JP7216378B2 - rasp holder - Google Patents

Description

The present invention relates to rasp holders.

Artificial hip joint replacement surgery is an operation that attempts to alleviate this hindrance by replacing the hip joint with an artificial joint when the deformation of the hip joint causes a hindrance in daily life. General hip arthroplasty is described, for example, in Non-Patent Document 1 below.

In general artificial hip joint replacement surgery, the head of the femur is resected, a member called a stem is inserted into the femur to cover the head, and a cup for artificial hip joint replacement is fixed to the acetabulum of the pelvis. By arranging the head in the cup, the hip joint can slide smoothly.

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By the way, currently, although artificial hip joint replacement surgery is generally performed, there are various problems with each instrument used in the surgery.

For example, in hip replacement surgery, it is necessary to open the wound in the leg near the patient's femur to replace the patient's hip joint. There are many cases of interference by the retractor, which poses a problem in efficient surgery.

Further, for example, a canal finder, which is used to confirm the direction of the medullary canal after excising the head of the femur, has a problem that it is difficult to know which direction the tip is facing during use.

In addition, the canal finder is formed on the premise that cutting is performed at the tip, and there is also the problem that the cutting posture and cutting area are limited, resulting in poor efficiency.

Also, for example, when inserting a stem into the femur after resecting the head of the femur, a rasp (file) large enough to insert the stem is inserted into the femur as a preparatory work. The patient's body position is a significant limitation.

Also, for example, when inserting a cup for artificial hip joint replacement into the acetabulum, it is necessary to fix the bone matrix and the cup with bolts (screws), but the bolt fixing holes are not arranged in appropriate positions. There is In addition, in a method in which there is no locking mechanism between the cup and the bolt, and the bolt is tightened to crimp the bone and the bolt, and the cup is indirectly fixed, the fixation between the bone and the bolt may be weak. This cup fixation concern can result in limited surgical efficiency. In order to reduce the burden on the patient as much as possible, it is necessary to reduce these restrictions as much as possible and perform efficient surgery.

SUMMARY OF THE INVENTION Accordingly, it is an object of the present invention to provide a rasp holder for more efficient hip replacement surgery.

A rasp holder according to one aspect of solving the above-described problems secures a space large enough to insert the stem when inserting the stem into the femur after resecting the femoral head of the femur. , holds a rasp that is inserted into the femur and cuts the inside of the medullary cavity, and the rasp is a file that cuts inside the medullary cavity, and has a bent portion formed with a rasp holding portion that holds the rasp at the tip a gripping portion connected to the bending portion; and a driving portion connected to the gripping portion, the driving portion being used to insert the rasp into the femur by hitting with a hammer; The shape when viewed from the end is a triangle with rounded corners, the apex of the rounded triangle is approximately parallel to the direction of the rasp insertion axis, and the bent portion is bent when viewed from the side and from the top. is.

As described above, the present invention can provide a rasp holder for more efficient hip replacement surgery.

It is a figure which shows the outline of the retractor which concerns on embodiment. FIG. 4 is a diagram showing an image of a claw member of the retractor according to the embodiment; FIG. 4 is a diagram showing an image of a moving member of the retractor according to the embodiment; It is a figure which shows the outline of the canal finder which concerns on embodiment. It is a figure which shows the cross-sectional shape outline of the intermediate part of the canal finder which concerns on embodiment. It is a figure which shows the outline of the canal finder which concerns on embodiment. It is a figure which shows the outline at the time of providing the return part of the canal finder which concerns on embodiment. It is a figure which shows the outline of the return part of the canal finder which concerns on embodiment. It is a figure which shows the outline of the rasp holder which concerns on embodiment. FIG. 4 is a diagram schematically showing a state in which a rasp holder according to the embodiment holds a rasp; 4 is a schematic diagram of a rasp holding portion of the rasp holder according to the embodiment; FIG. FIG. 4 is a diagram showing an outline (upper surface) of a bent portion of the rasp holder according to the embodiment; 4 is a diagram schematically showing the shape of the driving portion of the rasp holder according to the embodiment; FIG. FIG. 10 is a diagram schematically showing another example of the rasp holder according to the embodiment (a rasp holder for experts); It is a figure which shows the outline of the stem which concerns on embodiment. It is a figure which shows the outline of the cup which concerns on embodiment. It is a figure which shows the outline of the cross section of the cup which concerns on embodiment.

