JP4955320B2 - Orthopedic surgical instrument set - Google Patents

Description

  The present invention relates to an orthopedic surgical instrument set, and in particular, includes a shaft-like member engaged and fixed to a bone, and a sleeve through-hole that accommodates the shaft-like member so as to be movable in the axial direction. A sleeve member provided with a side engagement portion, a fixed side engagement portion engaged with the sleeve side engagement portion, and a fixed plate portion extending from the fixed side engagement portion, The present invention relates to a structure of a holding device used when using an implant system including a fixing member provided with a fixing side opening portion communicating with the sleeve through hole in a fixing side engaging portion.

  Generally, a sleeve having a shaft-shaped member made of a bone screw or the like called a lag screw, and a sleeve through-hole that accommodates the shaft-shaped member so as to be movable in the axial direction, and a sleeve-side engagement portion provided on the base end side thereof A fixed side engaging portion that engages with the sleeve side engaging portion; and a fixing plate portion extending from the fixed side engaging portion; There is known an implant system for bone surgery including a fixing member having a fixing side opening communicating with a hole (for example, see Patent Documents 1 to 3 below).

  In the implant system configured as described above, the sleeve member configured to be able to insert the shaft-shaped member engaged and fixed to the bone and the fixing member fixed to the outer surface of the bone are provided separately. As a result, the shaft-like member and the sleeve member can be attached to the bone first, and then the fixing member can be engaged with the sleeve member. Therefore, the surgical operation is minimally invasive, that is, the incision range during the operation is reduced. It is possible to reduce the burden on the patient, and it is possible to perform minimally invasive plate fixation (MIPO: Minimally Invasive Plate Osteosynthesis) in line with the recent minimally invasive surgery (MIS) flow. It has a suitable structure.

On the other hand, in this implant system, it is necessary to securely engage the sleeve side engaging portion of the sleeve member and the fixed side engaging portion of the fixing member within the body, but these engaging operations must be performed manually. Is difficult, and it is also difficult to confirm that the two are securely engaged. Therefore, in order to facilitate the engagement operation of such an implant system, a first instrument attached to the sleeve member and a second instrument attached to the fixing member are provided, respectively. There has been proposed an apparatus configured so that the sleeve member and the fixing member can be reliably engaged by positioning the first instrument and the second instrument via the third instrument (for example, The following patent document 4).
U.S. Pat. No. 4,438,762 JP-A-8-98846 JP 2002-65687 A JP 2005-511116 A

  However, in the apparatus including the second instrument attached to the above-described fixing member, the female screw 46 is formed on the opening edge of the slot 40 corresponding to the fixing side opening of the bone plate 12 corresponding to the fixing member, while the first screw A male thread 94 is formed on a rod 92 projecting from the end of the housing 88 of the second instrument so as to be able to be screwed together with the female thread 46, and the end of the housing 88 is inserted into the slot 40 together with the rod 92. By providing a key tab 98 disposed on the second plate, the second instrument and the bone plate 12 can be connected. Accordingly, the connection structure between the fixing member and the second instrument is complicated, and accurate positioning is required at the time of mounting, and screwing operation is required at the time of mounting and dismounting, which makes it difficult to mount and remove. There is a point.

  In particular, when it is necessary to further manipulate the bone plate 12 after removing the second instrument, or when the fracture portion heals and the bone plate 12 is removed, the male screw 94 and the female screw 46 are used. In the body (under the skin), it is very difficult to connect the second instrument to the bone plate 12. Further, when the bone plate 12 is removed after the fracture has healed, it may be necessary to apply a certain amount of stress to the second instrument due to the fact that the callus is attached. Since the engagement strength between the tool and the bone plate 12 is not always sufficient, there is a problem that the mounting structure between the two may be damaged.

  Therefore, the present invention solves the above-mentioned problems, and its object is to provide an orthopedic surgical instrument set including a holding instrument that has a simple connection structure to an implant and good workability at the time of attachment / detachment. It is in.

In view of such circumstances, the orthopedic surgical instrument set of the present invention includes a shaft-like member engaged and fixed to a bone, and a sleeve through-hole that accommodates the shaft-like member so as to be movable in the axial direction, and is on the proximal side A sleeve member provided with a sleeve side engaging portion on one end, and close to one end so that the sleeve member can be engaged with the sleeve member in a state of being overlapped in the thickness direction by sliding with respect to the sleeve side engaging portion. A fixed-side opening provided on the fixed-side engaging portion and a fixed plate portion extending from the fixed-side engaging portion toward the other, and communicated with the sleeve through-hole in the fixed-side engaging portion. Ri Na comprise a rolled Mashimasu that plate-shaped fixing member in a direction inclined with respect to the axial direction of the shaft-like member, engageable with the fixed-side engaging portion on the sleeve side engagement portion aspects And a holding device configured to be capable of mounting the fixing member. That a orthopedic surgical instrument set, the opening edge of the fixed side opening, the formed parallel to the axis of the sleeve through hole, said sleeve member side is inclined with respect to the extending direction of the fixing member An inclined inner surface portion provided with a gap between the sleeve side engaging portion and the sleeve side engaging portion, the inclined inner surface portion being provided at an opening edge on the one end side of the fixed side opening, And an engagement outer surface portion having an end portion disposed in the fixed side opening in a state of being attached to the fixed side engagement portion and engaging the protruding inner surface portion from the inside of the fixed side opening at the end portion. An engagement member having a wedge-shaped inner surface engagement portion, and an end surface disposed along the extending direction in contact with the surface of the fixed side engagement portion in a state of being attached to the fixed side engagement portion, The engagement member is opened from the end surface by opening to the end surface. Accommodation hole serial end to accommodate the base of the engaging member so as to protrude, and the fixing member from outside opposite to the direction toward protruding from the fixed-side opening into the projecting inner surface from the end face The holding member having an abutting portion configured to be able to abut against an outer surface portion of the one end of the engaging member, and the engaging member so that a distance between the inner surface engaging portion and the abutting portion changes. And a member moving means configured to be able to select a state in which the inner surface engaging portion can be withdrawn from the interval and a state in which the inner surface engaging portion cannot be withdrawn by relatively moving the holding member.

