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JP2002159500A - 靭帯固定システム - Google Patents

靭帯固定システム

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Publication number
JP2002159500A
JP2002159500A JP2000403551A JP2000403551A JP2002159500A JP 2002159500 A JP2002159500 A JP 2002159500A JP 2000403551 A JP2000403551 A JP 2000403551A JP 2000403551 A JP2000403551 A JP 2000403551A JP 2002159500 A JP2002159500 A JP 2002159500A
Authority
JP
Japan
Prior art keywords
staple
plate
ligament
fixing
driving
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
JP2000403551A
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English (en)
Inventor
Tomoaki Koseki
智明 小関
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Koseki Medical KK
Original Assignee
Koseki Medical KK
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Filing date
Publication date
Application filed by Koseki Medical KK filed Critical Koseki Medical KK
Priority to JP2000403551A priority Critical patent/JP2002159500A/ja
Priority to US10/182,285 priority patent/US20040073222A1/en
Priority to PCT/JP2001/010359 priority patent/WO2002043597A1/ja
Publication of JP2002159500A publication Critical patent/JP2002159500A/ja
Pending legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B17/0642Surgical staples, i.e. penetrating the tissue for bones, e.g. for osteosynthesis or connecting tendon to bone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/04Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B17/0643Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B2017/0641Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body

Landscapes

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

Abstract

(57)【要約】 【課題】侵襲が少なく、効率的な固定力得られ、正確に
ステープルを打ち込める安価な靭帯固定システムを提供
する。 【解決手段】穴の開いた平板状のプレートを靭帯に固定
し、折り返された靭帯をさらにステープルで固定する。
プレートの穴を複数とする。プレートの底面、上面を曲
面とする。クロスバーを使用し、平行確認可能とする。
ステープル脚部先端を中心線から内側に寄せる。脚部内
側に切り込みを入れる。脚部断面を多角形とする。プレ
ートを押さえ、スライドバーによる打ち込み構造を持つ
打ち込み器を使用する。鋳造で製造する。

