in the Example, although the trapezoidal pushing part 61 is formed in the horizontal surface, it is not restricted to this. As a constituent material of the trapezoidal pushing portion, stainless steel, titanium alloy, or the like is preferable.
[0025]
The connecting portion 62 is a rod-like portion provided substantially vertically above the base end surface of the trapezoidal pushing portion 61. The connecting portion 62 is inserted into the connecting portion insertion hole 13 formed at the tip portion of the shaft portion 11. In the embodiment, the connecting portion 62 is manufactured as a separate member from the trapezoidal pushing portion 61, and is fixed by screwing the distal end portion of the connecting portion 62 and the proximal end portion of the trapezoid pushing portion 61. Yes. Further, the outer diameter of the connecting portion 62 is made slightly smaller than the inner diameter of the connecting portion inserting recess 13 of the pressing member described later.
[0026]
The pressing mechanism 7 includes a support plate 10 that is detachably attached to the upper end opening of the cylindrical member 2, penetrates the support plate 10 in a substantially vertical direction, and is screwed with the support plate 10, and the lower end portion is It is provided on the upper end side of the shaft portion 11 and the shaft portion 11 that can come into contact with the upper end portion of the pushing member 6, for rotating the shaft portion 11. Hold The pressing mechanism 7 further includes a pressing member, and the pressing mechanism 7 advances to the lower end side of the shaft portion 11 by rotating the gripping portion 12 in a state where the support plate 10 is fixed to the cylindrical member 2. Thus, the pushing member 6 can be pushed down.
The pressing mechanism 7 includes a support plate 10 and a pressing member having a shaft portion 11 and a grip portion 12 provided on the upper end side of the shaft portion 11.
[0027]
The support plate 10 is produced as a plate member having substantially the same shape as the upper end opening of the tubular member 2. The support plate 10 is attached and fixed to the upper end opening of the tubular member using a screw or the like during the bone plug forming operation. Near the center of the support plate 10, as shown in FIG. 9, there is provided a threading through portion 14 through which the shaft portion 11 penetrates substantially vertically. Specifically, a screw groove 14 a that is screwed with a screw thread 15 a formed on the screw portion 15 of the shaft portion 11 is formed on the inner surface of the screw penetration portion 14. The screw groove 14a is formed from the vicinity of the upper surface of the support plate 10 to the vicinity of the lower end. With such a configuration, the shaft portion 11 can move up and down with respect to the support plate 10 while being screwed with the screwing through portion 14. In addition, the support plate 10 is provided with two penetration holes 19 through which the tip of the positioning protrusion 8 described above penetrates at equal intervals. The support plate 10 is provided with two screw holes 18 at regular intervals for attaching the support plate 10 to the tubular member 2. The length of the thread groove 14a forming portion of the threading through portion 14 is preferably 5.0 to 15 mm.
[0028]
As shown in FIG. 8, the shaft portion 11 includes an insertion recessed portion 13 into which the connecting portion 62 of the pushing member 6 is inserted at the tip, and a threaded portion that is threadedly engaged with the threaded through portion 14 of the support plate 10 near the middle. 15 is formed along the axial direction. Further, a grip portion 12 that rotates the shaft portion 11 is provided at the upper end portion of the shaft portion 11.
The connecting portion insertion recessed portion 13 is a portion that is formed at the distal end portion of the shaft portion 11 and stores the pushing member 6 in a loosely fitted state. The inner diameter of the insertion recess 13 is made slightly larger than the outer diameter of the connecting portion 62. The length of the insertion hole 13 in the axial direction of the shaft portion 11 is continuous. Result The portion 62 is made longer than the axial length. When the connecting portion 62 is inserted into the insertion recess 13, the shaft portion 11 is rotatable about the connecting portion 62.
[0029]
A screw thread 15 a that is screwed into the screw groove 14 a formed in the screwing portion through portion 14 is formed in the screwing portion 15. Since the screwing portion 15 can move up and down without shaking to the left and right with respect to the support plate 10 and to increase the vertical movement distance of the pushing member 6 attached to the distal end portion of the shaft portion 11, It is formed to have a certain length along the axial direction of the portion 11. Specifically, the axial length of the screwing portion 15 is preferably 10 to 30 mm. With such a configuration, when the gripping portion 12 is rotated in either the left or right direction, the shaft portion 11 advances to the lower end side with respect to the support plate 10 and the pushing member 6 is pressed toward the lower end side. In addition, even if the grip part 12 is rotated and the shaft part rotates and proceeds to the lower end side, the pushing member 6 hardly rotates and only proceeds to the lower end side. Moreover, although the screwing part 15 is integrally formed with the shaft part 11 in the Example, it is not restricted to this.