Hereinafter, the artificial hip joint replacement surgery tool according to the embodiment of the present invention will be described in detail with reference to the drawings along with the specific flow of surgery. This invention may, however, be embodied in many different forms and should not be limited to the specific illustrations of embodiments set forth below.

(Retractor)
FIG. 1 is a diagram schematically showing a retractor 1 according to this embodiment. The retractor 1 includes a first frame 11 having a rod-shaped member 111 formed with a gear groove 1111 and a first arm member 112 fixed to the rod-shaped member 111, and a rod-shaped member in the first frame 11. A second frame 12 having a moving member 121 meshed with the gear groove 1111 of 111, a second arm member 122 fixed to the moving member 121, and a and a pair of claw members 131, 132 to be attached.

In the present retractor 1, the first frame 11 is a main member serving as the skeleton of the present retractor 1, and is composed of the rod-like member 111 and the first arm members 112 as described above. The first member 112 and the rod-shaped member 111 are connected substantially perpendicularly. The first member 112 and the rod-like member 111 are not limited, but are preferably integrally configured from the viewpoint of ensuring mechanical strength. The material of the rod-shaped member 111 and the first arm member 112 is not particularly limited, but metal such as stainless steel or resin such as polycarbonate is preferable.

The length of the rod-shaped member 111 in the present retractor 1 can be appropriately adjusted according to the size of the wound, but is preferably in the range of 10 cm or more and 30 cm or less, and the length of the first arm member 112 can also be adjusted as appropriate. Although possible, it is preferably in the range of 10 cm or more and 20 cm or less.

Further, in the present retractor 1 , a gear groove 1111 is formed in the rod-shaped member 111 . This is a groove with which the moving member 121 is meshed, and although details will be described later, the meshing of the gear of the moving member 121 with this gear groove 1111 enables reliable movement and fixation.

Also, the first arm member 112 in the present retractor 1 is a rod-shaped member capable of holding the claw member 131 . The first arm member 112 is preferably linear, but may partially have a bent portion. A claw member may be fixed integrally with the tip of the first arm member 112, but the claw member 131 can be detachably fixed by, for example, a locking mechanism. is preferred. An image diagram of the claw member is shown in FIG. By doing so, detachment becomes possible, and symmetrical installation and retraction are possible by turning over the upper surface and the lower surface depending on the fixing direction of the claw member. In addition, FIG. 2(a) is a view of the claw member viewed from the extending direction of the first and second arm members, and FIG. 2(b) is a view of this from the side.

Further, in the present retractor 1, the cross section of the first arm member 112 is preferably polygonal such as quadrangular or hexagonal. By doing so, it is possible to prevent the claw member 131 from rotating around the first arm member 112 when the claw member 131 is detachable.

Further, in the present retractor 1, the second frame 12 is also a member serving as a main skeleton of the retractor 1, like the first frame 11. As described above, the rod-shaped member 111 in the first frame 11 and a second arm member 122 fixed to the moving member 121 .

The moving member 121 of the retractor 1 is a member that is meshed with the gear groove 1111 and that can move on the rod-shaped member 111 by rotating. By doing so, the distance between the first arm member and the second arm member can be adjusted and secured to a desired length.

The moving member 121 of the present retractor 1 is not limited as long as it can be meshed with the gear groove 1111, but preferably has a gear and a knob member connected to the gear. By doing so, the gear can be easily moved by combining the gear and the gear groove and by rotating the knob member.

In this case, it is also preferable that the moving member 121 further comprises a pawl member whose release and fixing can be controlled, forming a so-called ratchet mechanism. In this way, by controlling the release and fixation of the pawl member, the distance between the first arm member and the second arm member can be easily adjusted, while stably fixing it in a desired state. can.

