JP6205950B2 - Hip prosthesis - Google Patents

Description

  The present invention relates to an improvement of an artificial hip joint surgical instrument used when installing a femoral stem or acetabular cup component in an artificial hip joint operation.

  As an instrument used for artificial hip joint surgery, for example, there is an artificial hip joint replacement assisting auxiliary member described in Patent Document 1 below. This is composed of a bone fitting part and an installation information display part, and is created from a three-dimensional model on a computer by a rapid prototyping technique such as stereolithography. The bone fitting portion is created using a three-dimensional shape of an acetabulum or a femur serving as an operation site for replacement of an artificial hip joint, and a part or all of the bone fitting portion is fitted to the acetabulum or the femur. The installation information display unit provides information on appropriate positions and directions of the acetabular component and the femoral component based on a preoperative plan for hip replacement.

JP 2008-188400 A

By the way, in artificial hip joint surgery, the proper installation position and installation alignment of the femoral stem are important in order to properly transmit the stress applied to the artificial hip joint to the femur, and are acceptable for the individual femoral bone marrow cavity. It is important for adapting and stabilizing the largest component size, and is a factor that influences postoperative results and is one of the key points of preoperative planning. The actual hip replacement is
a, femoral head resection,
b, excavation of the femoral bone marrow cavity;
c, femoral stem insertion and fixation,
It is performed by the procedure. For this reason, in determining the insertion position of the femoral stem at c, excision of the femoral head of a and excavation of the medullary cavity of b are important operations.

  These operations are performed based on a preoperative plan. In actual surgery, a part of bone developed from a skin incision that can be directly viewed in the surgical field can be referred to. However, there are many cases where the development of the surgical site is limited due to obesity. Also, if the bone morphology is significantly deformed, it is far from the usual anatomy, so the operator makes a mistake, resecting the femoral head at a height different from the preoperative plan, and the medullary cavity in a different direction There is a risk that the excavation and the femoral stem may be installed at different positions. In such a case, there is a possibility that complications may occur during or after the operation, such as fracture of the femur during insertion of the femoral stem or dislocation after the operation. Currently, a navigation device that guides a precise preoperative plan during surgery by computer technology has been developed, but generally it is not widespread, and there is a demand for methods and instruments that are simpler and easier to operate. . On the other hand, a cup component is installed on the acetabular side, and in this case as well, it is necessary to specify the installation position well in the same manner.

  The present invention focuses on the above points. The purpose of the present invention is to remove the femoral head, excise the medullary cavity, and to properly align the femoral stem even when the deployment of the surgical site is limited. The work such as installation should be performed well in accordance with the preoperative plan. Another purpose is to perform minimally invasive surgery to expand the surgical field from a very small skin incision without removing as much as possible soft tissue such as muscles. Is to install a stem. Yet another object is to successfully place the cup component even on the acetabular side.

The present invention is a surgical instrument for performing appropriate placement of a femoral stem on the basis of a preoperative plan when performing hip replacement, which is in contact with the intertrochanteric ridge of the femoral neck Abutment fixation part that fixes itself and has an edge that indicates the high level of osteotomy in the femoral neck , the excavation direction of the femoral bone marrow cavity or the femoral stem to properly install the femoral stem based on the preoperative plan installation guide portion serving as a guide for indicating the insertion direction and insertion center point, and wherein the kite comprising a.

One of the main forms is that the installation guide portion is inserted with a first wire indicating the inclination of the femoral bone marrow cavity excavation direction or the femoral stem insertion direction with respect to the bending / extending direction and the varus / valgus direction. It has the 1st wire holding through-hole for doing. One of the other forms is that the installation guide portion inserts a second wire for inserting a second wire indicating the inclination of the femoral bone marrow cavity excavation direction or the femoral stem insertion direction with respect to the anterior / posterior twist direction. It has a wire holding through hole . According to still another aspect, a direction parallel to a direction orthogonal to the first wire and the second wire passes through the insertion center point of the femoral stem on the osteotomy surface of the femoral neck. Features. Alternatively, the installation guide part has a third wire holding through-hole for inserting a third wire for grasping the angle of the osteotomy excision surface in the femoral neck . Yet another embodiment is characterized in that an auxiliary tool is used that is coupled to the installation guide portion in a preset posture and indicates the center direction of the femoral stem in the coupled state.

