JP7161588B2 - knee arthroplasty surgical instrument - Google Patents

Description

TECHNICAL FIELD The present invention relates to a surgical instrument for total knee arthroplasty used in total knee arthroplasty.

In total knee arthroplasty, when bone resection is performed at the distal end of the femur, a resection guide section as disclosed in Patent Document 1 and page 37 of Non-Patent Document 1, for example, is used. In total knee arthroplasty, a resection guide is fixed to the osteotomy of the distal end of the femur with a fixation pin. By inserting a bone saw (resection blade) into the slit of the resection guide portion, a desired position on the distal end of the femur can be resected. The femoral component of the artificial knee joint is installed using the osteotomy surface thus formed as the installation surface.

U.S. Pat. No. 8,313,491

DePuy, "Attune Knee System", [online], [searched on March 6, 2017], Internet <http://synthes.vo.llnwd.net/o16/LLNWMB8/INT%20Mobile/Synthes% 20International/Product%20Support%20Material/legacy_DePuy_PDFs/DSUS-JRC-0115-0680-1_LR.pdf>

However, during bone resection with the bone saw as described above, the resection guide fixed to the distal end of the femur by the fixing pin is lifted up from the distal end of the femur due to the vibration of the bone saw. Sometimes. In that case, the bone resection is performed at a position different from the planned position.

SUMMARY OF THE INVENTION The present invention is intended to solve the above problems, and an object of the present invention is to provide an artificial knee joint replacement that can prevent the resection guide portion from rising from the distal end of the femur during bone resection of the distal end of the femur. It is to provide a surgical surgical instrument.

(1) A surgical instrument for total knee joint replacement according to one aspect of the present invention for achieving the above object comprises a slit for guiding the cutting direction of a cutting blade for cutting the distal end of the femur, and the distal end of the femur. a resection guide section provided with a fixing pin hole into which a fixation pin is inserted for fixing to the proximal end; a pressing portion that can be pressed, wherein the pressing portion is a shaft portion; a contact portion that contacts the resection guide portion; and a grip portion that is provided on the other end side of the shaft portion and configured as a portion to be gripped by an operator, and the resection guide portion includes the A connected portion to which the connecting portion is detachably connected or a contacted portion to which the contact portion abuts is provided in a state in which the resection guide portion is installed at the distal end of the femur.

According to this configuration, after the resection guide section is fixed to the distal end of the femur by the fixing pin, the resection blade is guided by the slit of the resection guide section, thereby appropriately cutting each site on the distal end of the femur. can be cut at any position.

Further, according to this configuration, when the distal end of the femur is resected along the slit of the resection guide portion as described above, the resection guide portion is pressed toward the distal end of the femur by the pressing portion. As a result, when the distal end of the femur is resected by the resection blade, the resection guide is prevented from rising from the distal end of the femur due to the fixing pin gradually coming out due to the vibration of the resection blade. can.

Moreover, according to this configuration, in a state in which the contact portion of the pressing portion is in contact with the contacted portion of the resection guide portion, or in a state in which the connecting portion of the pressing portion is connected to the connected portion of the resection guide portion, The resection guide section can be pressed by the pressing section. As a result, it is possible to reliably prevent the resection guide portion from rising from the distal end of the femur.

Therefore, according to this configuration, it is possible to provide a surgical instrument for artificial knee joint replacement that can prevent the resection guide portion from rising from the distal end of the femur when resecting the distal end of the femur.

(2) Preferably, one of the contact portion and the contacted portion is provided as a recess, and the other of the contact portion and the contact portion is slidable with respect to the inner surface of the recess. It is provided as a convex portion that abuts in the state.

According to this configuration, one of the abutting portion and the abutted portion provided as a recess is in contact with the other of the abutting portion and the abutted portion provided as the convex portion, and is cut off by the pressing portion. The guide portion is pressed. That is, according to this configuration, since the convex portion is fitted inside the concave portion, when the pressing portion presses the resection guide portion, the pressing portion does not slip from the resection guide portion and come off the resection guide portion. can be prevented.

(3) More preferably, the outer surface of the convex portion and the inner surface of the concave portion are formed in a shape including a part of a spherical surface.

According to this configuration, when the pressing portion presses the resection guide portion, a portion of the spherical surface included in the convex portion and a portion of the spherical surface included in the concave portion are in surface contact. That is, according to this configuration, the abutting portion of the pressing portion can be brought into close contact with the abutted portion of the resection guide portion over a relatively wide range. You can definitely tell the department.

Moreover, according to this configuration, it is possible to slide in a state in which parts of the spherical surfaces included in both the convex portion and the concave portion are in close contact with each other. As a result, for example, when inserting the resection blade into the slit of the resection guide section to resect the distal end of the femur, if the pressing section interferes with resection of the distal end of the femur and it is difficult to resect the distal end of the femur, the spherical surfaces of the convex portion and the concave portion It is possible to change the inclination of the pressing portion with respect to the resection guide portion while maintaining the state in which the portions are in close contact with each other, thereby separating the pressing portion from the resection blade. That is, according to this configuration, it is possible to prevent interference between the resection blade and the pressing portion when resecting the distal end of the femur.

(4) More preferably, the radius of curvature of the spherical surface included in the inner surface of the concave portion is larger than the radius of curvature of the spherical surface included in the outer surface of the convex portion.

