JP5403812B2 - Surgical instrument for femoral fracture treatment - Google Patents

Description

  The present invention relates to a surgical instrument for treating a femoral fracture for accurately and reliably inserting a lag screw used for treatment when a femoral neck fractures into a bone head.

  Since the neck of the femur is thin, it is easy to fracture, and a femoral fracture treatment device used to treat this fracture is generally near the femur A as shown in FIG. Nail B to be inserted into the medullary cavity from the distal end, and through the fracture surface D from the through hole (lag screw insertion hole) C formed obliquely upward in the nail B and into the femoral head E of the femur A And a lag screw F to be inserted. In this case, the insertion of the lag screw F is performed while viewing the X-ray transmission image, but since the base (neck part) of the bone head E is particularly thin, it requires a certain skill to be inserted into the center thereof.

  For this reason, an instrument called a target device (hereinafter referred to as a device) shown in Patent Document 1 below is used. This is a guide pin that is connected to the upper part of the nail and hangs along the outside of the thigh, and serves as a guide for accurately inserting the lag screw into the lag screw insertion hole formed in the nail at the lower part. Has a guide pin insertion hole.

  The guide pin insertion hole is accurately aimed at the lag screw insertion hole, and the angle between the two insertion (insertion) holes is set to the crossing angle between the femoral bone axis and the head center axis Is. Therefore, if a guide pin is installed using this device and a lag screw is inserted into the guide pin, the lag screw can be accurately inserted into the lag screw insertion hole formed in the nail. The insertion angle of the lag screw can be set parallel to the central axis of the head.

  However, this alone cannot determine whether the guide pin is accurately inserted into the center of the bone head. This determination is based on an X-ray transmission image, which is based on an image irradiated with X-rays from the front and rear direction (AP plane) of the femur and an image irradiated from the left and right direction (ML plane). Specifically, while observing the X-ray transmission image, the guide pin is slightly inserted into the bone head to judge the situation, but this device is only in the lag screw insertion hole formed in the nail. Since the guide pin that can be used as a guide can only be inserted accurately, if the nail insertion depth is not appropriate, the guide pin will move up and down from the head of the bone, and if the nail is tilted inward or outward or back and forth, The pin breaks through the bone head.

  The same applies to the case where the nail is rotated, and the guide pin is inserted while being tilted forward and backward of the bone head and cannot be inserted along the center of the bone head. If you insert it in the wrong direction, you will have to try again, but if you repeat this many times, the bone head tissue will be damaged, the lag screw will be less fixed, and the treatment effect will not increase sufficiently, and the operation time will be reduced. However, the burden on the patient is large.

  Therefore, in order to predict the insertion direction and angle of the guide pin, an instrument called a one-shot guide (hereinafter referred to as a striker product name) is attached to the device. FIG. 8 is an explanatory diagram of the AP surface showing the use state of the guide, FIG. 9 is an X-ray transmission image of the AP surface, and FIG. 10 is an X-ray transmission image of the ML surface, but is inserted into the femur a. As described above, the device d is connected to the nail b (c is the lag screw insertion hole).

  On the other hand, a guide e is attached to the device d so as to be rotatable under a certain restraint state, and the guide e is provided at the center with a marker f made of two metal wires and a distance from the marker f. An indicator g made of a single metal wire is provided. FIG. 7 is an explanatory diagram of the X-ray irradiation apparatus, in which the X-ray source i and the light receiving surface j are arranged to face each other by 180 ° with the bone head h and the guide e interposed therebetween.

  Then, the operation of aligning the direction of the lag screw insertion hole c formed in the nail b with the center line of the bone head h is performed by first guiding the indicator e so that the indicator g is displayed at the center of the marker f. Adjust the position. As a result, the indicator g and the axis of the lag screw insertion hole c are on the same irradiation line (surface) L. Thereafter, the device d is operated to insert the nail b into the insertion depth, front, rear, left and right. The inclination and rotation direction are adjusted, and the indicator g is aligned with the center of the bone head h. If the guide pin k is inserted from the device d toward the lag screw insertion hole c of the nail b after this adjustment operation, the guide pin k passes over the indicator g and the direction as predicted (the center of the bone head h). It can be inserted in the direction along the axis).