Another invention is a surgical instrument for performing appropriate placement of an acetabular cup component based on a preoperative plan when performing hip replacement, comprising a base having a shape following the shape of the acetabulum, Guide means for indicating the center axis of the acetabular cup component or the reaming center axis for making a hole in the acetabulum, and for inserting an auxiliary pin having a fixed positional relationship with a preset reference pin on the pelvis Positioning means.

One of the main forms is that the base portion has an acetabular socket having a characteristic shape for each patient, and the outer surface-side protruding portion that interferes at the time of installation is cut into a tapered shape so that the surgical plan of the acetabulum It is characterized by being adapted appropriately at the position of . In another embodiment, the reference pin is erected in a direction parallel to a triangular reference plane connecting the left and right upper anterior iliac spines and the pubic connection . In another embodiment, an auxiliary pin having a fixed positional relationship with respect to the reference pin is inserted into the positioning means, and an auxiliary tool that holds the auxiliary pin and the reference pin is used. Positioning with respect to a reference pin is performed. The above and other objects, features and advantages of the present invention will become apparent from the following detailed description and the accompanying drawings.

  According to the present invention, the abutment fixing portion of the surgical instrument is designed to hit the intertrochanteric ridge, which is greatly uneven in the femoral neck with a characteristic shape for each patient. The surgical instrument can be fixed and the operation of the femoral head, excision of the medullary cavity, and installation of the femoral stem can be performed in a minimally invasive manner according to the preoperative plan even when the deployment of the surgical site is limited. Can be performed well.

FIG. 1A is a perspective view showing an artificial hip joint surgical instrument according to Embodiment 1 of the present invention, and FIG. 1B is a photograph of an actual product. It is a figure which shows a mode that the surgical instrument with respect to a femoral neck part is attached. (A) is a figure which shows a high level of osteotomy, (B) is a figure which shows a varus-valgus direction. It is a figure which shows the front twist / back twist direction and the femoral stem insertion point. It is a figure which shows the bending / extension direction and the installation direction of a femoral stem. It is a perspective view which shows the auxiliary tool of Example 2 of this invention. It is a figure which shows the use condition of the auxiliary tool of the said Example 2. FIG. It is a figure which shows the reference | standard pin in Example 3 of this invention. It is a figure which shows an example of the instrument for cup installation in the said Example 3. FIG. It is a figure which shows the mode of correction of the said appliance for cup installation. It is a figure which shows the mode of the installation assistance tool of the said cup installation instrument, and installation.

  Hereinafter, the form for implementing this invention is demonstrated in detail based on an Example.

  Hereinafter, embodiments of the present invention will be described with reference to FIGS. FIG. 1 (A) is a perspective view showing an artificial hip joint surgical instrument (hereinafter simply referred to as “surgical instrument”) of this embodiment, and FIG. 1 (B) is a photograph of a prototype. FIG. 2 (A) shows the femoral neck, and FIG. 2 (B) shows a state in which a surgical instrument is being attached to the femoral neck. In these drawings, the stem installation device 10 is in contact with and closely contacts the bone, and a contact fixing portion A for fixing the entire device, the excision position of the femoral head, excavation of the medullary cavity, and insertion of the femoral stem. It is comprised by the installation guide part B which instruct | indicates a direction.

  As shown in FIG. 2, the part AA of the contact fixing part A contacts the greater trochanter 102 of the femoral neck 101 of the femur 100, and the part AB contacts the lesser trochanter 104 of the femoral neck 101. In addition, a heel portion AC is provided that is hooked on the intertrochanter ridge 106 from the greater trochanter 102 to the lesser trochanter 104, and a recessed portion AD that extends from the heel portion AC to the femoral neck 101 is extended.

  It is important that the abutment fixing portion A of the stem installation instrument 10 stably fixes the stem installation instrument 10 at the surgical site without causing an error in the installation position and without causing a deviation. It is also important that it is easy to deploy during surgery, has little invasion to the surgical site, and can be fixed with a small contact surface. From this point, in this embodiment, the butt portion AC, which is a shape learned across the intertrochanter ridge 106, is provided in the contact fixing portion A. FIG. 2 (C) shows a cross section viewed in the direction of the arrow along the line # II- # II in FIG. 2 (B), and the collar portion AC of the contact fixing portion A is the intertrochanter ridge 106. It straddles.

  As described above, the abutment fixing portion A is formed so as to straddle the intertrochanteric ridge 106, which is a characteristic portion of the femoral neck 101, and the stem is stable with a small contact area. The installation tool 10 can be fixed.