According to this configuration, for example, compared to the case where the radius of curvature of the spherical surface included in the inner surface of the recess and the radius of curvature included in the outer surface of the protrusion are the same, the pressing portion can can be greatly tilted with respect to the resection guide. That is, according to this configuration, when the distal end of the femur is resected by the resection blade, the pressing portion can be largely separated from the resection blade, so interference between the resection blade and the pressing portion can be prevented.

(5) Preferably, the outer surface of the projection has at least part of a conical shape.

According to this configuration, the resection guide can be pressed against the distal end of the femur by at least a part of the conical shape of the outer surface of the projection.

(6) Preferably, one of the connecting portion and the connected portion includes a portion provided with a through hole, and the other of the connecting portion and the connected portion is a claw hooked in the through hole. It is configured including a shaped part.

According to this configuration, when the cutting guide part is pressed by the pressing part, one of the two is hooked to the other. Therefore, when the pressing part presses the resection guide part, it is possible to prevent the detachment of the pressing part from the resection guide part. In other words, the pressing state of the resection guide portion by the pressing portion can be maintained.

(7) Preferably, the connected portion includes a connecting groove into which the connecting portion is slidably fitted.

According to this configuration, the connected portion can be configured by the groove-shaped connecting groove, so that the configuration of the connected portion can be simplified.

(8) More preferably, the connecting groove also includes an end portion of a removal jig for removing the resection guide section installed on the distal end of the femur from the distal end of the femur. is configured to fit into the

According to this configuration, the connecting groove functioning as the connected portion for connecting the pressing portion to the resection guide portion can also be used to fit the end portion of the removal jig to the resection guide portion. can be done. That is, according to this configuration, since the connecting groove as the connected portion can be used for other purposes, the configuration of the excision guide portion can be simplified.

(9) Preferably, the shaft portion is provided with a bent portion extending between the connecting portion and the grip portion or between the contact portion and the grip portion. .

According to this configuration, when the pressing portion presses the excision guide portion, the pressing portion can be largely spaced outward from the excision guide portion. This can prevent interference between the resection blade and the pressing portion when resecting the distal end of the femur.

ADVANTAGE OF THE INVENTION According to this invention, the surgical instrument for artificial knee joint replacement which can prevent a resection guide part from rising from the distal end of a femur at the time of bone resection of the distal end of a femur can be provided.

1 shows a surgical instrument for total knee arthroplasty according to an embodiment of the present invention; FIG. FIG. 2 is a front view of the resection guide shown in FIG. 1; 3A is a perspective view of the resection guide portion shown in FIG. 2, and FIG. 3B is a perspective view of the resection guide portion shown in FIG. . FIG. 4A is a cross-sectional view taken along line IVA-IVA of FIG. FIG. 4B is a cross-sectional view showing a state in which the abutting portion of the pressing tool abuts against the abutted concave portion shown in FIG. 4A. FIG. 10 is a diagram showing a state in which the resection guide section is fixed to the distal end of the femur; Figure 2 is a perspective view of the pressing instrument shown in Figure 1; 1. It is a perspective view which shows an example of the usage pattern of the surgical instrument for artificial knee joint replacement surgery shown in FIG. Fig. 8(A) is a side view showing an example of a usage pattern of the surgical instrument for total knee replacement surgery, Fig. 8(A) is a drawing showing a state when the bone saw is inserted into the front slit, and Fig. 8(B) is a FIG. 10 is a diagram showing a state in which the bone saw is inserted into the rear slit; FIG. 10 is a view showing a cross-sectional portion of a contacted concave portion of a resection guide portion according to a modification, showing a state in which a contacting portion of a pressing instrument is in contact. FIG. 10(A) is a view showing the shape of the contacting portion of the pressing instrument according to the modification, and is a view showing a state in which the contacting recess shown in FIG. 9(B) is in contact. 10(B) is a diagram showing a state in which the contact portion shown in FIG. 10(A) is in contact with the contacted concave portion shown in FIG. 9(C). FIG. 10(C) is a diagram showing a state in which the contact portion shown in FIG. 10(A) is in contact with the contacted concave portion shown in FIG. 9(E). FIG. 11(A) is a view showing the shape of a contacting portion of a pressing instrument according to a modification, and is a view showing a state in which the contacting recess shown in FIG. 9(D) is in contact. FIG. 11B is a diagram showing a state in which the contact portion of the pressing instrument according to the modification is in contact with the contacted portion of the excision guide portion according to the modification. FIG. 11(C) is a diagram showing a state in which the contact portion shown in FIG. 11(B) is in contact with the contacted portion of the excision guide portion according to the modification. FIG. 12(A) is a view showing the shape of a connection portion of a pressing instrument according to a modification, showing a state of being connected to a connection groove (connected portion) of a resection guide portion according to the modification. is. Moreover, FIG. 12(B) is a diagram schematically showing a state in which the end of the removal jig is connected to the connection groove shown in FIG. 12(A). It is a perspective view of a pressing instrument according to a modification. FIG. 11 is a perspective view showing an example of a usage pattern of a surgical instrument for total knee replacement surgery according to a modified example. FIG. 11 is a perspective view showing an example of a usage pattern of a surgical instrument for total knee replacement surgery according to a modified example.