According to the present invention, by setting appropriately the relative positional relationship between the engagement member and the holding member by member moving means, and place the inner surface engaging portion on the inner side of the inclined inner surface portion, member moves in this state By relatively moving the engaging member and the holding member by the means, the contact portion of the holding member is brought into contact with the fixed member in the direction opposite to the direction toward the inclined inner surface from the inside of the fixed side, it is possible to hold the retainer in a fixed member configured so that the inner surface engaging portion is disabled out de.

Therefore, according to the present invention, the state in which the inner surface engaging portion engages with the inclined inner surface portion is maintained or not maintained by relatively moving the engaging member and the holding member by the member moving means. Therefore, an extremely simple structure is sufficient, and precise positioning is not required during installation, and screwing operation is not required during attachment / detachment, so that the attaching / detaching operation of the holding device and the fixing member is not necessary. It becomes easy.

In this invention, it is preferable that the said inclined inner surface part is a surface which faced diagonally with respect to the said extension direction to the said sleeve member side over the whole thickness direction of the said opening edge . By forming a plane facing obliquely on the side of the sleeve member over an inclined inner surface portion of the upper SL across the thickness direction of the opening edge, an inclined inner face portion, for securing the spacing provided on the side of the sleeve member It is no longer necessary to provide a step between the part and the above-mentioned distance can be secured only by providing an integral continuous inclined surface, so that the portion that causes stress concentration can be reduced, and the inclination can be reduced. Since the substantial cross-sectional area in the vicinity of the inner surface can also be increased, the rigidity of one end of the fixing member can be increased, and the engagement strength between the holding device and the fixing member can be increased.

In the present invention, the fixing member extends in a direction inclined to the axial direction of the shaft-like member, since the inclined inner surface portion is inclined along the axis of the shaft-like member, the shaft-like member Even when the base end side of the shaft is configured to be able to pass through the fixed side opening, the inclined inner surface portion is inclined along the axial direction of the shaft-like member, so that the opening range of the fixed side opening is unnecessarily enlarged. Since it is not necessary, the rigidity of the fixing member can be increased.

  In the present invention, the inclined inner surface portion preferably has a concave curved surface shape along the inner surface of the sleeve through-hole. According to this, since the inclined inner surface portion has a concave curved surface shape along the inner surface of the sleeve through-hole, the rigidity of the fixing member can be further increased, and the engagement strength between the fixing member and the holding device can be further increased. Can be increased. In this case, if the inner surface engaging portion has a convex curved surface shape that fits into the concave curved surface shape, the engagement strength can be further increased, and a fixing member can be formed according to the degree of fitting. It is also possible to regulate the mounting posture of the holding device with respect to.

In this invention, it is preferable that the said fixed plate part extends in the direction which has an obtuse angle with respect to the axial direction of the said shaft-shaped member from the said fixed side engaging part. According to this, since the axis of the shaft-shaped member is set to an obtuse angle with respect to the extending direction of the fixed member, the inclined inner surface provided on one end side of the fixed-side opening is the base of the shaft-shaped member. Since it becomes difficult to touch the end side, even when the base end side of the shaft-shaped member is configured to be able to pass through the fixed side opening, it is not necessary to unnecessarily enlarge the opening range of the fixed side opening. Stiffness can be increased.

Since in the present invention, the inclined inner surface portion provided on the one end side of the fixed-side opening, portion of the fixing member to which the abutting portion abuts is an outer surface portion of said one end, Since the holding device can be attached to one end side of the fixing member, it is possible to reduce the burden on the patient by minimizing the invasion, such as reducing the incision range during the operation.

In addition, it is preferable that the said member moving means is a feed screw mechanism screwed to the said engagement member on the basis of the said holding member. As the member moving means, the holding member and the engaging member are relatively moved, and as a result, it can be selected whether or not the inner surface engaging portion can escape from the sleeve member side of the inclined inner surface portion. Any material can be used as long as it is a feed screw mechanism that is screwed into the engagement member with the holding member as a reference, so that the engagement member moves in the axial direction of the feed screw with respect to the holding member. Therefore, the relative movement of the holding member and the engaging member can be realized with an extremely simple structure, and it is possible to move the holding member and the engaging member reliably and precisely.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, an implant system including a shaft-like member, a sleeve member, and a fixing member according to the present invention will be described with reference to FIGS. 4A is a side view showing the assembled state of the implant system, FIG. 4B is a front view of the assembled state, FIG. 5A is an exploded front view of the sleeve member and the fixing member, and FIG. ) Is an exploded bottom view, FIG. 6A is an exploded longitudinal sectional view of the implant system, FIG. 6B is a rear view of the fixing member, FIG. 6C is a plan view of the fixing member, and FIG. ) Is a bottom view of the fixing member, and FIG. 6E is a longitudinal sectional view of the sleeve member.