  Next, the edge AF of the concave portion AD of the above-described contact fixing portion A is formed so as to indicate the osteotomy high level (cutting position) of the femoral neck portion 101. As shown in FIG. 3A, a hip joint is constituted by a large concave acetabulum (acetabulum) 130 and a femoral head 110. When performing hip replacement, the femoral head 110 is cut at the position of the femoral neck 101. The high bone cut LC, which is the cutting position, is the length of the patient's foot, the medullary cavity of the femur 100. The doctor decides at the stage of preoperative planning in consideration of the shape of the femur, the size of the femoral stem to be used, and the like. Then, as shown in FIG. 3B, the determined position of the high osteotomy LC is set so as to be the edge AF of the concave portion AD of the contact fixing portion A.

  Next, returning to FIG. 1, an installation guide portion B is formed in the contact fixing portion A described above. The installation guide part B is configured by rectangular parallelepiped blocks BA, BB, BC, and the blocks BA, BB intersect each other, and the intersecting part and the contact fixing part A are joined by the block BC. . In these blocks BA, BB and BC, wire holding through holes QA, QB and QC are formed, respectively.

  Of these, the wire (steel wire) 140 is inserted into the wire holding through hole QA of the block BA as shown in FIG. The direction of the wire 140 in FIG. 3B indicates the varus / valgus direction DA, which is the inclination of the femur 100 on the coronal surface. FIG. 3B is viewed from the left as shown in FIG. The direction of the wire 140 in FIG. 5 indicates a bending / extending direction DC that is an inclination in the sagittal plane of the femur 100. That is, bending / extension / valgus / valgus is indicated by the same wire 140 axis, but the reference direction differs by 90 degrees (difference between the coronal surface and the sagittal surface). FIG. 4 described later shows the relationship between the varus / valgus direction DA and the bending / extending direction DC. The direction through the center DAS of the bone marrow cavity ZC is the actual insertion direction of the femoral stem ZS, and the femoral stem ZS is inserted in the direction of the arrow FS. The bending / extension direction DC and the center of the bone marrow cavity ZC (insertion center of the femoral stem ZS) DAS are parallel (see FIG. 5).

  Next, as shown in FIG. 4, the wire 142 is inserted into the wire holding through hole QB of the block BB. This wire 142 indicates the front / back twist direction DB which is rotation (twist) of the femur 100 in the horizontal plane. Note that the front / reverse twist direction DB indicated by the wire 142 indicates the angle at which the front twist is inserted into the medullary cavity of the femoral stem ZS determined by the operator in the surgical plan. That is, the front / back twist direction DB and the parallel line DBS passing through the implant insertion center point DX are parallel to each other.

  Next, a direction DD parallel to a direction shown by a wire (not shown) inserted through the wire holding through hole QC of the block BC is a direction orthogonal to the wires 140 and 142, and the implant insertion center point DX is Pass through. That is, the intersection point is the implant insertion center point DX on the osteotomy surface 120 translated in the direction of the wire passing through the blocks BA, BB, BC, and the implant insertion center point DX is the femoral stem length on the osteotomy surface 120. It is the insertion position of the shaft.

The stem installation tool 10 having the shape and structure as described above is manufactured as follows.
(1) First, a CT (computed tomography) image or an MRI (magnetic resonance) image of the hip part of a patient undergoing hip replacement is acquired.
(2) Next, a three-dimensional image of the hip joint is obtained by a computer, and a preoperative plan for hip replacement is performed based on the three-dimensional image. As such 3D preoperative planning software for hip replacement, for example, there is “ZedHip” manufactured by Lexi Co., Ltd. This
a, the shape of the patient's femur 100,
b, the size of the femoral stem used,
c, osteotomy high LC
d, varus / valgus direction DA
e, Front / Reverse Twist Direction DB
f, bending / extension direction DC
g, Implant insertion center point DX on the osteotomy surface 120
Is determined.
(3) Next, applying the rapid prototyping technology, the stem installation tool 10 is manufactured using optical resin or the like. The shape of the contact fixing part A of the stem installation instrument 10 is specified by the shape of the femur 100 of the patient a and the osteotomy high LC of the c. The installation guide B of the stem installation instrument 10 includes the bending / extension direction DA of d, the front / rear direction DB of e, the varus / valgus direction DC of f, and the osteotomy surface 120 of g. The shape is specified by the implant insertion center point DX. In addition, since the instrument 10 for stem installation respond | corresponds to the osseous irregularity peculiar to the patient of a hip joint part, it is manufactured for every patient.