  However, since the practitioner sets the marker f and the indicator g while viewing the X-ray transmission image, the indicator g can be placed between the marker f even when the positional relationship between the irradiation line L and the guide e is slightly inclined. It may be difficult to judge whether it is in the center. This is because the marker f and the indicator g have a depth, but the individual ones do not have a depth. Therefore, even if the marker f and the indicator g are slightly inclined, the indicator g is near the center of the marker f and it is difficult to make an accurate determination. Because. In other words, the sensitivity as the marker f is not sufficient. Another reason is that the device d itself is not provided with a clear aim that matches the axis of the lag screw insertion hole c of the nail b.

U.S. Pat. No. 7,077,847

  The present invention solves such a problem, and it is possible to easily determine whether or not the guide marker coincides with the X-ray irradiation direction, thereby increasing its sensitivity, and the device itself has a nail. It has a clear aim that matches the axis of the lag screw insertion hole. Furthermore, the marker itself can be expanded and contracted according to the patient's body shape to facilitate the confirmation.

  Under the above-mentioned problems, the present invention is connected to the upper part of a nail inserted along the bone axis from the proximal end of the femur according to claim 1 and extends along the outer side of the thigh, and has a lower end. A target device in which a guide pin insertion hole for inserting a guide pin for a lag screw inserted from a lag screw insertion hole formed in a nail is formed toward the lag screw insertion hole, and a guide It is connected to the pin insertion hole and rotates around the axis connecting the guide pin insertion hole and the lag screw insertion hole, receives X-ray irradiation, and sets the insertion direction of the guide pin with respect to the femoral head by the transmitted image In a surgical instrument for treating a femoral fracture comprising a center guide provided with an X-ray marker, the X-ray marker is made into two wall-like ones having a depth in the X-ray irradiation direction, and the target device Providing the kick sight which coincides with the center line of the lag screw thorn in hole in the guide pin projecting point is obtained by providing a femoral fracture treatment surgical instrument according to claim.

  Further, the present invention provides the above-mentioned surgical instrument, wherein the X-ray marker described in claim 2 is two loop-shaped metal wires parallel to the surface of the center guide, and the aim is described in claim 3. The means provided on the AP surface that is X-ray irradiation from the front and rear direction of the femur and the ML surface that is X-ray irradiation from the left-right direction, and the aim of the ML surface according to claim 4 is perpendicular to the X-ray irradiation direction Means which are U-shaped grooves, means for extending and retracting the center guide according to claim 5 are provided.

  According to the first aspect of the present invention, if the depth of the X-ray marker is visible in the X-ray transmission image, the direction of the irradiation line irradiated from the X-ray source is not correct. In that case, the position of the X-ray source is corrected so that the depth cannot be seen, or the position of the X-ray marker (center guide) is corrected, but this makes the irradiation line collinear with the X-ray marker. Can be set. In other words, the sensitivity of the X-ray marker could be increased. At this time, if the center guide is correctly set to the central axis of the bone head, the irradiation line inevitably passes through the axis of the AP surface and ML surface of the lag screw insertion hole of the nail. In addition, since the target device or nail is provided with an aim that coincides with the axis of the lag screw insertion hole, when the guide pin is inserted while checking with an X-ray transmission image, the guide pin The position where you can see can be predicted.

  Furthermore, according to the X-ray marker of claim 2, there is a depth and the inclination with respect to the X-ray irradiation direction can be easily discriminated, and according to the means of claims 3 and 4, the aim can be made easier to see. . According to the means of claim 5, the center guide can be brought closest to the patient's body, the association with the aim of the device can be made clearer, and the insertion of the guide pin can be confirmed in a longer range.

