阅读说明：本技术 引导器件和骨孔形成方法 (Guide device and bone hole forming method ) 是由 松村保之 坂本宜瑞 藤崎健 于 2020-03-06 设计创作，主要内容包括：引导器件具备：筒状的引导部,其具有供超声波探头贯穿的第1通孔,并用于引导贯穿第1通孔的超声波探头的移动,该超声波探头用于使其顶端部接触于骨并利用超声波振动在该骨上形成孔；以及突出部,其具有与第1通孔平行地延伸的第2通孔,该突出部从引导部的一端突出,并且该突出部的与第2通孔的轴线正交的截面形状同所述超声波探头的顶端部的、与所述第1通孔的轴线正交的截面形状一致。(The guide device is provided with: a tubular guide portion which has a 1 st through hole through which the ultrasonic probe is inserted and guides movement of the ultrasonic probe inserted through the 1 st through hole, the ultrasonic probe being configured to contact a distal end portion thereof with a bone and to form a hole in the bone by ultrasonic vibration; and a protrusion having a 2 nd through hole extending in parallel with the 1 st through hole, the protrusion protruding from one end of the guide portion, and a cross-sectional shape of the protrusion orthogonal to an axis of the 2 nd through hole being identical to a cross-sectional shape of the distal end portion of the ultrasonic probe orthogonal to the axis of the 1 st through hole.)

1. A guide device, characterized in that,

the guide device is provided with:

a tubular guide portion which has a 1 st through hole through which an ultrasonic probe is inserted, and which guides movement of the ultrasonic probe inserted through the 1 st through hole, the ultrasonic probe being configured to contact a distal end portion of the ultrasonic probe with a bone and to form a hole in the bone by ultrasonic vibration; and

and a protrusion having a 2 nd through hole extending in parallel with the 1 st through hole, the protrusion protruding from one end of the guide portion, and a cross-sectional shape of the protrusion orthogonal to an axis of the 2 nd through hole being identical to a cross-sectional shape of the distal end portion of the ultrasonic probe orthogonal to the axis of the 1 st through hole.

2. Guiding device according to claim 1,

a tip end portion of the guide portion is obliquely removed from one end of the guide portion with respect to an axis of the guide portion.

3. Guiding device according to claim 1,

the base end of the protrusion is provided so as to be located on the outer peripheral surface of one end side of the guide portion.

4. Guiding device according to claim 1,

the guide means further has a rib provided upright on an outer peripheral surface of the guide portion,

the rib extends in the axial direction of the guide portion and has a scale indicating the length of the distal end portion of the ultrasonic probe inserted into the bone hole.

5. A guide device, wherein,

the guide device is provided with:

a tubular guide portion which has a through hole through which an ultrasonic probe is inserted, and which guides movement of the ultrasonic probe inserted through the through hole, the ultrasonic probe being configured to contact a distal end portion of the ultrasonic probe with a bone and to form a hole in the bone by ultrasonic vibration;

an offset portion provided at a position offset with respect to an axis of the through hole on a distal end side of the guide portion, the offset portion having an abutment portion capable of abutting against an outer wall of the bone at a position closer to the through hole in a direction orthogonal to the axis; and

and a bone hole introduction portion provided on the offset portion on a side opposite to a side where the through hole is located in a direction orthogonal to the axis, the bone hole introduction portion being capable of being introduced into the hole formed in the bone, a cross-sectional shape of the bone hole introduction portion in the direction orthogonal to the axis having a rectangular shape smaller than a rectangle inscribed in an inner peripheral surface of the through hole.

6. The guiding device of claim 5,

the guide portion has a circular cross-sectional shape in a direction orthogonal to the axis.

7. The guiding device of claim 5,

the offset portion is tapered from the guide portion side toward a tip end side in a direction along the axis.

8. The guiding device of claim 5,

the bone hole introduction part has a rectangular cross-sectional shape in a direction orthogonal to the axis.

9. The guiding device of claim 5,

the guide portion, the offset portion, and the bone hole introduction portion have linear gravity center positions.

10. The guiding device of claim 5,

the through hole has a cross-sectional shape in a direction orthogonal to the axis that is larger than a cross-sectional shape of the distal end portion of the ultrasonic probe in the direction orthogonal to the axis.

11. A bone hole forming method, wherein,

in the bone hole forming method, a guide device is used, and the guide device includes:

a tubular guide portion which has a through hole through which an ultrasonic probe is inserted, and which guides movement of the ultrasonic probe inserted through the through hole, the ultrasonic probe being configured to contact a distal end portion of the ultrasonic probe with a bone and to form a hole in the bone by ultrasonic vibration;

an offset portion provided at a position offset with respect to an axis of the through hole on a distal end side of the guide portion, the offset portion having an abutment portion capable of abutting against an outer wall of the bone at a position closer to the through hole in a direction orthogonal to the axis; and

a bone hole introduction portion provided on the offset portion on a side opposite to a side where the through hole is located in a direction orthogonal to the axis, the bone hole introduction portion being capable of being introduced into the hole formed in the bone, a cross-sectional shape of the bone hole introduction portion in the direction orthogonal to the axis having a rectangular shape smaller than a rectangle inscribed in an inner peripheral surface of the through hole,

in the bone hole forming method, the offset portion is inserted between bones of the joint, the abutting portion is abutted against the outer wall,

forming a 1 st bone hole in the bone by the ultrasonic probe inserted into the through hole of the guide portion in a state where the abutting portion abuts against the outer wall,

the bone hole leading-in part is led into and embedded into the 1 st bone hole,

forming a 2 nd bone hole on the bone using the ultrasonic probe inserted into the through hole of the guide part in a state where the bone hole introduction part is fitted into the 1 st bone hole,

cutting a bone portion between the 1 st and 2 nd bone holes using the ultrasonic probe.