  The stem installation device 10 manufactured as described above is sterilized and used during artificial hip joint replacement. First, the operator pushes against the corresponding portion of the femoral neck 101 with the operator's hand so as to straddle the intertrochanteric ridge 106, and adheres and fixes to the bone surface. Next, the surgeon cuts the femoral head 110 along the edge AF of the contact fixing portion A of the stem installation instrument 10. Subsequently, the surgeon performs the varus / valgus direction DA from the insertion center point DX on the osteotomy surface 120 along the varus / valgus direction DA, the front / back twist direction DB, and the bending / extension direction DC. The front / back twist direction DB and the bending / extension direction DC are referred to as appropriate, and the femoral stem ZS is installed along these directions.

  As described above, by performing the artificial femoral replacement using the stem installation device 10, operations such as excision of the femoral head, excavation of the medullary cavity, and installation of the femoral stem are performed in accordance with the preoperative plan. It can be done well. Further, according to the method of the present embodiment, it can be carried out in the same manner as the conventional surgery, and there is no need to drive a guide pin into the bone, so that there is an advantage that it is minimally invasive.

  Next, Embodiment 2 of the present invention will be described with reference to FIGS. This embodiment is applied when the operator grasps the central axis direction of the femoral stem ZS when the femoral stem ZS is installed in the direction of the surgical plan. For example, a wire is set up to confirm the installation axis direction and insertion point of the femoral stem ZS, or a pilot hole is opened using a small-diameter drill. In this embodiment, as shown in FIG. 6, a stem assisting tool 200 is used for the above-described stem installation tool 10. In addition, in the stem installation instrument 10 of the present embodiment, a block BB2 is used instead of the block BB, and the block BB2 is not orthogonal to the block BA but has a predetermined angle. A wire 152 passes through the block BB2. The wire 152 is provided to grasp the anteversion angle of the femoral stem ZS and the angle of the resection surface of the femoral neck. In FIG. 6, PA represents a frontal plane with respect to the stem installation axis, and PB represents a sagittal plane with respect to the stem installation axis.

The stem auxiliary tool 200 includes:
a, a base 210 through which the wire 140 penetrates and is positioned by being connected to the block BA of the stem installation tool 10 by a tenon 213 (unevenness).
b, an arm 212 extended in a direction orthogonal to the longitudinal direction of the base 210 (the direction of the block BC or the direction orthogonal to the direction of the wire 140),
c, a holding portion 214 provided at the tip of the arm 212 and having a guide hole 216 in a direction parallel to the wire 140;
It has.

  Among these, the base 210 is provided with a through hole 211 in the longitudinal direction thereof, and the through hole 211 is continuous with the wire holding through hole QA of the block BA of the stem installation tool 10. For this reason, the wire 140 penetrating the through hole 211 is further inserted through the wire holding through hole QA. The length of the arm 212 is set so that the center of the guide hole 216 of the holding portion 214 is the center of the femoral stem ZS. As described above, the stem installation device 10 is fixed to a corresponding portion of the femoral neck 101. In this state, the stem assisting tool 200 is caused to penetrate the wire 140 through the base 210 and the tenon 213. In this case, the center of the guide hole 216 of the holding portion 214 is the center of the femoral stem ZS.

  Next, the operation of the present embodiment will be described. First, the stem auxiliary tool 200 is attached to the stem installation tool 10, and the wire 140 is connected to the block BA of the stem installation tool 10 from the through hole 211 of the base 210. It penetrates through the wire holding through hole QA. At this time, the stem auxiliary tool 200 is stably fixed in a predetermined posture with respect to the stem installation tool 10 by the penetration of the wire 140 and the connection of the tenon 213.

  When the pilot hole indicating the central axis of the femoral stem ZS is opened using the stem assisting tool 200, the drill attachment 220 is inserted into the guide hole 216 of the holding portion 214 as shown in FIG. To do. On the drill side of the drill attachment 220, a stopper 222 having a diameter larger than that of the guide hole 216 and hitting the holding portion 214 is provided, and a non-slip 224 for the femoral great trochanter portion is provided at the tip. . Thus, the drill attachment 220 is fixed to the holding portion 214. In this state, the drill 226 is inserted into the through hole 225 of the drill attachment 220, and a hole is made in the femur. The formed femoral hole serves as a pilot hole serving as an appropriate central axis of the femoral stem ZS.