FIG. 1 shows a surgical instrument 1 for total knee replacement according to an embodiment of the present invention. 2 is a front view of the resection guide portion 2 shown in FIG. 1. FIG. 3A is a perspective view of the resection guide section 2 shown in FIG. 2, and FIG. 3B is a view of the resection guide section 2 shown in FIG. It is a perspective view. 4A is a cross-sectional view taken along line IVA-IVA in FIG. FIG. 4B is a cross-sectional view showing a state in which the contact portion 35 of the pressing device 3 is in contact with the contact recess 18 shown in FIG. 4A. 5 is a perspective view showing a state in which the resection guide section 2 is fixed to the distal end of the femur 101. FIG.

In each figure described below, for convenience of explanation, the direction indicated by the arrow indicated as "up" is indicated as "upper" or "upper", and the direction indicated by the arrow indicated as "down" is indicated as "lower" or "lower" and "front". The direction indicated by the arrow is forward or forward, the direction indicated by the arrow marked rear is rearward or backward, the direction indicated by the arrow marked right is right, the direction indicated by the arrow marked left is indicated called the left side. 2, 3, 5, 7, 8, 11, 12, 14, and 15 correspond to the vertical direction, front-back direction, and left-right direction of the patient's body, respectively. . 6 and 13 are for explaining the shape of the pressing device, and do not necessarily correspond to the vertical direction, front-back direction, and left-right direction in other figures. .

A surgical instrument 1 for total knee arthroplasty according to this embodiment is used in total knee arthroplasty. Artificial knee joint replacement surgery is surgery to replace the knee joint of a patient whose knee joint is severely deformed due to, for example, osteoarthritis, chronic rheumatoid arthritis, or the like, with an artificial knee joint.

A surgical instrument 1 for artificial knee joint replacement surgery according to the present embodiment, as shown in FIG. 1, includes a resection guide section 2 and a pressing instrument 3 (pressing section).

[Structure of resection guide part]
2 and 3, the resection guide part 2 is formed in a block shape having a thickness in the vertical direction. The resection guide part 2 has a body part 11 and a fixing part 20, which are integrally formed. The body portion 11 is a portion that constitutes the central portion of the resection guide portion 2 when the resection guide portion 2 is viewed from above and is formed in a rectangular shape. The fixing portion 20 is a portion formed to extend slightly outward from each of the left and right edges of the main body portion 11 . Two fixing pin holes 21 are formed in each fixing portion 20 at intervals in the front-rear direction. The fixation pin hole 21 is a hole into which the fixation pin 5 for fixing the resection guide part 2 to the femoral distal end 101 is inserted. When the resection guide part 2 is fixed to the femur distal end 101 of the patient's femur 100, the fixing pin 5 is driven into the femur distal end 101 through the fixing pin hole 21, whereby the femur distal end is fixed. It is fixed relative to the posterior extremity 101 .

A plurality of slits 12, 13, 14a, and 14b are formed in the excision guide portion 2. As shown in FIG. Specifically, the resection guide portion 2 is formed with a front slit 12, a rear slit 13, a front chamfer slit 14a, and a rear chamfer slit 14b. These slits 12, 13, 14a, 14b are for guiding the resection direction of a bone saw 50 (resection blade, shown in phantom lines in FIG. 8) for resecting the distal end of the femur 101. As shown in FIG.

The front slit 12 extends along the resection direction in which the front side of the distal femur 101 is resected in a state where the resection guide part 2 is placed on the distal femur 101 . The front slit 12 is for resecting the front side of the distal end 101 of the femur. The front slit 12 is formed in the front portion of the body portion 11 of the resection guide portion 2, as shown in FIGS. The front slit 12 is formed in a slit shape elongated in the left-right direction, and penetrates the main body 11 in the up-down direction.

The rear slit 13 extends along the resection direction in which the rear surface side of the distal femur 101 is resected in a state where the resection guide part 2 is placed on the distal femur 101 . The rear slit 13 is for resecting the rear side of the distal end 101 of the femur. The rear slit 13 is formed in the rear portion of the excision guide section 2, as shown in FIGS. The rear slit 13 is formed in a slit shape elongated in the left-right direction, and penetrates the main body 11 in the up-down direction.

The front chamfer slit 14 a is for forming a chamfer surface on the front side portion of the distal end of the femur 101 . As shown in FIGS. 2 and 3, the front chamfer slit 14a is formed to extend from the central portion of the front surface of the excision guide portion 2 toward the central portion of the back surface of the excision guide portion 2 and to both the left and right sides. there is The front chamfer slit 14a is formed in a slit shape extending obliquely with respect to the surface extending in the vertical and horizontal directions.

The posterior chamfer slit 14b is for forming a chamfer surface on the posterior portion of the femoral distal end 101 . As shown in FIGS. 2 and 3, the rear chamfer slits 14b are formed rearwardly of the front chamfer slits 14a and on both left and right sides of the central portion of the excision guide portion 2 in the front-rear direction. there is The rear chamfer slit 14b is formed in a slit shape extending obliquely with respect to the surface extending in the vertical and horizontal directions.

A pair of reference holes 15, 15, a pair of inner rotation holes 16, 16, and a pair of outer rotation holes 17, 17 are formed in the body portion 11 of the excision guide portion 2. As shown in FIG. Each of the holes 15, 16, and 17 is a through hole penetrating through the body portion 11 in the vertical direction, and is configured as a different hole. Although detailed description is omitted, these holes 15, 16, and 17 are formed when the resection guide section 2 is placed at the reference position, which is the installation position of the resection guide section 2 based on the preoperative plan. This is a hole used when installing the distal end of the femur 101 in a state where the is rotated with respect to the reference position.