In addition, in the retractor 1, the moving member 121 allows the gripping member 14 to be detachable from the second frame 12, and to rotate and move when the gripping member 14 is attached to the second frame 12. It is also preferable to have a structure that cannot be rotated when removed. By doing so, by removing the knob member 14 after fixation, unevenness due to the knob member 14 can be reduced, and symmetrical installation and retraction are possible, which contributes to improvement in surgical efficiency. can. An image of this case is shown in FIG.

Further, the second arm member 122 of the present retractor 1 is a rod-shaped member similar to the first arm member 112 and can hold the claw members 131 and 132 . Also, the second arm member 122 is arranged with a portion substantially parallel to the first arm member 112 . Incidentally, the claw members 131 and 132 may be fixed integrally to the tip of the second arm member 122, but the claw members can be detachably fixed by, for example, a locking mechanism. is also preferred. By doing so, detachment becomes possible, and symmetrical installation and retraction are possible depending on the fixing direction of the claw member.

It is preferable that the moving member 121 and the second arm member 122 in the present retractor 1 are integrally formed except for small parts such as gears. By doing so, sufficient strength can be ensured. It should be noted that, as a material for forming the second frame, metal such as stainless steel and resin such as polycarbonate are preferable examples, as in the case of the first frame.

As is clear from the above description, the claw members 131 and 132 of the retractor 1 can be fixed to the first arm member 112 and the second arm member 122 . If it is detachable, an arm member insertion part into which the tip of the arm member can be inserted, a plate-shaped part for adjusting the depth and stably holding and securing the wound, claws with deep claws, is configured with Although the depth (length) of the plate-like portion can be adjusted as appropriate, it is preferably 2 cm or more and 10 cm or less, and the width thereof is preferably 1 cm or more and 5 cm or less. In addition, it is preferable that the claw member is a set having a plurality of plate-like portions with different depths so that the claw member can be adjusted appropriately according to the size of the patient's body, the size of the retraction, and the like.

Further, the shape of the claw of the claw member may be one without cuts as shown in the above drawings, but cuts are formed to form a comb-tooth shape and have a pressing portion and a folded portion. can be anything. By forming the cut portion, it is possible to prevent the patient's body tissue from sticking more than necessary, and the pressing portion can obtain a force for pressing the wound portion of the patient downward.

In addition, the claw of the claw member has a curved (flexed) recessed portion (a portion curved and protruding toward the wound) in the width direction so as not to damage the patient's wound more than necessary. is preferred (see, for example, FIG. 3(c)). By doing so, it is possible to stably expand the wound according to the shape of the wound of the patient, and as described above, the risk of damaging the wound of the patient more than necessary is reduced.

(Canal Finder)
In artificial hip joint replacement surgery, the femur is exposed after the incision is made, and the head of the femur is cut with a bone saw or the like to prepare for inserting the stem into the medullary canal of the femur. The operation of inserting this stem is performed by inserting a canal finder into the femur and confirming the direction of the medullary canal in the femur.

FIG. 4 shows an outline of the canal finder 2 according to this embodiment. As shown in the figure, the canal finder 2 has a tip portion 21, an intermediate portion 22, and a grip portion 23 connected via bending portions 24 and 25, respectively.

Since the canal finder 2 of this embodiment can confirm the direction in which the medullary cavity is formed and can cut the bone, it is preferably made of a hard member, specifically steel or the like. metal, but may be made of hard plastic.

As described above, the canal finder 2 of this embodiment can join a plurality of members as long as the distal end portion 21, the intermediate portion 22, and the grip portion 23 are connected via the bent portions 24 and 25. However, from the viewpoint of facilitating manufacture and strength, it is preferable that it be constructed of an integral member.

In the canal finder 2 of this embodiment, the distal end portion 21 is a rod-shaped portion that is used to confirm the central axis of the medullary cavity. In the canal finder 2 according to this embodiment, it is preferable that the distal end portion 21 taper toward the distal end. By doing so, it becomes easier to insert into the medullary canal.

