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WO2021152854A1 - Dispositif de marquage, procédé de marquage et procédé de formation de trou osseux - Google Patents

Dispositif de marquage, procédé de marquage et procédé de formation de trou osseux Download PDF

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Publication number
WO2021152854A1
WO2021152854A1 PCT/JP2020/003805 JP2020003805W WO2021152854A1 WO 2021152854 A1 WO2021152854 A1 WO 2021152854A1 JP 2020003805 W JP2020003805 W JP 2020003805W WO 2021152854 A1 WO2021152854 A1 WO 2021152854A1
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WO
WIPO (PCT)
Prior art keywords
marking
tip
target position
arthroscope
marking device
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2020/003805
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English (en)
Japanese (ja)
Inventor
藤崎　健
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Corp
Original Assignee
Olympus Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Corp filed Critical Olympus Corp
Priority to JP2021574425A priority Critical patent/JPWO2021152854A5/ja
Priority to PCT/JP2020/003805 priority patent/WO2021152854A1/fr
Publication of WO2021152854A1 publication Critical patent/WO2021152854A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions

Definitions

  • the present invention relates to a marking device, a marking method, and a bone hole forming method.
  • anterior cruciate ligament reconstruction which is a technique for reconstructing the ligament of the knee, it is desirable to form the bone hole formed to fix the collected tendon at the target position and shape.
  • Patent Document 1 discloses a drill guide that guides a drill for connecting a plurality of bone holes to form an oval bone hole.
  • the drill guide has a body in which a drill insertion hole is formed and a plurality of protrusions to be inserted into a plurality of bone holes.
  • the plurality of protrusions project forward from the main body in parallel with the center line direction of the drill insertion hole.
  • the bone hole for fixing the tendon used as an alternative to the anterior cruciate ligament to the bone can be stably fixed by forming a rectangular shape having the same shape as the tendon fixture at the target position. ..
  • a circular bone hole is formed by using a drill, a bone hole having a size and shape different from that of the tendon fixture is formed, which is stable. It was difficult to fix the tendon.
  • an ultrasonic treatment tool having a rectangular cutting surface to form a bone hole having the same size and shape as the tendon fixing tool, it is possible to stabilize the fixation of the tendon. ..
  • the cutting surface of the ultrasonic treatment tool is rectangular, if the position where the bone hole is formed is the slope of the bone with respect to the direction of insertion of the ultrasonic treatment tool into the body, the slope of the bone Since the cutting surface of the ultrasonic treatment tool is cut in an inclined posture, it becomes difficult to position the bone hole, and the size and direction of the bone hole are deviated.
  • the cutting surface of the ultrasonic treatment tool can be applied to the target position on the slope of the bone in a posture in which the size and direction of the hole do not deviate. It is desirable to mark the target position.
  • the present invention has been made in view of the above problems, and an object of the present invention is to provide a marking device, a marking method, and a bone hole forming method capable of marking a target position when forming a bone hole. It is to be.
  • the marking device includes a first marking portion having a first tip portion, a second marking portion having a second tip portion, and the like.
  • the first marking portion has a shaft portion extending from the base end side of the first marking portion and the second marking portion, and a handle portion connected to the base end side of the shaft portion.
  • the tip position of the second tip is different from that of the second tip in the direction along the axis.
  • the angle formed by the virtual straight line passing through the first tip portion and the second tip portion and the axis line is 40 degrees or more and 55 degrees or less. be.
  • the distance between the first tip portion and the second tip portion in the direction orthogonal to the direction along the axis is set in the treatment target portion. It is shorter than the longitudinal length of the preset rectangular cutting area.
  • the first tip portion has a first linear portion extending in a first orthogonal direction orthogonal to a direction along the axis, and a first linear portion extending along the axis. It has a second linear portion extending in a second orthogonal direction orthogonal to the first orthogonal direction, and the second tip portion is in the first orthogonal direction. It has an extending third linear portion and a fourth linear portion extending in the second orthogonal direction.
  • the first marking portion and the second marking portion have a marking depth capable of identifying the depth when marking the treatment target portion. Has an identification unit.
  • the marking device is inserted to the position of the bone to be marked while observing in the field of view of the arthroscope, and the first marking target position is in the field of view of the arthroscope.
  • the first marking portion of the marking device is brought into contact with the arthroscope, and the first marking portion is brought into contact with the first marking portion in the field of view of the arthroscope.
  • the marking device is driven into the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are brought into contact with each other. As a result, a first recess and a second recess are formed.
  • the position is confirmed by observing the first recess and the second recess formed in the above invention with the arthroscope.
  • the marking device is inserted to the position of the bone to be marked while observing in the field of view of the arthroscope, and the first marking is made in the field of view of the arthroscope.
  • the first marking portion of the marking device is brought into contact with the target position, and the first marking portion is brought into contact with the target position in the field of view of the arthroscope, and the second marking portion is brought into contact with the second marking target position.
  • the marking device is in contact with the first marking target position and the second marking target position in a state where the first marking portion and the second marking portion are in contact with each other.
  • a first recess and a second recess are formed by driving in, and one of the first recess and the second recess formed while observing in the field of view of the arthroscope.