It is a perspective view which shows the combination of a target device and a center guide. It is a perspective view which shows the combination of a target device and a center guide. FIG. 2 is a view as viewed in the direction of arrow (a) in FIG. 1. It is a partial perspective view of a marker part. It is a partial top view which shows the setting of AP surface by a center guide. It is a partial top view which shows the setting of ML surface by a center guide. It is explanatory drawing which shows the relationship between a patient and an X-ray irradiation apparatus. It is explanatory drawing of AP surface which shows the use condition of a center guide. It is an X-ray transmission image of the AP surface showing the use state of the center guide. It is an X-ray transmission image of the ML plane showing the use state of the center guide. It is explanatory drawing which shows the relationship between a nail and a lag screw.

  DESCRIPTION OF EMBODIMENTS Hereinafter, embodiments of the present invention will be described with reference to the drawings. Here, directions such as up and down, front and rear, and left and right are sometimes referred to, but this is based on a standing state. That is, the front side is the abdomen side, the back side is the back side, the upper side is the head side, the lower side is the foot side, the left side is the left side, the right side is the right side (in the thigh, the inner side is the crotch side, The outside is the outside of the body). 1 and 2 are explanatory views showing a state in which the center guide is attached to the target device, and FIG. 3 is a view taken in the direction of the arrow (b) in FIG. 3 and the tip 4 are curved in a sickle shape in the same plane, and a guide pin insertion hole 6 through which the guide sleeve 5 for guiding the guide pin P is passed through the base 2 is formed obliquely upward in this plane. It is a thing.

  The tip 4 is connected to the upper end of a nail 8 inserted along the bone axis of the femur 7, whereby the device 1 and the nail 8 are integrated. A concave portion 9 is formed on the top surface of the distal end portion 3, and a U-shaped groove 10 is provided at the center of the concave portion 9 with a length that aligns the guide pin insertion hole 6 of the nail 8 with the axis. This forms the aim. In this case, the tip 4 is made of metal, and the U-shaped groove 10 is clearly visible in the X-ray transmission image in that direction.

  As is well known, the nail 8 is mainly composed of a base column portion 11 of a metal member, and a lag screw insertion hole 12 for inserting a lag screw (not shown) is formed in the base column portion 11. . At this time, the axial center of the guide pin insertion hole 6 and the lag screw insertion hole 12 of the device 1 is concentric with the same inclination, and is set to the crossing angle of the femur 7 and the bone head 13 on the AP surface. Therefore, when the guide pin P is passed through the guide pin insertion hole 6, as long as the nail 8 is inserted along the bone axis of the femur 7, it is inserted through the lag screw insertion hole 12 in parallel with the bone head 13. It has come to be.

  A center guide (hereinafter referred to as a guide) 14 is fitted to the guide sleeve 5 on the back surface of the device 1, and is curved in the same plane from the fitting portion 15 made of resin to the marker portion 17 through the guide arm 16. It is a thing. In this case, a tail column 18 is attached to the marker portion 17, and the tail column 18 is slidably provided in a guide groove 19 formed in the guide arm 16. Therefore, the marker portion 17 can be expanded and contracted with respect to the guide arm 16 by inserting / removing the tail column 18 into / from the guide groove 19. In this example, a certain amount of resistance is given to the sliding of the tail column 18 and the fixing structure of the tail column 18 is not particularly taken, but it may be fixed with a tightening bolt or the like.

  FIG. 4 is a partial perspective view of the marker unit 17. The marker unit 17 is provided with an X-ray marker (hereinafter referred to as a marker) 20, and the marker 20 of this example includes two parallel loop-shaped metal wires. Is provided in parallel to the surface of the guide arm 16 and the like, and by doing so, two wall-like ones having a depth are formed. The portions other than the marker 20 are made of a resin having a high X-ray transmittance. When the X-ray is irradiated from a direction parallel to the marker 20, the marker 20 becomes two walls and appears on the light receiving surface. (In order to prevent a decrease in X-ray transmittance, a through hole 21 is formed inside the loop-shaped metal wire of the marker portion 17).