Moreover, since the state which pushed in the pushing member 6 is continued by the screwing of the shaft part 11 and the support plate 10, the bone piece 5 can be compressed reliably.
[0030]
The gripping part 12 is attached by being screwed to the upper end part of the shaft part. The gripping part 12 is produced so that the cross section is a quadrangle, and the four corners of the quadrangle are chamfered and chamfered. A knurled (not shown) is formed on the portion so as to be easily gripped. In the embodiment, the grip portion 12 is manufactured in a shape intended to be gripped by hand, but is not limited thereto. For example, it may be made into a shape that can be connected to an electric rotating device so that it can be rotated by an electric rotating device or the like.
Moreover, as a constituent material of the cylindrical member, the die member, the pushing member connecting portion, the pressing mechanism, and the positioning protrusion described above, stainless steel such as SUS630, titanium, titanium alloy, and the like are preferable. Moreover, it is preferable that the cylindrical member, the die member, the pressing member, the pressing mechanism, and the positioning protrusion described above are heat-treated after being processed into a predetermined shape.
[0031]
Next, a method for using the bone plug forming instrument of the present invention will be described taking ACL reconstruction as an example. FIG. 13 is an explanatory diagram for explaining how to use the bone plug forming device (before filling), FIG. 14 is an explanatory diagram for explaining how to use the bone plug forming device (after filling), and FIG. In ACL reconstruction, after inserting and fixing a graft ligament to a bone hole, it is a figure for demonstrating the state which inserted the bone plug into the bone hole opening part of the femoral side joint attachment site | part and the tibial side joint attachment site | part. .
A process of collecting a bone fragment used for bone plug formation using the bone plug forming instrument of the present invention will be described.
First, the knee joint is bent by 75 to 80 ° using the lower limb holding device, and the lower limbs are dropped. A 1-2 cm longitudinal incision is made on the inner skin of the rough tibial surface. Then, the bone fragment 5 is extracted while forming the bone hole 22 with a hollow bone drill using a positioning guide from the incised location toward the anterior cruciate ligament tibial joint surface attachment portion 26. Specifically, it is preferable that the bone pieces to be collected have a length of 10 to 40 mm and a diameter of 5.0 to 15 mm. Thus, the bone fragment 5 used for the bone plug forming instrument 1 of the present invention is collected. Subsequently, a bone hole having a diameter of 7 to 9 mm is drilled to the anterior cruciate ligament tibial attachment using a bone hole forming drill instead of the hollow bone drill. Subsequently, using the same bone hole forming drill, a bone hole having a diameter of 7 to 9 mm is drilled from the anterior cruciate ligament femoral joint joint surface 28 toward the outer cortex of the femur through the bone hole. It should be noted that a bone fragment scraped off when forming a bone hole with a bone hole forming drill may also be collected for forming a bone plug. In addition, the bone fragments collected as described above are usually used as they are, but when the bone fragments are large, it is preferable that they are crushed so as to be accommodated in the bone plug forming instrument. Then, after forming the bone hole, the graft ligament is inserted into the bone hole 22 formed as described above, and transplanted to the outer cortical surface 29 of the femur and the inner cortical surface 34 of the tibia using the fixing member 24, the fixing device 25, and the like. Fix both ends of the ligament.
[0032]
Next, the process of forming a bone plug using the bone plug forming instrument of the present invention will be described.
The bone plug forming space forming die member 41 and the moving path forming die member 42 are accommodated in the cylindrical member 2 along the positioning protrusions 8 in this order.
The bone piece 5 collected as described above is put into the bone plug forming space 3 formed by the bone plug forming space forming die member 41 and the moving path 9 formed by the moving path forming die member 42. The input amount is preferably such that when the bone fragment is pushed in by the bone piece pushing member 6, the bone piece is completely filled in the recess. After the bone piece is inserted, the pressing mechanism 7 is disposed along the positioning protrusion 8 from the upper side of the cylindrical member 2, and the support plate 10 is attached to the upper part of the cylindrical member 2 from above using screws. In this state, the pushing member 6 is located near the upper part of the moving path 9 as shown in FIG.