  • the cutting treatment tool is inserted at the position of, and the bone hole is formed by cutting with the cutting treatment tool, and the first dent and the second dent formed while observing in the field of view of the arthroscope.
  • the cutting treatment tool is inserted into the position of the other recess, and the cutting treatment tool is used for cutting to form a bone hole.
  • the bone between the bone hole formed at the position of the one recess and the bone hole formed at the position of the other recess is formed.
  • a bone hole is formed by cutting with the cutting treatment tool.
  • the marking device, marking method, and bone hole forming method according to the present invention have the effect of being able to mark a target position when forming a bone hole.
  • FIG. 1 is a diagram showing a marking device according to the first embodiment.
  • FIG. 2 is an enlarged view of the tip end side of the marking device according to the first embodiment.
  • FIG. 3 is a diagram showing an example of the marking depth identification function.
  • FIG. 4 is a diagram showing an ultrasonic treatment tool system according to the first embodiment.
  • FIG. 5A is a side view showing the tip end side of the ultrasonic probe.
  • FIG. 5B is a front view showing the tip treatment portion of the ultrasonic probe.
  • FIG. 6 is a block diagram showing the configuration of the treatment system according to the first embodiment.
  • FIG. 7 is a perspective view of the femur showing the anterior cruciate ligament attachment portion and the cutting region.
  • FIG. 8 is a side view of the femur showing the anterior cruciate ligament attachment portion and the cutting region.
  • FIG. 9 is a diagram showing a state in which the first tip portion and the second tip portion of the marking device are in contact with the first marking target position and the second marking target position.
  • FIG. 10 is a perspective view of the femur showing a state in which the first tip portion and the second tip portion of the marking device are in contact with the first marking target position and the second marking target position.
  • FIG. 11 is a perspective view of the femur in which the first recess and the second recess are formed at the anterior cruciate ligament attachment portion.
  • FIG. 12 is a side view of the femur in which the first recess and the second recess are formed at the anterior cruciate ligament attachment portion.
  • FIG. 13 is a perspective view of the femur showing a state in which the long side of the tip treated portion of the ultrasonic probe is aligned with the second recess.
  • FIG. 14 is a perspective view of the femur showing a state in which a first bone hole is formed in the anterior cruciate ligament attachment portion.
  • FIG. 15 is a perspective view of the femur showing a state in which the long side of the tip-treated portion of the ultrasonic probe is aligned with the first recess.
  • FIG. 16 is a perspective view of the femur showing a state in which a second bone hole is formed in the anterior cruciate ligament attachment portion.
  • FIG. 17 is a perspective view of the femur showing a state in which the tip treatment portion of the ultrasonic probe is brought into contact with the partition wall portion.
  • FIG. 18 is a perspective view of the femur in which a rectangular bone hole is formed.
  • FIG. 19 is a side view of the femur in which a rectangular bone hole is formed.
  • FIG. 20 is a diagram showing the tip end side of another example of the marking device according to the first embodiment.
  • FIG. 21 is a diagram showing the tip end side of the marking device according to the second embodiment.
  • FIG. 22 is a diagram showing the tip end side of the marking device according to the third embodiment.
  • FIG. 23 is a diagram showing a square bracket-shaped recess marked by the marking device according to the third embodiment.
  • FIG. 24 is a diagram showing the tip end side of another example of the marking device according to the third embodiment.
  • FIG. 25 is a diagram showing an L-shaped recess marked by the marking device shown in FIG. 24.
  • FIG. 26 is a diagram showing an example of a marking method using the marking device according to the fourth embodiment.
  • FIG. 27 is a diagram showing an example of a marking method using the marking device according to the fourth embodiment.
  • FIG. 28 is a diagram showing an example of a marking method using the marking device according to the fifth embodiment.
  • FIG. 29 is a diagram showing an example of a marking method using the marking device according to the fifth embodiment.
  • FIG. 30 is a diagram showing an example of a marking method using the marking device according to the sixth embodiment.
  • FIG. 31 is a diagram showing an example of a marking method using the marking device according to the sixth embodiment.
  • FIG. 1 is a diagram showing a marking device 1 according to the first embodiment.
  • FIG. 2 is an enlarged view of the tip end side of the marking device 1 according to the first embodiment.
  • the marking device 1 has a marking portion 11, a shaft portion 12, and a handle portion 13.
  • the marking portion 11 has a first marking portion 11A and a second marking portion 11B.
  • the first marking portion 11A has a linear first tip portion 111A.
  • the first tip portion 111A forms a side connecting the inner side surface 112A and the outer side surface 113A of the first marking portion 11A to each other.
  • the second marking portion 11B has a linear second tip portion 111B.
  • the second tip portion 111B forms a side connecting the inner side surface 112B and the outer side surface 113B of the second marking portion 11B to each other.
  • the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B differ in tip position by a distance h in the direction along the axis C.
  • the second tip 111B is located closer to the tip than the tip 111A of 1.
  • the angle ⁇ formed by the axis C of 1 is preferably 40 degrees or more and 55 degrees or less.
  • the first tip portion 111A of the first marking portion 11A which is on the short side in the direction along the axis C, marks the first marking target position P1 (see FIG. 6) described later. ..
