JPH0975367A - Guide for drilling collum femoris part - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable an operator to easily and efficiently set the exact insertion angle of guide pins and to insert the guide pins by pivotally fitting pawl pieces to both sides in the transverse direction of a gate block and mounting a tightening mechanism at the rear end side of this gage block. SOLUTION: The gage block 1 consists of a broad block of a flat trapezoidal shape having a flat rear end face 10, a slope, a perpendicular surface and a front end face 13. A tooth part and friction coefft. increasing part 131 for detaining the bite to the outer flank of the femur in order to stabilize the fixing state to the femur are inscribed on this front end face 13. Oblique holes 110, 111 for insertion of the guide pin to be inserted with the guide pins D are penetrated to cross each other from the slope to the front end face 13 toward the bone head 91 of the femur. Both flanks 14 in the transverse direction of the gate block 1 are recessed with longitudinal grooves 141 for guiding wedge pieces 3a downward from the rear end face 10 and are formed with recessed parts for pivotally fitting the pawl pieces 2 downward from these longitudinal grooves 141. The tightening mechanism 3 has a wedge piece 3a and a push rod to advance and retreat this piece.

Description

Detailed Description of the Invention

[0001]

TECHNICAL FIELD The present invention relates to a femoral neck drill guide.

[0002]

2. Description of the Related Art As a method for treating fractures or cracks around the neck of a femur, generally, a screw bolt such as a compression hip screw or a canceller screw is provided between the head of the femur and the neck. The method of tightening is adopted. In such an operation, it is indispensable to insert a guide pin from below the greater trochanter of the femur to the center of the femoral head as the first step. If the angle of this guide pin is not correct, the tightening effect of the above-mentioned screw bolts is insufficient. , Become uncertain.

Conventionally, as shown in FIG. 11, a tool for setting the insertion angle of a guide pin generally has a structure in which a handle H is attached to a gauge block G having an oblique hole g at an angle of 130 to 150 °. It was target. However, in such a structure, since one surface of the gauge block G is simply applied to the outer surface of the femur and is not fixed, the gauge block G is not stable,
It is difficult to set the angle of the guide pin easily and accurately, because the position of the guide pin shifts even if it is touched by fingers or vibration is applied. Moreover, even when the guide pin is inserted with the angle determined, the gauge block G must be firmly held in the femur with the hand, and therefore the gait pin cannot be inserted by itself, and at least the gait pin is inserted. A total of two staff members are required, one to enter the staff and one to hold the gauge block G, which causes a problem that the operation is complicated and takes time and effort.

[0004]

SUMMARY OF THE INVENTION The present invention was made by research to solve the above-mentioned problems, and its purpose is to eliminate the need to press the gauge block by hand. An object of the present invention is to provide a femoral neck perforation guide having a simple structure capable of easily and efficiently setting the guide pin insertion angle and the guide pin insertion.

[0005]

In order to achieve the above object, the present invention is to lock the inside of the distal end portion on both sides in the width direction of a gauge block in which a guide pin insertion sloping hole is formed in the contact surface with the femur. A pair of claw pieces having teeth are pivotally attached, and a tightening mechanism having a wedge piece for tilting the claw pieces toward the closing side is attached to the rear end side of the gauge block. The tightening mechanism includes a screw shaft screwed into a female screw hole provided on the rear end surface of the gauge block and a push rod having a female screw hole screwed into the screw shaft, and the screw shaft penetrates through the wedge piece at the center thereof. It is preferable that the structure has a through hole, and that both end portions are provided with inclined surfaces that come into contact with the rear end portions of the claw pieces to forcibly blunt the tip side of the claw pieces. It is suitable for use that the elastic member is forcibly expanded. Further, the femoral neck drilling guide according to the present invention preferably further includes a neck axial center confirmation jig, and the neck axial center confirmation jig includes a first pin fitted to the oblique hole and the first pin. It has a parallel second pin. The guide pin insertion slanted holes are preferably provided at two or more different angles.

[0006]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS FIG. 1 shows an embodiment of a femoral neck piercing guide according to the present invention in a single state, and FIGS. 2 to 4 show a used state. In FIG. 1, A is a guide body, and B ₁ and B ₂ are jigs for confirming the axial center. 2 to 4, 9 is the femur, 90 is the greater trochanter, 91 is the head of the bone,
Reference numeral 92 is an outer surface, 93 is an inner surface, 94 is a front surface, 95 is a rear surface, and D is a guide pin. The guide main body A includes a block gauge 1, a pair of left and right claw pieces 2 and 2, and a tightening mechanism 3 having a wedge piece 3a for moving the claw pieces 2 and 2 to the closing side. Made of high quality material.