Then, the grasping portion 12 is rotated, the pushing member 6 is pushed to the lower end side, and bone fragments are compressed and filled in the lower part of the bone plug forming space 3 to form the bone plug 17.
In particular, Hold When the holding part 12 is rotated in the direction in which the shaft part 11 advances to the lower end side, the pushing member 6 advances while pushing the bone piece 5 to the lower end side. At this time, the shaft portion 11 moves to the lower end side while rotating with respect to the pushing member 6. Further, when the gripping portion 12 is rotated, the pushing member 6 advances downward while pulverizing the bone fragments 5, and all the bone fragments 5 in the movement path 9 are within the bone plug forming space 3 as shown in FIG. Compressed and filled. Then, a sufficient pressing force is applied to the bone fragments filled in the bone plug formation space 3. Hold When the holding portion is further rotated and left still for a while, a bone plug is formed in the bone plug formation space.
[0033]
After forming the bone plug, the support plate (upper lid) 10 is removed from the cylindrical member 2, and the pressing mechanism 7 is removed from the cylindrical member 2. Then, the lower lid 21 is removed from the tubular member 2. At this time, the positioning protrusion 8 attached to the upper surface of the closing plate 21 is used for positioning the positioning protrusion housing portion (penetrating hole) 43 of the bone plug forming space forming die member 41 and the moving path forming die member 42. It is extracted from the protrusion (penetration hole) 44. Then, the moving path forming die member 42 is taken out from the cylindrical member 2. Then, the bone plug forming space forming die member 41 is pushed forward from the lower side of the cylindrical member 2 and is taken out from the cylindrical member. Then, the removed bone plug forming space forming die member 41 is divided into two and the bone plug 17 is taken out.
When the bone plug extrusion hole is formed in the lower plug of the bone plug forming device and the die member for forming the bone plug forming space, the lower cover and the bone plug are removed after the support plate is removed from the cylindrical member. The bone plug is taken out of the recess by penetrating the extrusion rod into the extrusion hole formed in the forming space forming die member.
[0034]
After the bone ligament thus prepared is inserted into the bone hole and fixed in the bone hole in the ACL reconstruction, as shown in FIG. 15, from the side of the graft ligament into the opening of the tibial joint surface attachment portion 26, the thigh It is inserted into the opening of the bone side joint surface attachment portion 28. By inserting the bone plug in this way, the graft ligament inserted into the bone hole can be pressed and fixed to the inner wall of the bone hole near the tibial joint surface attachment part and the femoral side joint surface attachment site, Strength in the joint can be increased. In general ACL reconstruction, the shape of the bone hole (near the opening of the bone hole) is determined in advance by several types of bone drills and bone hole forming drills, so different concave portions are formed. If several types of die members are prepared as required, a bone plug having a required shape can be produced without performing complicated operations. Also, in bone grafting for fractures, a die member having a recess having a shape close to the shape of a pulverized part (bone plug embedding part) is selected, and a bone plug is formed and processed into a predetermined shape easily. Bone plugs can be made.
[0035]
Moreover, you may use a bone filling material (bone substitute material) instead of a bone fragment for formation of a bone plug.
As the bone filling material, hydroxyapatite, α-tricalcium phosphate, β-tricalcium phosphate, or a mixture thereof is used as a main component. In addition, as the bone filling material, any of a naturally curable bone filling material that is naturally hardened by mixing or the like, and a bone filling material that is hardened by being compressed by a pressing member as in the case of a bone fragment are used. May be.
In particular, the present invention is effective when using a bone filling material that hardens when compressed.
As the bone filling material that hardens by compression, powders such as hydroxyapatite, α-tricalcium phosphate, β-tricalcium phosphate, or a mixture thereof are used. Moreover, you may add shaping | molding adjuvants, such as a binder and a thickener, to these powders suitably. This type of bone filling material forms a bone plug of a predetermined shape by putting the bone filling material into the bone plug forming space and filling and compressing (strong pressure) with a pushing member, as in the case of bone fragments. Can do. The bone plug may be fired after being molded by filling and compressing.
[0036]
It is also possible to use a natural sclerosing bone filler, specifically, a powder containing α-tricalcium phosphate, tetracalcium phosphate, calcium hydrogen phosphate, and hydroxyapatite, What consists of a kneading liquid containing sodium chondroitin sulfate, disodium succinate anhydride, and water is used. A method of using the bone plug forming instrument when using this bone filling material will be described.
