JP6502202B2 - Measurement device for artificial ankle surgery - Google Patents

Description

  SUMMARY OF THE INVENTION The present invention relates to tensioning of the ligament by inserting it between the osteotomy on the distal end of the tibia for attaching the tibial component and the osteotomy on the proximal end of the talus for attaching the talar component in total knee arthroplasty. The present invention relates to a measuring device for surgical operation of artificial ankle joints which can be suitably implemented to measure the propriety of ligament balance.

  Conventionally, for knee joint diseases such as osteoarthritis of the knee, rheumatoid arthritis, and trauma, an artificial knee joint in which a living knee joint is removed and replaced with an artificial knee joint in order to ensure smooth joint movement. Replacement is being performed.

  In total knee arthroplasty, since it is necessary to ensure the same movement as a normal living knee joint, the total knee replacement has to be performed, for example, between the femur and the tibia in which the bone has been removed, for example, The tension of the ligament in the knee joint and the like are measured using the ligament tension device disclosed in the patent or the measurement device for the total knee replacement surgery disclosed in Patent Document 2, and the propriety of the ligament balance is confirmed. There is.

Japanese Patent Application Publication No. 2005-537046 Unexamined-Japanese-Patent No. 2004-237064

  In the prior art used in total knee arthroplasty as described in the above-mentioned Patent Document 1, the two bearing surfaces which lock to the femur and tibia bone cutting surfaces translate in the longitudinal or medial-lateral direction. Further, in Patent Document 2, it is possible to turn around an axis parallel to the osteotomy and measure the degree of equilibrium. On the other hand, in the artificial joint, it is difficult to apply tension by bringing the support surface into abutment between the bone cutting surfaces of the distal end of the tibia and the proximal end of the talar in the original joint movement range of the ankle joint. Also, the tension of the ligament can not be measured separately on the same mounting surface on which the one supporting surface is mounted on one of the bone cutting surfaces, and the ligament balance of the joint in the ankle joint Can not be confirmed properly.

  The object of the present invention is to make it possible to individually measure the tensions of the inner and outer ligaments in the original joint movement range and also on the same mounting surface in the ankle joint, and to balance the ligament after artificial ankle joint replacement. An object of the present invention is to provide a measurement device for artificial ankle surgery that can be accurately confirmed.

The present invention is a measurement apparatus for artificial ankle surgery, which measures tension by a ligament between a distal end of a tibia and a proximal end of a talar in an artificial ankle surgery in which a living ankle joint is replaced with an artificial ankle joint. ,
When the pair of grips that are displaceable in the approaching direction and the separating direction and the pair of gripping parts are displaced in the direction in which the pair of gripping parts move closer, they are displaced in the direction away from each other, and the pair of gripping parts separate from each other An operating tool having a pair of operating parts which are displaced in the directions approaching each other when displaced in the
A first base portion having a detachable insertion portion in the pair of operating portions and extending along a predetermined first axis , and provided at the first base portion at the distal end of the tibia and the proximal end of the talar bone It possesses first contact portion where the first abutment surface flat abutting either one is formed, and a first abutment member mounted on one of the actuating portion through the spigot ,
A second base portion having a detachable insertion portion in the pair of operating portions and extending along a second axis parallel to the first axis, any one of a distal end of a tibia and a proximal end of a talar bone It possesses a second contact portion in which the second abutment surface flat abutting the other are provided, the second mounted to the other of the actuating portion through the insertion portion provided in the second base part An abutting body ,
Measuring means for measuring the magnitude of the force acting on the first and second contact surfaces based on the displacement in the approaching direction and the separating direction of the gripping portions provided in the pair of gripping portions; , only including,
The insertion portion of the first contact body and the first contact portion are mutually offset in a direction perpendicular to an imaginary plane including the first axis and the second axis. It is a measuring device for artificial knee joint surgery characterized by the above.

  Further, according to the present invention, the first contact portion is provided on the first base so as to be angularly displaceable around a predetermined first angular displacement axis perpendicular to a virtual plane including the first axis and the second axis. It is characterized by being

  Further, the present invention is characterized in that the second contact portion is a plate-like body.

  Further, according to the present invention, the second contact portion is provided with a protrusion protruding from the second contact surface at a portion opposite to the portion attached to the other operation piece. .