  At this time, if X-rays are not irradiated in parallel with the loop surface of the marker 20, the respective metal lines are duplicated in a loop shape, so the X-ray irradiation line (surface) and the marker 20 are not coplanar. I understand that. If the X-ray irradiation line and the marker 20 are not on the same plane, the marker 20 (guide 14), the bone head 13 and the nail 8 (device 1) are provided at intervals, so that there is an error in the aiming direction. Will occur. For this reason, it is necessary to set the same plane as much as possible in order to increase accuracy.

  The fitting portion 15 of the guide 14 can rotate in a plane perpendicular to the guide sleeve 5, and is parallel to a plane (AP surface) perpendicular to the device arm 3 and the like with the guide sleeve 4 as the center. The satellite motion can be performed across the plane (ML plane). (22 is a fixed knob). The guide arm 16 and the marker portion 17 following the guide arm 16 are in the same plane when viewed from the AP surface, and the marker 20 and the U-shaped groove 10 overlap when viewed from the ML surface. That is, the guide 14 and the curved surface of the device 1 are not crossed (not tilted), and rotate between the AP surface and the ML surface in the same surface orientation.

  Regarding the insertion of the lag screw by the device 1 and the guide 14, the setting of the AP surface will be described based on the perspective view of FIG. 1 and the plan view of FIG. The patient is lying on the bed in a supine position. First, the upper end of the nail 8 is connected to the distal end 4 of the device 1 and the nail 8 is inserted into the femur 7, and the device arm 3 and the base 2 are moved. Align directly to your body. At this time, the insertion depth of the nail 8 and the correction of the inclination of the inside and outside and the front and back are performed while looking at the X-ray transmission image, and the upper part of the nail 8 is slightly looked at the proximal end side of the femur 7 Insert to match the centerline.

  Next, the fitting portion 15 of the guide 14 is fitted to the guide sleeve 5 of the device 1. Then, the guide 14 is rotated to the front of the thigh on the operation side (the tip 4 having the marker 20 is separated from the device 1 to the extent that it does not interfere with the front of the body), and the marker 20 is the lug of the device 1 It sets so that it may come to the exit of the screw insertion hole 12. FIG.

  In this setting state, the insertion location of the guide pin P (the height of the lag screw insertion hole 12 and the inclination in the inner and outer directions) is determined while viewing the X-ray transmission image. At this time, the marker 20 is looped ( If there is a depth), the X-ray source and the marker 20 are not in the same plane, so the depth of the marker 20 cannot be seen by adjusting the position of the guide 14 or the position / angle of the X-ray source. Like that. Then, the positional relationship between the marker 20 and the bone head 13 is matched. The displacement at this time is inclined when the marker 20 is vertically displaced with respect to the central axis of the bone head 13 and when the marker 20 is inward or outward (vertical) direction. This is the case. In the former case, the insertion depth of the nail 8 is adjusted, and in the latter case, the inclination of the nail 8 in the inner and outer directions is corrected.

  As a result, the setting of the AP surface has been completed, so the ML surface is now set. The perspective view of FIG. 2 and the plan view of FIG. 6 show this, but in this operation, the guide 14 is turned to the outside of the thigh 90 °, and the marker 20 is moved to the head of the head while viewing the X-ray transmission image. (When the marker 20 looks like a loop at this time, the position of the guide 14 or the position / angle of the X-ray source is adjusted as described above). In addition, in the X-ray transmission image at this time, it is preferable that the marker 20 is sufficiently captured. Therefore, the marker portion 17 is pulled out from the guide arm 16 and the marker 20 is extended to the body side as much as possible.

  In particular, X-rays cannot be irradiated from the side by interfering with the other thigh, etc., so the other thigh is lifted and irradiated from an oblique direction in the vertical direction. ) Is very important. Then, the positional relationship between the marker 20 and the bone head 13 is matched. The displacement at this time is the case where the marker 20 itself is displaced in the front-rear direction with respect to the central axis of the bone head 13 and the center of the bone head 13. However, in the case of the former, the inclination of the nail 8 is corrected, and in the case of the latter, the nail 8 is rotated.