First, the said powder agent and kneading | mixing liquid are mixed and a paste-form mixture is produced. Then, before the paste-like mixture is hardened, it is injected into the bone plug-forming space of the bone plug-forming instrument using a syringe or the like, and the paste-like mixture is formed into the bone plug by the pushing member by the same operation as that for the bone fragment. Fill the lower part of the space and press lightly. In the case of a natural curable bone filling material, since it hardens spontaneously, it is not necessary to compress it strongly by a pushing member. After the bone filling material has hardened, the bone plug is taken out from the bone plug forming device by the same operation as that for the bone fragment, and used for ACL reconstruction, crushed fracture surgery, and the like.
Moreover, you may use the mixture of a bone fragment and the bone filling agent mentioned above for bone plug formation. Molding aids such as binders and thickeners may be appropriately added to the mixture of bone fragments and bone filler.
[0037]
Next, a bone plug forming instrument according to another embodiment of the present invention will be described.
16 is an external view of the bone plug forming device of the present invention, and FIG. 17 is a bone plug forming device shown in FIG. In FIG. 18 is an external view of a lower lid used in the bone plug forming device shown in FIG. 16, and FIG. 19 is a bone plug forming device shown in FIG. It is an external view of the bone plug extrusion member used for.
The present invention is a bone plug forming device 70 for forming a bone fragment 5 into a bone plug 90 having a predetermined shape. The bone plug forming device 70 has an upper end opened and a lower end closed, and the bone fragment 5 is internally provided. A cylindrical member having a bone fragment storage space 74 for storing 71 And a plate-shaped cutting member 82, and a cylindrical member 71 Is a cylindrical member from the upper end to the side 71 The plate-like cutting member 82 includes a pair of cut portions 81 a and 81 b that extend obliquely with respect to the central axis of the plate, and the plate-like cutting member 82 faces the cut portions 81 a and 81 b facing each other in a state where the bone piece 5 is stored in the bone piece storage space 74. And the bone piece 5 stored in the bone piece storage space 74 can be cut.
[0038]
As shown in FIG. 16, the bone plug forming instrument 70 of the present invention includes a cylindrical member 71 having notches 81 a and 81 b and a bone fragment storage space 74, and a plate-like cutting member 82.
As shown in FIGS. 16, 17, and 18, the cylindrical member 71 includes a cylindrical member main body 72 having an open upper end and a lower end, and a lower lid removably attached to the lower end surface of the cylindrical member main body 72. 73. The cylindrical member main body 72 is formed in a cylindrical shape, and a bone fragment storage space 74 formed inside from the upper end to the vicinity of the lower end, and a lower lid attaching portion 75 that is formed at the lower end and serves as a portion to which the lower lid 73 is attached. It has. The bone fragment storage space 74 is made to have substantially the same diameter from the upper end to the lower end, and the inner diameter of the lower lid mounting portion 75 is smaller than that of the bone fragment storage space 74, and from the upper end (the lower end of the bone fragment storage space) to the lower end. It is produced to have substantially the same diameter up to (the lower end surface of the cylindrical member main body). A screw groove portion 76 is formed on the inner peripheral surface of the lower lid attachment portion 75 so as to be screwed with a screw thread portion 77 formed on the lower lid 73. Moreover, the upper end surface and lower end surface of the cylindrical member main body are made flat.
[0039]
As shown in FIGS. 16, 17, and 18, the lower lid 73 includes a bottom surface forming portion 78 and a protruding portion 79 provided on the top surface of the bottom surface forming portion 78.
The bottom surface forming portion 78 is formed in a disk shape having substantially the same size as the bottom surface of the cylindrical member main body portion 72. The protruding portion 79 is formed in a columnar shape, and a threaded portion 77 for screwing with the screw groove portion 76 of the lower lid attaching portion 75 is formed on the outer peripheral surface of the protruding portion 79 from the upper end to the vicinity of the lower end. . With such a configuration, the lower lid 73 is detachably attached to the lower lid attaching portion 75. Further, the upper end surface 80 of the projecting portion 79 is made flat, and when the lower lid 73 is attached to the cylindrical member main body 72, the lower end surface of the bone fragment storage space 74 and the upper end surface 80 of the projecting portion 79 are They are on the same plane and form part of the bone fragment storage space 74.