  • the second tip portion 111B of the second marking portion 11B which is on the long side in the direction along the axis C, marks the second marking target position P2 (see FIG. 6) described later.
  • the distance L between the first tip portion 111A and the second tip portion 111B in the direction orthogonal to the direction along the axis C is the femoral lateral condyle 100 (see FIG. 7), which is a treatment target site to be described later. Shorter than the longitudinal length of the preset rectangular cutting area 150 in. In the first embodiment, the distance L between the first tip portion 111A and the second tip portion 111B is set to 6 [mm], but the description is not limited to this.
  • the shaft portion 12 is connected to the base end side of the first marking portion 11A and the second marking portion 11B, and is connected to the base end side from the first marking portion 11A and the second marking portion 11B along the axis C. It has a rod shape that is stretched to.
  • the handle portion 13 is connected to the base end side of the shaft portion 12 and has a hammer head 131 that is hit by a hammer 4 (see FIG. 9) described later.
  • the hammer head 131 forms an end surface on the proximal end side along the axis C of the marking device 1.
  • the marking device 1 by hitting the hammer head 131 with the hammer 4, the pressing force is applied to the first marking portion 11A and the second marking portion 11B from the handle portion 53 through the shaft portion 12. Is transmitted.
  • the marking device 1 may be provided with a marking depth identification function for identifying the marking depth by the first marking portion 11A and the second marking portion 11B.
  • a marking depth identification function for example, as shown in FIG. 3, linear scales 14A and 14B indicating the marking depth are provided on the side surfaces of the first marking portion 11A and the second marking portion 11B. You may.
  • the marking depth identification function is not limited to the linear scales 14A and 14B, and the marking depth may be identified by the outer diameter shape of the first marking portion 11A and the second marking portion 11B. ..
  • FIG. 4 is a diagram showing the ultrasonic treatment tool system 5 according to the first embodiment.
  • the ultrasonic treatment tool system 5 is mainly composed of an ultrasonic treatment tool 6, a control device 7, and a foot switch 8 for instructing on / off of ultrasonic vibration.
  • the ultrasonic treatment tool 6 and the control device 7 are connected by a cable 68, and drive power is supplied and control signals are communicated.
  • the front surface 71 of the control device 7 is provided with a plurality of connectors 72 for connecting to the cable 68, various operation switches 73, and a display screen 74 for displaying information necessary for treatment.
  • the operation switch 73 functions as, for example, a switching instruction unit that gives an instruction to switch the drive mode of the ultrasonic treatment tool 6.
  • the ultrasonic treatment tool 6 is composed of a device body 61 and an ultrasonic probe 64.
  • the device main body 61 has a tubular shape with a grippable diameter, and has a housing 61a in which an ultrasonic probe 64 penetrates and is arranged, and an ultrasonic vibrator unit 61b which is an ultrasonic generator unit that can be attached to and detached from the housing 61a. It is composed of.
  • the ultrasonic vibrator unit 61b houses an ultrasonic generation unit 62 made of an ultrasonic vibration element such as a piezoelectric body and a horn 63 that efficiently transmits ultrasonic waves.
  • the base end side of the ultrasonic probe 64 and the tip end side of the horn 63 are acoustically connected, and the ultrasonic waves generated by the ultrasonic wave generating unit 62.
  • the vibration is transmitted to the tip treatment portion 65, which will be described later, of the ultrasonic probe 64.
  • an operation switch 67 for instructing the on / off of ultrasonic vibration by the operator's finger operation is provided on the upper surface of the housing 61a.
  • the foot switch 8 has a function of instructing the on / off of ultrasonic vibration by the operator's foot operation.
  • the ultrasonic probe 64 is an elongated rod-shaped shaft member (probe body) that transmits ultrasonic vibrations, and is made of a metal material such as a titanium alloy.
  • the base end portion of the ultrasonic probe 64 is a vibration input unit to which vibration energy (ultrasonic vibration) supplied from the ultrasonic wave generating unit 62 is input.
  • a tip treatment portion 65 for cutting and treating a bone which is a treatment target, is formed by vibrating with a predetermined amplitude.
  • the base end portion of the ultrasonic probe 64 and the tip treatment portion 65 are connected by a probe main body which is a transmission portion that transmits vibration energy (ultrasonic vibration) input to the base end portion to the tip treatment portion 65. ..
  • the ultrasonic probe 64 is covered with a sheath 66 from the housing 61a to an arbitrary length.
  • the sheath 66 is not in close contact with the ultrasonic probe 64, and a slight gap is provided between the sheath 66 and the ultrasonic probe 64 so as not to attenuate the ultrasonic vibration.
  • the sheath 66 is fixed at the node position of ultrasonic vibration on the tip end side of the housing 61a.
  • the tip portion of the tip treatment portion 65 has a staircase that is convex toward the tip side by the first striking surface 65a, the second striking surface 65b, and the third striking surface 65c.
  • a step is formed.
  • the outer shell of the tip treatment portion 65 in the direction orthogonal to the axial direction is a rectangle having a long side length a and a short side length b.