  Next, when the wire is erected in order for the surgeon to grasp the insertion point and insertion axis of the femoral stem ZS, the wire 150 is inserted into the guide hole 216 of the holding portion 214 as shown in FIG. . Thereby, the wire 150 can be set up so as to indicate the insertion point and the insertion axis of the femoral stem ZS.

  Thus, according to the present embodiment, since the stem assisting tool 200 is used, a pilot hole indicating the center of the femoral stem ZS is opened, and the insertion point and the insertion axis of the femoral stem ZS are operated. An operation such as setting up the wire 150 for a person to grasp can be performed easily.

  Next, Embodiment 3 of the present invention will be described with reference to FIGS. The embodiment described above relates to the femur side, but this embodiment relates to the pelvis side, and is an embodiment for excavating the acetabulum and inserting components of the artificial joint.

  First, the reference pin will be described with reference to FIG. At the time of surgery, the patient is lying on his or her side lying sideways with the affected area up, but the orientation does not necessarily stabilize and changes. Therefore, in this embodiment, a reference pin is provided at an appropriate position on the pelvis, and work is performed based on this. The reference pin may be determined in any way, but in this embodiment, as shown in FIG. 8A, a triangular shape connecting the left and right upper anterior iliac spines KA and KB of the pelvis K and the pubic joint KC. The reference pin KP is set up in a direction parallel to the reference plane KS. FIG. 8B shows an example of the reference pin KP, and the reference pin KP is erected on the upper edge KH of the acetabulum.

  FIG. 9 shows an example of a cup installation tool used in this embodiment. The cup setting device 300 measures the shape of the patient's acetabulum three-dimensionally, and manufactures a shape that matches the three-dimensional printing by a technique such as three-dimensional printing. FIG. 9A shows the appearance, and FIG. 9B shows a cross section viewed in the arrow direction along line # 9- # 9 in FIG. In these drawings, the cup setting device 300 is configured around a base portion 302 having a substantially hemispherical shape that is similar to the shape of a patient's acetabulum. A drill hole 310 is provided near the center of the base 302, and an auxiliary pin hole 320 is provided on the side. In addition, as shown in the cup installation direction, a recess 304 is formed in the frontal plane and in the cross-sectional direction starting from the cup installation center 302.

  Among these, the center direction 312 of the drill hole 310 is an installation center axis of the cup component installed on the acetabulum or a center axis of cup reaming, and as shown in FIG. Thus, the direction has a predetermined distance (interval) ΔR and a predetermined front opening angle φK and a tilting body angle or reaming angle φS. These distances and angles are set for each patient in the preoperative plan. The center 314 of the drill hole 310 coincides with the movement center of the reamer that forms a hemispheric surface for installing the cup component, and the step 313 of the drill hole 310 centering on 314 forms a pilot hole for the reamer. It becomes a stopper for the drill guide to be opened, and defines the drilling depth of the pilot hole. Next, the auxiliary pin hole 320 is a hole for inserting an auxiliary pin KPH (see FIG. 11 to be described later) standing at a position corresponding to the interval between the position of the reference pin KP and the attachment position of the cup installation tool 300. It is.

  By the way, although the cup installation device 300 described above is manufactured by, for example, a three-dimensional printing technique, when the patient's acetabulum has a depression (acetabular acetabulum) or the like, the shape is measured three-dimensionally, and the data If the three-dimensional printing is performed using as is, the cup installation device 300 is manufactured along the shape of the recess. For example, as shown in FIG. 10A, a protruding portion 330 and an extending portion 332 are formed outside the hemispherical base portion 302. If these protrusions 330 and the extension portions 332 are present, the cup installation device 300 cannot be installed on the patient's acetabulum due to the interference. Therefore, in this embodiment, as shown in FIG. 10 (B), the protrusions 330 and 332 are cut into a tapered shape 334 that opens on the base 302 side. This processing can be done by applying CAD design correction to the data obtained by subtracting the 3D measurement data of the patient's acetabulum from the 300 CAD volume data. However, after the printing, the protrusions 330 and 332 are cut. It is also possible to apply.