In addition, the body portion 11 of the excision guide portion 2 is formed with a contact recess 18 (contact portion, recess).

The abutted concave portion 18 is provided as a portion with which the tip portion (abutting portion 35) of the pressing instrument 3, which will be described later in detail, abuts. The contacted concave portion 18 is a concave portion formed slightly forward of the central portion of the body portion 11 of the resection guide portion 2 . The contact recess 18 is slightly recessed upward from the lower surface of the main body 11, and the shape of the inner surface 18a is formed in a substantially hemispherical shape including a part of a spherical surface (see FIG. 4A). .

[Configuration of pressing instrument]
FIG. 6 is a perspective view of the pressing device 3 shown in FIG. The pressing instrument 3 is used by pressing the resection guide section 2 placed on the distal end of the femur 101 toward the distal end of the femur 101 . When the bone saw 50 is moved along the slits 12, 13, 14a, and 14b to resect each part of the distal end of the femur 101, the pressing instrument 3 causes the bone saw 50 to vibrate so that the resection guide part 2 moves the femur. This is to prevent it from coming up from the bone distal end 101 .

The pressing device 3 is a device whose overall shape is elongated in the vertical direction. The pressing instrument 3 includes a shaft portion 31, a contact portion 35 (convex portion), and a grip portion 39, which are integrally provided.

The shaft portion 31 has a first shaft portion 32 and a second shaft portion 33 integrally formed with the first shaft portion 32 . The first shaft portion 32 is a columnar portion extending in the vertical direction. The second shaft portion 33 is a columnar portion having an outer diameter smaller than that of the first shaft portion 32 and is provided to extend upward from the first shaft portion 32 . The first shaft portion 32 and the second shaft portion 33 are arranged coaxially.

The contact portion 35 is a portion provided on the upper end surface side of the shaft portion 31 and is provided as a tip portion of the pressing instrument 3 . The contact portion 35 is provided as a portion that contacts the inner surface 18a of the contacted concave portion 18 of the resection guide portion 2 in a slidable manner. The contact portion 35 is formed so as to protrude upward in a hemispherical shape. As a result, the outer surface 35a of the contact portion 35 is formed in a hemispherical shape including a part of the spherical surface. Referring to FIG. 4B, the radius of curvature R1 of the inner surface 18a of the abutted concave portion 18 of the resection guide portion 2 is set to be larger than the radius of curvature R2 of the outer surface 35a of the abutting portion 35. .

The grip portion 39 is a portion provided on the lower end surface side of the shaft portion 31 . The grasping portion 39 is configured as a portion that is grasped by the operator when the pressing instrument 3 is used by the operator. The grip portion 39 is formed to extend downward from the lower end surface of the shaft portion 31 . A front portion and a rear portion of the grip portion 39 are formed flat. Four concave portions 39a are formed in the right and left portions of the grip portion 39, respectively, and are spaced apart from each other in the vertical direction. By providing the uneven surface of the grasping portion 39 in this manner, the operator can firmly grasp the grasping portion 39 without slipping.

[how to use]
FIG. 7 is a perspective view showing an example of a usage pattern of the surgical instrument 1 for total knee replacement surgery shown in FIG. 8 is a side view showing an example of usage of the surgical instrument 1 for total knee replacement surgery, and FIG. 8(A) shows a state in which the bone saw 50 is inserted into the front slit 12. FIG. FIG. 8(B) is a diagram showing a state in which the bone saw 50 is inserted into the rear slit 13. As shown in FIG. The surgical instrument 1 for total knee arthroplasty according to this embodiment can be used as follows.

Referring to FIG. 5, the operator first fixes the resection guide portion 2 to the osteotomy surface 101a formed at the femur distal end 101 of the femur 100 of the patient. Specifically, the operator places the resection guide section 2 at the reference position based on the preoperative plan with respect to the osteotomy surface 101a of the distal end of the femur 101, and then attaches the fixation pin 5 to the resection guide section 2. is driven into the distal end of the femur 101 through the fixation pin hole 21 (see FIG. 2). Thereby, the resection guide part 2 can be fixed to the femoral distal end 101 (see FIG. 5).

After that, the operator confirms the balance of the medial and lateral ligaments, and if the ligament balance is appropriate, moves the bone saw 50 along the slits 12, 13, 14a, 14b of the resection guide part 2 in that state, Each site on the distal femur 101 is resected.

By the way, when the bone saw 50 is used to resect the distal end of the femur 101 as described above, the vibration of the bone saw 50 is transmitted to the distal end of the femur 101, and the vibration causes the fixing pin 5 to come off gradually. There is a risk that the resection guide part 2 will also gradually rise from the distal end of the femur 101 . In that case, the positions of the slits 12, 13, 14a, 14b deviate from the preoperative plan. , the placement surface of the femoral component is also misaligned.

In this respect, the surgical instrument 1 for total knee replacement surgery according to this embodiment can solve the above problems. Specifically, when each part of the distal end of the femur 101 is resected by the bone saw 50, the abutting portion 35 of the pressing instrument 3 is abutted against the abutted concave portion 18 of the resection guide portion 2. It is pressed toward the femoral distal end 101 side (see FIG. 7). As a result, the resection guide section 2 can be prevented from floating relative to the distal end of the femur 101 as described above, and the slits 12, 13, 14a, and 14b of the resection guide section 2 are prevented from being displaced. This allows the femoral distal end 101 to be resected at an appropriate position.