  The implant system is engaged with and fixed to a bone in a state where the implant system is introduced into the bone. The shaft-shaped member 10 is composed of, for example, a bone screw (lag screw), and the shaft-shaped member 10 can be moved in the axial direction. The sleeve member 30 is provided with a sleeve through-hole 30a to be accommodated in the sleeve, and a sleeve side engagement portion 32 is provided on the proximal end side thereof, and the sleeve side engagement portion 32 of the sleeve member 30 can be engaged with the sleeve member 30. The fixed side engaging portion 41 provided near one end of the fixed member and the fixed side extending from the fixed side engaging portion 41 toward the other side in a direction having an obtuse angle with respect to the axial direction of the shaft member 10. A plate-shaped fixing member 40 having a plate portion 42 and including a fixed-side opening 41 a communicating with the sleeve through-hole in the fixed-side engaging portion 41. Each of these members is preferably composed of a biocompatible material, such as stainless steel, pure titanium, titanium alloy, or the like.

  The shaft-like member 10 has a screw 11 at the tip and a tool engaging portion 12 at the base, and is provided with a shaft hole 10a that extends uniformly from the tip to the base. The screw 11 is a tapping screw that engages with the inside of the bone, and fixes the shaft-like member 10 in the axial direction with respect to the bone while being screwed into the bone. Further, the tool engagement portion 12 is provided with an engagement hole 12a opened at the end, and the engagement hole 12a is rotationally driven in a state of being engaged with a rotary tool (not shown). The shaft hole 10a is for allowing a guide wire (not shown) to pass therethrough. With the guide wire inserted through the shaft hole 10a, the shaft-like member 10 is screwed into the bone while being guided by the guide wire.

  The shaft-like member 10 is configured as a bone screw in the illustrated example, but any shaft-like member that is introduced into the bone and engaged and fixed to the bone may be used. For example, it is configured with a diameter-expandable or inflatable tip engaging portion that is engaged and fixed to a bone, or a bone nail having various cross-sections that are driven into and fixed to a bone. Is also possible.

  The sleeve 30 member has a cylindrical portion 31 and a hook-shaped sleeve side engaging portion 32 connected to an end portion of the cylindrical portion 31. The sleeve member 30 is provided with a sleeve through hole 30a that penetrates the cylindrical portion 31 and the sleeve side engaging portion 32. The sleeve through hole 30a can be inserted into the tool engaging portion 12 and the shaft portion 13 of the shaft member 10. It is comprised so that. As shown in FIG. 6E, a retaining portion 31a configured so that the inner diameter of the sleeve through hole 30a is smaller than the other diameter is formed at the distal end portion of the cylindrical portion 31, and this retaining portion 31a. Is configured so that the tool engaging portion 12 of the shaft-like member 10 cannot pass through. Thus, in the case of the illustrated example, the shaft-like member 10 and the sleeve member 30 are assembled so as to be able to protrude and retract in the state shown in FIGS. 4A and 6A, but not separated from each other.

  Moreover, as shown in FIG.6 (e), a pair of flat inner surface part 31b is formed in the inner surface of the retaining part 31a on both sides across the axis. The inner surface portion 31b is engaged with a pair of outer surface portions 13a provided on the shaft portion 13 of the shaft-shaped member 10, thereby restricting the shaft-shaped member 10 from rotating around the axis. However, when the tool engaging portion 12 of the shaft-shaped member 10 is engaged with the retaining portion 31a and the shaft-shaped member 10 is protruded most from the sleeve member 30, the inner surface of the retaining portion 31a is the shaft. The small-diameter neck portion 13b of the cylindrical member 10 is opposed to this, so that the anti-rotation action of the axial member 10 by the inner surface portion 31b is released, and the axial member 10 is configured to be rotatable with respect to the sleeve 30 member. It has become.

  Further, the sleeve-side engagement portion 32 of the sleeve 30 member is configured to be detachable from the fixed-side engagement portion 41 of the fixing member 40 by sliding in the vertical direction in the figure. Here, as shown in FIG. 5A, an engagement mark 32t is formed on an opening edge provided in the sleeve side engagement portion 32 of the sleeve through hole 30a. In the case of the illustrated example, the engagement mark 32t is configured in a closed curve shape surrounding the fixed side opening 41a, and is preferably formed in a shape along the fixed side opening 41a, for example, an ellipse or an ellipse. The engagement mark 32t is desirably formed by removing a surface film (for example, an oxide film of pure titanium or a titanium alloy) covering the surface of the sleeve member 30 with a laser beam or the like.

  As shown in FIGS. 5 and 6, the sleeve side engaging portion 32 and the fixed side engaging portion 41 have tapered engaging surfaces 32 s and 41 s, and slide the sleeve member 30 and the fixing member 40 in the vertical direction in the drawing. In this way, they are engaged with each other in the thickness direction. Specifically, an inverted trapezoidal convex portion protrudes from the sleeve side engaging portion 32 in the thickness direction, and the engaging surface 32s is formed on the outer peripheral side surface of the convex portion. In addition, an inverted trapezoidal concave portion is formed in the fixed-side engaging portion 41 so as to fit in the thickness direction with the convex portion, and the engaging surface 41s is formed on the inner peripheral side surface of the concave portion. The engaging surfaces 32 s and 41 s are each formed in a U shape in plan view, and restrict the sleeve member 30 and the fixing member 40 from being separated in the thickness direction over a wide range. Further, the sleeve side engaging portion 32 and the fixed side engaging portion 41 have substantially the same width within a planar overlapping range, and the boundary line between both engaging portions is the side portion of the overlapping portion of both engaging portions. It is configured to appear only in