  Next, with reference to FIG. 11, the cup auxiliary tool 400 for installing the cup installation tool 300 on the patient's acetabulum KG will be described. FIG. 4A is a perspective view showing a state at the time of installation, and FIG. 4B is a view seen from the direction of arrow F11 in FIG. In these drawings, the cup auxiliary tool 400 includes pin holders 410 and 420 for holding the reference pin KP and the auxiliary pin KPH in parallel, respectively. These pin holders 410 and 420 are attached to a support rod 430, and the pin interval ΔK can be adjusted by screws 412 and 422. The screw 414 adjusts and fixes the position of the reference pin KP in the axial direction, and the screw 424 adjusts and fixes the position of the auxiliary pin KPH in the axial direction. The interval ΔK between the reference pin KP and the auxiliary pin KPH is determined in advance by the operator in the preoperative plan. The tip of the auxiliary pin KPH is inserted into the auxiliary pin hole 320 of the cup installation device 300 described above.

Next, the overall procedure of the present embodiment will be described.
(1) Three-dimensionally measure the shape of the patient's acetabular KG. Further, the center axis 312 (see FIG. 9) of the cup component (not shown) with respect to the reference pin KP is determined by the preoperative plan. That is, the distance ΔR from the reference pin KP, the front opening angle φK, and the tilting body angle φS are determined. The position of the auxiliary pin KPH can also be calculated from the three-dimensional data of the installation center axis 312 and the acetabulum KG, and the cup installation tool 300 is manufactured using these data.
(2) At this time, the correction processing shown in FIG.
(3) Next, using the cup auxiliary tool 400 shown in FIG. 11, as shown in the figure, the cup setting device 300 is set on the patient's acetabulum KG, and the reference pin KP is set on the acetabular margin KH. It is driven into the upper part, and the auxiliary pin KPH is driven into the auxiliary pin hole 320 of the cup installation tool 300. Thereby, the cup installation instrument 300 is fixed to the preoperative plan position with respect to the acetabulum KG.
(4) Next, a drill (not shown) is inserted into the drill hole 310 of the cup installation tool 300 to make a hole in the cup reaming direction. This direction and depth are consistent with the cup component installation plan for the acetabulum KG shown in FIG.
(5) Next, the cup installation tool 300, the cup auxiliary tool 400, and the auxiliary pin KPH are removed. Then, with the hole drilled in the acetabulum KG as an axis, the inside of the acetabulum KG is shaved with a reamer (not shown) to form a hemispherical surface.
(6) Next, a cup component is driven into the hemispherical surface formed on the acetabulum KG using the reference pin KP so as to be the installation center axis.

  As described above, by using the cup installation tool 300 and the cup auxiliary tool 400, operations such as acetabular reaming (excavation) and cup component installation can be performed preoperatively without being affected by the posture of the patient. Can be done well along.

In addition, this invention is not limited to the Example mentioned above, A various change can be added in the range which does not deviate from the summary of this invention. For example, the following are also included.
(1) In the first embodiment, the osteotomy high position LC, the varus / valgus direction DA, the anterior / posterior twist direction DB, the bending / extension direction DC, and the insertion position DX of the femoral stem long axis in the osteotomy surface 120 Is shown with the stem installation instrument 10, but only a part of the stem may be shown. Furthermore, for example, the direction of the block BB of the installation guide B may be a direction parallel to the cervical osteotomy angle (tilt angle).
(2) The shapes of the stem installation tool 10, the stem support tool 200, the cup installation tool 300, and the cup support tool 400 shown in the above embodiment are merely examples, and may be modified to have similar functions. .
(3) The cup auxiliary tool 400 and the auxiliary pin KPH shown in the third embodiment are also examples, and any means may be used as long as the cup device 300 can be installed at a predetermined position.
(4) The stem installation method shown in the first and second embodiments and the cup installation method shown in the third embodiment are not necessarily applied simultaneously, and may be performed separately.

  According to the present invention, the femoral stem can be successfully placed in the femoral bone marrow cavity according to the preoperative plan by using the stem installation tool and its auxiliary tool, which is suitable for artificial hip joint replacement. is there. In addition, by using the cup setting device and its auxiliary tools, the cup component can be satisfactorily set on the acetabulum according to the preoperative plan, which is suitable for artificial hip joint replacement.