  Further, the present invention is characterized in that the second contact body is formed with a through hole penetrating in a direction close to and away from the first contact body.

  Further, according to the present invention, the second contact portion is provided on the second base so as to be angularly displaceable around a second angular displacement axis which is predetermined in advance and perpendicular to a virtual plane including the first axis and the second axis. It is characterized by being

  According to the present invention, the first contact body and the second contact body are displaced in the direction away from each other while maintaining parallel, by operating the grips of the operation tool in the direction in which they approach each other, One abutment surface abuts on either the distal end of the tibia and the proximal end of the talus, and the second abutment surface abuts on either the distal end of the tibia and the proximal end of the talus The magnitude of the force between the holding parts at the time is measured by the measuring means.

  In this manner, the first and second abutments are displaced in parallel to the distal end of the tibia and the proximal end of the talus so that the first and second abutment surfaces abut, so that the bearing surface on the osteotomy surface Without changing the size of the force according to the measured position between the tibia and the talar, the tension of the ligament can be confirmed separately on the inside and outside.

  Further, according to the present invention, since the first contact member is provided on the first base portion so as to be angularly displaceable at the first angular position which is predetermined in advance, the angle and shape of the measurement target portion such as a bone surface Even if they are different from each other, the first contact surface can be reliably abutted against the measurement target portion, and the tension of the ligament can be accurately measured as the magnitude of the force of the measurement means.

  Further, according to the present invention, since the plate-like body having the second contact surface is used, the occupied space between the bone cut surfaces can be reduced, and the second contact member is the tibia at the time of insertion and removal. Smooth insertion and removal can be achieved without problems such as catching on the distal end or the proximal end of the talus.

  Further, according to the present invention, since the second contact body is provided with a protrusion projecting from the second contact surface, the protrusion is a tibia or a tibial surface in a state in which the second contact surface faces the tibia or the talus. The second abutment body can be easily positioned by engaging in a direction of withdrawal with respect to the talar bone, and the shift can be prevented.

  Further, according to the present invention, since the through hole is formed in the second contact body, the operator can check the part where the second contact body is facing through the through hole, which is convenient. Sex is improved.

  Further, according to the present invention, since the second abutment body has the second abutment piece, also at the other end of the tibia and the proximal end of the talus, the angle of the measurement target site such as the osteotomy and Even if the shape is different, the second support surface can be reliably brought into contact with the measurement target site, and the tension of the ligament can be accurately measured as the load of the measurement means.

It is a front view showing measuring device 1 for artificial ankle joint surgery of one embodiment of the present invention. It is a top view of measuring device 1 for artificial ankle joint surgery. FIG. 1 is a perspective view of a measurement apparatus 1 for artificial ankle surgery. It is the enlarged rear view which looked at each operation part 3a, 3b and its vicinity from the back of FIG. It is a front view which shows the state which angularly displaced the 1st contact part 18a of the 1st contact body 4a with respect to the 1st base 17a. It is a figure which shows the state which turned over the 1st contact part 18a of the 1st contact body 4a in parallel with respect to the 1st base 17a. It is a figure which shows the state which turned over so that the 1st contact part 18c of the 1st contact body 14c may become parallel with respect to the 1st base 17c. It is a figure which shows the structure of the 2nd contact body 4b.

  FIG. 1 is a front view showing a measurement apparatus 1 for artificial ankle joint surgery according to an embodiment of the present invention, FIG. 2 is a plan view of the measurement apparatus 1 for artificial ankle joint surgery, and FIG. FIG. 1 is a perspective view of a measuring device 1; The measuring device 1 for artificial ankle joint surgery according to the present embodiment includes the distal end 19a of the tibia 19 and the proximal side of the talar bone 20 shown in FIG. The tension of the ligament between the end 20a is measured inside and outside, and it is used to confirm the ligament balance in the original joint movement range.