  The fixed member 40 includes the fixed side engaging portion 41 and a fixed plate portion 42 extending from the fixed side engaging portion 41. The fixed side engaging portion 41 is provided with a fixed side opening 41 a formed so as to communicate with the sleeve through hole 30 a of the sleeve member 30 in a state where the sleeve member 30 and the fixed member 40 are engaged. The fixed side opening 41a is configured such that the tool engaging portion 12 of the shaft-like member 10 or the proximal end side of the shaft portion 13 can pass through in the assembled state. When the sleeve member 30 and the fixing member 40 are completely engaged as shown in FIG. 4, the engagement mark 32t is hidden or visually recognized inside the fixed side opening 41a. Thus, it can be confirmed whether or not the sleeve side engaging portion 32 and the fixed side engaging portion 41 are completely engaged. In the illustrated example, the engagement mark 32t is hidden in the fully engaged state of the sleeve side engaging portion 32 and the fixed side engaging portion 41 as shown in FIG. The engagement mark 32t may be configured to be visually recognized along the inner edge of the fixed side opening 41a. That is, the engagement mark 32t only needs to be able to determine the complete engagement state between the sleeve side engagement portion 32 and the fixed side engagement portion 41.

  The opening range of the fixed side opening 41a is formed in an extended shape (elliptical or oval) extending along the extending direction of the fixed member 40. The fixed side opening 41a communicates with the sleeve through hole 30a of the sleeve member 30, and at least a part of the opening range of the fixed side opening 41a is the opening of the sleeve through hole 30a when viewed along the axis of the sleeve through hole 30a. It is configured to have an opening range that matches the range. That is, even if the base end side of the shaft-shaped member 10 (the tool engaging portion 12 and the shaft portion 13) protrudes from the sleeve through hole 30a toward the fixed side engaging portion 41, the fixed side engaging portion 41 is not touched. It is configured to pass through the fixed side opening 41a. Here, of the inner surface of the fixed-side opening 41a, the inner surface portion on the one end portion (upper end in FIG. 4) side and the inner surface portion on the other end portion (lower end in FIG. 4) (opposing inner surface portion described later) are both. It is inclined parallel to the axis of the sleeve through hole 30a. In particular, the inner surface portion on one end side is an inclined inner surface portion 41t that is inclined toward the sleeve member 30 over the entire thickness direction of the opening edge of the fixed-side opening 41a. In the assembled state, there is a gap between the inclined inner surface portion 41t and the sleeve side engaging portion 32 (the front side end surface thereof or the opening surface of the sleeve through-hole 30a that opens to this). Further, in the illustrated example, the inclined inner surface portion 41t is formed in a concave curved surface shape along the inner surface of the sleeve through hole 30a, and preferably continuous with the inner surface in the assembled state. The inclined inner surface portion 41t only needs to be engageable with an engaging member 51 of the holding device 50 described later, and therefore, the inclined inner surface portion 41t faces the sleeve member 30 and is spaced from the sleeve side engaging portion 32. What is necessary is just to become the overhanging inner surface part which has. For example, it may be a surface that faces the sleeve side engaging portion 32 with a gap in an opposed posture.

  The reason why the opening edge of the fixed-side opening 41a is configured as described above is that stress applied to the shaft-shaped member 10 near one end of the fixing member 40 (the shaft-shaped member 10 on the bone head of the femur). 4 is transmitted through the sleeve member 30 in order to secure rigidity capable of withstanding the stress, the fixed side is secured to the fixed side. This is because the opening edge portion on one end side of the opening edge of the opening 41a needs to be particularly thick. That is, in order to ensure the rigidity of one end portion of the fixing member 40 so that the base end side of the shaft-shaped member 10 can pass through the fixed-side opening 41a, it is inclined within a range that does not hinder the passage of the shaft-shaped member 10. It is required to increase the protruding amount of the inner surface portion 41t. In this case, the most preferable aspect for securing the rigidity of one end portion is that the inclined inner surface portion 41t is constituted by an inner surface portion inclined over the entire thickness direction as shown in the figure, and the inclined inner surface portion 41t is a sleeve. It is continuous with the inner surface of the through hole 30a (note that there is a slight step between them in the illustrated example).

  Further, in the present embodiment, the fixed plate portion 42 extends from the fixed side engaging portion 41 in an obtuse angle direction with respect to the axis 10x of the shaft-like member 10, so that the protruding inner surface portion such as the inclined inner surface portion 41t. It is advantageous to increase the rigidity of the fixing member by providing the one on the one end portion side of the fixing member 40 of the fixing side opening 41a. In this case, even if the base end side of the shaft-like member 10 is configured to be able to pass through the fixed side opening 41a, a sufficient amount of overhanging of the overhanging inner surface portion can be secured, and in particular, the inclined inner surface portion 41t is set to the axis 10x. This is because the thickness of one end portion of the fixing member 40 can be sufficiently ensured if it is formed so as to be inclined along the sleeve through hole 30a. Furthermore, if the inclined inner surface portion 41t is formed in a concave curved surface shape along the inner surface of the sleeve through hole 30a, the rigidity of the fixing member 40 can be further increased.

  On the other hand, the fixed plate portion 42 has a plurality of screw holes 42a. These screw holes 42a are configured to engage with the bone screw head when passing through a bone screw shaft (not shown), and the fixing plate portion 42 is fixed on the outer surface of the bone by the bone screw. Is done.