12. The bone hole forming method according to claim 11,

when the bone portion is cut by the ultrasonic probe, the ultrasonic probe is inserted into the through hole of the guide portion in a state where the offset portion of the guide device is in contact with the inner wall surface of the 1 st bone hole.

Technical Field

The invention relates to a guide device and a bone hole forming method.

Background

In the anterior cruciate ligament reconstruction technique based on the BTB (Bone tension Bone: Bone-patellar Tendon-Bone) method for fixing tendons with rectangular Bone fragments, it has been known that a rectangular Bone hole for fixing the Bone fragments is formed in an anterior cruciate ligament attachment portion on the lateral surface of the femoral lateral condyle by an ultrasonic probe (see patent document 1 and the like). When such a rectangular bone hole is formed by the ultrasonic probe, since the joint cavity is narrow, two bone holes of a quadrangle smaller than a desired rectangular bone hole are temporarily formed adjacently, and then the two bone holes are communicated to form 1 bone hole.

Documents of the prior art

Patent document

Patent document 1: international publication No. 2018/078831

Disclosure of Invention

Problems to be solved by the invention

However, when forming two bone holes, the operator advances the ultrasonic probe with respect to the anterior cruciate ligament attachment portion using the free hand, and therefore it is difficult to accurately orient the axis of the ultrasonic probe in the direction and position in which the bone hole is to be formed. Therefore, it is difficult to form a desired bone hole in a direction and at a position where the bone hole is to be formed.

The present invention has been made in view of the above-described problems, and an object thereof is to provide a guide device and a bone hole forming method that assist an operation of forming a desired bone hole in a direction in which the bone hole is to be formed using an ultrasonic probe.

Means for solving the problems

In order to solve the above problems and achieve the object, the present invention provides a guide device, comprising: a tubular guide portion which has a 1 st through hole through which an ultrasonic probe is inserted, and which guides movement of the ultrasonic probe inserted through the 1 st through hole, the ultrasonic probe being configured to contact a distal end portion of the ultrasonic probe with a bone and to form a hole in the bone by ultrasonic vibration; and a protrusion having a 2 nd through hole extending in parallel with the 1 st through hole, the protrusion protruding from one end of the guide portion, and a cross-sectional shape of the protrusion orthogonal to an axis of the 2 nd through hole being identical to a cross-sectional shape of the distal end portion of the ultrasonic probe orthogonal to the axis of the 1 st through hole.

In the above-described invention, the guide device according to the present invention is characterized in that a distal end portion of the guide portion is removed from one end of the guide portion so as to be inclined with respect to an axis of the guide portion.

In the above-described guide device, the base end of the protrusion is provided so as to be positioned on the outer peripheral surface of the guide portion on the one end side.

In the above-described invention, the guide device of the present invention further includes a rib provided upright on the outer peripheral surface of the guide portion, the rib extending in the axial direction of the guide portion and having a scale indicating the length of insertion of the distal end portion of the ultrasonic probe into the bone hole.

Further, the present invention provides a guide device, comprising: a tubular guide portion which has a through hole through which an ultrasonic probe is inserted, and which guides movement of the ultrasonic probe inserted through the through hole, the ultrasonic probe being configured to contact a distal end portion of the ultrasonic probe with a bone and to form a hole in the bone by ultrasonic vibration; an offset portion provided at a position offset with respect to an axis of the through hole on a distal end side of the guide portion, the offset portion having an abutment portion capable of abutting against an outer wall of the bone at a position closer to the through hole in a direction orthogonal to the axis; and a bone hole introduction portion provided on the offset portion on a side opposite to a side where the through hole is located in a direction orthogonal to the axis, the bone hole introduction portion being capable of being introduced into the hole formed in the bone, a cross-sectional shape of the bone hole introduction portion in the direction orthogonal to the axis having a rectangular shape smaller than a rectangle inscribed in an inner peripheral surface of the through hole.

In the above-described invention, the guide device of the present invention is characterized in that a cross-sectional shape of the guide portion in a direction orthogonal to the axis is circular.

In the above-described invention, the guide device of the present invention is characterized in that the offset portion is tapered from the guide portion side toward the tip end side in the direction along the axis.

In the above-described invention, the guide device according to the present invention is characterized in that the bone hole introducing portion has a rectangular cross-sectional shape in a direction orthogonal to the axis.

In the above-described invention, the guide device of the present invention is characterized in that each of the center of gravity positions of the guide portion, the offset portion, and the bone hole introduction portion is linear.

In the above-described invention, the guide device according to the present invention is characterized in that a cross-sectional shape of the through hole in a direction orthogonal to the axis is larger than a cross-sectional shape of the distal end portion of the ultrasonic probe in the direction orthogonal to the axis.

Further, the present invention provides a bone hole forming method using a guide device, the guide device including: a tubular guide portion which has a through hole through which an ultrasonic probe is inserted, and which guides movement of the ultrasonic probe inserted through the through hole, the ultrasonic probe being configured to contact a distal end portion of the ultrasonic probe with a bone and to form a hole in the bone by ultrasonic vibration; an offset portion provided at a position offset with respect to an axis of the through hole on a distal end side of the guide portion, the offset portion having an abutment portion capable of abutting against an outer wall of the bone at a position closer to the through hole in a direction orthogonal to the axis; and a bone hole introduction portion provided on the opposite side of the offset portion to the side where the through hole is located in the direction orthogonal to the axis, the bone hole introduction portion being capable of being introduced into the hole formed in the bone, a cross-sectional shape of the bone hole introduction portion in the direction orthogonal to the axis having a rectangular shape smaller than a rectangle inscribed in an inner peripheral surface of the through hole, in the bone hole forming method, the offset portion is inserted between bones of a joint, the abutment portion is brought into abutment with the outer wall, in a state in which the abutment portion is brought into abutment with the outer wall, a 1 st bone hole is formed in the bone by the ultrasonic probe inserted into the through hole of the guide portion, the bone hole introduction portion is introduced and fitted into the 1 st bone hole, and in a state in which the bone hole introduction portion is fitted into the 1 st bone hole, a 2 nd bone hole is formed in the bone by the ultrasonic probe inserted into the through hole of the guide portion, cutting a bone portion between the 1 st and 2 nd bone holes using the ultrasonic probe.