  If the center line of the marker 20 and the head 13 coincides, the aim of the device 1 (the axis of the lag screw insertion hole 12 of the nail 8) and the center of the marker 20 should be matched. Check. On the AP surface, the nail 8 is used to confirm that the line connecting the inlet and the outlet of the lag screw insertion hole 12 passes through the center of the marker 20. In addition, although the entrance and the exit are dents even from the side, it can be determined, but in order to facilitate this, a groove or a streak may be inserted in the center line connecting the entrance and the exit, and the X-ray irradiation direction It is easier to discriminate if grooves or the like are formed in a perpendicular direction.

  On the ML plane, it is performed by the device 1 and it is confirmed that the U-shaped groove 10 that is the aim is passing through the center of the marker 20. Since the U-shaped groove 10 at this time is perpendicular to the X-ray irradiation direction, confirmation is easier. Since the direction in which the guide pin P is inserted can be predicted by these operations, it is confirmed that it is correct. With the above, the setting of the AP surface and the ML surface is completed, and the guide pin P inserted from the guide pin insertion hole 6 of the device 1 passes through the lag screw insertion hole 12 of the nail 8 and the two markers 20. It will be accurately inserted into the center of the bone head 13 through the line. When inserting the guide pin P, the X-ray transmission image confirms that the guide pin P is inserted in the correct direction and angle.

  In this case, since the marker portion 17 can be expanded and contracted, the insertion state of the guide pin 4 can be confirmed in a longer range if the marker portion 17 is extended to reach the body. If the guide pin 4 is correctly inserted, the guide 14 is removed, the guide sleeve 4 is pulled out, and the lag screw is inserted to a predetermined depth of the bone head 13. Make sure that is correct.

DESCRIPTION OF SYMBOLS 1 Target device 2 Base part 3 Device arm 4 Tip part 5 Guide sleeve 6 Guide pin insertion hole 7 Femur 8 Nail 9 Recessed part 10 Aiming (U-shaped groove)
DESCRIPTION OF SYMBOLS 11 Base pillar part 12 Lag screw insertion hole 13 Bone head 14 Center guide 15 Fitting part 16 Guide arm 17 Marker part 18 Tail pillar 19 Guide groove 20 Marker 21 Through-hole 22 Fixing knob P Guide pin

Claims (5)

  It is connected to the upper part of the nail inserted along the bone axis from the proximal end of the femur, hangs along the outer side of the thigh, and is inserted through the lag screw insertion hole formed in the nail at the lower end part A target device in which a guide pin insertion hole for inserting a guide pin for guiding the lag screw is formed toward the lag screw insertion hole, and the guide pin insertion hole and the lag screw insertion hole coupled to the guide pin insertion hole. For the treatment of femoral fractures comprising a center guide provided with an X-ray marker that rotates around the axis connecting the two and receives X-ray irradiation and sets the insertion direction of the guide pin with respect to the femoral head by the transmitted image In the surgical instrument, the X-ray marker is formed in the shape of two walls that are deep in the X-ray irradiation direction, and the rag scribing is performed at the guide pin protruding portion of the target device or nail. Femur fracture treatment surgical instrument, characterized in that a matched sight with the center line of over thorns in hole.   The surgical instrument for treating a femoral fracture according to claim 1, wherein the X-ray marker is two loop-shaped metal wires parallel to the surface of the center guide.   The surgical instrument for treating a femur fracture according to claim 1 or 2, wherein the aim is provided on an AP surface that is X-ray irradiation from the front and rear direction of the femur and an ML surface that is X-ray irradiation from the left and right direction.   The surgical instrument for treating a femoral fracture according to claim 3, wherein the aim of the ML surface is a U-shaped groove perpendicular to the X-ray irradiation direction provided in the target device.   The surgical instrument for treating a femoral fracture according to any one of claims 1 to 4, wherein the center guide can be expanded and contracted.