The operator can adjust the orientation of the pressing instrument 3 according to which slit 12, 13, 14a, 14b the bone saw 50 is inserted. Specifically, referring to FIG. 8A, when inserting the bone saw 50 into the front slit 12 to resect the front portion of the distal end of the femur 101, the pressing instrument 3 is pressed against the resection guide section 2. In this state, the portion of the pressing device 3 on the side of the grasping portion 39 can be tilted rearward. By doing so, it is possible to avoid interference between the bone saw 50 and the pressing instrument 3 when cutting the distal end of the femur 101 .

Similarly, referring to FIG. 8(B), when inserting the bone saw 50 into the rear slit 13 to resect the rear portion of the distal end of the femur 101, the pressing instrument 3 is pressed against the resection guide section 2. In this state, the gripping part 39 side portion of the pressing instrument 3 can be tilted forward. By doing so, it is possible to avoid interference between the bone saw 50 and the pressing instrument 3 when cutting the distal end of the femur 101 .

[effect]
As described above, according to the surgical instrument 1 for total knee arthroplasty according to the present embodiment, after the resection guide section 2 is fixed to the distal end of the femur 101 by the fixing pin 5, the bone saw 50 is attached to the resection guide. By being guided by the slits 12, 13, 14a and 14b of the portion 2, each portion of the distal end of the femur 101 can be cut at appropriate positions.

Further, according to the surgical instrument 1 for artificial knee joint replacement, when the femoral distal end 101 is resected along the slits 12, 13, 14a, 14b of the resection guide part 2 as described above, the pressing instrument 3 presses the resection guide part 2 toward the femoral distal end 101 side. As a result, when the distal end of the femur 101 is resected by the bone saw 50, the fixing pin 5 gradually comes off due to the vibration of the bone saw 50. Floating up can be prevented.

Moreover, according to the surgical instrument 1 for artificial knee joint replacement, the cutting guide portion 2 is moved by the pressing device 3 while the contacting portion 35 of the pressing device 3 is in contact with the contacted concave portion 18 of the cutting guide portion 2 . can be pressed. As a result, it is possible to reliably prevent the resection guide portion 2 from rising from the distal end of the femur 101 .

Therefore, according to the surgical instrument 1 for artificial knee joint replacement, it is possible to prevent the resection guide part 2 from rising from the distal femur 101 during the bone resection of the distal femur 101. We can provide surgical instruments for

Further, according to the surgical instrument 1 for artificial knee joint replacement, the abutting portion 35 provided as a convex portion is in contact with the abutted concave portion 18 provided as a concave portion, and the resection guide portion is pushed by the pressing instrument 3 . 2 is pressed. That is, according to the surgical instrument 1 for total knee arthroplasty, since the convex portion is fitted inside the concave portion, when the pressing instrument 3 presses the resection guide section 2, the pressing instrument 3 does not move the resection guide section 2. It is possible to prevent the cutting guide part 2 from slipping off from the cutting guide part 2.例文帳に追加

Further, according to the surgical instrument 1 for total knee arthroplasty, when the resection guide portion 2 is pressed by the pressing instrument 3, a portion of the spherical surface included in the contact portion 35 and the contact concave portion 18 include A portion of the spherical surface is in surface contact. That is, according to the surgical instrument 1 for artificial knee joint replacement, the abutting portion 35 of the pressing instrument 3 can be brought into close contact with the abutted concave portion 18 of the excision guide portion 2 over a relatively wide range. Therefore, the pressing force from the pressing instrument 3 can be reliably transmitted to the resection guide portion 2 .

Further, according to the surgical instrument for total knee joint replacement 1, for example, compared to the case where the radius of curvature of the spherical surface included in the inner surface of the abutted concave portion and the radius of curvature included in the outer surface of the abutting portion are the same. , the pressing instrument 3 can be greatly inclined with respect to the excision guide part 2 while keeping the contact recess 18 and the contact part 35 in close contact with each other. That is, according to the surgical instrument 1 for total knee arthroplasty, the pressing instrument 3 can be largely separated from the bone saw 50 when resecting the distal end of the femur 101 with the bone saw 50 . interference can be prevented.

Although the embodiments of the present invention have been described above, the present invention is not limited to the above-described embodiments, and various modifications are possible within the scope of the claims. For example, it may be implemented by changing as follows.

[Modification]
(1) FIGS. 9(A) to 9(E) are diagrams showing cross-sectional portions of abutted concave portions 23 to 27 of a resection guide portion according to a modification, in which the abutting portion 35 of the pressing instrument abuts. It is a figure which shows the state which touched.

In the above-described embodiment, an example in which the radius of curvature R1 of the inner surface 18a of the recessed portion 18 to be contacted is greater than the radius of curvature R2 of the contact portion 35 has been described, but the present invention is not limited to this. Specifically, as shown in FIG. 9A, the curvature radius R3 of the inner surface 23a of the abutted concave portion 23 may be set to be the same as the curvature radius R2 of the contact portion 35. As shown in FIG. Alternatively, as shown in FIG. 9B, the radius of curvature R4 of the inner surface 24a of the abutted concave portion 24 may be smaller than the radius of curvature R2 of the abutting portion 35.

Further, in the above-described embodiment, an example in which the inner surface 18a of the abutted concave portion 18 is formed in a shape including a part of a spherical surface has been described, but the present invention is not limited to this. Specifically, as shown in FIGS. 9(C) to 9(E), the inner surfaces 25a to 27a of the abutted recesses 25 to 27 may have a shape that does not include a portion of the spherical surface.