In the above-described bone hole forming method according to the present invention, when the bone portion is cut by the ultrasonic probe, the ultrasonic probe is inserted into the through hole of the guide portion in a state where the offset portion of the guide device is in contact with the inner wall surface of the 1 st bone hole.

ADVANTAGEOUS EFFECTS OF INVENTION

The guide device and the bone hole forming method of the present invention have an effect of being able to assist an operation of forming a desired bone hole in a direction in which the bone hole is to be formed using the ultrasonic probe.

Drawings

Fig. 1 is a schematic configuration diagram of an ultrasonic device system according to embodiment 1.

Fig. 2 is a diagram showing an external shape of the distal treatment portion of the ultrasonic probe according to embodiment 1, as viewed from an oblique direction.

Fig. 3 is a view showing a state in which a bone hole is formed by an ultrasonic device.

Fig. 4 is a perspective view showing an external appearance of the guide device according to embodiment 1.

Fig. 5 is a sectional view of the guide device of embodiment 1.

Fig. 6 is a view showing a state where the small-diameter drill is inserted into a treatment target portion.

Fig. 7 is a view showing a state where the small-diameter drill is inserted through the 2 nd through hole.

FIG. 8 is a view showing a state in which the 1 st bone hole is formed in the treatment target site by the distal treatment portion.

Fig. 9 is a view showing a state where the protrusion is inserted into the 1 st bone hole.

Fig. 10 is a view showing a state in which a 2 nd bone hole is formed in a treatment target site by the distal end treatment portion.

Fig. 11 is a view showing a treatment target site in which the 1 st bone hole and the 2 nd bone hole are opened.

Fig. 12 is a diagram showing a treatment target site in which a desired rectangular bone hole is formed.

Fig. 13 is a view showing a part of an ultrasonic device to which the guide device of embodiment 2 is attached.

Fig. 14 is a diagram showing a state in which the ultrasonic probe is inserted into a treatment target region.

Fig. 15 is a perspective view showing a guide device according to embodiment 3.

Fig. 16 is a view showing the guide device according to embodiment 3 as viewed from the tip end side along the axial direction.

Fig. 17 is a sectional view showing a state where an ultrasonic probe is inserted through a through hole of a guide device according to embodiment 3.

Fig. 18 is a perspective view showing a state where the offset portion of the guide device is inserted between bones of the knee joint.

Fig. 19 is a view showing a state in which the 1 st abutment surface of the offset portion is abutted against the posterior wall of the femoral lateral condyle.

FIG. 20 is a view showing a state where the distal treatment portion is brought into contact with the formation position of the 1 st bone hole.

FIG. 21 is a view showing a state in which a 1 st bone hole is formed by cutting with the distal treatment portion.

Fig. 22 is a perspective view showing a state in which the 1 st bone hole is formed in the femoral outer condyle.

Fig. 23 is a view showing a state in which a bone hole introducing part is introduced into the 1 st bone hole.

FIG. 24 is a view showing a state where the distal treatment portion is brought into contact with the formation position of the 2 nd bone hole.

FIG. 25 is a view showing a state in which a 2 nd bone hole is formed by cutting with the distal treatment portion.

Fig. 26 is a perspective view showing a state in which the 1 st bone hole and the 2 nd bone hole are formed in the femoral outer condyle.

FIG. 27 is a view showing a state where the 2 nd abutment surface of the offset part abuts against the 1 st inner wall surface of the 1 st bone hole.

Fig. 28 is a view showing a state where the distal end treatment portion is in contact with a partition wall existing between the 1 st bone hole and the 2 nd bone hole.

Fig. 29 is a view showing a state in which a partition wall existing between the 1 st bone hole and the 2 nd bone hole is cut by the distal end treatment portion.

Fig. 30 is a diagram showing a state where a desired rectangular bone hole is formed.

Fig. 31 is a perspective view showing a state in which a desired rectangular bone hole is formed in the femoral outer condyle.

Detailed Description

Next, an embodiment of the guide device of the present invention is explained. The present invention is not limited to the embodiments.

(embodiment mode 1)

Fig. 1 is a schematic configuration diagram of an ultrasonic device system 1 according to embodiment 1. The ultrasonic device system 1 according to embodiment 1 is composed of an ultrasonic device 2, a power supply unit 3, and a foot switch 4. The ultrasonic device 2 and the power supply unit 3 are connected by a cable 28, and supply of driving power and communication of control signals are performed from the power supply unit 3 to the ultrasonic device 2 via the cable 28. The power supply unit 3 is provided with a plurality of connectors 31 to which cables 28 and the like are connected, a plurality of operation switches 33, and a display screen 32 on which information necessary for treatment is displayed.

The ultrasonic device 2 has a device body 21 and an ultrasonic probe 24. The device main body 21 includes a case 21a through which the ultrasonic probe 24 passes and an ultrasonic wave generating portion 21b which is detachable from the case 21 a. An ultrasonic vibration element 22 formed of a piezoelectric body or the like and a horn 23 for transmitting ultrasonic waves efficiently are housed in the ultrasonic wave generating section 21 b. In a state where the ultrasonic generator 21b is attached to the housing 21a, the proximal end side of the ultrasonic probe 24 and the distal end side of the horn 23 are connected, and the ultrasonic vibration generated by the ultrasonic generator 21b is transmitted to the distal end treatment portion 25 of the ultrasonic probe 24. An operation switch 27 for instructing on/off of the ultrasonic vibration by a finger operation is provided on the upper surface of the housing 21 a. The foot switch 4 has a function similar to that of the operation switch 27, and instructs the ultrasonic vibration to be turned on or off by foot operation. A part of the outer periphery of the ultrasonic probe 24 is covered with the sheath 26 to an arbitrary length from the housing 21 a.