[0040]
Tubular member 71 As shown in FIG. 16 and FIG. 71 From the vicinity of the top center of the tube 71 A first set of cut portions 81a extending obliquely toward one side surface of the cylindrical member, and a tubular member 71 And a second set of cut portions 81b that extend obliquely from the vicinity of the center of the upper end toward the other side surface of the cylindrical member. The notches 81a and 81b are respectively cylindrical members. 71 Is formed in a slit shape from the upper end surface to the vicinity of the center of the side surface (side wall) of the cylindrical member main body. By forming the notches 81a and 81b in this way, the upper part of the columnar bone fragment stored in the bone fragment storage space 74 can be gradually thinned toward the upper end side. . In the embodiment, the cut portion 81a and the cut portion 81b are formed obliquely at substantially the same angle with respect to the central axis. However, the present invention is not limited thereto, and each of the cut portions 81a and 81b is formed obliquely at different angles with respect to the central axis. May be. In addition, as a notch part, it is not limited to what was mentioned above, For example, you may form as one set of notch parts toward the other side surface side from the one side surface of a cylindrical member main-body part.
[0041]
The plate-like cutting member 82 is provided on the opposite side of the plate-like cutting portion 83 and the cutting portion insertion side of the plate-like cutting portion 83, and is used to insert the bone fragment cutting member 82 when cutting the bone fragment 5. It comprises a hitting portion 84 to be hit.
As shown in FIG. 16, the plate-shaped cutting portion 83 has a length in the vertical direction longer than the length of the cut portion forming portion, and is a cylindrical member. 71 It is produced as a quadrangular plate-like member that is wider than the diameter. Further, the plate-like cutting portion 83 is made thinner than the gap (width) between the notches 81a and 81b so that it can be inserted into the notches 81a and 81b. Moreover, the cross-sectional shape of the plate-shaped cutting part 83 is formed so as to gradually become thinner from the proximal end part (the hitting part 84 side) toward the distal end part. With such a configuration, the bone fragment 5 stored in the bone fragment storage space 74 can be easily cut. In addition, as the plate-shaped cutting member 82, only the vicinity of the distal end portion (insertion side) may have a diameter reduced in a tapered shape toward the distal end.
The hitting portion 84 is made in a rod shape and is attached to the base end portion (the side opposite to the insertion side) of the plate-like cutting portion 83. The hitting portion 84 and the plate-like cutting portion 83 are fixed by fitting the base end portion of the plate-like cutting portion 83 into a notch formed linearly on the side surface of the hitting portion 84. Moreover, it is preferable to fix both firmly by an adhesive agent, welding, etc. In addition, you may produce a hit | damage part by rounding the base end part of a plate-shaped cutting part.
[0042]
Further, the bone plug forming instrument 70 includes a bone plug push-out member 85 that is used in a state where the lower lid 73 is removed from the tubular member main body 72. The bone plug push-out member 85 is a tubular member main body 72. A bone plug push-out protrusion 87 that can be inserted into the cylindrical member main body 72 from the lower end opening of the tube member is provided.
The pushing member 85 includes a bottom surface forming portion 86 and a bone plug push-out projection 87 provided on the top surface of the bottom surface forming portion 86. The bottom surface forming portion 86 is formed in a disk shape having substantially the same size as the bottom surface of the cylindrical member main body portion 72. The protrusion 87 is formed in a cylindrical shape that is longer in the axial direction than the protrusion 79 of the lower lid 73. Specifically, it is preferable that the upper portion of the protruding portion 87 is formed so as to enter the bone fragment storage space 74 when the pushing member 85 is inserted from the lower lid attaching portion 75. Further, the protruding portion 87 is made slightly smaller than the inner diameter of the lower lid attaching portion 75, and unlike the protruding portion 79, a screw thread portion for screwing with the lower lid attaching portion 75 is provided on the outer peripheral surface. Not. With such a configuration, when the pushing member 85 is inserted into the lower lid attaching portion 75, the upper portion of the protruding portion 87 enters the bone fragment storage space 74 and is formed into a predetermined shape as shown in FIG. The bone plug 90 is pushed out from the upper end opening of the cylindrical member.
As a constituent material of the above-described cylindrical member and plate-like cutting member, stainless steel such as SUS630, titanium, titanium alloy, and the like are preferable. Moreover, it is preferable that a cylindrical member and a plate-shaped cutting member are heat-processed after processing into a predetermined shape.