As shown in FIGS. 2, 4, and 5, the gauge block 1 includes a flat rear end surface 10 and inclined surfaces 11 on both sides thereof.
It has a flat trapezoidal shape having 11 and vertical surfaces 12, 12 and a front end surface 13 or a wide block similar thereto. The front end surface 13 is provided with a tooth portion or a friction coefficient increasing portion (hereinafter referred to as a tooth portion) 131 that bites and locks on the outer side surface 93 of the femur 9 in order to stabilize the fixed state to the femur 9. Then, a plurality of guide pin insertion oblique holes 110, 1 for inserting the guide pins D from the two inclined surfaces 11, 11 to the front end surface 13 toward the head 91 of the femur 9.
11 are provided so as to cross each other. The guide pin insertion oblique holes 110 and 111 are at least two kinds of angles within the range of 130 to 150 °, for example, 135 ° and 145 °. In this embodiment, one guide pin insertion sloping hole 110, 111 is provided at the center of each inclined surface 11, 11 in the width direction. Of course, as shown in FIG. 6A, two may be provided on each of the inclined surfaces 11 and 11. The gauge block 1 is provided with a female screw hole 114 having a required depth at the center of the rear end face 10. Further, the rear end surface 10 is provided on both side surfaces 14 of the gauge block 1 in the width direction.
Vertical groove 14 for guiding the wedge piece 3a downward from
1, 141 are recessed, and further vertical grooves 141, 14
Below 1 there is a recess 14 for pivotally mounting the tabs 2, 2.
2, 142 are formed.

The claw pieces 2 and 2 as a whole are gauge blocks 1
Is formed in a lever shape having a dimension longer than the height dimension of the gauge block, and a protrusion 20 is fixed to the upper portion of the intermediate portion in the longitudinal direction by means of screws or welding. The gauge block 1 is fitted in the recess 142.
It is pivotally supported by a pivot shaft 5 which is inserted in the.
In this pivoted state, the claw pieces 2 and 2 reach a level where the rear end portions 21 and 21 project appropriately above the rear end surface 10 of the gauge block 1, and the front end portions 22 and 22 reach the front end surface 13 of the gauge block 1. It is located far ahead of the level. And the tips 22 and 22 are curved appropriately,
A tooth portion or a friction coefficient increasing portion (hereinafter referred to as a tooth portion) 221 that bites into and locks the front surface 94 and the rear surface 95 of the femur 9 is formed on the inner side thereof. The nail pieces 2, 2
In order to facilitate the attachment of the diaper to the femur 9, in this embodiment, as shown in FIG. 4, an elasticity represented by a cancel spring is provided between the claw pieces 2 and 2 and the width direction side surfaces 14 and 14 of the gauge block 1. The members 6 and 6 are arranged, and the urging force of the elastic members 6 and 6 causes the tip portions 22 and 22 of the claw pieces 2 and 2 to expand in the normal state.

The tightening mechanism 3 has a wedge piece 3a and a push rod 3b for advancing and retracting the wedge piece 3a. The push rod 3b has a female screw hole 30 formed in a required range from the tip thereof.
The latter half of the screw shaft 3c screwed into the female screw hole 114 formed in the rear end surface 10 of the gauge block 1 is screwed into the. An operating handle 31 is attached to the rear end of the push rod 3. The wedge piece 3b is the rear end surface 1 of the gauge block 1.
0 has a length dimension that exceeds the width dimension as a whole, has a through hole 32 that is inserted through the screw shaft 3c in the central portion, and has longitudinal portions of the gauge block 1 at both end portions. Vertical surfaces 33, 33 slidingly contacting the grooves 141, 141 and the claw pieces 2,
The inclined surfaces 34, 34 that come into contact with the rear end portions 21, 21 of the second projection 21 are provided. An elastic member 3d such as a coil spring for urging the wedge piece 3b in the direction opposite to the gauge block is provided between the lower surface of the wedge piece 3b and the rear end surface 10 of the gauge block 1.
Is interposed.