Fig. 2 is a diagram showing an external shape of the distal treatment portion 25 of the ultrasonic probe 24 according to embodiment 1, as viewed from an oblique direction. The ultrasonic probe 24 of embodiment 1 is formed integrally with a distal end treatment portion 25 provided on the distal end side in the arrow a direction in the drawing, which is the axial direction of the ultrasonic probe 24. As the material of the ultrasonic probe 24 and the distal end treatment portion 25, for example, titanium alloy or the like can be used. The distal end treatment portion 25 is a cutting tool using ultrasonic vibration, and includes a base portion 25a and a distal end portion 25 b. The base portion 25a is formed in a shape that defines the contour shape of a bone hole formed in a bone by the ultrasonic probe 24. The base portion 25a has a rectangular cross-sectional shape orthogonal to the axis, with a length a on one side and a length b (< a) on the other side. The distal end portion 25b is formed in a mountain shape that contacts the bone in the direction of travel of the ultrasonic probe 24.

Next, the formation of the bone hole 101 by the ultrasonic probe 24 will be described with reference to fig. 3. When the distal treatment portion 25 of the ultrasonic probe 24 is brought into contact with the treatment target site 100 of the bone and ultrasonically vibrated in the direction of arrow B in the drawing, the portion of the bone which mechanically collides with the distal treatment portion 25 is pulverized into fine particles by the hammering action. Then, the operator pushes the distal treatment portion 25 into the treatment target site 100, whereby the distal treatment portion 25 crushes bone powder and enters the treatment target site 100, thereby forming a rectangular bone hole 101 having the same cross-sectional shape as the base portion 25a perpendicular to the axis.

In the anterior cruciate ligament reconstruction using the ultrasonic device system 1 according to embodiment 1, rectangular longitudinal a × transverse b 1-st and 2-nd bone holes 111 and 112 (see fig. 11) are formed in the anterior cruciate ligament attachment portion on the lateral surface of the femoral condyle as the treatment target site 100 so as to be adjacent to each other at a predetermined interval Δ b (< b). Then, the 1 st bone hole 111 and the 2 nd bone hole 112 are connected to each other, thereby finally forming a rectangular bone hole 110 (see fig. 12) having a length a on one side and a length 2b + Δ b on the other side.

Next, the guide device 5 for guiding the ultrasonic probe 24 in the traveling direction will be described. Fig. 4 is a perspective view showing an external appearance of the guide device 5 according to embodiment 1. Fig. 5 is a sectional view of the guide device 5 of embodiment 1.

The guide device 5 of embodiment 1 has a guide portion 51 and a protruding portion 52. The guide unit 51 is a tube having a 1 st through hole 51a through which the ultrasonic probe 24 is inserted, and guides the ultrasonic probe 24 in the traveling direction while restricting the traveling direction of the ultrasonic probe 24 to a fixed direction. The guide portion 51 has a cutout portion 51b formed by removing the guide portion 51 obliquely to the arrow C direction in the figure, which is the axial direction of the guide portion 51. Thus, since a space is formed near the protruding portion 52 of the guide portion 51, visibility of the distal treatment portion 25 of the ultrasonic probe 24 inserted through the 1 st through hole 51a can be improved.

The projection 52 projects by a length L and has a 2 nd through hole 52a parallel to the 1 st through hole 51a through which the small-diameter drill 6 passes. In embodiment 1, the "small diameter" refers to a diameter of a circle smaller than a cross-sectional shape of the ultrasonic probe 24 orthogonal to the axis. In embodiment 1, the diameter of the small-diameter drill 6 is 2.4[ mm ]]. In addition, the axis AX of the 1 st through hole 51a shown in FIG. 5₁And the axis AX of the 2 nd through hole 52a₂The inter-axial distance d therebetween is shorter than the long side of the finally formed rectangular bone hole 110 (see fig. 12). The protruding portion 52 is provided on the outer peripheral surface of the leading end side, which is one end side of the guide portion 51. The tip of the protrusion 52 protrudes further toward the axial tip than the tip of the guide 51. The base end of the protrusion 52 is located on the outer peripheral surface of the leading end side of the guide 51. Of the projection 52 with the axis AX₂The orthogonal cross-sectional shape is non-circular and coincides with the cross-sectional shape of the distal treatment portion 25 orthogonal to the axis. Preferably, the protrusion 52 has a radius from the axis AX₂The orthogonal cross-sectional shape is smaller than the cross-sectional shape orthogonal to the axis of the distal treatment portion 25, and the protrusion 52 is configured to be able to fit into the bone hole formed by the distal treatment portion 25Size. The length L of the projection 52 is such that the guide 51 will not be displaced when the projection 52 is inserted into the bone hole, and L is set to 5[ mm ], for example]。

The traveling direction of the ultrasonic probe 24 is determined by inserting the ultrasonic probe 24 through the 1 st through hole 51a of the guide device 5 and guiding the ultrasonic probe 24 by the inner peripheral surface of the 1 st through hole 51 a. The ultrasonic probe 24 is inserted through the 1 st through hole 51a of the guide 51, and the distal treatment portion 25 is pressed against the treatment target site 100 while protruding from the opening on the axial distal end side of the 1 st through hole 51 a.

Next, a procedure of guiding the ultrasonic probe 24 by the guide device 5 and forming a bone hole of a desired rectangular shape in the treatment target site 100 of the bone will be described.