  The implant system configured as described above is used, for example, as follows when treating a fracture near the femoral head of the femur. First, a guide wire (not shown) is inserted from the outer surface of the femur into the bone head, and a hole is made in the bone with a drilling device such as a reamer using this guide wire as a guide means. At this time, the hole drilled in the bone has a smaller hole diameter corresponding to the shaft-shaped member 10 in the inner part, and a larger hole diameter corresponding to the outer diameter of the cylindrical part 31 of the sleeve member 30. A stepped hole shape having Thereafter, the guide wire is inserted through the assembly of the shaft member 10 and the sleeve member 30 shown in FIG. 6A, and the shaft member 10 is introduced (screwed) into the bone using the guide wire as a guide means. Then, the rotation operation portion at the tip of the rotary tool (not shown) is inserted into the sleeve through hole 30a and engaged with the tool engagement portion 12 of the shaft-like member 10. At this time, the sleeve member 30 is pulled out to the hand side of the rotary tool, and the shaft portion 10 is opposed to the sleeve member 30 by the neck portion 13b facing the retaining portion 31a and the flat portion 31b of the tubular portion 31. So that it can be rotated freely.

  In this state, the rotary tool is rotated to introduce (screw) the shaft-like member 10 into the bone. Confirm that the shaft-like member 10 has been introduced (screwed) to a sufficient depth (that is, that the tip of the screw 11 has reached the vicinity of the cortex in the bone head) with a fluoroscopic image such as an X-ray image. Then, the installation work is finished.

  After that, the sleeve member 30 is pushed into the bone, the inner surface portion 31b of the cylindrical portion 31 is engaged with the outer surface portion 13a of the shaft-shaped member 10, and the shaft-shaped member 10 and the sleeve member 30 are fixed around the axis. Like that. Then, the back surface of the sleeve side engaging portion 32 of the sleeve member 30 is brought into close contact with the bone surface. Thereafter, the fixing member 40 is inserted into the body, and the fixing side engaging portion 41 is slidably engaged with the sleeve side engaging portion 32 of the sleeve member 30 along the outer surface of the femur. Finally, the fixing plate portion 42 of the fixing member 40 is fixed on the outer surface of the femur (along the longitudinal direction of the tubular bone) by a bone screw (not shown).

  In the present embodiment, as described above, the outer surface portion 13a of the shaft-shaped member 10 and the inner surface portion 31b of the sleeve member 30 are engaged with each other in the rotational direction, so that the shaft-shaped member 10 is in the axis 10x direction with respect to the sleeve member 30. It can slide, but it cannot rotate. However, if it is not necessary to prevent the rotation of the bone head due to the rotation of the shaft-shaped member 10, the above-described engagement structure in the rotation direction of the shaft-shaped member 10 and the sleeve member 30 is not necessary. It is in a state of being rotatably connected.

  In the present embodiment, since the sleeve side engaging portion 32 and the fixed side engaging portion 41 are engaged in the thickness direction by the engaging structure (convex portion and concave portion) disposed therein, the sleeve side engaging portion is engaged. The overlapping part of the part 32 and the fixed side engaging part 41 is reduced in size (narrowed), and in particular, the burden on the patient is reduced even in an operation for an Oriental with a small femur size or an elderly person with weak bone strength. The effect that it can do is acquired.

  Furthermore, in this embodiment, since the width | variety and length of the sleeve side engaging part 32 can be reduced, the incision range at the time of a surgery can be reduced and the minimal invasiveness of a surgery can be improved. In particular, in the implant system according to the present embodiment, the sleeve member 30 and the fixing member 40 are separated from each other, and these are configured to be detachable. By reducing the length (dimension in the vertical direction in FIG. 5A) and the width (dimension in the horizontal direction in FIG. 5A) of the sleeve side engagement portion 32 of the member 30, the incision range is further reduced. This can further improve the minimally invasive surgery.

  FIG. 7 is a longitudinal sectional view showing a modification of the implant system mounted on the femur. Here, in the illustrated implant system, only the structure of the fixing member 40 'is different from that of the above-described embodiment, and the other shaft-like member 10 and the sleeve member 30 have the same structure as that of the above-described embodiment. Further, the state of engagement and fixation of the shaft-like member 10 with respect to the femur and the manner of fixing using the bone screw 48 on the outer surface of the femur of the fixing plate portion 42 of the fixing member 40 'are the same as in the previous embodiment. .

  The fixing member 40 ′ includes a fixed side engaging portion 41 and a fixed plate portion 42 similar to those of the previous embodiment, but further extends from the fixed side engaging portion 41 to the side opposite to the fixed plate portion 42. It differs from the said embodiment by the point provided with the extension part 43. FIG. The extension portion 43 is provided with one or a plurality of screw holes 43a, and another bone screw (lug screw) 47 can be inserted into the screw holes 43a so as to be engaged and held. Such a structure is preferable in that a plurality of pieces of bone can be securely fixed, particularly when a complicated fracture has occurred at the proximal end of the femur. This is also preferable in that it can be prevented from rotating around the shaft-like member 10 (lag screw).

  Next, the structure of the holding device that can be used in the implant system will be described in detail. FIG. 1 is a schematic perspective view of a holding device 50 constituting a part of an orthopedic surgical system according to the present invention, FIG. 2 is an enlarged partial side view of a mounting portion of the holding device 50, and FIG. FIG. 3B is a partial sectional view, and FIG. 3B is an exploded sectional view showing a modification of the main part of the holding device 50.