  The measurement apparatus 1 for artificial ankle joint surgery continues to the pair of grips 2a and 2b gripped by the operator and the grips 2a and 2b, and when the grips 2a and 2b are displaced in the direction A1 where they approach each other, A pair of actuating portions 3a that are displaced while maintaining a posture parallel to the mutually separating direction B1 and are displaced while maintaining a posture parallel to the mutually approaching direction B2 when the gripping portions 2a and 2b are displaced in the mutually separating direction A2. , And 3b, a first contact body 4a detachably mounted on one of the actuating portions 3a, and a second contact body 4b detachably mounted on the other actuating portion 3b, The distance of the tibia 19 to the first and second abutment surfaces 21a and 21b of the first and second abutment bodies 4a and 4b is determined based on the displacement of the grasping portions 2a and 2b in the approaching direction A1 and the separating direction A2. Proximal end 19a and the talus 20 And measuring means 5 for measuring the magnitude of the force acting from the end 20a.

  FIG. 4 is an enlarged rear view of the respective operating parts 3a and 3b and the vicinity thereof as viewed from the back of FIG. Each operating portion 3a, 3b has an operating member 8a, 8b which is generally in the form of a longitudinal block and in which guide elongated holes 6a, 6b extending along the first longitudinal axis L1 are formed. First link pins 9a and 9b are respectively inserted into the guide long holes 6a and 6b, and a pair of link members 10a and 10b crossing in an X shape are pin-connected to the first link pins 9a and 9b. Ru.

  Each of the grips 2a and 2b constitutes a part of a pair of curved rod-like operation members 11a and 11b. Each operation member 11a, 11b is pin-connected by the connecting pin 12 at the middle in the longitudinal direction. The other end of each link member 10a, 10b is pin-connected by a second link pin 14a, 14b to a mounting end 13a, 13b longitudinally opposite to the axis of the connecting pin 12. Each link member 10 a and 10 b is pin-connected by the third link pin 15 at the intersection.

  A link mechanism is configured by including the first link pins 9a and 9b, the respective link members 10a and 10b, the second link pins 14a and 14b, the third link pin 15, and the respective operating members 8a and 8b, and configuring each operation The members 8a and 8b can be displaced in the separating direction B1 and the approaching direction B2 while maintaining the postures parallel to each other.

  FIG. 5 is a front view showing a state in which the first contact portion 18a of the first contact body 4a is angularly displaced with respect to the first base 17a. FIG. 6 shows a state in which the first contact portion 18a of the first contact body 4a is tilted in parallel to the first base 17a, and FIG. 6 (1) shows a state in which the first contact portion 18a is tilted. It is a top view of the 1st contact body 4a, and Drawing 6 (2) is a front view of the 1st contact body 4a in the state where the 1st contact part 18a was turned over, and Drawing 6 (3) is the 1st It is a right side view of the 1st contact object 4a in the state where the contact part 18a was turned over, and Drawing 6 (4) is a perspective view of the 1st contact object 4a in the state where the 1st contact part 18a was turned over. The first contact body 4a described above is detachably attached to the actuating portion 3a which is one of the pair of actuating portions 3a and 3b, and extends along a first axis L1 defined in advance, and a first base portion 17a 17a is provided with a flat first abutment surface 21a provided on the distal end 19a of the tibia 19 and the distal end 19a of the aforementioned tibia 19 which is one of the proximal end 20a of the talar bone 20 And a contact portion 18a.

  The first base portion 17a has a rectangular plate-like base portion 22, a first rising portion 23 projecting from one end in the first axis L1 direction of the base portion 22 in the thickness direction to one side (upper side in FIG. 5), and a first rising portion. From the part 23 to one side in the first axis L1 direction (right side in FIG. 5), and from the other end of the base part 22 in the first axis L1 direction to the one side in the thickness direction A protruding second rising portion 25 and a third rising portion 26 protruding to one side in the thickness direction from a portion closer to the second rising portion 25 than the central portion of the base 22 in the first axis L1 direction are provided. A spherical fitting member 27 is held by the inserting portion 24 in a partially projecting state, and this fitting member 27 is protruded in a direction to protrude from the inserting portion 24 by a spring (not shown) provided in the inserting portion 24. It is spring-loaded and fitted in a fitting recess (not shown) formed in the actuating member 8a, whereby the first abutment 4a is detachably mounted on the actuating portion 3a.