Fig. 6 is a diagram showing a state in which the small-diameter drill 6 is inserted into a treatment target site 100 of a bone. The treatment target site 100 is a site in which a bone hole is formed by the ultrasonic probe 24 and which is a site of a bone to be treated is modeled and represented. First, the operator aligns the axis of the small-diameter drill 6 with the direction in which a bone hole is to be formed in the treatment target site 100, and inserts the small-diameter drill 6 into the treatment target site 100 as shown in fig. 6. Next, as shown in fig. 7, the operator inserts the small-diameter drill 6 inserted into the treatment target site 100 through the 2 nd through hole 52a of the projection 52 in the guide device 5, and brings the projection 52 into contact with the surface of the treatment target site 100. Next, the operator inserts the ultrasonic probe 24 into the 1 st through hole 51a of the guide portion 51 in the guide device 5, and projects the distal treatment portion 25 from the cutaway portion 51 b. Then, as shown in fig. 8, the operator brings the distal treatment portion 25 into contact with the surface of the treatment target region 100 so that one side of the length a in the cross-sectional shape orthogonal to the axis of the distal treatment portion 25 and the surface of the protrusion portion 52 facing the ultrasonic probe 24 are parallel to each other. At this time, the ultrasonic probe 24 is guided by the inner peripheral surface of the 1 st through hole 51a and advanced in a direction parallel to the axis of the small-diameter drill 6, that is, in a direction in which a bone hole is to be formed in the treatment target site 100. Then, the operator causes the ultrasonic probe 24 to ultrasonically vibrate, and thereby forms the 1 st bone hole 111 having a length a on one side and a length b on the other side at the treatment target site 100 by the distal treatment portion 25, as shown in fig. 8.

Next, the operator pulls out the small-diameter drill 6 and the ultrasonic probe 24 from the treatment target site 100. Thereafter, as shown in fig. 9, the operator reverses the orientation of the guide device 5 by 180 degrees, and inserts the protrusion 52 into the 1 st bone hole 111. Thereby, the distal end of the guide portion 51 is positioned to face the drill hole 120 opened in the treatment target site 100 by the small-diameter drill 6, and the guide device 5 is positioned with respect to the treatment target site 100. Next, as shown in fig. 10, the operator causes the ultrasonic probe 24 to penetrate through the 1 st through hole 51a of the guide 51, and causes the distal end treatment portion 25 to protrude from the 1 st through hole 51a, so that the distal end treatment portion 25 is brought into contact with the surface of the treatment target portion 100 such that the one side of the distal end treatment portion 25 and the surface of the protrusion 52 facing the ultrasonic probe 24 are parallel to each other. At this time, the advancing direction of the ultrasonic probe 24 is restricted by the inner peripheral surface of the 1 st through hole 51a to the direction in which a bone hole is to be formed with respect to the treatment target site 100. Then, as shown in fig. 10 and 11, the operator ultrasonically vibrates the ultrasonic probe 24 to form a 2 nd bone hole 112 having a length a on one side and a length b on the other side at the treatment target site 100 by the distal treatment portion 25. By forming the 2 nd bone hole 112 in the treatment target site 100 in this manner, the penetrating direction of the 2 nd bone hole 112 is formed parallel to the penetrating direction of the 1 st bone hole 111.

After the 2 nd bone hole 112 is formed at the treatment target site 100, the operator pulls out the ultrasonic probe 24 and the guide device 5 from the treatment target site 100. As a result, as shown in fig. 11, in the treatment target site 100, the 1 st bone hole 111 and the 2 nd bone hole 112 are adjacent to each other with a bone portion having a certain gap Δ b between the 1 st bone hole 111 and the 2 nd bone hole 112. For the interval Δ b, Δ b < b, preferably Δ b < 0.5 b. Then, the operator removes the bone between the 1 st bone hole 111 and the 2 nd bone hole 112 in the treatment target site 100 using a dilator or the like, and as shown in fig. 12, the 1 st bone hole 111 and the 2 nd bone hole 112 are communicated with each other, thereby finally forming a rectangular bone hole 110 having a vertical direction a × a horizontal direction (2b + Δ b). As an example, in the case where a is 5[ mm ], b is 4[ mm ], and Δ b is 2[ mm ], a rectangular bone hole 110 having one side of 5[ mm ] and the other side of 10[ mm ] is formed.

In embodiment 1, by guiding the ultrasonic probe 24 using the guide device 5, the 1 st bone hole 111 and the 2 nd bone hole 112 can be adjacently formed at a target position and angle with respect to the treatment target site 100. Thereby, the desired rectangular bone hole 110 can be accurately formed in the direction in which the bone hole is to be formed, without being limited to the operator. In particular, the effect is more remarkable when the skill of the operator is low.

In embodiment 1, the axis AX of the 1 st through hole 51a shown in fig. 5 is defined by₁And the axis AX of the 2 nd through hole 52a₂The axial distance d between the protrusion 52 and the axis AX of the 2 nd through hole 52a₂When the length in the orthogonal direction is b, the inter-axis distance d is shorter than the length (2b + Δ b) on the other side of the long side of the rectangular bone hole 110 (b < d < 2b + Δ b). As described above, since Δ b < b, and preferably Δ b < 0.5b, is given to the distance Δ b, the inter-axis distance d satisfies b < d < 3b, and preferably satisfies b < d < 2.5 b. Thus, when the 2 nd bone hole 112 is formed in the treatment target portion 100, the distal treatment portion 25 that is in contact with the surface of the treatment target portion 100 is positioned in the drill hole 120 opened by the small-diameter drill 6 that penetrates the 2 nd through hole 52 a. Therefore, by forming the 2 nd bone hole 112 in the treatment target site 100, the drill hole 120 can be eliminated from the treatment target site 100, and therefore, it is possible to prevent an unnecessary hole from being left in the treatment target site 100.

(embodiment mode 2)

Next, embodiment 2 of the present invention will be explained. In the following description of embodiment 2, the same components as those of embodiment 1 are denoted by the same reference numerals, and detailed description thereof will be omitted. The procedure for guiding the ultrasonic probe 24 using the guide device 5 and forming the desired rectangular bone hole 110 in the treatment target site 100 is substantially the same as that of embodiment 1, and the detailed description of the portions common to embodiment 1 is omitted.