  • the length a of the long side is 5 [mm] and the length b of the short side is 4 [mm], but the description is not limited to this.
  • FIG. 6 is a block diagram showing the configuration of the treatment system 10 according to the first embodiment.
  • the treatment system 10 according to the first embodiment performs a treatment of opening a rectangular bone hole 110 (see FIG. 18) in the femoral lateral condyle 100, which is a treatment target site, and is the ultrasonic treatment tool system 5.
  • the ultrasonic treatment tool system 5 includes an ultrasonic treatment tool 6 having an ultrasonic generation unit 62, an ultrasonic probe 64, and the like, a control device 7, and an operation switch 67.
  • the endoscope system 9 controls an arthroscope 91 made of a rigid endoscope, which is a kind of endoscope, a light source 92 that irradiates visible light as a light source of illumination light, and the entire endoscope system 9.
  • Control unit 93 input unit 94 such as a keyboard or touch panel, display unit 95 that displays treatment information including the photographed treatment status, and water supply, drainage, or drainage of physiological saline to the periphery including the femoral external condyle 100. It is composed of a water supply / drainage unit 96 for perfusing.
  • the water supply / drainage unit 96 sends and drains physiological saline to the periphery including the femoral lateral condyle 100 through the arthroscope 91, but perfusion containing physiological saline or the like from the ultrasonic treatment tool 6
  • the liquid may be supplied and drained.
  • a rectangular bone hole 110 is formed in the anterior cruciate ligament attachment portion 140 to which the anterior cruciate ligament is attached to the femoral lateral condyle 100, which is the treatment target site, shown in FIGS. 7 and 8.
  • the anterior cruciate ligament attachment portion 140 is located on the slope of the lateral femoral condyle 100.
  • the rectangular cutting region 150 shown by the broken line in FIGS. 7 and 8 indicates the position where the bone hole 110 is formed in the anterior cruciate ligament attachment portion 140.
  • the length D of the short sides 150a and 150b of the cutting region 150 and the length W of the long sides 150c and 150d are the same as the length of the short side and the length of the long side of the bone hole 110.
  • the length D of the short sides 150a and 150b of the cutting region 150 is 5 [mm]
  • the length W of the long sides 150c and 150d of the cutting region 150 is 10 [mm]. Do, but are not limited to this.
  • the cutting region 150 is not shown in the actual anterior cruciate ligament attachment portion 140. Therefore, in the first embodiment, the anterior cruciate ligament attachment portion 140 is used to mark the target position when the bone hole 110 is formed by using the ultrasonic treatment tool 2 so that the bone hole 110 can be formed in the cutting region 150. The surface is marked by the marking device 1.
  • FIG. 9 is a side view showing an example of the marking procedure under the arthroscope 91 using the marking device 1. It is a side view of the femoral lateral condyle 100.
  • FIG. 10 is a perspective view showing an example of the marking procedure under the arthroscope 91 using the marking device 1. The figures shown in FIGS. 10 to 19 show images in a range that can be visually recognized as a field of view of the arthroscope 91.
  • the operator inserts the marking portion 11 and the shaft portion 12 of the marking device 1 from the portal 121 opened in the skin 120.
  • the operator observes the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91, and the marking device until the marking portion 11 reaches the anterior cruciate ligament attachment portion 140.
  • Insert 1 in the field of view of the arthroscope 91, the operator makes the first marking portion 11A at the first marking target position P1 (the position corresponding to the short side 150a of the cutting region 150 in FIG. 10). The tip portion 111A of the above is brought into contact with the surface.
  • the operator makes the second marking target position P2 (short side in the cutting region 150 in FIG.
  • the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B are oriented in the direction along the axis C.
  • the tip position is different. Therefore, in the marking device 1 according to the first embodiment, the first tip portion 111A and the second tip portion 111B can be easily brought into contact with the slope of the bone, and the bone hole can be easily contacted by using the ultrasonic treatment tool 2.
  • Marks (first recess 161 and second recess 162) of the target position when forming the 110 can be marked on the anterior cruciate ligament attachment portion 140.
  • the width W 1 obtained by subtracting the distance L between the first recess 161 and the second recess 162 from the lateral length W of the cutting region 150 shown in FIG. 11 is super It is the same as the length b of the short side of the tip treatment portion 65 of the ultrasonic probe 64.
  • the bone hole forming the bone hole by the ultrasonic treatment tool 6 under the arthroscope 91 The forming method will be described.
  • the operator confirms the position of the second dent 162 formed in the anterior cruciate ligament attachment portion 140 by the arthroscope 91.
  • the operator inserts the ultrasonic probe 64 of the ultrasonic treatment tool 6 from the portal opened in the skin.
  • the operator observes the tip treatment portion 65 of the ultrasonic probe 64 on the side of the first recess 161 with respect to the second recess 162, as shown in FIG.
  • One long side of the tip treatment portion 65 is aligned with the position of the second recess 162 so as to be located on the opposite side to the above.
  • FIG. 1 A square tubular first bone hole 101 as shown in the above is formed.
  • the operator confirms the position of the first dent 161 formed in the anterior cruciate ligament attachment portion 140 by the arthroscope 91.