  The first contact portion 18 a is formed of a plate-like member having a rectangular planar shape. In the first contact portion 18a, the first screw receiving portion 29, the second screw receiving portion 30, and the rising portion 31 are provided on the surface opposite to the base portion 22 and extend from one end of the first contact portion 18a in the longitudinal direction. It is provided in this order towards the other end of the direction. The shaft portion of the screw shaft 32 is inserted into the first screw receiving portion 29, and the screw shaft 32 is rotatably held. A cylindrical guide sleeve 33 is attached to the shaft portion of the screw shaft 32. A screw shaft head 34 is formed on one end side in the axial direction of the guide sleeve 33 of the screw shaft 32. The screw portion on the other axial end side of the guide sleeve 33 of the screw shaft 32 is screwed to the second screw receiving portion 30.

  One end of the link member 36 is pin-connected to the guide sleeve 33 by the link pin 35, and the other end of the link member 36 is pin-connected to the second rising portion 25 by the link pin 37. The rising portion 31 is pin coupled to the third rising portion 26 by the link pin 38.

  With such a configuration, the first contact portion 18a is connected to the first base portion 17a so as to be angularly displaceable about an angular displacement axis L3 perpendicular to an imaginary plane including the first axis L1 and a second axis L2 described later. . By rotating the screw shaft head 34, the contact position of the guide sleeve 33 in contact with the end face of the screw shaft head 34 is moved in the axial direction of the screw shaft 32, and the first contact portion 18a is moved around the angular displacement axis L3. Can be adjusted so that the maximum inclination angle θ of the first abutment surface 21a with respect to the virtual one plane coincides with the osteotomy of the distal end 19a of the tibia 19.

  Such a first contact body 4a is on the right side in FIG. 6 (1) when viewed from the operator holding the operation tool 3 in a state where the first contact body 4a is attached to the operation tool 3. The first contact portion 18a and the configuration related thereto are disposed, and the insertion portion 24 is disposed on the left side of the first contact portion 18a. By this, the first abutment 4a is inserted between the distal end 19a of the tibia 19 and the proximal end 20a of the talar 20, and the rightward region (i.e., the inner side for the right foot, the outer side for the left foot) The tension of the ligament can be measured in Next, the first abutment 4c for measuring the tension of the ligament at the left side (i.e., the outer side for the right foot and the inner side for the left foot) will be described.

  FIG. 7 shows a state in which the first contact portion 18c of the first contact body 4c is tilted in parallel to the first base portion 17c, and FIG. 7 (1) shows that the first contact portion 18c is tilted. 7 (2) is a front view of the first contact body 4c in a state in which the first contact portion 18c is tilted, and FIG. 7 (3) is a plan view of the first contact body 4c in the separated state. It is a right side view of the 1st contact object 4c in the state where the 1st contact part 18c was turned over, and Drawing 7 (4) is a perspective view of the 1st contact object 4c in the state where the 1st contact part 18c was brought down It is. In addition, since the first contact body 4c for left measurement is configured to be plane-symmetrical to the first contact body 4a for right measurement described above, the corresponding portions are denoted by the same reference symbols or the same numerals. The subscript c is added, and duplicate explanations are omitted.

  The first contact member 4c is used by being attached to the actuating portion 3a instead of the first contact member 4a for right measurement described above. In a state where the first contact body 4c is attached to the operation tool 3, the first contact portion 18c is on the left side (the lower side in FIG. 7 (1)) when viewed from the operator gripping the operation tool 3. A configuration related thereto is disposed, and the insertion portion 24 is disposed on the right side of the first contact portion 18c. By this, the first abutment body 14c is inserted between the distal end 19a of the tibia 19 and the proximal end 20a of the talar 20, and the tension of the ligament is measured at the left side, and the above-mentioned right measurement is made. By comparing with the measurement result using the first contact body 4a, it is possible to confirm the propriety of the ligament balance in the original joint movable range.