In addition, cutting grooves are formed in the tip portion 21 , the intermediate portion 22 , and the bent portion 24 between the tip portion 21 and the intermediate portion 22 . By forming the shaving groove, it is possible to insert into the medullary canal and cut the bone while confirming the central axis of the medullary canal.

Also, the grip portion 23 in the canal finder 2 of the present embodiment is literally a portion that allows the user to stably grip the canal finder. The gripping portion 23 is also a rod-shaped member, and although the core must be made of a hard member, it is preferable that the circumference thereof be covered with an elastic member such as rubber. This makes it less slippery and easier to grip.

The intermediate portion 22 in the canal finder of this embodiment is arranged between the tip portion 21 and the grip portion 23 and is used for adjusting the length and angle, and is connected to each through a bent portion. there is

Further, the cross section of the intermediate portion is preferably a rounded polygon, more specifically a rounded triangle. By doing so, the user can easily confirm in which direction and at what angle the canal finder is currently oriented. More specifically, by arranging the ridgeline of the rounded polygon so as to be substantially parallel to the plane along the direction of insertion of the canal finder, it is possible to determine which direction the canal finder extends at all times during use. It is possible to easily check whether there is An image diagram in this case is shown in FIG.

In addition, in the canal finder of this embodiment, the tip portion 21, the intermediate portion 22, and the grip portion 23 are zigzag bent on a plane, and the intermediate portion 3 and the grip portion are more inclined than the bending angle A between the tip portion and the intermediate portion. It is preferable that the bending angle B of 4 is larger. More specifically, the bending angles A and B are preferably obtuse angles, the bending angle A being preferably 100 degrees or more and 130 degrees or less, and the bending angle B being 110 degrees or more and 140 degrees or less. By doing so, the user can insert the canal finder 2 from above while keeping the tip of the canal finder horizontal (see FIG. 6).

As described above, grooves for cutting are provided in the bent portion 24 between the tip portion 21 and the intermediate portion 22 of the canal finder 2 according to this embodiment.

Further, in the canal finder 2 according to the present embodiment, the bent portion 24 between the tip portion 21 and the intermediate portion 22 may be provided with a return portion 27 for cutting. A diagram of this case is shown in FIG. Moreover, although this return portion 27 is provided in the central portion in this figure, it may be provided at both corner portions of the end.

As shown in this figure, by providing the barbed portion (projection), the canal finder 2 according to the present embodiment can cut the bone even when the canal finder 2 is pulled. As a result, cutting can be performed not only at the tip but also at the return portion 27, so that more cutting postures and cutting regions are possible. In addition, it is also preferable that a cut groove is formed in the return portion 27 from the viewpoint of increasing cutting efficiency.

It is also preferable that the width of the return portion is narrower than the widths of the tip portion, the intermediate portion, and the bent portion. By doing so, there is an advantage that the tip of the return portion can be made sharper and the cutting efficiency can be improved. An image diagram in this case is shown in FIG.

As described above, it is possible to provide a canal finder that has a higher cutting function and facilitates confirmation of the direction.

(rasp and rasp holder)
After confirming the direction of the medullary cavity with the canal finder 2, the operator inserts the rasp 4 to secure the size of the space for inserting the stem, and cuts the inside of the medullary cavity. FIG. 9 is a schematic diagram of the rasp holder 3 according to this embodiment, and FIG. 10 is a schematic diagram of the rasp holder 3 holding the rasp 4 .

As shown in these figures, the rasp holder 3 according to the present embodiment includes a bent portion 31 having a rasp holding portion 311 formed at its tip, and a grip portion 32 connected to the bent portion 31 . The rasp holder 3 also has a driving portion 33 connected to the grip portion 32 .

The rasp holding portion 311 in the rasp holder 3 has a portion to be inserted into an insertion hole formed in the rasp 3, and is configured to stably hold the rasp after being inserted. . Specifically, the rasp holding portion 311 includes a projection 3112 to be inserted into the insertion hole, and a claw 3111 to be inserted into the rasp and to hook the rasp in the same manner as the projection 3112. The projection 3112 and the claw By controlling the insertion and withdrawal of 3111, the rasp can be attached and detached by hooking or opening the recess in the rasp. It is preferable that the claw 3111 is controlled by a mechanism provided inside the bent portion 31 and the grip portion 32 . That is, the rasp holding portion 311 is controlled by an attachment/detachment mechanism 3113 provided inside the bending portion 31 and the grip portion 32 . An image of this case is shown in FIG. By providing both the projection 3112 and the claw 3111 as in the present rasp holder 3, there is an advantage that the force for stably holding the rasp can be strengthened against movements such as turning during surgery.