10: Stem placement instrument 100: Femur 101: Femoral neck 102: Greater trochanter 104: Lesser trochanter 106: Intertrochanteric ridge 110: Femoral head 120: Surface 130: Acetabulum 140, 142, 150, 152: Wire 200: Stem auxiliary tool 210: Base 211: Through hole 212: Arm 213: Tenon 214: Holding part 216: Guide hole 220: Drill attachment 222: Stopper 225: Through hole 226: Drill 300: Cup installation tool 302 : Base 304: Concave 310: Drill hole 312: Center direction 313: Step 314: Center 320: Auxiliary pin hole 330: Protruding part 332: Extension part 334: Tapered shape 400: Auxiliary tools for cups 410 and 420: Pin holder 412 , 422: Screw 414: Screw 424: Screw 430: Support rod A: Contact fixing part AA: Part AB: Part AC: Scissors AD: concave portion AF: edge B: installation guide portion BA, BB, BC: block BB2: block DA: varus / valgus direction DAS: center DB: forward / reverse direction DBS: parallel line DC: bending / extension Direction DD: Direction DX: Implant insertion center point K: Pelvis KA, KB: Upper anterior iliac spine KC: Pubic ligation KG: Acetabular KH: Joint capsule KP: Reference pin KPH: Auxiliary pin KS: Reference plane LC: High position PA : Frontal plane with respect to stem installation axis PB: Sagittal plane QA, QB, QC with respect to stem installation axis: Wire holding through hole ZC: Bone marrow cavity ZS: Femoral stem ΔK: Pin interval ΔR: Distance φK: Front opening angle φS: Inclined body Corner

Claims (11)

A surgical instrument for performing appropriate placement of a femoral stem based on a preoperative plan when performing hip replacement,
Abutting and fixing part having an edge that indicates the high level of osteotomy in the femoral neck while fixing the instrument itself by contacting the intertrochanteric ridge of the femoral neck ;
An installation guide portion that serves as a guide indicating the excavation direction of the femoral bone marrow cavity or the insertion direction of the femoral stem and the insertion center point in order to appropriately install the femoral stem based on the preoperative plan;
An artificial hip surgery instrument characterized by comprising: A first wire holding for inserting the first wire, wherein the installation guide portion indicates the inclination of the excavation direction of the femoral bone marrow cavity or the insertion direction of the femoral stem with respect to the bending / extending direction and the varus / valgus direction The artificial hip surgery instrument according to claim 1, further comprising a through hole . The installation guide portion has a second wire holding through-hole for inserting a second wire indicating an inclination in the excavation direction of the femoral bone marrow cavity or the insertion direction of the femoral stem with respect to the anterior / posterior twist direction. The artificial hip joint surgical instrument according to claim 1 or 2. The direction parallel to the direction orthogonal to the first wire and the second wire passes through the insertion center point of the femoral stem in the osteotomy surface of the femoral neck. The artificial hip joint surgical instrument according to any one of the above. The said installation guide part has a 3rd wire holding | maintenance through-hole for inserting the 3rd wire for grasping | ascertaining the angle of the osteotomy excision surface in the said femoral neck part. The artificial hip joint surgical instrument as described.   The artificial hip joint according to any one of claims 1 to 5, wherein an auxiliary tool is used which is coupled to the installation guide portion in a preset posture and indicates a central direction of the femoral stem in the coupled state. Surgical instruments. A surgical instrument for performing appropriate placement of the acetabular cup component based on a preoperative plan when performing hip replacement surgery,
A base that follows the shape of the acetabulum,
Guide means for indicating an installation center axis of the acetabular cup component or a reaming center axis for making a hole in the acetabulum ;
Positioning means for inserting an auxiliary pin having a fixed positional relationship with respect to a preset reference pin on the pelvis;
An artificial hip surgery instrument characterized by comprising:   The base is tapered in the acetabular fossa with a characteristic shape for each patient by cutting away the external protrusion that interferes during installation so that it fits appropriately at the position of the acetabular surgical plan. The artificial hip joint surgery instrument according to claim 7, wherein The artificial hip joint surgical instrument according to claim 7 or 8 , wherein the reference pin is erected in a direction parallel to a triangular reference plane that connects the left and right upper anterior iliac spines and the pubic joint.   An auxiliary pin having a fixed positional relationship with respect to the reference pin is inserted into the positioning means, and positioning with respect to the reference pin is performed by using an auxiliary tool that holds the auxiliary pin and the reference pin. The artificial hip joint surgery instrument according to any one of claims 7 to 9.   An artificial hip joint surgical instrument comprising the artificial hip joint surgical instrument according to any one of claims 1 to 6 and the artificial hip joint surgical instrument according to any one of claims 7 to 10.