(2) FIG. 10(A) is a view showing the shape of a contacting portion 41 of a pressing instrument according to a modification, showing a state in which the contacting portion 41 is in contact with the contacted concave portion 24 shown in FIG. 9(B). It is a diagram. 10(B) is a diagram showing a state in which the contact portion 41 shown in FIG. 10(A) is in contact with the contacted concave portion 25 shown in FIG. 9(C). 10(C) is a diagram showing a state in which the contact portion 41 shown in FIG. 10(A) is in contact with the contacted concave portion 27 shown in FIG. 9(E).

In the embodiment described above, an example in which the outer surface 35a of the contact portion 35 is formed in a shape including a part of a spherical surface has been described, but the present invention is not limited to this. Specifically, as shown in FIGS. 10A to 10C, the outer surface 41a of the contact portion 41 has at least a portion of a conical shape (for example, a side surface of a conical shape). may be According to this configuration, the outer surface 41 a of the contact portion 41 can press the resection guide portion 2 against the distal end of the femur 101 . 10(A) to 10(C) are illustrated as the shape of the abutted concave portion with which the abutting portion 41 abuts, the abutted concave portion is not limited thereto. The shape of may be a shape other than these.

(3) FIG. 11(A) is a view showing the shape of the abutting portion 42 of the pressing instrument according to the modification, and shows a state in which it abuts against the abutted concave portion 26 shown in FIG. 9(D). It is a diagram. The abutting portion 42 of the pressing instrument according to this modification has a flat distal end surface and an R-shaped peripheral edge portion of the distal end surface.

(4) FIG. 11(B) is a diagram showing a state in which the abutment portion 43 of the pressing instrument according to the modification is in abutment with the abutted portion 28 of the excision guide portion according to the modification. FIG. 11(C) is a diagram showing a state in which the abutment portion 43 of the pressing instrument shown in FIG. 11(B) abuts against the abutted portion 29 of the excision guide portion according to the modification.

In the above-described embodiment and each of the modified examples, an example in which the contact portion is provided as a convex portion and the contacted portion is provided as a concave portion has been described. Not exclusively. Specifically, as shown in FIGS. 11B and 11C, the abutting portion 43 is provided as a recess formed in a concave shape, and the abutted portions 28 and 29 are formed in a convex shape. You may provide as a convex part. The abutted portion 28 is formed to extend downward from a concave portion formed in the lower surface 4 of the resection guide portion, and has a spherical tip portion. The abutted portion 29 is formed to extend downward from the lower surface 4 of the resection guide portion and has a spherical tip portion.

11(B) and 11(C) illustrate examples in which the radius of curvature of the contact portion 43 and the radius of curvature of the contacted portions 28 and 29 are the same, but the present invention is not limited to this. , the radius of curvature of the abutting portion 43 may be greater than the radius of curvature of the abutted portions 28 and 29 . Alternatively, the radius of curvature of the contact portion 43 may be smaller than the radius of curvature of the contacted portions 28 and 29 .

(5) FIG. 12(A) is a diagram showing the shape of the connecting portion 44 of the pressing instrument according to the modification, and is connected to the connecting groove 48 (connected portion) of the excision guide portion according to the modification. It is a figure which shows the state which is. 12(B) is a diagram schematically showing a state in which the end 62 of the removal jig 60 is connected to the connection groove 48 shown in FIG. 12(A).

The pressing instrument according to this modified example is provided with a connecting part 44 shown in FIG. 12A instead of the contact part 35 of the pressing instrument 3 according to the above-described embodiment. Further, in the resection guide section according to this modified example, a connecting groove 48 shown in FIG. 12A is provided instead of the abutted concave portion 18 in the resection guide section 2 according to the above-described embodiment. The connecting groove 48 is formed in a groove shape extending in the left-right direction on the lower surface 4 of the resection guide portion, and the connecting portion 44 is detachably and slidably connected. In the pressing instrument and the resection guide according to this modified example, in a state in which the connecting portion 44 of the pressing instrument is fitted into the connecting groove 48 of the resection guide section (in the state of FIG. 12A), the pressing instrument is attached to the resection guide section. It becomes impossible to move up and down against The connecting portion 44 is detachably connected to the connecting groove 48 .

Further, in the connecting groove 48 of the resection guide part according to the present modification, a removal jig 60 for removing the resection guide part fixed to the distal femur 101 from the distal femur 101 is provided. The ends 62 are also matable. The removal jig 60 has a structure like a slide hammer, and its end portion 62 is configured to fit into the connecting groove 48 . In the removal jig 60 , the hammer portion 65 is slid downward along the vertically elongated shaft portion 61 provided integrally with the end portion 62 , and the hit portion 63 provided at the lower end portion of the shaft portion 61 is moved downward. be hammered into. As a result, a force is applied to the resection guide in a direction in which the resection guide separates from the distal end of the femur 101 . With the removal jig 60, the resection guide part can be removed from the distal end of the femur 101 by performing the operation of hitting the hammer part 65 against the hit part 63 once or a plurality of times as described above.

As described above, according to the surgical instrument for total knee arthroplasty according to the present modification, the connected portion can be configured by the connecting groove 48 formed in a groove shape, thereby simplifying the configuration of the connected portion. can.