  • the operator observes in the field of view of the arthroscope 91, and as shown in FIG. 15, the tip treatment portion 65 of the ultrasonic probe 64 has a first bone hole 101 with respect to the first recess 161. Align one long side of the tip treatment portion 65 with the position of the first recess 161 so that it is located on the side.
  • the operator vibrates the ultrasonic probe 64 ultrasonically while observing in the field of view of the arthroscope 91, and cuts the bone in the vibration direction (axial direction) of the ultrasonic probe 64.
  • FIG. A square tubular second bone hole 102 is formed as shown in the above.
  • the surgeon confirms the position of the bone partition 103 existing between the first bone hole 101 and the second bone hole 102 by the arthroscope 91, which is shown in FIG.
  • the operator brings the tip treatment portion 65 of the ultrasonic probe 64 into contact with the partition wall portion 103 while observing in the field of view of the arthroscope 91.
  • the surgeon vibrates the ultrasonic probe 64 ultrasonically while observing in the field of view of the arthroscope 91, and cuts the partition wall portion 103 in the vibration direction (axial direction) of the ultrasonic probe 64.
  • the first bone hole 101 and the second bone hole 102 are communicated with each other to form a rectangular bone hole 110 as shown in FIG.
  • the rectangular bone hole 110 having a short side length of D and a long side length of W, as shown in FIG. 19, is formed in the anterior cruciate ligament attachment portion 140. It can be easily formed at the target position.
  • the second recess 162 was first cut by aligning the tip treatment portion 65 of the ultrasonic probe 64, but the first one was first cut.
  • the tip treatment portion 65 of the ultrasonic probe 64 may be aligned with the recess 161 of the ultrasonic probe 64 to perform cutting.
  • the first tip portion 111A of the first marking portion 11A and the second tip portion 111B of the second marking portion 11B May be connected by a curved surface 115 to form the marking portion 11.
  • the marking portion 211 of the marking device 201 is connected to the tip end side of the shaft portion 212, and has a linear first tip portion 2111A forming a pair of short sides and It has a second tip portion 2111B, and a rectangular opening 2112 surrounded by a pair of linear third tip portions 2111C and a fourth tip portion 2111D forming a long side.
  • the marking portion 211 includes a first marking portion having a first tip portion 2111A, a second marking portion having a second tip portion 2111B, and a third tip portion 2111C. It also serves as a third marking portion having the above and a fourth marking portion having the fourth tip portion 2111D.
  • the portion where the first tip portion 2111A and the second tip portion 2111B bite into the living tissue is made small so as to concentrate the stress. There is.
  • the first tip portion 2111A and the second tip portion 2111B forming a pair of short sides have different tip positions in the direction along the axis C, and the second tip portion 2111B is the first tip portion 2111A. It is located on the tip side in the direction along the axis C. Further, the third tip portion 2111C and the fourth tip portion 2111D forming a pair of long sides are inclined in an upward gradient from the first tip portion 2111A to the second tip portion 2111B.
  • the first marking target is formed by the first tip 2111A, the second tip 2111B, the third tip 2111C, and the fourth tip 2111D of the marking portion 211.
  • a rectangular recess can be formed that includes the position P1 and the second marking target position P2.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set in front of the slope of the femoral lateral condyle 100.
  • the cruciate ligament attachment portion 140 can be marked.
  • the marking portion 311 of the marking device 301 is connected to the tip end side of the shaft portion 312, and the first marking portion 311A and the second marking portion 11B are connected to each other.
  • Each is configured in a square bracket shape when viewed from the tip side of the axis C.
  • the first marking portion 311A has a first side wall 3111A, a second side wall 3112A, and a third side wall 3113A erected from the tip surface 3110 of the marking portion 311 along the axis C. ..
  • the first side wall 3111A extends along the lateral direction (the first orthogonal direction orthogonal to the direction along the axis C) on the tip surface 3110 of the marking portion 311.
  • the second side wall 3112A and the third side wall 3113A are along the longitudinal direction (the direction along the axis C and the second orthogonal direction orthogonal to the first orthogonal direction) on the tip surface 3110 of the marking portion 311. It is postponed.
  • the second side wall 3112A is connected to one end of the first side wall 3111A in the lateral direction.
  • the third side wall 3113A is connected to the other end of the first side wall 3111A in the lateral direction.
  • a linear tip 3114A is provided at the tip of the first side wall 3111A.
  • a linear tip 3115A is provided at the tip of the second side wall 3112A.
  • a linear tip portion 3116A is provided at the tip of the third side wall 3113A.
  • the linear tip portion 3114A provided at the tip of the first side wall 3111A is the first linear portion in the present invention.
  • the linear tip portion 3115A provided at the tip of the second side wall 3112A and the linear tip portion 3116A provided at the tip of the third side wall 3113A are the second linear portion in the present invention. Is.
  • the first tip portion is composed of the tip portions 3114A, 3115A, and 3116A.
  • the length of the tip portion 3114A is substantially the same as the length of the short side of the tip surface 3110 of the marking portion 311.
  • the lengths of the tip portions 3115A and 3116A are shorter than the length of the tip portion 3114A and shorter than half the length of the long side of the tip surface 3110 of the marking portion 311.