Fig. 13 is a view showing a part of the ultrasonic device 2 to which the guide device 5 of embodiment 2 is attached. Fig. 14 is a diagram showing a state in which the ultrasonic probe 24 is inserted into the treatment target region 100.

As shown in fig. 13, the guide device 5A of embodiment 2 is provided with a wing portion 54 having a scale 54a on the outer peripheral surface of the guide portion 51 on the rear end side in the axial direction. The wing portion 54 is a flat plate that is erected from the outer peripheral surface of the guide portion 51 and extends in the axial direction of the guide portion 51. The scale 54a indicates the length of the distal treatment portion 25 of the ultrasonic probe 24 that enters the treatment target portion 100 after forming a bone hole therein. The wing part 54 is located on the axis AX of the guide part 51₁The orthogonal direction is on the opposite side of the projection 52. The guide device 5A has a cap 55 that can be attached to the tip portion of the case 21a of the ultrasonic device 2. The cap 55 is provided with a regulating plate 53 as a regulating portion, and the regulating plate 53 contacts the wing portion 54 around the axis of the guide portion 51, whereby the guide portion 51 is regulated to rotate about the small-diameter drill 6 inserted through the 2 nd through hole 52 a.

In the case of the guide device 5A according to embodiment 2, when the 1 st bone hole 111 is formed in the treatment target site 100, the rotation of the guide portion 51 is restricted by bringing the wing portion 54 into contact with the restriction plate 53, and the ultrasonic probe 24 is inserted into the 1 st through hole 51 a. This enables the distal treatment portion 25 to be relatively positioned with respect to the small-diameter drill 6 that has passed through the 2 nd through hole 52 a. As a result, the positional accuracy in forming the 1 st bone hole 111 in the treatment target site 100 by the distal end treatment portion 25 can be improved.

Further, the restricting plate 53 is provided with a chevron-shaped pointer 53a, and the pointer 53a is an indicating portion that indicates the position of the scale 54a corresponding to the entry length of the distal end treatment portion 25 in a state where the restricting plate 53 and the wing portion 54 are in contact with each other. As shown in fig. 13, the scale 54a is indicated to be 0[ mm ] by the pointer 53a in a state where the distal treatment portion 25 is brought into contact with the surface of the treatment target portion 100. As shown in fig. 14, in a state where the distal treatment portion 25 has entered the inside of the treatment target portion 100, the wing portion 54 is relatively moved with respect to the limiting plate 53, and thereby, for example, the scale 54a is indicated to be 40[ mm ] by the pointer 53a as the entered length of the distal treatment portion 25.

In the guide device 5A according to embodiment 2, when the operator forms the 1 st bone hole 111 and the 2 nd bone hole 112 in the treatment target site 100 using the ultrasonic probe 24, the entered length of the distal treatment portion 25 can be read by the scale 54 a. Thus, the 1 st and 2 nd bone holes 111 and 112 of the target depth are easily formed without being limited to the operator.

(embodiment mode 3)

Next, embodiment 3 of the present invention will be explained. In the following description of embodiment 2, the same components as those of embodiment 1 are denoted by the same reference numerals, and detailed description thereof will be omitted.

Fig. 15 is a perspective view showing a guide device 305 according to embodiment 3. Fig. 16 is a view of the guide device 305 of embodiment 3 as viewed from the tip side in the axial direction. Fig. 17 is a sectional view showing a state where the ultrasonic probe 24 is inserted through the guide device 305 according to embodiment 3.

The guide device 305 of embodiment 3 has a guide portion 351, a biasing portion 352, a bone hole introduction portion 353, and a handle portion 354.

The guide 351 has a through hole 351a through which the ultrasonic probe 24 is inserted, and is a tube shape that guides the movement of the ultrasonic probe 24 while restricting the travel of the ultrasonic probe 24 inserted through the through hole 351a to a fixed direction. The guide portion 351 is aligned with the axis AX₃The cross-sectional shape in the orthogonal direction is circular.

The guide portion 351 has a notch 351b at the distal end thereof, and the notch 351b is aligned along the axis AX₃Is formed by obliquely removing the cutting line in the axial direction E. Accordingly, since a space is formed in the guide portion 351 at a position near the offset portion 352 and the bone hole introduction portion 353, visibility of the distal treatment portion 25 of the ultrasonic probe 24 inserted through the through hole 351a can be improved.

The offset portion 352 is plate-shaped extending in the axial direction E, and is provided on the distal end side of the guide portion 351 with respect to the axis AX₃An offset position. The offset portion 352 protrudes further toward the distal end side in the axial direction E than the distal end of the guide portion 351. Further, the base end of the offset portion 352 is located on the outer peripheral surface of the leading end side of the guide portion 51. At the offset portion 352 on the axis AX₃A 1 st contact surface 352a is provided at a position closer to the through hole 351a in the orthogonal direction, and the 1 st contact surfaceThe surface 352a is an abutment portion that can abut against a posterior wall 401 (see fig. 19) that is an outer wall of the femoral external condyle 400 to be described later as a treatment target portion. In addition, the offset portion 352 is located at the axis AX₃The 2 nd contact surface 352b is provided on the opposite side of the 1 st contact surface 352a in the orthogonal direction. Further, the offset portion 352 may be along the axis AX₃In the direction of (3), a tapered shape is formed from the guide portion 351 side toward the distal end side.