[0043]
Next, the usage method of the bone plug formation instrument 70 of this invention is demonstrated. FIG. 20 is an explanatory view for explaining a method of using the bone plug forming instrument of the present invention, FIG. 21 is an explanatory diagram for explaining a method of using the bone plug forming instrument of the present invention, and FIG. It is explanatory drawing for demonstrating the usage method of this bone plug formation instrument.
First, as in the case of the bone plug forming instrument 1, a columnar bone plug forming bone piece 5 is collected with a hollow bone drill. The bone fragment 5 is preferably sized to be stored in the bone fragment storage space 74 of the bone plug forming device 70 without a gap. Specifically, the bone fragment preferably has a diameter of 5.0 to 15 mm, a length of about 10 to 40 mm. When the bone piece is large, the size is adjusted by cutting with a chisel or the like so as to be housed in the bone piece housing space.
[0044]
The bone piece 5 collected in this way is stored in the bone piece storage space 74 of the cylindrical member 71. Then, in a state where the cylindrical member 71 is fixed by hand or a vise, the cut portion insertion side of the plate-like cutting member 82 is inserted into one cut portion 81a, and the hit portion 84 is hit with a hammer or the like. Cylindrical member 71 The plate-shaped cutting member 82 is advanced toward the side of the bone to cut the bone fragment. The same operation is performed on the other cut portion 81b to cut the bone piece 5. By such an operation, the upper end portion of the columnar bone fragment can be formed into a shape (wedge shape) that gradually becomes thinner toward the upper end.
After forming the bone plug, the lower lid 73 is removed from the cylindrical member main body 72, and instead, the pushing member 85 is inserted from the lower end surface of the cylindrical member main body 72. Thereby, the bone plug formed in the bone plug storage space 74 is formed into a cylindrical member by the distal end surface of the protruding portion 87 of the pushing member 85. 71 A cylindrical member extruded to the upper end side of 71 It is taken out from the inside.
The bone plug 90 formed as described above is inserted into and fixed to a bone hole formed by ACL reconstruction or the like (not shown) in the same manner as the bone plug produced by the bone plug forming device 1.
[0045]
【The invention's effect】
The bone plug forming device of the present invention is a bone plug forming device for forming a bone fragment, a bone filling material, or a mixture of a bone piece and a bone filling material into a bone plug of a predetermined shape, the bone plug forming device comprising: A cylindrical member whose upper end is open and whose lower end is closed; a die member for forming a bone plug forming space which is accommodated in the cylindrical member so as to be able to be inserted and removed and extends from the upper end toward the lower end; A pressing member for compressing and filling a bone fragment placed in the bone plug forming space of the die member into a lower side of the bone plug forming space; and a pressing mechanism for pressing the pressing member downward. .
For this reason, according to the bone plug forming instrument of the present invention, a bone plug having a predetermined shape can be formed from the collected bone fragments by a simple operation.
[0046]
The bone plug forming device of the present invention is a bone plug forming device for forming a bone fragment into a bone plug of a predetermined shape, wherein the bone plug forming device has an upper end opened and a lower end closed, and A cylindrical member having a bone fragment storage space for storing a bone fragment and a plate-like cutting member, and the cylindrical member extends obliquely with respect to the central axis of the cylindrical member from the upper end side toward the side surface. A pair of facing incisions are provided, and the plate-like cutting member can be inserted into the facing incisions in a state in which bone fragments are stored in the bone fragment storage space, and is stored in the bone fragment storage space The cut bone fragment can be cut.
For this reason, according to the bone plug forming instrument of the present invention, a bone plug having a predetermined shape can be formed from the collected bone fragments by a simple operation.
[Brief description of the drawings]
FIG. 1 is an external view of a bone plug forming device of the present invention.
FIG. 2 is an exploded view of the bone plug forming device of the present invention.
FIG. 3 is an external view of a cylindrical member main body constituting a cylindrical member used in the bone plug forming instrument shown in FIG.
4 is an external view of a lower lid that constitutes the cylindrical member shown in FIG. 2. FIG.
FIG. 5 is an external view of a die member for forming a bone plug forming space, which is an embodiment used in the bone plug forming device shown in FIG. 1;
FIG. 6 is a plan view of the bone plug forming space forming die member shown in FIG. 5;
FIG. 7 is an external view of a moving path forming die member used in the bone plug forming instrument shown in FIG.
8 is an external view of a pressing member of a pressing mechanism used in the bone plug forming device shown in FIG. 1. FIG.
FIG. 9 is an external view of a support plate used in the bone plug forming instrument shown in FIG.