  FIG. 8 is a view showing the configuration of the second contact body 4b, FIG. 8 (1) is a perspective view of the second contact body 4b, and FIG. 8 (2) is a front view of the second contact body 4b. FIG. 8 (3) is a plan view of the second contact member 4b, and FIG. 8 (4) is a right side view of the second contact member 4b. The second contact body 4b is a rectangular plate-like portion 40 which is a plate-like body in plan view, a rising portion 41 rising from one end in the longitudinal direction of the plate-like portion 40 in one thickness direction, and a rising portion 41 From the longitudinal axis L2 direction one side (right side in FIG. 8 (2)), and the insertion portion 43 detachably mounted on the actuating portion 3a, and the thickness direction one side from the other end of the plate portion 40 in the longitudinal direction And a protruding portion 44 protruding to the

  The plate-like portion 40 described above has the flat second contact surface 45. The tibial surface of the proximal end 20a of the talar bone 20 abuts on the second abutment surface 45 and makes surface contact, and the operating tool 3 is positioned and stabilized along with the first abutment body 4a on the same mounting surface be able to.

  The insertion part 43 is comprised similarly to the insertion part 24 of the above-mentioned 1st contact body 4a. A spherical fitting member 46 is held in a partially projecting state in the insertion portion 43, and this fitting member 46 is protruded in a direction of protruding from the insertion portion 43 by a spring (not shown) provided in the insertion portion 43. It can be spring-loaded and fitted in a fitting recess (not shown) formed on the actuating member 8b, whereby the second abutment 4b can be detachably mounted and locked on the actuating portion 3b.

  Referring again to FIGS. 1 to 3, cylinder portion 5a of measuring means 5 is supported by one holding portion 2a, and rod 5b of measuring means 5 is connected to the other holding portion 2b. The magnitude of the force acting on the first and second contact surfaces 21a and 21c is measured based on the displacement of the portions 2a and 2b in the approaching / deviating direction, and measurement is performed using a scale or the like provided on the cylinder portion 5a. The surgeon can confirm the magnitude of the force. Such measuring means 5 may be realized by, for example, a spring scale.

  As another embodiment of the present invention, a through hole 50 may be formed in the plate-like portion 40 of the second contact member 4b.

  Moreover, the protrusion 44 which protrudes from the 2nd contact surface 45 may be formed in the plate-like-part 40 longitudinal direction other end part of the 2nd contact body 4b as other embodiment of this invention.

  According to the measuring apparatus 1 for artificial ankle joint surgery of the present embodiment configured as described above, the first contact body 4a is operated by operating the grips 2a and 2b of the operating tool in the direction A1 in which they approach each other. And the second abutment body 4b are displaced in the direction B1 keeping them parallel to each other, and the first abutment surface 21a is either one of the distal end 19a of the tibia 19 and the proximal end 20a of the talar 20 The second abutment surface 21b abuts on the other of the distal end 19a of the tibia 19 and the proximal end 20a of the talar 20, and the magnitude of the force between the grips 2a and 2b at this time is measured Measured by means 5.

  Thus, the first and second abutment surfaces 21a, 21c; 21b of the first and second abutment bodies 4a, 4c; 4b abut on the distal end 19a of the tibia 19 and the proximal end 20a of the talus 20 Therefore, for example, the same mounting surface is maintained in the bone cutting surface of the talar bone 20, the first contact member 4a is converted to the other first contact member 4b, and the first and second contact surfaces 21a and 21b are parallel or inclined, and in the same mounting surface between the tibia 19 and the talar 20, whether it is the left foot or the right foot, the ligament tension is measured on the inside and the outside to add to the original joint movement range・ The ligament balance of abduction can be confirmed.

  In addition, since the first contact members 4a and 4c for right and left are provided on the first bases 17a and 17c so that the first contact portions 18a and 18c can be angularly displaced at a first predetermined angular position, the bone cutting surface Even if the angle and the shape of the measurement target site are different, the first contact surfaces 21a and 21c are reliably brought into contact with the measurement target site, and the tension of the ligament is accurately measured as the magnitude of the force by the measuring means 5. can do.

  In addition, since it is formed of a plate-like body having the second abutment surface 21b, the second abutment body 4b is caught on the distal end 19a of the tibia 19 or the proximal end 20a of the talar bone 20 at the time of insertion and withdrawal. Smooth insertion and removal are possible without causing problems such as

  In addition, since the second contact body 4b is provided with the protrusion 44 projecting from the second contact surface 21b, the protrusion 44 is provided in a state in which the second contact surface 21b is opposed to the tibia 19 or the talar bone 20. The second abutment 4b can be easily positioned by engaging the tibia 19 or the talar 20 in the direction of withdrawal.