In embodiment 3, as shown in fig. 15, the offset portion 352 has a width W in the 1 st orthogonal direction orthogonal to the axial direction E₁For example, set to 5[ mm ]]. In embodiment 3, as shown in fig. 16, the offset portion 352 has a thickness t in the 2 nd orthogonal direction orthogonal to the axial direction E₁For example, set to 1[ mm ]]。

In embodiment 3, the axis AX is aligned with the distal end treatment portion 25 of the ultrasonic probe 24 inserted into the through hole 351a of the guide 351 and the 1 st abutment surface 352a of the biasing portion 352, as shown in fig. 17₃Distance d in orthogonal direction₁For example, set to 2[ mm ]]。

The bone hole introduction portion 353 is capable of being introduced into a bone hole formed in the femoral lateral condyle 400 and abuts the offset portion 352. Specifically, the bone hole introduction portion 353 is provided on the same axis AX as the offset portion 352₃The side opposite to the side where the through hole 351a is located in the orthogonal direction, in other words, the 2 nd contact surface 352b side of the offset portion 352. The bone hole introduction portion 353 protrudes from the distal end of the guide portion 351 by a length L in the axial direction E. The bone hole introduction portion 353 is connected to the outer peripheral surface of the guide portion 351 on the distal end side. The distal end of the bone hole introduction portion 353 is located on the distal end side of the distal end of the guide portion 351 in the axial direction E, and is located on the proximal end side of the distal end of the offset portion 352 in the axial direction E. The proximal end of the bone hole introduction portion 353 is located closer to the proximal end side than the distal end of the guide portion 51 in the axial direction E, and is located closer to the distal end side than the proximal end of the offset portion 352 in the axial direction E.

When the through hole 351a of the guide portion 351 is viewed from the axial direction E, the bone hole introduction portion 353 intersects with the axis AX₃The orthogonal cross-sectional shape is shown in FIG. 16, ratio and throughThe rectangle 360 inscribed in the inner peripheral surface of the hole 351a has a small rectangular shape. Further, the bone hole introduction portion 353 intersects the axis AX₃The cross-sectional shape in the orthogonal direction is the same as the cross-sectional shape (projected shape viewed from the axial direction E) orthogonal to the axis of the distal treatment portion 25 of the ultrasonic probe 24. The size of the cross-sectional shape of the bone hole introduction portion 353 is smaller than the cross-sectional shape (the projected shape) of the distal end treatment portion 25, and the bone hole introduction portion 353 is sized to be inserted into the bone hole formed by the distal end treatment portion 25 together with the offset portion 352.

In embodiment 3, the width W2 in the 1 st orthogonal direction orthogonal to the axial direction E of the bone hole introduction portion 353 shown in fig. 16 is set to, for example, 5[ mm [, n ]]. In embodiment 3, as shown in fig. 16, the thickness t of the bone hole introduction portion 353 in the 2 nd orthogonal direction orthogonal to the axial direction E is set to be smaller than the thickness t in the 2 nd orthogonal direction₂For example, set to 3[ mm ]]。

The length L of the 2 nd contact surface 352b of the offset portion 352 in the axial direction E₁And the length L of the bone hole introduction portion 353 in the axial direction E₂The length of the guide portion 351 is set so as not to be displaced from the femoral lateral condyle 400 when the offset portion 352 and the bone hole introduction portion 353 are inserted into the bone hole. In embodiment 3, the length L₁And said length L₂For example, each is set to 7[ mm ]]. In embodiment 3, the total thickness t (the distance between the 1 st contact surface 352a of the offset portion 352 and the contact surface 353a of the bone hole introduction portion 353) of the offset portion 352 and the bone hole introduction portion 353 in the 2 nd orthogonal direction orthogonal to the axial direction E shown in fig. 17₃For example, set to 4[ mm ]]。

The handle portion 354 is connected to the proximal end side of the guide portion 351 and is a portion that is held by the operator when performing treatment using the guide device 305. In embodiment 3, the shape of the handle portion 354 is a plate shape, but the shape of the handle portion 354 is not particularly limited as long as the shape does not hinder the penetration of the ultrasonic probe 24 into the through hole 351a of the guide portion 351 or the like.

In the guide device 305 according to embodiment 3, the guide portion 351, the offset portion 352, and the bone hole introduction portion 353 may be formed in a linear shape at their respective barycentric positions.

Fig. 18 is a perspective view showing a state where the offset portion 352 of the guide device 305 is inserted between bones of the knee joint. Fig. 19 is a view showing a state in which the 1 st abutment surface 352a of the offset portion 352 abuts against the posterior wall 401 of the lateral femoral condyle 400.

First, the operator aligns the axis of the guide device 305 with the direction in which the bone hole is to be formed in the lateral femoral condyle 400, inserts the offset portion 352 of the guide device 305 between the bones of the knee joint formed by the lateral femoral condyle 400 and the like as shown in fig. 18, and brings the 1 st abutment surface 352a of the offset portion 352 into abutment with the posterior wall 401 of the lateral femoral condyle 400 as shown in fig. 19. Next, as shown in fig. 20, the operator inserts the ultrasonic probe 24 into the through hole 351a of the guide portion 351 in the guide device 305, projects the distal treatment portion 25 from the cutaway portion 351b, and brings the distal treatment portion 25 into contact with the surface of the femoral external condyle 400 such that one side of the length a of the distal treatment portion 25 faces the posterior wall 401 side of the femoral external condyle 400. At this time, the ultrasonic probe 24 is guided by the inner peripheral surface of the through hole 351a and travels in a direction in which a bone hole is to be formed for the femoral condyle 400. Then, the operator ultrasonically vibrates the ultrasonic probe 24, thereby cutting the femoral external condyle 400 with the distal treatment portion 25 as shown in fig. 21. Thus, as shown in FIG. 22, the lateral femoral condyle 400 is separated from the posterior wall 401 by a distance d₁The position of (1) is formed with a 1 st bone hole 411 of a rectangular shape having a length of a on one side and a length of b (< a) on the other side. Further, the 1 st bone hole 411 is formed so as not to penetrate the lateral femoral condyle 400.