Next, the cervical axis center checking jig B ₁ is for checking the front axis, and connects the first pin 7a and the second pin 7b having the same diameter as the guide pin D as shown in FIG. The pieces 7c are held in parallel with each other at a predetermined interval. First pin 7
a is shorter than the second pin 7b, and has a rotation preventing projection 700 that comes into contact with the lateral side surface 14 of the gauge block 1 near the tip of the first pin 7a and has a planar L-shaped piece. 7
The position d is fixed using a push screw or the like so as to be positionally adjustable. The piece piece 7d has a relationship in which its long axis is displaced by 90 degrees from the connecting piece 7c. The cervical axis center checking jig B ₂ is for checking the outer axis and has the same structure as the cervical axis center checking jig B ₁ except that the long axis of the piece 7d is the connecting piece 7c. They differ in that they have a parallel relationship. The detent is not limited to the structure using the inclined surface 11 and the lateral side surface 14, and may be a pin insertion method. 6 (b) and 6 (c) show this example, in which the detent holes 112, 1 are provided near the guide pin insertion oblique holes 110, 111 of the gauge block 1.
On the other hand, 12 'is bored, while a small diameter rotation stopping pin 71 fitted in the rotation preventing holes 112, 112' is fixed to the piece piece 7d.

FIG. 7 shows an example of the connection between the connecting piece 7c and the first pin 7a and the second pin 7b in the neck axial center checking jig B ₁ and the neck axial center checking jig B ₂ . As shown in (a), a square bar is used as the connecting piece 7c, and the first pin 7
Alternatively, a and the second pin 7b may be inserted and fixed by the push screw 7h. In this case, the distance between the first pin 7a and the second pin 7b is fixed. In (b), a square bar is used as the connecting piece 7c, but the upper half is halved in the width direction to form a separating piece 74, and several holes 75 are formed at the boundary between the separating piece 74 and the base piece 73. Are formed at intervals, and any one of the holes 75 is selected to insert the second pin 7b, and the tightening screws 76, 7
6 is fixed to the separation piece 74 and the base piece 73 by screwing. In this case, the distance between the first pin 7a and the second pin 7b can be adjusted arbitrarily.
(C) is a simplified version of the cervical shaft center confirmation jig B ₁ and the cervical shaft center confirmation jig B ₂ , in which one wire is bent in a U-shape and the connecting piece 7c and the The first pin 7a and the second pin 7b are formed.

Although the cervical shaft center checking jig B ₁ and the cervical shaft center checking jig B ₂ are separate members in FIG. 1,
The present invention is not limited to this, and a single jig B for checking the neck axis can be used.
₁ and the neck axial center checking jig B ₂ may be commonly used. This may be done by allowing the mounting angle of the first pin 7a with respect to the connecting piece 7c to be displaced by 90 degrees. FIG. 8 shows an example thereof. In FIG. 8A, recesses 77 and 78 are provided on the outer circumference of the first pin 7a at intervals of 90 degrees, and the connecting piece 7c has a recess.
A push screw 7h having a rod tip that selectively fits in 7, 78 is screwed. When the first pin 7a is rotated to align the depression 77 with the push screw 7h, the long axis of the piece piece 7d becomes parallel to the connecting piece 7c, and the neck axis confirmation jig B ₂ is formed. Further, if the depression 78 is aligned with the push screw 7h, the long axis of the piece piece 7d is displaced by 90 degrees from the connecting piece 7c, so the neck axis confirmation jig B
It becomes ₁ . (B) uses a ball 7f, a spring 7g, and a screw 7h in place of the push screw 7h.

Next, an example of performing a femoral neck fracture surgery using the femoral neck punch guide according to the present invention will be described. First, a portion appropriately below the greater trochanter 90 is cut on the outer surface 92 of the femur. In this state, the operation handle 31 of the push rod 3b is held, and the guide main body A is brought close to the above portion. In this way, the pair of left and right claw pieces 2 and 2 are smoothly fitted on the femur 9 because the distal ends thereof are expanded by the elastic members 6 and 6, and the front end surface 13 of the gauge block 1 is provided with the teeth 131. It contacts the lateral surface 92 of the femur.

When the operating handle 31 is rotated in this state, the screw shaft 3c advances into the female screw hole 30 of the push rod 3a, so that the push rod 3a approaches the gauge block 1 and thereby the wedge piece 3b.
Moves forward against the bias of the elastic member 3d. In this advance, the vertical surfaces 33, 33 are the vertical grooves 141, 14 of the gauge block 1.
It is stable because it is guided by 1. The rear end portions 21 and 21 of the claw pieces 2 and 2 come into contact with the inclined surfaces 34 and 34 due to the forward movement of the wedge piece 3b. 5
Is tilted about the fulcrum, and the distal end side is narrowed against the biasing force of the elastic members 6 and 6, and the distal end portions 22 and 22 sandwich the front surface 94 and the rear surface 95 of the femur, and the tooth portion 22 is formed on the surfaces thereof.
1,221 bite. As a result, the guide body A is firmly fixed to the femur 9 so that the gauge block 1 is in close contact with the outer side surface 92. Therefore, after that, the guide body A
There is no effect even if you take your hand away from the surgical field.