  • the second marking portion 311B has a first side wall 3111B, a second side wall 3112B, and a third side wall 3113B which are erected from the tip surface 3110 of the marking portion 311 along the axis C. ..
  • the first side wall 3111B extends along the lateral direction (first orthogonal direction) of the tip surface 3110 of the marking portion 311.
  • the second side wall 3112B and the third side wall 3113C extend along the longitudinal direction (second orthogonal direction) of the tip surface 3110 of the marking portion 311.
  • the second side wall 3112B is connected to one end of the first side wall 3111B in the lateral direction.
  • the third side wall 3113B is connected to the other end of the first side wall 3111B in the lateral direction.
  • a linear tip 3114B is provided at the tip of the first side wall 3111B.
  • a linear tip 3115B is provided at the tip of the second side wall 3112B.
  • a linear tip portion 3116B is provided at the tip of the third side wall 3113B.
  • the linear tip portion 3114B provided at the tip of the first side wall 3111B is the third linear portion in the present invention.
  • the linear tip portion 3115B provided at the tip of the second side wall 3112B and the linear tip portion 3116B provided at the tip of the third side wall 3113B are the fourth linear portion in the present invention. Is. Then, in the second marking portion 311B, the tip portion 3114B, 3115B, 3116B constitutes the second tip portion.
  • the length of the tip portion 3114B is substantially the same as the length of the short side on the tip surface 3110 of the marking portion 311.
  • the lengths of the tip portion 3115B and the tip portion 3116B are shorter than the length of the tip portion 3114B and shorter than half the length of the long side on the tip surface 3110 of the marking portion 311.
  • the first tip portion of the first marking portion 311A and the second tip portion of the second marking portion 311B are different in tip position in the direction along the axis C, and the first tip position is different.
  • the second tip is located closer to the tip than the tip.
  • the first marking portion 311A and the second marking portion 311B are used to form a bone hole 110 with respect to the slope of the femoral lateral condyle 100 at a target position.
  • Marking can be performed by forming the square bracket-shaped first recess 163 and the square bracket-shaped second recess 164 shown in FIG. 23.
  • the marking device 301 has a marking depth identification function for identifying the marking depth by the first marking unit 311A and the second marking unit 311B.
  • Scales 15A and 15B indicating the depth of marking may be provided on the side surfaces of the first marking portion 311A and the second marking portion 311B.
  • the first side wall 3111A of the first marking portion 311A and the first side wall 3111B of the second marking portion 311B shown in FIG. 23 are formed in FIG. 24.
  • the cutout portion 3117A and the cutout portion 3117B shown in the above may be provided, respectively.
  • the tip portion 3114A of the first marking portion 311A shown in FIG. 23 is divided into two tip portions 3114Aa and 3114Ab with the notch portion 3117A as a boundary.
  • the tip portion 3114Aa and the tip portion 3115A form an L-shape
  • the tip portion 3114Ab and the tip portion 3116A form an L-shape when viewed from the tip side of the axis C.
  • the tip portion 3114B of the second marking portion 311B shown in FIG. 23 is divided into two tip portions 3114Ba and 3114Bb with the notch portion 3117B as a boundary.
  • the tip portion 3114Ba and the tip portion 3115B form an L-shape
  • the tip portion 3114Bb and the tip portion 3116B form an L-shape when viewed from the tip side of the axis C.
  • the first marking portion 311A and the second marking portion 311B are positioned at a target position for forming the bone hole 110 with respect to the slope of the femoral lateral condyle 100.
  • Marking can be performed by forming a pair of L-shaped recesses 165a and 165b and a pair of L-shaped recesses 166a and 166b shown in 25.
  • the first marking portion 411A, the second marking portion 411B, the first shaft portion 412A, the second shaft portion 412B, and the handle It has a part 413.
  • the first marking portion 411A and the second marking portion 411B each have a long cubic shape in a direction orthogonal to the axis C.
  • the short side 4111A located on the outside marks the first marking target position P1
  • the first tip of the present invention is a department.
  • the short side 4112B located inside marks the second marking target position P2
  • the second tip of the present invention is a department.
  • the first shaft portion 412A is connected to the base end side of the first marking portion 411A, and has a rod shape extending from the first marking portion 411A to the base end side along the axis C.
  • the second shaft portion 412B is connected to the base end side of the second marking portion 411B, and has a rod shape extending from the second marking portion 411B to the base end side along the axis C.
  • the handle portion 413 has a hammer head 4131 that is hit by the hammer 4.
  • the hammer head 4131 forms an end surface on the proximal end side along the axis C of the marking device 401.
  • the handle portion 413 is connected to the base end side of the first shaft portion 412A and the base end side of the second shaft portion 412B, and the first shaft portion 412A and the second shaft portion 412B are connected to each other. At least one is held movable in the direction along the axis C.
  • the first shaft portion 412A is fixed to the handle portion 413
  • the second shaft portion 412B is held by the handle portion 413 so as to be movable along the axis C with respect to the handle portion 413.
  • the second shaft portion 412B is fixed to the handle portion 413 by a fixing member such as a screw when it is not moved to the handle portion 413, and is fixed to the handle portion 413 when it is moved to the handle portion 413. Is released. Further, the first shaft portion 412A and the second shaft portion 412B may be bundled by magnetic force, for example, by providing magnets to each other.