Description

【発明の詳細な説明】
【0001】
【発明の属する技術分野】本発明は靭帯修復手術の際用
いる靭帯を骨表面に固定するためのステープル及びプレ
ートの組み合わせ固定システムに関する。
【0002】
【従来の技術】靭帯を固定する方法は通常靭帯を一本の
ステープルで固定した後、靭帯を反対方向に折り返し、
折り返した上から初めのステープルに近接させて二本目
のステープルを打ち込むダブルステープリングと呼ばれ
る方法が一般的である。また固定力を上げるため、同じ
靭帯の断端を複数のステープルで間隔をおいて固定する
こともある。
【0003】ステープル先端の鋭利な部分は脚部の中心
線上にある。また脚部の横断面は円又は四角形である。
【0004】ステープルを打ち込むための打ち込み器
は、ステープルの水平部分を掴むか、或いは脚部途中を
挟み込んで把持し、本体後端を打ち込む構造である。
【0005】ステープル、打ち込み器は切削加工により
製造される。
【0006】
【発明が解決しようとする課題】ダブルステープリング
法は2本打ち込まれたステープルの両脚によって組織が
挟み込まれ、ステープルサイトペイン(ステープルによ
る痛み)を発生しやすい。またステープル2本分の埋没
体積が発生するため、患者に対する侵襲が大きい。
【0007】ACL(前十字靭帯)等は再建後ステープ
ルの抜去を前提としているが、ダブルステープリング法
はステープル脚部が骨組織を挟み込み、抜去時にしばし
ば骨組織を壊してしまう。
【0008】靭帯を固定する際、靭帯長手方向に対し直
角にステープルを打ち込むと最も固定力が大きい。同じ
靭帯の断端を複数のステープルで固定する際、目検討で
直角を測るためステープルの向きを一定に保ちにくく、
効率的な固定力が得られにくい。
【0009】骨表面は円柱状であり、また滑りやすい。
ほとんどの場合ステープルは打ち込んでいく際、両脚が
広がっていく傾向にあり、脚部が広がったステープルは
抜けやすい。
【0010】ステープルの水平部分や脚部の途中を挟み
込んだ状態で打ち込むと、ステープル先端は骨表面でス
リップしやすく、両脚は開きやすく、打ち込み角度も一
定に保てず、安定した打ち込みができない。
【0011】切削加工による製造は時間、手間がかか
り、コスト高となる。複雑な曲面が出しにくい。
【0012】
【課題を解決するための手段】上記の問題点を解決する
ために、本発明は、ダブルステープリングのようにステ
ープルを2本並べて打ち込むのではなく、ステープルと
プレートを組み合わせることにより骨に対する負荷が少
なく、且つ充分な固定力を得る固定システムとした。平
板状のプレート底面には引き寄せてきた靭帯を骨表面に
仮固定するための複数のスパイクが付いており、中央部
分は外周に沿った形状で穴が開いている。コの字型ステ
ープルは水平部分がプレートの穴に入る寸法であり、靭
帯を引き寄せてきた反対方向へ反転させ、ステープルを
打ち込むと、ステープルの両脚はプレートの穴部分を通
して骨表面に到達し、ステープルの水平部分下面が靭帯
を骨表面に押しつけ、靭帯を固定する。
【0013】より負荷の大きい部位には、プレート中央
部分の穴が長手方向に並列に複数開いているタイプを用
い、複数のステープルを打ち込むことにより靭帯をより
強固に固定することが可能である。
【0014】プレート底面を骨表面に密着するよう曲面
とすることにより、ステープルは打ち込み時骨表面でス
リップしない。またプレート上部も靭帯接触部分が緩や
かな曲面となるよう角をすべて丸くした形状とすること
により、靭帯を傷つけることなく、また埋没縫合後、体
表面からの違和感、異物感も少ない。
【0015】同じ靭帯の断端を複数のステープル及びプ
レートで固定する際、X字型のクロスバーを用いる。四
方の頂点のピンをプレート間に接続すると互いのプレー
トが平行であることを確認することが可能である。これ
によりステープルの向きを一定に保ち、効率的な固定力
が得られる。
【0016】ステープル両脚の鋭利な先端が脚部の中心
線から内側に寄っていることにより、打ち込み時の両脚
の広がりを防ぐことが可能となる。また両脚中央部内側
に一又は複数の切れ込みを設けることでも同じ効果が得
られる。
【0017】ステープル両脚の横断面を五角以上の多角
形とし、各々の頂点を結ぶ線が直線ではなく、脚部内側
に向かって曲線となっていると骨内での垂直方向の接触
面積が減り、打ち込み時の抵抗が少ない。ステープルは
打ち込む時は骨面に対して垂直に入っていくが、打ち込
み後は靭帯が骨表面に出た水平部分に固定されるのでス
テープルが抜けようとする力は水平部分横方向にかか
る。ステープル脚部面が内側に向かって曲線となってい
ると、抜けようとする力に対しては逆に曲面が骨組織と
の接触面を増やし、抵抗を大きくする。抜去する際には
再び垂直方向に引き抜くので抵抗は少なくなる。
【0018】上記ステープル及びプレートを打ち込むた
めの打ち込み器は、先端部分はプレートがフィットする
ような凹面形状とし、グリップ後端を打ち込めばプレー
トを容易に骨表面に固定できる。先端部分手前にはステ
ープル挿入用の横窓があり、ここからステープルを入れ
る。ステープル先端は骨表面に当たるが、脚部はすべて
カバーで覆われている。先端部分に接続するグリップ内
は筒状であり、この筒内にスライドバーを挿入しスライ
ドバー後端を打つことにより先端のステープルを骨内に
打ち込む。ステープルは固定されたプレートの穴に正確
に入り込んでいき、脚部はカバーで覆われているので方
向、角度が安定している。両脚が開くこともない。
【0019】上記ステープル、プレート、打ち込み器の
蝋模型を作り、その周囲を耐火物で固め、次に加熱し蝋
模型を消失させ、その空間に金属の溶湯を注ぎ冷却し、
形状を成型する鋳造による製造方法により安価で安定し