  The holding device 50 includes a mounting portion 50A and a gripping portion 50B connected to the proximal end of the mounting portion 50A. The mounting portion 50A includes an engagement member 51, a holding member 52, and an engagement member 51. And a moving member 53 for relatively moving the holding member 52. The grip portion 50 </ b> B includes a shaft body portion 54 fixed to the holding member 51 and a grip portion 55 fixed to the base end of the shaft body portion 54.

The engaging member 51 includes a wedge-shaped inner surface engaging portion 51b that engages with the fixing member 40 at an end portion 51a (lower end in the drawing). The inner surface engaging portion 51b has an engaging outer surface portion 51s having a shape substantially matching with the inclined inner surface portion 41t. In the case of the illustrated example, the engaging outer surface portion 51s has an outer surface shape inclined in the thickness direction corresponding to the inclined surface of the inclined inner surface portion 41t, and more specifically, a concave curved surface shape along the inner surface of the sleeve through hole 30a. It is comprised by the convex curved surface shape fitted to 41t of inclined inner surface parts. The end 51a is configured to be introduced into the fixed-side opening 41a, and is extended in a direction corresponding to the extending direction of the opening range of the fixed-side opening 41a (for example, elliptical or oval). have. Further, a screw hole 51 c is provided on the proximal end side of the engagement member 51, and a portion where the screw hole 51 c is provided is accommodated inside the holding member 52. In the state where the holding device 50 is mounted on the fixing member 40, the end surface of the end portion 51a is a flat surface parallel to the opening surface of the fixing side opening 41a of the fixing member 40, and the sleeve member 30 in this state. The engaging member 51 is configured to be movable with respect to the holding member 52 to such an extent that the fixing member 40 can be removed without interfering with the holding member 52. Note that the end 51a of the engaging member 51 is in the process of attaching and detaching the holding device 50 to and from the fixing member 40 in a state where the inner surface engaging portion 51b is disposed within the interval so as to engage with the inclined inner surface portion 41t. What is necessary is just to be comprised so that the engaging member 51 may not interfere with the sleeve member 30. FIG.

  The holding member 52 has a flat end surface 52a at the tip and a contact portion 52b protruding from the end edge of the end surface 52a. A contact inner surface portion 52s is provided inside the contact portion 52b. The abutting inner surface portion 52 s has a concave curved inner surface shape that fits into an outer surface portion of one end portion of the fixing member 40. A receiving hole 52c for receiving the base portion of the engaging member 51 is opened in the end face 52a. The accommodating hole 52c accommodates the engaging member 51 such that the end portion 51a protrudes from the end surface 52a, and the engaging outer surface portion 51s of the engaging member 51 and the abutting inner surface of the holding member 52 The engagement member 51 is formed with a margin so that the engagement member 51 can move in the direction in which the distance to the portion 52s increases or decreases. Further, the holding member 52 is provided with a stepped insertion hole 52d communicating with the accommodation hole 52c.

  The moving member 53 has a screw shape having a male screw portion 53a screwed into the screw hole 51c of the engaging member 51 and a head portion 53b having a shoulder portion engaged with the insertion hole 52d of the holding member 52. is doing. The head 53b protrudes outward from the holding member 52, and is configured such that the screwing depth with respect to the engaging member 51 can be changed by rotating the head 53b. The head 53b is provided with a tool engaging portion 53c formed of, for example, a hexagonal concave hole, and the tool engaging portion 53c is used to rotate the moving member 53 using a tool such as a wrench (not shown). It is preferable to be configured so that The solid line in FIG. 3A indicates the position of the engaging member 51 when the engaging outer surface portion 51s approaches the abutting inner surface portion 52s, but the head 53b of the moving member 53 is moved around the axis 53x. When the screwing depth of the male threaded portion 53a with respect to the screw hole 51c of the engaging member 51 is decreased by rotating, the engaging outer surface portion 51s is brought into contact with the abutting inner surface portion 52s as shown by a broken line in the drawing. The engaging member 51 moves in the direction of separating. On the contrary, by reversing the rotation direction of the rotation operation with respect to the moving member 53, the engagement member 51 can be moved from the state shown by the broken line in the drawing to the state shown by the solid line in the drawing.

  In the case of the illustrated example, the axis 53x of the moving member 53 is inclined with respect to the end surface of the end portion 51a or the end surface 52a, so that the head portion 53b protrudes obliquely outward. Rotating operation is easy. The axis 53x is orthogonal to the axis 51x of the engaging member 51, and the axis 51x of the engaging member 51 is configured to be parallel to the inclination direction of the engaging outer surface portion 51s. Thereby, the engaging force when the engaging member 51 moves and the engaging outer surface 51s engages with the inclined inner surface 41t can be increased. Further, the inclination direction of the engaging outer surface portion 51s is configured to be parallel to the inclination direction of the inclined inner surface portion 41t when the holding device 50 is attached to the fixing member 40. Thereby, since the contact area of both when the engaging outer surface part 51s engages with the inclined inner surface part 41t increases, the engagement strength can be increased.

  In the state where the engagement member 51 is disposed at the position indicated by the broken line in FIG. 3A, the distance between the engagement outer surface portion 51s and the contact inner surface portion 52s is separated, and thus the inner surface engagement portion 51b is fixed. It can be made to escape from the side opening 41a, and conversely, the inner surface engaging portion 51b can be introduced into the fixed side opening 41a from the outside. On the other hand, in the state where the engagement member 51 is disposed at the position indicated by the solid line in FIG. 3A, the distance between the engagement outer surface portion 51s and the contact inner surface portion 52s is closer, and therefore the inner surface engagement portion 51b. Cannot escape from the fixed side opening 41a, and conversely, the inner surface engaging portion 51b cannot be introduced into the fixed side opening 41a from the outside.