Further, according to the surgical instrument for total knee joint replacement according to this modified example, the connecting groove 48 functioning as a connected portion for connecting the pressing instrument to the resection guide portion is formed at the end of the removal jig 60 . It can also be used to fit the portion 62 against the resection guide. That is, according to this configuration, since the connecting groove 48 as the connected portion can be used for other purposes, the configuration of the excision guide portion can be simplified.

(3) FIG. 13 is a perspective view of a pressing instrument 3a according to a modification. Moreover, FIG. 14 is a perspective view showing an example of a usage pattern of the surgical instrument 1a for artificial knee joint replacement according to the modification.

The pressing instrument 3a according to this modified example differs in the structure of the shaft portion from the pressing instrument 3 according to the above-described embodiment. In the following, points different from the above embodiment will be mainly described, and descriptions of other points will be omitted.

The first shaft portion 34 of the shaft portion 31 of the pressing instrument 3 a according to this modification has a bending portion extending between the contact portion 35 and the grip portion 39 so as to bend the middle portion of the first shaft portion 34 . A portion 34a is provided. As a result, the distal end side portion of the first shaft portion 34 and the second shaft portion 33 extend obliquely with respect to the grip portion 39 side portion of the first shaft portion 34 and the grip portion 39 .

The tip portion of the pressing instrument 3a according to the present modification is bent as described above. By using such a pressing instrument 3a, the pressing instrument 3a can be largely spaced outward from the resection guide part 2 when pressing the resection guide part 2 with the pressing instrument 3a. This can prevent interference between the bone saw 50 and the pressing instrument 3a when resecting the distal end of the femur 101 .

(4) FIG. 15 is a perspective view showing an example of a usage pattern of the surgical instrument 1b for artificial knee replacement surgery according to the modification.

Compared to the resection guide part 2 of the above embodiment, the resection guide part 2a of the surgical instrument for total knee arthroplasty 1b according to this modified example has a A through hole portion 49 is provided as a connected portion. Further, the pressing instrument 3b of the surgical instrument for total knee replacement surgery 1b according to this modified example has a hook part 45 as a connecting part instead of the abutting part 35, unlike the pressing instrument 3 of the above-described embodiment. is provided.

The through-hole portion 49 is provided in the central portion of the lower surface of the excision guide portion 2, and a through-hole 49a is formed in the central portion when viewed from the left-right direction.

The hook portion 45 is provided on the tip side (upper end surface side) of the shaft portion 31 of the pressing instrument 3b. Specifically, the hook portion 45 is formed in a claw shape extending in an arc from the tip portion of the shaft portion 31 . The hook portion 45 is hooked on the through-hole portion 49 by inserting the tip portion thereof into the through-hole portion 49 a of the through-hole portion 49 . Thereby, the hook portion 45 is detachably connected to the through hole portion 49 of the excision guide portion 2 .

The surgical instrument 1b for artificial knee joint replacement according to this modification can be used as follows. Specifically, first, in the same manner as when the surgical instrument 1 for total knee joint replacement according to the above-described embodiment is used, the resection guide portion 2a is attached to the osteotomy surface 101a of the distal end of the femur 101. Fixed. Then, the hook portion 45 of the pressing instrument 3b is inserted and hooked into the through hole 49a of the through hole portion 49 of the resection guide portion 2a thus fixed, and the pressing instrument 3b is moved to the distal end 101 of the femur. push to the side. As a result, when the bone saw 50 is moved along the slits 12, 13, 14a, and 14b to cut each portion of the distal femur 101, the resection guide portion 2a is lifted from the distal femur 101. can be prevented.

Moreover, according to this modified example, when the resection guide portion 2a is pressed by the pressing instrument 3b, one is hooked to the other. Therefore, when the pressing instrument 3b presses the resection guide part 2a, it is possible to prevent the detachment of the pressing instrument 3b from the resection guide part 2a. In other words, the pressing state of the resection guide portion 2a by the pressing instrument 3b can be maintained.

In this modified example, the pressing instrument 3b is provided with the hook portion 45 as the connecting portion, while the excision guide portion 2a is provided with the through hole portion 49 as the connected portion. It is not limited to this. Specifically, the pressing instrument may be provided with a through-hole portion as a connecting portion, while the excision guide portion may be provided with a hook portion as a connected portion.

(5) In the above-described embodiment, an example in which the abutted concave portion 18 as a abutted portion is formed near the central portion of the excision guide portion 2 has been described. Further, in the modified example described with reference to FIG. 15, an example in which the through-hole portion 49 as the connected portion is formed in the vicinity of the central portion of the excision guide portion 2a has been described. However, not limited to this, the abutted portion and the connected portion may be formed in other portions of the excision guide portion.

(6) In the above-described embodiment and each modified example, an example in which one abutted portion or one connected portion is provided in the excision guide portion has been described, but the present invention is not limited to this. Specifically, a plurality of abutted portions or connected portions may be formed in the excision guide portion.

INDUSTRIAL APPLICABILITY The present invention can be widely applied as a surgical instrument for total knee arthroplasty used in total knee arthroplasty.