In addition, it is preferable that the rasp holding portion of the present rasp holder 3 is configured so that when it is inserted into the rasp, it fits within the joint portion (inside the insertion hole) and does not protrude outward.

In addition, the bent portion of the rasp holder is bent when viewed from the side and when viewed from the top. When viewed from the side, it is as described above, but FIG. 12 shows an outline when viewed from the top. Although this drawing shows the rasp holder for the right side, the rasp holder for the left side may be bilaterally symmetrical.

This rasp holder is bent not only in the so-called vertical direction (when viewed from the side) but also in the horizontal direction (when viewed from the top). This is because the patient's femur is normally at the same level as the pelvis during surgery, and the direction of the medullary canal of the femur is also at a position close to the level of the pelvis. Therefore, when a straight rasp holder is used, the rasp holder is inevitably close to the patient's body such as the pelvis. Since there is a risk of putting pressure on the patient's body by pushing the patient's body, using a bent rasp holder like this rasp holder reduces the risk of placing a burden on the patient's body. can be reduced. Rasp holders for right and left are required.

By the way, in this rasp holder, the axial direction of the gripping portion and the rasp insertion axial direction are substantially parallel to each other when the rasp is held. The rasp holder may hammer a drive connected to the rear end portion of the grip to insert the rasp. In this case, by making the axial direction of the driving portion and the direction of the insertion axis of the rasp substantially parallel, the force to the rasp can be reliably transmitted, and the direction of insertion can be stabilized. The shape of the rear end portion is preferably a polygon with rounded corners, particularly a triangle with rounded corners, and the vertex is preferably substantially parallel to the direction of the insertion axis. An image of this case is shown in FIG.

The joint between the rasp and the rasp holder needs to be firmly fixed because the impact from the hammer works. The rasp holder can be attached and detached by grasping the lever (handle) of the rasp holder, but it is equipped with a two-step locking mechanism that fixes the lever itself so that it does not unintentionally come off due to the impact of the hammer. This makes it possible to withstand stronger impacts. It is desirable to insert the rasp holder by hitting it with a hammer or attaching a pneumatic or electric instrument such as a woodpecker.

However, as described above, the burden on the patient can be reduced when the patient is further away from the body. It may be within the range of 160 degrees or more. An image diagram in this case is shown in FIG. By doing so, the rasp holder can be further removed from the patient's body, avoiding collision with the ilium and the wing of the ilium, thereby making insertion and removal of the rasp easier. In this angle range, a difference occurs between the direction in which force is applied to the grasping member and the direction in which force is applied to the rasp. When inserting the rasp holder, it is usually necessary for the operator to move to the patient's head side and insert the rasp holder toward the patient's leg side. However, if the angle formed by the axial direction of the grasping portion and the direction of the rasp insertion axis is within the range of 140 degrees or more and 160 degrees or less, the operator can insert it toward the patient's foot side while standing on the patient's foot side. it becomes possible to Since there is no need for the operator to move the standing position when manipulating the femur, the operation can be performed efficiently.

(stem insertion)
After cutting the inside of the femur with a rasp, the stem 5 is inserted into the medullary canal cut by the rasp. An image diagram in this case is shown in FIG.

As shown in this figure, the stem is configured with a neck and a head, and the orientation and height of the neck, the so-called offset, are appropriately selected according to the condition of the patient's hip joint.

(cup installed)
The cup is then secured to the acetabulum of the hipbone. An outline of the cup is shown in FIG. The cup is hemispherical, with one hole in the center and a plurality of holes for bolting (screw holes) around it. In this step, prior to fixing the cup, a spherical drill with a blade having the same shape as the cup is pressed against the acetabulum to form a recess having the same shape as the cup.