た形状の製品を量産できる。複雑な曲面を作り出すこと
も容易である。
【0020】
【発明の実施の形態】以下、本発明の実施の形態を図面
に基づいて説明する。図1は請求項1に係るステープル
1とプレート2の組み合わせ固定システムを例示してい
る。平板状のプレート2底面には引き寄せてきた靭帯3
を骨表面に仮固定するためのスパイク4が四隅に付いて
おり、中央部分は穴が開いている。靭帯3を引き寄せて
きた反対方向へ反転させ、ステープル1を打ち込むと、
ステープル1の両脚5はプレート2の穴部分を通して骨
表面に到達し、ステープル1の水平部分6下面が靭帯3
を骨表面に押しつけ、靭帯3を固定する。
【0021】図2は請求項2に係るプレート中央部分の
穴が長手方向に並列に二つ開いているタイプを示してい
る。2本のステープルを打ち込むことにより靭帯をより
強固に固定することが可能である。
【0022】図3は請求項3に係るプレート底面を骨表
面に密着するよう曲面とし、またプレート上部も靭帯接
触部分が緩やかな曲面となるよう角をすべて丸くした形
状としたタイプを示している。ステープルは打ち込み時
骨表面でスリップせず、靭帯を傷つけることなく、また
埋没縫合後、体表面からの違和感、異物感も少ない。
【0023】図4は請求項4に係る同じ靭帯3の断端を
複数のステープル1及びプレート2で固定する際、X字
型のクロスバー7を用いてプレート間において互いのプ
レートが平行であることを確認することが可能なX字型
平行維持器具を装着したタイプを例示している。X字型
のクロスバー7四方の頂点にプレートに接続するための
ピン8がX字型クロスバー7に対して垂直に立ってお
り、プレート2長手方向一辺の両端に設けられた仮固定
穴9にこのピン8を挿入することによって互いのプレー
ト2が固定され平行であることを確認することができ
る。平行の確認後プレート2を骨表面に固定し、X字型
のクロスバー7を外し、ステープル1を打ち込む。
【0024】図5は請求項5に係る両脚の鋭利な先端が
脚部の中心線から内側に寄っていることにより、打ち込
み時の両脚の広がりを防ぐ構造としたことを特徴とする
ステープルを図示している。図の場合比率は1:2であ
る。
【0025】図6は請求項6に係る両脚中央部内側に切
れ込み10a,10b,10cを設けることにより打ち
込み時の両脚の広がりを防ぐ構造としたことを特徴とす
るステープルを示している。図の場合3つの切れ込み1
0a,10b,10cを入れている。また請求項7に係
る部分として両脚の横断面が五角形であり、各々の頂点
を結ぶ線が直線ではなく、脚部内側に向かって曲線とな
っている。
【0026】図7は請求項8に係るステープル1及びプ
レート2を打ち込むための打ち込み器を例示している。
先端部分はプレート1がフィットするような凹面形状と
し、グリップ11後端を打ち込めばプレート1を容易に
骨表面に固定できる。先端部分手前にはステープル1挿
入用の横窓12があり、ここからステープル1を入れ
る。横窓12の反対側は壁である。横窓12の下はステ
ープル1先端位置確認用の小窓が開いている。ステープ
ル1先端は骨表面に当たるが、脚部5はカバーで覆われ
ている。先端部分に接続するグリップ11内は筒状であ
り、この筒内にスライドバー13を挿入しスライドバー
13後端を打つことにより先端のステープル1を骨内に
打ち込む。スライドバー13の形状は断面がステープル
1の水平部分と幅、厚みを同じくし、後端部は打ち込み
用の円盤が付いている。スライドバー13の後端部の円
盤を打ち込むと、ステープル1は固定されたプレート2
の穴に正確に入り込んでいき、脚部5はカバーで覆われ
ているので方向、角度が安定している。両脚が開くこと
もない。
【0027】
【発明の効果】本発明は以上説明したような形態で実施
され以下に記載されるような効果を奏する。
【0028】請求項1により、骨に対する負荷が少な
く、且つ充分な固定力を得る固定システムを供給する。
スパイク付きのプレートが骨表面に固定され、その枠の
内側で靭帯を押さえつけ固定するので、ステープルの傾
きも抑制され、ステープルサイトペインの発生もほとん
どない。
【0029】請求項2により靭帯をより強固に固定する
ことが可能である。
【0030】請求項3によりステープルは打ち込み時骨
表面でスリップしない。また靭帯を傷つけることなく、
また埋没縫合後、体表面からの違和感、異物感も少な
い。
【0031】請求項4によりステープルの向きを一定に
保ち、効率的な固定力が得られる。
【0032】請求項5及び6によりステープル打ち込み
時の両脚の広がりを防ぐことが可能となる。
【0033】請求項7により打ち込み時の抵抗が少な
い。抜けようとする力に対しては逆に抵抗を大きくす
る。抜去する際には再び抵抗は少なくなる。
【0034】請求項8によりプレートを容易に骨表面に
固定できる。ステープルはプレートの穴に正確に入り込
んでいき方向、角度が安定している。両脚が開くことも
ない。
【0035】請求項9により安価で安定した形状の製品
を量産できる。複雑な曲面を作り出すことも容易であ
る。
【図面の簡単な説明】
【図1】ステープル、プレートによる固定システムの外
観図である。
【図2】プレートに2つの穴が開いているタイプの外観
図である。
【図3】プレートの底面、上面が曲面を呈しているタイ
プの外観図である。
【図4】クロスバーを使用したタイプの外観図である。
【図5】先端部分が内側に寄っているステープルの平面
図である。
【図6】両脚内側に切れ込みが入り、脚部断面が5角形
のステープル平面図である。
【図7】打ち込み器正面図、側面図、底面図である。
【符号の説明】
1ステープル 2プレート 3靭帯 4スパイク 5脚部 6水平部 7クロスバー 8ピン 9仮固定穴 10a,10b,10c切れ込み 11グリップ 12横窓 13スライドバー