Therefore, when the end 51a of the engagement member 51 is introduced into the fixed side opening 41a in the state of the broken line in the figure, and then the movement member 53 is operated to move the engagement member 51 to the position indicated by the solid line in the figure, Since the engaging portion 51b engages with the inclined inner surface portion 41t and the abutting inner surface portion 52s contacts the fixing member 40 and the end portion 51a cannot escape from the fixed side opening 41a, the holding device 50 is fixed. The state is held by the member 40. At this time, the end surface 52a of the holding member 52 abuts on the surface of the fixed side engaging portion 41 as shown in the drawing, and is arranged along the extending direction of the fixed member 40.

In the present embodiment, the engaging outer face 51s of the engagement member 51 is configured in a convex curved surface which fits into the concave curved surface shape of the inclined inner surface portion 41t, closely engaging outer surface portion 51s to the inclined inner surface portion 41t By doing so, the holding posture of the fixing member 40 attached to the holding device 50 can be regulated. However, since the end portion 51a of the engaging member 51 has an extended shape that can be fitted into the opening range of the extended shape of the fixed side opening 41a, the engaging inner surface portion 51s is not in close contact with the inclined inner surface portion 41t. The posture of the fixing member 40 with respect to the holding device 50 is roughly regulated only by inserting the end portion 51a of the combined member 51 into the fixing side opening 41a.

  As shown in FIG. 3B, an elastic member 56 such as a coil spring is interposed between the engaging member 51 and the holding member 52, and the engaging member 51 and the holding member 52 are always connected by the elastic member 56. By moving the engagement member 51 relative to the holding member 52, the movement of the engagement member 51 can be more reliably obtained. That is, the position of the engaging member 51 with respect to the holding member 52 can be set reliably by the moving member 53. Here, when the engaging member 51 is moved from the position shown by the solid line in FIG. 3A to the position shown by the broken line in the drawing, the elastic force of the elastic member 56 becomes the driving force.

  The above-described holding device 50 described above is suitable for the fixing member 40 shown in FIGS. 4 to 6. However, when the fixing member 40 ′ of the modified example shown in FIG. 7 is used, the holding member 52 abuts. This can be dealt with by changing the position of the portion 52 b and the shape of the abutting inner surface portion 52 s so as to fit the tip of the extension portion 43. Note that the screw hole 51c, the insertion hole 52d of the engagement member 51, the moving member 53 provided with the male screw 53a and the head 53b, and the elastic member 56 used as necessary include the above-mentioned. A member moving means is constituted.

  FIGS. 8 to 10 are schematic process diagrams showing a work procedure when performing an operation using the holding device 50. First, the body surface is incised to form a skin opening a and an incision range A shown in FIG. The incision range A is formed obliquely from the skin opening a to the outer surface of the femur along the axis 10x of the shaft-shaped member 10. The inclination angle of the incision range A is usually about 130 to 150 degrees with respect to the outer surface of the femur (this is the angle between the axis 10x of the shaft member 10 and the extending direction of the fixed plate portion 42 (the above-mentioned The position of the skin opening a and the inclination angle are preliminarily determined by using a positioning tool (not shown) such as an angle template (angle checker) or the like to obtain a fluoroscopic image such as an X-ray image. Is set based on After that, as described above, the guide pin is introduced from the outer surface of the femur, the reamer processing for forming the stepped hole, and the introduction of the shaft member 10 are sequentially performed, and the shaft member as shown in FIG. 10 and sleeve member 30 are introduced into the bone.

  Next, the fixing member 40 is attached to the holding device 50 as shown in FIG. 8, and the distal end of the fixing plate portion 42 is introduced into the body through the skin opening a, and along the outer surface of the femur as shown in FIG. Then, the fixing plate portion 42 is inserted to the distal side, and the fixing side engaging portion 41 of the fixing member 40 is once arranged in the state distant from the sleeve side engaging portion 32 of the sleeve member 30. Thereafter, as shown in FIG. 10, the fixing member 40 is slid proximally along the outer surface of the femur to engage the fixing side engaging portion 41 with the sleeve side engaging portion 32.

  When the sleeve member 30 and the fixing member 40 are engaged as described above, the holding device 50 is removed from the fixing member 40. In order to completely engage the sleeve member 30 and the fixing member 40, an impact may be applied to the fixing member 40 in the slide fitting direction using an appropriate impactor or the like as necessary. Thereafter, the fixing member 40 is fixed by inserting a bone screw into at least one screw hole 42a of the fixing plate portion 42 of the fixing member 40 and introducing it into the femur. At this time, when the first bone screw is inserted into any one of the screw holes 42a of the fixing plate portion 42 and screwed into the bone, the opening edge on the proximal side of the screw hole 42a is pressed by the head of the bone screw. The fixing member 40 is pressed to the proximal side, so that the sleeve side engaging portion 32 and the fixed side engaging portion 41 are completely engaged (the slide engaging structure is engaged most deeply). Can be obtained with certainty.