Since the setting of the gauge block 1 is completed in this state, the guide pins D can be inserted into the head 91 by selecting the oblique holes 110 and 111 of the inclined surface 11.
In order to obtain a more accurate puncture angle, as shown in FIG. 9, a cervical axial center confirmation jig B ₁ may be attached to the guide main body A to adjust the fixing position with respect to the femur. That is, FIG.
The first pin 7a protruding from the piece 7d as shown in (b)
Is inserted into the desired inclined hole 110 or 111 for inserting the guide pin of the inclined surface 11, the anti-rotation protrusion 700 comes into contact with the width direction side surface 14 of the gauge block 1, and the second pin 7b is located above the front surface of the femur. To position. This state is shown in FIG. 9A. At this time, the first pin 7a and the second pin 7b are displaced, and therefore, the first pin 7a corresponding to the guide pin.
The axis of does not coincide with the cervical axis CL. To correct this, the operating handle 31 is slightly rotated to loosen the tightening of the claw pieces 2 and 2 to the femur, and the first pin 7a and the second pin 7b are moved to the neck as shown in FIG. 9 (c). The guide main body A may be finely moved in the axial direction of the femur so as to be overlapped on the axis CL, and the operation handle 31 may be rotated and tightened. The fine movement operation is X
It can be done easily and accurately while monitoring on a line TV.

Since the front surface axis is aligned by the above operation, a neck axis center checking jig B _{2 in} which the long axis of the piece piece 7d is parallel to the connecting portion 7c is used and attached to the guide body A. Figure 10
Adjust the fixed position for the femur as shown in. That is, also in this case, the first pin 7a is attached to the guide pin insertion sloping hole 110 of the inclined surface 11 so that the anti-rotation protrusion 700 protruding from the piece 7d abuts on the lateral side surface 14 of the gauge block 1. Insert into 111. In this way, the second pin 7b is located above the outer side surface 92 of the femur. This state is shown in FIG. 10A, and at this time, the first pin 7
Since a and the second pin 7b are displaced, the axis of the first pin 7a corresponding to the guide pin does not match the neck axis CL. To correct this, the operation handle 31 is slightly rotated to loosen the tightening of the femur 9 by the claw pieces 2 and 2, and the first pin 7a and the second pin 7b are moved to the neck as shown in FIG. 10 (b). The guide body A may be finely moved in the circumferential direction of the femur so as to be overlapped on the axis CL, and the operation handle 31 may be rotated and tightened. The fine movement operation can be performed easily and accurately while monitoring it with an X-ray television or the like.

Since the piercing angle of the guide pin is accurately set by the above operation, the cervical axial center confirmation jig B ₂ is then removed from the gauge block 1 and the first line is indicated by the phantom line in FIG.
Guide pin insertion sloping hole 110 in which pin 7a was inserted
Alternatively, the guide pin D is inserted into 111 and inserted into the center of the head of the bone. The gauge block 1 has the claw pieces 2 and 2 as described above.
Since it is firmly fixed to the femur 9 by holding it, the guide pin D can be inserted easily and accurately. If the guide pin is inserted in this way, the position is confirmed with an X-ray television or the like, and then the guide body A is removed from the guide pin D and the femur. This is the operating handle 31
Is loosened and the gauge block 1 is moved in the axial direction of the guide pin D, which is extremely simple. That is,
When the operating handle 31 is rotated to the loosening side and the push rod 3a is retracted, the wedge piece 3b is retracted by the urging force of the elastic member 3d, thereby releasing the pressing on the rear end portions 21 and 21 of the claw pieces 2 and 2. Therefore, the claw pieces 2 and 2 are expanded by the urging force of the elastic member 6, and the fixation to the femur 9 is instantly released. Then, after that, it suffices to hold the operation handle 31 and move it in the axial direction of the guide pin D, whereby the gauge block 1 is pulled out from the rear end of the guide pin D.

The rest of the surgical procedure is the same as the conventional procedure. The length of the guide pin D is measured using a guide pin depth gauge, the head of the bone is reamed and tapped with a reamer and a drill, and a hip screw is used with a wrench. Is screwed in and a side plate is attached to this, and compression is applied by an impactor, or a cortical screw is screwed through the lateral surface 92 of the femur to fix the side plate, and then compression is applied by an impactor.

When the cervical shaft center checking jig having the structure as shown in FIG. 8 is used, a push screw or screw 7h with the first pin 7a still inserted in the gauge block 4 is used.
Is loosened to displace the connecting piece 7c by 90 degrees, and the push screw or the screw 7h is screwed in to change the relative direction between the piece piece 7d and the connecting piece 7c. Therefore, the front shaft and the outer shaft can be confirmed with one shaft center confirmation jig.