1, 1a, 1b Surgical instrument for artificial knee joint replacement 2, 2a Resection guide section 3, 3a, 3b Pressing instrument (pressing section)
5 fixing pin 12 front slit (slit)
13 rear slit (slit)
14a Front chamfer slit (slit)
14b Rear chamfer slit (slit)
18, 23 to 27 abutted concave portion (abutted portion)
28, 29 abutted portions 31, 34 shaft portions 35, 41, 42, 43 abutting portions 39 grip portion 44 connecting portion 45 hook portion (connecting portion)
48 Connection groove (connected part)
49 through-hole portion (connected portion)
50 bone saw (cutting blade)
101 distal femur

Claims (7)

a resection guide section provided with a slit for guiding the resection direction of a resection blade that resects the distal end of the femur, and a fixing pin hole into which a fixing pin for fixing to the distal end of the femur is inserted;
a pressing part capable of pressing the resection guide part installed at the distal end of the femur toward the distal end of the femur;
The pressing part is
a shaft;
a connection portion provided on one end side of the shaft portion and detachably connected to the resection guide portion, or a contact portion abutting on the resection guide portion;
a grasping portion provided on the other end side of the shaft portion and configured as a portion to be grasped by an operator;
including
The resection guide part has a connected part to which the connecting part is detachably connected in a state in which the resection guide part is installed at the distal end of the femur, or a contacted part to which the contact part abuts. is provided,
The abutted portion is provided on a side opposite to a surface facing the distal end of the femur when the resection guide portion is installed on the distal end of the femur ,
One of the abutment portion and the abutted portion is provided as a recess, and the other of the abutment portion and the abutted portion is a protrusion that slidably abuts against the inner surface of the recess. is established as
A surgical instrument for artificial knee joint replacement , wherein the outer surface of the convex portion and the inner surface of the concave portion are formed in a shape including a part of a spherical surface . The surgical instrument for total knee arthroplasty according to claim 1 ,
A surgical instrument for artificial knee joint replacement, wherein the radius of curvature of the spherical surface included in the inner surface of the concave portion is larger than the radius of curvature of the spherical surface included in the outer surface of the convex portion. a resection guide section provided with a slit for guiding the resection direction of a resection blade that resects the distal end of the femur, and a fixing pin hole into which a fixing pin for fixing to the distal end of the femur is inserted;
a pressing part capable of pressing the resection guide part installed at the distal end of the femur toward the distal end of the femur;
The pressing part is
a shaft;
a connection portion provided on one end side of the shaft portion and detachably connected to the resection guide portion, or a contact portion abutting on the resection guide portion;
a grasping portion provided on the other end side of the shaft portion and configured as a portion to be grasped by an operator;
including
The resection guide part has a connected part to which the connecting part is detachably connected in a state in which the resection guide part is installed at the distal end of the femur, or a contacted part to which the contact part abuts. is provided,
The abutted portion is provided on a side opposite to a surface facing the distal end of the femur when the resection guide portion is installed on the distal end of the femur,
One of the abutment portion and the abutted portion is provided as a recess, and the other of the abutment portion and the abutted portion is a protrusion that slidably abuts against the inner surface of the recess. is established as
A surgical instrument for total knee arthroplasty, wherein the outer surface of the projection has at least a portion of a conical shape. a resection guide section provided with a slit for guiding the resection direction of a resection blade that resects the distal end of the femur, and a fixing pin hole into which a fixing pin for fixing to the distal end of the femur is inserted;
a pressing part capable of pressing the resection guide part installed at the distal end of the femur toward the distal end of the femur;
The pressing part is
a shaft;
a connection portion provided on one end side of the shaft portion and detachably connected to the resection guide portion, or a contact portion abutting on the resection guide portion;
a grasping portion provided on the other end side of the shaft portion and configured as a portion to be grasped by an operator;
including
The resection guide part has a connected part to which the connecting part is detachably connected in a state in which the resection guide part is installed at the distal end of the femur, or a contacted part to which the contact part abuts. is provided,
The abutted portion is provided on a side opposite to a surface facing the distal end of the femur when the resection guide portion is installed on the distal end of the femur,
One of the connecting portion and the connected portion includes a portion provided with a through hole, and the other of the connecting portion and the connected portion includes a claw-shaped portion that is hooked in the through hole. A surgical instrument for total knee arthroplasty, comprising: a resection guide section provided with a slit for guiding the resection direction of a resection blade that resects the distal end of the femur, and a fixing pin hole into which a fixing pin for fixing to the distal end of the femur is inserted;
a pressing part capable of pressing the resection guide part installed at the distal end of the femur toward the distal end of the femur;
The pressing part is
a shaft;
a connection portion provided on one end side of the shaft portion and detachably connected to the resection guide portion, or a contact portion abutting on the resection guide portion;
a grasping portion provided on the other end side of the shaft portion and configured as a portion to be grasped by an operator;
including
The resection guide part has a connected part to which the connecting part is detachably connected in a state in which the resection guide part is installed at the distal end of the femur, or a contacted part to which the contact part abuts. is provided,
The abutted portion is provided on a side opposite to a surface facing the distal end of the femur when the resection guide portion is installed on the distal end of the femur,
A surgical instrument for artificial knee joint replacement, wherein the connecting portion includes a connecting groove into which the connecting portion is slidably fitted. The surgical instrument for total knee arthroplasty according to claim 5 ,
The connecting groove is configured such that an end of a removal jig for removing the resection guide section placed on the distal end of the femur from the distal end of the femur is also fitted into the connecting groove. A surgical instrument for total knee arthroplasty, characterized by comprising: The surgical instrument for total knee arthroplasty according to any one of claims 1 to 6 ,
The shaft portion is provided with a bent portion that extends to bend between the connecting portion and the gripping portion or between the contact portion and the gripping portion, Surgical instrument for total knee arthroplasty.

Images