  The holding device 50 can also be used when removing the implant system from the body. In this case, the holding device 50 is mounted on the fixing member 40, and the fixing member 40 is slid and removed from the sleeve member 30 using the holding device 50 in a state where the bone screw or the like is removed, and then the shaft-like member 10 is removed. And the sleeve member 30 is extracted. If it does in this way, the skin opening a and the incision range A at the time of extraction can be made small, and the burden given to a patient can be reduced. At this time, in the holding device 50 of the present embodiment, the mounting work on the fixing member 40 can be performed more easily than in the past, so it is difficult to mount the holding device 50 on the fixing member 40 embedded in the body. Never happen. Further, in the holding device 50 according to the present embodiment, the engagement strength (attachment rigidity) with respect to the fixing member 40 can be increased as compared with that using a conventional screw connection or the like, so that a temporary bone is formed when the fixing member 40 is removed. It is possible to prevent accidents such as destruction of the mounting structure due to removal resistance caused by the above.

In the above SL embodiment, as member moving means for allowing relative movement of the holding member 52 and the engagement member 51, but feed screw mechanism to the moving member 53 and the screw holes 51c and main structure is provided The member moving means is not limited to the above-described embodiment, and can be constituted by various moving mechanisms such as a known slide type moving mechanism and a rotating type moving mechanism .

The schematic perspective view of the holding instrument of the orthopedic surgical instrument set of embodiment. The expanded partial side view which shows the mounting part of the holding device. The fragmentary longitudinal cross-section which shows the holding tool with a fixing member. The side view (a) and front view (b) which show the assembly state of the implant system of embodiment. The exploded front view (a) and bottom view (b) of the sleeve member and fixing member of the implant system. The exploded sectional view (a) of the implant system, the rear view (b) of the fixing member, the plan view (c) of the fixing member, the bottom view (d) of the fixing member, and the sectional view (e) of the sleeve member. The longitudinal cross-sectional view which shows the structure and usage aspect of a different implant system. The schematic process drawing which shows the use condition 1 of the holding device. The schematic process drawing which shows the use condition 2 of the holding device. The schematic process drawing which shows the use condition 3 of the holding device.

DESCRIPTION OF SYMBOLS 10 ... Shaft-shaped member, 30 ... Sleeve member, 30a ... Sleeve through-hole, 31 ... Cylindrical part, 32 ... Sleeve side engaging part, 40 ... Fixed member, 41 ... Fixed side engaging part, 41a ... Fixed side opening, 41t ... Inclined inner surface portion, 42 ... Fixing plate portion, 50 ... Holding device, 51 ... engaging member, 51a ... End portion, 51b ... Inner surface engaging portion, 51s ... Engaging outer surface portion, 51c ... Screw hole, 52 ... Holding Member 52a ... End face 52b Contact part 52s Contact inner surface part 53 Moving member 53a Male screw

Claims (5)

An axial member engaged and fixed to the bone;
A sleeve member provided with a sleeve through-hole that accommodates the shaft-like member so as to be movable in the axial direction, and a sleeve-side engagement portion provided on the base end side;
A fixed-side engaging portion provided near one end so as to be able to engage with the sleeve member by sliding with respect to the sleeve-side engaging portion of the sleeve member in the thickness direction , and the fixing has a fixed plate portion extending toward the side engaging portion to the other, Ri Na comprise a stationary side opening communicating with the sleeve through hole in the fixed-side engaging portion, in the axial direction of the shaft-like member a plate-shaped fixing member that Mashimasu extending in a direction inclined against,
A holding device configured to be capable of mounting the fixing member in a manner in which the fixing side engaging portion can be engaged with the sleeve side engaging portion;
An orthopedic surgical instrument set comprising:
An opening edge of the fixed side opening is formed in parallel with the axis of the sleeve through-hole , is inclined with respect to the extending direction of the fixed member and faces the sleeve member, and An inclined inner surface portion provided with a gap therebetween is provided, and the inclined inner surface portion is provided at an opening edge on the one end side of the fixed side opening,
The holding device is engaged to engage the inner side of the fixed side open to the inclined inner surface portion at said end portion and having an end portion disposed on the fixed side in an opening in a state mounted on the stationary side engagement portion An engagement member having a wedge-shaped inner surface engagement portion having an outer surface portion, and a surface that contacts the surface of the fixed side engagement portion in a state of being mounted on the fixed side engagement portion, and is disposed along the extending direction. An end surface that opens into the end surface, a receiving hole that receives the base portion of the engagement member so that the end portion of the engagement member protrudes from the end surface, and a protrusion hole that protrudes from the end surface from within the fixed-side opening. A holding member having an abutting portion configured to be able to abut against an outer surface portion of the one end portion of the fixing member from the outside opposite to the direction toward the inclined inner surface portion; and the inner surface engaging portion; The engagement member so that the distance to the contact portion changes. Orthopedic surgery, comprising: member moving means configured to select the state in which the inner surface engaging portion can escape from the interval and the state in which the inner surface engaging portion cannot escape by moving the holding member relatively. Surgical instrument set. 2. The orthopedic surgical instrument according to claim 1, wherein the inclined inner surface portion is a surface that is inclined obliquely with respect to the extending direction toward the sleeve member over the entire thickness direction of the opening edge. set. 2. The inclined inner surface portion has a concave curved surface shape along the inner surface of the sleeve through-hole, and the inner surface engaging portion is formed in a convex curved surface shape that fits into the concave curved surface shape. Or the orthopedic surgical instrument set of 2.



The orthopedic surgical instrument set according to any one of claims 1 to 3, wherein the member moving means is a feed screw mechanism that is screwed into the engagement member with the holding member as a reference . An opening range of the fixed-side opening is formed in an extending shape extending along an extending direction of the fixing member, and the end portion of the engaging member is extended in a direction corresponding to the extending direction of the opening range. The orthopedic surgical instrument set according to any one of claims 1 to 4, wherein the orthopedic surgical instrument set has a shape .

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