Then, the cup is inserted into the formed concave portion and fixed in the acetabulum. The outer surface of the cup is rough-textured, and by using the resistance produced by this unevenness, it is possible to prevent displacement within the acetabulum.

In addition, a hole is formed in the center position of the cup as described above, and when fixing the cup to the acetabulum, a cup holder is connected to this hole and pressed against the acetabulum to insert the cup into the acetabulum. fix the cup.

Then, after the rotating shaft of the drill is pulled out, screw members are inserted into the plurality of surrounding holes, and the cup and the bone are firmly fixed with the screw members. This allows the cup to be more securely fixed to the acetabulum.

In this case, it is preferable that the positions of the plurality of bolt fixing holes are formed symmetrically from the center, and that each bolt fixing hole is preferably separated by 1.5 cm or more from the viewpoint of strength. . For example, for cups with an outer diameter of 40 mm and 42 mm, 4 holes are formed at 90-degree intervals on the circumference of the swing width of 45 degrees from the center of the sphere, or for cups with an outer diameter of 44 mm and 46 mm, 45 degrees from the center of the sphere. Make 6 holes at 60 degree intervals on the circumference of the swing width, or form 8 holes at 45 degree intervals on the circumference of the swing width of 45 degrees from the center of the ball for cups with an outer diameter of 48 mm or more. is preferred. Moreover, it is preferable that a screw groove is formed on the side surface of each bolt fixing hole. By adopting such a locking mechanism, the cup and the bolt are integrated, and the cup and the bone can be firmly fixed more reliably. Although the example of this figure shows an example of 8 holes, the number of holes is not limited as long as it has the above functions.

In this case, it is also preferable that the center hole is also a locking mechanism so that the locking screw can be fixed. This site has BoneStok (bone mass) and the thickness of the bone matrix is sufficient, so the fixation of the screw can be easily obtained. In addition, since it is located at the center of the cup axis, there is little risk of the cup moving due to excessive torque being applied when tightening the screw. By doing so, for example, cups with outer diameters of 40 mm and 42 mm have 5 holes, cups with outer diameters of 44 mm and 46 mm have 7 holes, and cups with an outer diameter of 48 mm or more have 9 holes, together with the plurality of bolt fixing holes. It is formed. An image of this case is shown in FIG.

Then, a receiving member made of resin or ceramic is inserted inside the cup and fixed. This completes the installation of the cup.

(stem mating)
After the cup is installed, the neck of the stem is covered with a head, and the head and the receiving member of the cup are fitted together. This completes the replacement of the artificial hip joint. In addition, in this fitting, it is necessary to sufficiently check the operation so as not to dislocate easily.

(suture)
After confirming that the above series of procedures have been completed, the retracted site is sutured to complete the artificial joint replacement.

As described above, by providing the artificial hip joint replacement surgery tool of the present embodiment and the system in which these are combined, it is possible to perform more efficient artificial hip joint replacement surgery.

INDUSTRIAL APPLICABILITY The present invention has industrial applicability as a tool for artificial hip joint replacement.

Claims (2)

When a stem is to be inserted into the femur after resection of the head of the femur, an intramedullary cavity is inserted into the femur to secure a space large enough to insert the stem. is a rasp holder that holds the rasp that cuts the
The rasp is a file for cutting the intramedullary cavity,
A bent portion having a rasp holding portion that holds the rasp at the tip thereof, a grip portion connected to the bent portion, and a driving portion connected to the grip portion ,
The driving part is used to insert the rasp into the femur by hitting with a hammer,
The shape of the driving portion viewed from the rear end is a rounded triangle, and the vertex of the rounded triangle is substantially parallel to the insertion axis direction of the rasp ,
The rasp holder is bent when viewed from the side and when viewed from the top. 2. The rasp holder according to claim 1, wherein an angle between the axial direction of the gripping portion and the insertion axis direction of the rasp is in the range of 140 degrees or more and 160 degrees or less when the rasp is held by the rasp holding portion.

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