  In addition, by forming the through hole 50 in the second contact body 4b, it is possible to confirm the portion where the second contact body 4b is opposed through the through hole 50, and the convenience is improved. Be done.

  In addition, since the second abutment 4b has the second abutment 18b, the angle of the measurement target portion such as the osteotomy also at either the distal end 19a of the tibia 19 or the proximal end 20a of the talar 20 Even if the shape is different, the second contact portion 18b can be reliably supported at the measurement target portion, and the tension of the ligament can be accurately measured as the load of the measurement means.

  In another embodiment of the present invention, the first contact body 4a for right measurement shown in FIGS. 5 and 6 is used as the second contact body instead of the plate-like second contact body 4b shown in FIG. Alternatively, the first contact body 4c for left measurement shown in FIG. 7 may be used upside down.

  Further, in still another embodiment of the present invention, in order to measure the inside and the outside simultaneously, two first contact members 4a and 4c are attached to one actuating portion 3a, and the above-mentioned to the other actuating portion 3b. You may make it mount | wear the plate-shaped 2nd contact body 4b.

DESCRIPTION OF SYMBOLS 1 Prosthetic ankle joint measuring apparatus 2a, 2b Gripping part 3 Operating tool 3a, 3b Actuating part 4a, 4c 1st abutting body 4b 2nd abutting body 5 measuring means 5a cylinder part 5b Rod 8a, 8b actuating member 17a, 17c 1st base 18a, 18c 1st contact part 19 tibia 19a distal end 20 talus 20a proximal end 21a, 21c 1st contact surface 21b 2nd contact surface

Claims (6)

What is claimed is: 1. A measurement device for artificial joint surgery, which measures tension by a ligament between a distal end of a tibia and a proximal end of an talus in an artificial joint surgery in which a living ankle joint is replaced with an artificial joint.
When the pair of grips that are displaceable in the approaching direction and the separating direction and the pair of gripping parts are displaced in the direction in which the pair of gripping parts move closer, they are displaced in the direction away from each other, and the pair of gripping parts separate from each other An operating tool having a pair of operating parts which are displaced in the directions approaching each other when displaced in the
A first base portion having a detachable insertion portion in the pair of operating portions and extending along a predetermined first axis , and provided at the first base portion at the distal end of the tibia and the proximal end of the talar bone It possesses first contact portion where the first abutment surface flat abutting either one is formed, and a first abutment member mounted on one of the actuating portion through the spigot ,
A second base portion having a detachable insertion portion in the pair of operating portions and extending along a second axis parallel to the first axis, any one of a distal end of a tibia and a proximal end of a talar bone It possesses a second contact portion in which the second abutment surface flat abutting the other are provided, the second mounted to the other of the actuating portion through the insertion portion provided in the second base part An abutting body ,
Measuring means for measuring the magnitude of the force acting on the first and second contact surfaces based on the displacement in the approaching direction and the separating direction of the gripping portions provided in the pair of gripping portions; , only including,
The insertion portion of the first contact body and the first contact portion are mutually offset in a direction perpendicular to an imaginary plane including the first axis and the second axis. Measuring device for artificial ankle surgery characterized by   The first contact portion is provided on the first base so as to be angularly displaceable about a predetermined first angular displacement axis perpendicular to a virtual plane including the first axis and the second axis. The measurement apparatus for artificial ankle surgery according to claim 1.   The measurement apparatus for artificial ankle joint surgery according to claim 1 or 2, wherein the second contact portion is a plate-like body.   The said 2nd contact part is provided with the protrusion protruded from the said 2nd contact surface in the part on the opposite side to the part with which the said other action | operation piece is mounted | worn. The measurement apparatus for artificial ankle surgery according to any one of the above.   The through-hole penetrated to the said 2nd contact body in the direction which adjoins and separates to the said 1st contact body is formed, It is described in any one of the Claims 1-4 characterized by the above-mentioned. Measuring device for artificial ankle surgery.   The second contact portion is provided on the second base so as to be angularly displaceable around a second angular displacement axis which is predetermined in advance and perpendicular to a virtual plane including the first axis and the second axis. The measuring device for artificial ankle joint surgery according to any one of claims 1 to 5.

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