  • the surgeon first marks the marking device 401 from the portal 121 opened in the skin 120, the first marking portion 411A, the second marking portion 411B, the first shaft portion 412A, and the second. Insert the shaft portion 412B.
  • the operator reaches the anterior cruciate ligament attachment portion 140 with the first marking portion 411A while observing the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 within the field of view of the arthroscope 91. Insert the marking device 401 up to.
  • the operator brings the short side 4111A of the first marking portion 411A into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG. 27.
  • the operator puts the second shaft portion 412B on the handle portion 413 on the axis C in a state where the short side 4111A of the first marking portion 411A is in contact with the first marking target position P1. It is moved to the tip side, and the short side 4112B of the second marking portion 411B is brought into contact with the second marking target position P2.
  • the short side 4111A of the first marking portion 411A and the short side 4112B of the second marking portion 411B are tipped in the direction along the axis C.
  • the short side 4112B is positioned closer to the tip side than the short side 4111A by changing the position.
  • the operator hits the hammer head 4131 of the handle portion 413 with the hammer 4 in a state where the short side 4111A and the short side 4112B are in contact with the first marking target position P1 and the second marking target position P2.
  • the short side 4111A and the short side 4112B are driven into the first marking target position P1 and the second marking target position P2.
  • linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100.
  • a certain anterior cruciate ligament attachment portion 140 can be marked.
  • the first marking portion 511A, the second marking portion 511B, the first shaft portion 521A, the second shaft portion 521B, and the handle It has a part 513.
  • the first marking portion 511A has a linear first tip portion 5111A that comes into contact with the first marking target position P1.
  • the first tip portion 5111A forms a side connecting the inner side surface 5112A and the outer side surface 5113A of the first marking portion 511A to each other.
  • the second marking portion 511B has a linear second tip portion 5111B that comes into contact with the second marking target position P2.
  • the second tip portion 5111B forms a side connecting the inner side surface 5112B and the outer side surface 5113B of the second marking portion 511B to each other.
  • the first shaft portion 512A is connected to the base end side of the first marking portion 511A, and has a rod shape extending from the first marking portion 511A to the base end side along the axis C.
  • the second shaft portion 512B is connected to the base end side of the second marking portion 511B, and has a rod shape extending from the second marking portion 511B to the base end side along the axis C.
  • the handle portion 513 has a hammer head 5131 that is hit by the hammer 4.
  • the hammer head 5131 forms a proximal end surface of the marking device 501 along the axis C.
  • the handle portion 513 is connected to the proximal end side of the first shaft portion 512A and the proximal end side of the second shaft portion 512B, and at least one of the first shaft portion 512A and the second shaft portion 512B. Is movably held in the direction along the axis C.
  • the first shaft portion 512A is fixed to the handle portion 513
  • the second shaft portion 512B is held by the handle portion 513 so as to be movable along the axis C with respect to the handle portion 513.
  • the second shaft portion 512B is fixed to the handle portion 513 by a fixing member such as a screw when it is not moved to the handle portion 513, and is fixed to the handle portion 513 when it is moved to the handle portion 513. Is released. Further, the first shaft portion 512A and the second shaft portion 512B may be bundled by magnetic force, for example, by providing magnets to each other.
  • the surgeon has a first marking portion 511A, a second marking portion 511B, a first shaft portion 512A, and a second marking device 501 from the portal 121 opened in the skin 120. Insert the shaft portion 512B.
  • the operator reaches the anterior cruciate ligament attachment portion 140 with the first marking portion 511A while observing the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91. Insert the marking device 501 up to.
  • the operator brings the first tip portion 5111A of the first marking portion 511A into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG. 29.
  • the operator moves the second shaft portion 512B to the tip side of the axis C with respect to the handle portion 513 in a state where the first tip portion 5111A is in contact with the first marking target position P1. Then, the second tip portion 5111B of the second marking portion 511B is brought into contact with the second marking target position P2.
  • the first tip portion 5111A of the first marking portion 511A and the short side 5111B of the second marking portion 511B are oriented along the axis C.
  • the second tip portion 5111B is positioned closer to the tip side than the first tip portion 4111A.
  • the operator makes the hammer head of the handle portion 513 in a state where the first tip portion 5111A and the second tip portion 5111B are in contact with the first marking target position P1 and the second marking target position P2.
  • the 5131 is hit with a hammer 4, and the first tip portion 5111A and the second tip portion 5111B are driven into the first marking target position P1 and the second marking target position P2.
  • linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100.
  • a certain anterior cruciate ligament attachment portion 140 can be marked.
  • the marking device 601 has a marking portion 611, a shaft portion 612, and a handle portion 613.
  • the marking portion 611 has a cubic shape that is long in the direction orthogonal to the axis C, and has a triangular first marking portion 11A and a triangular second marking portion at both ends in the longitudinal direction of the tip surface, respectively. It has 11B and.
  • the first marking portion 11A has a linear first tip portion 6111A that comes into contact with the first marking target position P1.