[0020]

According to claim 1 of the present invention described above, the gauge block 1 is constituted by the claw pieces 2 and 2 and the wedge piece 3b.
Is firmly and stably fixed to the femur 9 and has no effect even if the hand is released or the operation field is removed. Therefore, it is possible to very easily perform the work of inserting the guide pin D, which is important in fracture surgery of the femoral neck, by one person, and the structure is simple and compact. Is obtained. According to claim 2 and claim 4, the guide body A and the neck axial center checking jigs B ₁ and B ₂ are used together, and the neck axial center checking jigs B ₁ and B ₂ are for inserting the guide pin. Since the first pin 7a fitted in the oblique hole and the second pin 7b parallel to the first pin 7a are provided, the insertion angle of the guide pin can be easily and accurately matched with the neck axis. The effect is obtained. According to the third aspect, since the claw pieces 2 and 2 can be in the expanded state in the normal state, there is an excellent effect that they can be easily attached to and removed from the femur 9.

[Brief description of drawings]

FIG. 1 is a perspective view showing an embodiment of a femoral neck drill guide according to the present invention.

FIG. 2 is a side view showing a usage state of the femoral neck drill guide according to the present invention as viewed from the front side of the femur.

FIG. 3 is a plan view showing the same usage state as seen from the rear surface side of the femur.

FIG. 4 is a sectional view taken along line XX of FIG.

FIG. 5 is a vertical sectional front view of a gauge block according to the present invention.

6 (a) and 6 (b) are side views showing another arrangement example of the guide pin insertion sloping holes of the gauge block in the present invention, and FIG. 6 (c) is (b).
FIG. 6 is a partial perspective view of a jig for confirming an axial center in the case of FIG.

FIG. 7 is a front view showing each embodiment of the cervical axis center checking jig of the present invention.

FIG. 8 is a partial cross-sectional view of a common type cervical axial center confirmation jig according to the present invention.

FIG. 9 is a side view showing an angle setting state using the femoral neck punch guide of the present invention.

FIG. 10 is a plan view showing an angle setting state using the femoral neck drill guide of the present invention.

FIG. 11 is a perspective view showing a conventional guide pin insertion angle setting tool.

[Explanation of symbols]

A Guide body B ₁ , B ₁ Neck cervical axis confirmation jig D Guide pin 1 Cage block 2, 2 Claw piece slide 3 Tightening mechanism 3a Wedge piece 3b Push rod 3c Screw shaft 6 Elastic member 7a 1st pin 7b 2nd pin 10 Rear end surface 11, 11 Inclined surface 30 Female screw hole 32 Through hole 34, 34 Inclined surface 110, 111 Guide pin insertion hole 9 Femur

Claims (4)

[Claims] 1. A pair of claws having engaging tooth portions 221 on the inner side of the distal end portions on both sides in the width direction of a gauge block 1 in which guide pin insertion sloping holes 110, 111 are formed on the contact surface with the femur. A femoral neck characterized in that a tightening mechanism 3 having a wedge piece 3b for pivotally attaching the pieces 2 and 2 and tilting the claw pieces 2 and 2 to the closing side is attached to the rear end side of the gauge block 1. Drilling guide. 2. A pair of claws having locking tooth portions 221 on the inner side of the distal end portions on both sides in the width direction of the gauge block 1 having guide pin insertion sloping holes 110, 111 formed on the contact surface with the femur. A guide main body A, to which the pieces 2 and 2 are pivotally attached, and a tightening mechanism 3 having a wedge piece 3b that tilts the claw pieces 2 and 2 to the closing side on the rear end side of the gauge block 1, and a guide pin insertion A femoral neck drilling guide including cervical axial center confirmation jigs B ₁ and B ₂ having a first pin 7a fitted in the oblique holes 110 and 111 and a second pin 7b parallel to the first pin 7a. 3. A screw shaft 3c which the tightening mechanism 3 is screwed into a female screw hole 114 provided in the rear end surface 10 of the gauge block 1,
A push rod 3a having a female screw hole 30 screwed into the screw shaft 3c.
The wedge piece 3b is provided with a through hole 32 through which the screw shaft 3c penetrates, and the rear ends 21 and 2 of the claw pieces 2 and 2 are provided at both ends.
The femoral neck piercing guide according to claim 1 or 2, further comprising inclined surfaces 34, 34 which are brought into contact with 1 to forcibly blunt the tip ends of the claw pieces 2, 2. 4. The femoral neck piercing guide according to claim 1, wherein the claw pieces 2 and 2 include those in which the elastic members 6 and 6 are forcibly expanded.