Claims (9)

    【特許請求の範囲】
  1. 【請求項1】靭帯修復手術の際用いる靭帯を骨表面に固
    定するためのステープル及びプレートの組み合わせ固定
    システムであり、平板状のプレート底面に、引き寄せて
    きた靭帯を骨表面に仮固定するための複数のスパイクが
    付いており、中央部分は外周に沿った形状で穴が開いて
    おり、コの字型ステープルは水平部分がプレートの穴に
    入る寸法であり、プレートを被うように靭帯を引き寄せ
    てきた反対方向へ反転させ、その上からステープルを打
    ち込むと、ステープルの両脚はプレートの穴部分を通し
    て骨表面に打ち込まれ、ステープルの水平部分下面が靭
    帯を骨表面に押しつけ、靭帯を固定するステープルとプ
    レートの組み合わせ固定システム。
  2. 【請求項2】上記ステープル及びプレートの組み合わせ
    固定システムの内、プレート中央部分の穴が長手方向に
    並列に複数開いており、各々の穴に入る寸法であるステ
    ープルを打ち込むことにより靭帯を固定する請求項1記
    載のステープルとプレートの組み合わせ固定システム。
  3. 【請求項3】上記ステープル及びプレートの組み合わせ
    固定システムの内、プレート底面が骨表面に密着するよ
    うに曲面を呈しており、またプレート上部も靭帯接触部
    分が緩やかな曲面となるよう角をすべて丸くした形状を
    特徴とする請求項1及び2記載のステープルとプレート
    の組み合わせ固定システム。
  4. 【請求項4】上記ステープル及びプレートの組み合わせ
    固定システムの内、同じ靭帯の断端を複数のステープル
    及びプレートで固定する際、X字型のクロスバー四方の
    頂点にプレートに接続するためのピンがX字型クロスバ
    ーに対して垂直に立ち、プレート間においてプレート長
    手方向一辺の両端に設けられた仮固定穴にこのピンを挿
    入することによって互いのプレートが平行であることを
    確認することが可能なX字型平行維持器具を装着可能な
    請求項1、2及び3記載のステープルとプレートの組み
    合わせ固定システム。
  5. 【請求項5】靭帯修復手術の際用いる靭帯を固定するた
    めのステープルであり、両脚の鋭利な先端が脚部の中心
    線から内側に寄っていることにより、打ち込み時の両脚
    の広がりを防ぐ構造としたことを特徴とする靭帯固定用
    ステープル。
  6. 【請求項6】上記靭帯修復手術の際用いる靭帯を固定す
    るためのステープルであり、両脚中央部内側に一又は複
    数の切れ込みを設けることにより打ち込み時の両脚の広
    がりを防ぐ構造としたことを特徴とする靭帯固定用ステ
    ープル。
  7. 【請求項7】上記靭帯修復手術の際用いる靭帯を固定す
    るためのステープルであり、両脚の横断面が五角以上の
    多角形であり、各々の頂点を結ぶ線が直線ではなく、脚
    部内側に向かって曲線となっていることを特徴とする請
    求項5及び6記載の靭帯固定用ステープル。
  8. 【請求項8】上記ステープル及びプレートの組み合わせ
    固定システムの内、ステープル及びプレートを打ち込む
    ための打ち込み器であり、先端部分は請求項1、2、3
    記載のプレートがフィットするような凹面形状となって
    おり、先端部分手前にはステープル挿入用の横窓があ
    り、先端部分に接続するグリップ内は筒状であり、この
    筒内にスライドバーを挿入しスライドバー後端を打つこ
    とにより先端のステープルを骨内に打ち込む構造を持つ
    打ち込み器。
  9. 【請求項9】上記ステープル、プレート、打ち込み器の
    蝋模型を作り、その周囲を耐火物で固め、次に加熱し蝋
    模型を消失させ、その空間に金属の溶湯を注ぎ冷却し、
    形状を成型する請求項1、2、3、4、5、6、7及び
    8記載のステープル、プレート、打ち込み器の鋳造によ
    る製造方法。
JP2000403551A 2000-11-28 2000-11-28 靭帯固定システム Pending JP2002159500A (ja)

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US10/182,285 US20040073222A1 (en) 2000-11-28 2001-11-28 Ligament fixing system
PCT/JP2001/010359 WO2002043597A1 (en) 2000-11-28 2001-11-28 Ligament fixing system

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