Next, the operator pulls out the ultrasonic probe 24 from the through hole 351a of the guide portion 351 in the guide device 305, and separates the 1 st abutment surface 352a of the offset portion 352 in the guide device 305 from the posterior wall 401 of the femoral lateral condyle 400. Thereafter, as shown in fig. 23, the operator inserts (inserts) the offset portion 352 and the bone hole introduction portion 353 of the guide member 305 into the 1 st bone hole 411, brings the abutment surface 353a of the bone hole introduction portion 353 into abutment with the 1 st inner wall surface 411a of the femoral condyle 400 located on the posterior wall 401 side in the 1 st bone hole 411, and brings the 1 st abutment surface 352a of the offset portion 352 into abutment with the 2 nd inner wall surface 411b facing the 1 st inner wall surface 411a in the 1 st bone hole 411. Thereby, positioning of the guide device 305 relative to the femoral lateral condyle 400 is accomplished.

Next, as shown in fig. 24, the operator inserts the ultrasonic probe 24 into the through hole 351a of the guide portion 351 in the guide device 305, projects the distal treatment portion 25 from the cutaway portion 351b, and brings the distal treatment portion 25 into contact with the surface of the femoral external condyle 400 such that the one side of the distal treatment portion 25 faces the 1 st bone hole 411 side. At this time, the ultrasonic probe 24 is guided by the inner peripheral surface of the through hole 351a and travels in a direction in which a bone hole is to be formed for the femoral condyle 400. Then, the operator ultrasonically vibrates the ultrasonic probe 24, thereby cutting the femoral external condyle 400 with the distal treatment portion 25 as shown in fig. 25. Thus, as shown in FIG. 26, the lateral femoral condyle 400 is separated from the 1 st bone hole 411 by a distance d₁Is positioned to form a 2 nd bone hole 412 having a length a on one side and a length b on the other side. In addition, the 2 nd bone hole 412 is formed so as not to penetrate the lateral femoral condyle 400. By forming the 2 nd bone hole 412 for the femoral external condyle 400 in this manner, the perforation direction of the 2 nd bone hole 412 is parallel to the perforation direction of the 1 st bone hole 411.

As shown in fig. 26, a predetermined distance (d) is left between the 1 st bone hole 411 and the 2 nd bone hole 412 of the femoral external condyle 400₁The same interval) of the septal walls 413, the 1 st bone hole 411 and the 2 nd bone hole 412 are formed adjacent to each other.

Next, the operator pulls out the ultrasonic probe 24 from the through hole 351a of the guide section 351 in the guide device 305. Thereafter, as shown in fig. 27, the operator pulls out the bone hole introduction portion 353 of the guide member 305 from the 1 st bone hole 411, and brings the 2 nd abutment surface 352b of the biasing portion 352 of the guide member 305 into abutment with the 1 st inner wall surface 411a of the 1 st bone hole 411. Thereby, positioning of the guide device 305 relative to the femoral lateral condyle 400 is accomplished.

Next, as shown in fig. 28, the operator inserts the ultrasonic probe 24 into the through hole 351a of the guide portion 351 of the guide device 305, projects the distal treatment portion 25 from the cutaway portion 351b, and brings the distal treatment portion 25 into contact with the femoral external condyle 400 such that the one side of the distal treatment portion 25 faces the 1 st bone hole 411 sideThe surface of the partition 413. At this time, the ultrasonic probe 24 is guided by the inner peripheral surface of the through hole 351a and travels in a direction in which a bone hole is to be formed for the femoral condyle 400. Then, the operator ultrasonically vibrates the ultrasonic probe 24, thereby cutting the septum 413 with the distal end treatment portion 25 as shown in fig. 29. As a result, as shown in FIG. 30, the 1 st bone hole 411 and the 2 nd bone hole 412 are communicated with each other, and finally, as shown in FIG. 31, one side is formed with a length a and the other side is formed with a length 2b + d₁A rectangular bone hole 410. As an example, when a is 5 mm]、b＝4[mm]、d₁＝2[mm]In the case of (2), one side is formed to be 5[ mm ]]The other side is 10 mm]A rectangular bone hole 410.

In embodiment 3, when the dividing wall 413 between the 1 st bone hole 411 and the 2 nd bone hole 412 is cut, the ultrasonic probe 24 may be guided without using the guide device 305, and the operator may operate the ultrasonic probe 24 with an empty hand.

In embodiment 3, by guiding the ultrasonic probe 24 using the guide means 305 so as to position the guide means 305 with respect to the femoral external condyle 400, the 1 st bone hole 411 and the 2 nd bone hole 412 can be adjacently formed at a target position and angle. Thereby, the desired rectangular bone hole 410 can be accurately formed in the direction in which the bone hole is to be formed, without being limited to the operator. In particular, the effect is more remarkable when the skill of the operator is low.

Industrial applicability

As described above, the guide device and the bone hole forming method of the present invention have utility in forming a desired rectangular bone hole in a direction in which the bone hole is to be formed using an ultrasonic probe.

Description of the reference numerals

1. An ultrasonic device system; 2. an ultrasonic device; 3. a power supply unit; 4. a foot switch; 5. 5A, 305, a guide device; 6. a small diameter drill bit; 21. a device body; 21a, a housing; 21b, an ultrasonic wave generating unit; 22. an ultrasonic vibration element; 23. an amplitude transformer; 24. an ultrasonic probe; 25. a tip treatment section; 25a, a base portion; 25b, a tip portion; 26. a sheath; 27. an operating switch; 28. a cable; 31. a connector; 32. displaying a picture; 33. an operating switch; 51. 351, a guide part; 51a, 1 st through hole; 51b, 351b, a notch portion; 52. a protrusion; 52a, 2 nd via; 53. a limiting plate; 53a, a pointer; 54. a wing portion; 54a, scale; 55. a cap portion; 100. treating a target site; 110. 410, bone holes; 111. 411, bone hole 1; 112. 412, bone hole 2; 351a, a through hole; 352. a bias part; 352a, 1 st contact surface; 352b, 2 nd abutment surface; 353. a bone hole introduction part; 353a and an abutting surface; 360. a rectangle shape; 400. the external femoral condyle; 401. a rear wall; 411a, inner wall surface No. 1; 411b, inner wall surface No. 2; 413. a partition wall.