  • the first tip portion 6111A forms a side connecting the inner side surface 6112A and the outer side surface 6113A of the first marking portion 611A to each other.
  • the second marking portion 611B has a linear second tip portion 6111B that comes into contact with the second marking target position P2.
  • the second tip portion 6111B forms a side connecting the inner side surface 6112B and the outer side surface 6113B of the second marking portion 611B to each other.
  • the tip end side of the shaft portion 12 is connected to the marking portion 611 by a shaft pin 614, and has a rod shape extending from the marking portion 611 toward the base end side along the axis C.
  • the marking portion 611 is rotatable about the shaft pin 614 with respect to the shaft portion 612.
  • the handle portion 613 has a hammer head 6131 that is hit by the hammer 4.
  • the hammer head 6131 forms an end surface on the proximal end side along the axis C of the marking device 601.
  • the operator inserts the marking portion 611 and the shaft portion 612 of the marking device 601 from the portal 121 opened in the skin 120.
  • the operator observes the vicinity of the anterior cruciate ligament attachment portion 140 in the femoral lateral condyle 100 in the field of view of the arthroscope 91, and the marking device until the marking portion 611 reaches the anterior cruciate ligament attachment portion 140. Insert 601.
  • the operator brings the first tip portion 6111A of the marking portion 611 into contact with the first marking target position P1 in the field of view of the arthroscope 91, as shown in FIG.
  • the operator further inserts the shaft portion 612 into the tip end side of the axis C with the first tip portion 6111A in contact with the first marking target position P1, centering on the shaft pin 614.
  • the marking portion 611 is rotated so that the second tip portion 6111B of the second marking portion 611B is brought into contact with the second marking target position P2.
  • the operator makes the hammer head of the handle portion 613 in a state where the first tip portion 6111A and the second tip portion 6111B are in contact with the first marking target position P1 and the second marking target position P2.
  • the 6131 is hit with a hammer 4, and the first tip portion 6111A and the second tip portion 6111B are driven into the first marking target position P1 and the second marking target position P2.
  • the marking device 601 As a result, linear recesses are formed at the first marking target position P1 and the second marking target position P2, respectively.
  • the mark of the target position when forming the rectangular bone hole 110 by using the ultrasonic treatment tool 2 is set on the slope of the femoral lateral condyle 100.
  • a certain anterior cruciate ligament attachment portion 140 can be marked.
  • the present invention can provide a marking device, a marking method, and a bone hole forming method capable of marking a target position when forming a bone hole.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Vascular Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
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  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif de marquage (1) pour marquer une position cible lors de la formation d'un trou osseux, comprenant : une première partie marquage (11A) ayant une première section d'extrémité avant (111A) ; une seconde partie marquage (11B) ayant une seconde section d'extrémité avant (111B) ; une partie arbre (12) prévue pour s'étendre à partir des côtés d'extrémité de base de la première partie marquage et de la seconde partie marquage ; et une partie poignée (13) reliée au côté d'extrémité de base de la partie arbre, la première section d'extrémité avant et la seconde section d'extrémité avant ayant différentes positions d'extrémité avant dans une direction le long de la ligne d'axe.
PCT/JP2020/003805 2020-01-31 2020-01-31 Dispositif de marquage, procédé de marquage et procédé de formation de trou osseux Ceased WO2021152854A1 (fr)

Priority Applications (2)

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JP2021574425A JPWO2021152854A5 (ja) 2020-01-31 マーキングデバイス
PCT/JP2020/003805 WO2021152854A1 (fr) 2020-01-31 2020-01-31 Dispositif de marquage, procédé de marquage et procédé de formation de trou osseux

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PCT/JP2020/003805 WO2021152854A1 (fr) 2020-01-31 2020-01-31 Dispositif de marquage, procédé de marquage et procédé de formation de trou osseux

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007503921A (ja) * 2003-09-02 2007-03-01 ウォーソー・オーソペディック・インコーポレーテッド 最少侵入での椎間板空間の準備及び移植片挿入のための装置及び技術
JP2011512943A (ja) * 2008-02-27 2011-04-28 イリオン・メディカル・リミテッド・ライアビリティ・カンパニー 非侵襲的整形外科的接合手術を行うための工具
WO2015046348A1 (fr) * 2013-09-27 2015-04-02 オリンパスメディカルシステムズ株式会社 Unité sonde, outil de traitement et système de traitement
JP5771670B2 (ja) * 2013-11-22 2015-09-02 タキロン株式会社 ドリルガイド

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007503921A (ja) * 2003-09-02 2007-03-01 ウォーソー・オーソペディック・インコーポレーテッド 最少侵入での椎間板空間の準備及び移植片挿入のための装置及び技術
JP2011512943A (ja) * 2008-02-27 2011-04-28 イリオン・メディカル・リミテッド・ライアビリティ・カンパニー 非侵襲的整形外科的接合手術を行うための工具
WO2015046348A1 (fr) * 2013-09-27 2015-04-02 オリンパスメディカルシステムズ株式会社 Unité sonde, outil de traitement et système de traitement
JP5771670B2 (ja) * 2013-11-22 2015-09-02 タキロン株式会社 ドリルガイド

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