FIG. 10 is a front view of a pushing member used in the bone plug forming device shown in FIG. 1;
FIG. 11 is an external view of a bone plug forming space forming die member which is another embodiment used in the bone plug forming instrument of the present invention.
12 is a top view of the bone plug forming space forming die member shown in FIG. 11. FIG.
FIG. 13 is an explanatory view for explaining a method of using the bone plug forming instrument of the present invention.
FIG. 14 is an explanatory diagram for explaining a method of using the bone plug forming instrument of the present invention.
FIG. 15 shows a state in which a bone plug is inserted into the femoral hole joint attachment site and the tibial joint attachment site after the graft ligament is inserted and fixed in the bone hole in the ACL reconstruction operation. It is explanatory drawing for demonstrating.
FIG. 16 is an external view of the bone plug forming device of the present invention.
FIG. 17 is a bone plug forming device shown in FIG. 16; In It is an external view of the cylindrical part of the used cylindrical member.
FIG. 18 is an external view of a lower lid used in the bone plug forming instrument shown in FIG.
19 is an external view of a bone plug pushing means used in the bone plug forming instrument shown in FIG.
FIG. 20 is an explanatory diagram for explaining a method of using the bone plug forming device of the present invention.
FIG. 21 is an explanatory diagram for explaining a method of using the bone plug forming device of the present invention.
FIG. 22 is an explanatory diagram for explaining a method of using the bone plug forming device of the present invention.
[Explanation of symbols]
1 Bone plug forming device
2 Tubular member
3 Bone plug formation space
4 Die members
5 bone fragments
7 Pressing mechanism
9 Route
17 Bone plug
33 recess
41 Dice member for forming bone plug forming space
42 Die member for moving path formation
70 Bone plug forming instrument
71 Cylindrical member
74 Bone fragment storage space
81a, 81b notch
82 Plate-shaped cutting member
85 Extruded member
90 bone plug

Claims (7)

A bone plug forming device for forming a bone fragment or bone filler or a mixture of bone fragment and bone filler into a bone plug of a predetermined shape, the bone plug forming device having an open upper end and a closed lower end A cylindrical member, a die member for forming a bone plug forming space that is housed in the cylindrical member so as to be able to be inserted and removed and extends from the upper end toward the lower end side, and the bone plug forming space in the die member A pushing member for compressing and filling the bone piece placed in the bone plug forming space into the lower side of the bone plug forming space, and a pushing mechanism for pushing down the pushing member to the lower end side, and the die member includes the bone plug The forming space forming portion is formed so as to be split in the axial direction, and the bone plug forming space of the die member has a wedge shape whose width becomes narrower toward the lower end, and the pushing member has a wedge shape. in front Bone plug formation device characterized by having a fabricated trapezoidal insert member invasion possible shape and size to the middle of the bone plug forming space forming portion.   2. The bone plug forming instrument according to claim 1, wherein the die member is provided with a moving path that communicates with an upper end side of the bone plug forming space and that allows the pushing member to move up and down. The die member includes a bone plug forming space forming die member that forms the bone plug forming space, and a moving path forming die that is mounted on the bone plug forming space forming die member to form the moving path. The bone plug forming instrument according to claim 2 , comprising a member. The pressing mechanism includes a support plate that is removably fixed to the upper end opening of the cylindrical member, and penetrates the support plate in a substantially vertical direction, and is screwed with the support plate. A shaft portion capable of coming into contact with the upper end portion of the pushing member; a pressing member provided on the upper end side of the shaft portion; and a gripping portion for rotating the shaft portion. wherein in a state in which the support plate is secured to the tubular member, either of the claims 1 and has a depressible the pushing member due to the progress of the grip portion to the lower end of the shaft portion by rotating 3 A bone plug forming device according to claim 1. Said tubular member, to one of 4 claims 1 upper and lower ends and has a lower cover which is mountable detachably on the lower end surface of the cylindrical member body opened and cylindrical member body The bone plug forming device as described. The bone plug forming instrument according to any one of claims 1 to 5 , wherein the cylindrical member and the die member are provided with an engagement mechanism for positioning a die member disposed in the cylindrical member. The engagement mechanism includes a die member positioning protrusion that extends substantially perpendicularly to an upper end side from the inner surface of the lower lid of the cylindrical member, and a positioning protrusion housing portion provided on the die member. Item 7. The bone plug forming device according to Item 6 .

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