JP2018175752A - Drill guide instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a drill guide instrument capable of avoiding interference between screws and reducing a work load on a doctor while allowing necessary angular displacement of the drill guide. SOLUTION: When an implant member 10 is arranged in a body, a drill guide device for guiding a drill 126 to be drilled in a bone is a first drill guide device 100 at a position corresponding to a hole 50 of the implant member 10. It has a plurality of guide holes 103, 105 that penetrate from one surface Sf1 to a second surface Sf2 and into which a drill guide 120 through which a drill 126 is inserted can be inserted, and at least one of the plurality of guide holes 103, 105 The deformation guide hole 105, and at least one of the cross sections perpendicular to the central axis of the deformation guide hole 105, is a displacement that allows the displacement of the insertion angle of the drill guide 120 to be a biased amount in the circumferential direction of the guide hole. It is configured to have a cross section having an allowable guide region. [Selection diagram] Fig. 3

Description

  The present invention relates to a drill guide instrument for guiding a drill for drilling a bone when the implant member is disposed in the body.

  Conventionally, an implant member is disposed in the body to connect fractured bones and to correct the posture of the bones. For example, when fixing fractures of long bones such as femur, tibia, humerus and calcaneus including fractures around joints, a plate-like plate (bone plate) is used as an implant member. The plate includes a body portion applied to the trunk of the long bone and a head portion applied to the distal end of the long bone, and holes for receiving screws in the body portion and the head portion (screw receptacles Holes) are formed.

  In addition, when the plate is fixed to a long bone by a screw, it is general that the hole into which the screw is inserted is previously drilled by the drill (bone drill). For example, a method of drilling a bone is to temporarily fix the plate at a predetermined position of the bone and fix a drill guide tool (guide block) to the head of the plate. The guide block is provided with guide holes at positions corresponding respectively to a plurality of screw receiving holes provided in the head portion of the plate. The guide hole is a hole (guide hole) for guiding a cylindrical drill guide through which the drill is inserted. Then, in a state where the drill guide is inserted into the guide hole, the drill is inserted into the drill guide and the bone is drilled through the screw receiving hole of the plate.

  Here, it is desirable that the screws for fixing the bones can be fixed at various angles with respect to the plate so that the bone cutting site can be appropriately fixed depending on the state of fracture. For this reason, the guide hole of the guide block is configured such that the drill guide can be arbitrarily displaced at an angle with respect to the guide hole over the entire region in the circumferential direction (see, for example, Patent Document 1).

  More specifically, the guide hole of the guide block is provided so as to penetrate from the first surface on the side (inner side) abutting the plate to the second surface on the opposite side (outer side), and in the first plane The hole shape is a circle larger than the diameter of the drill guide, and the hole shape in the second surface is a truncated cone having a circle larger in diameter than the hole shape of the first surface. Then, when the drill guide is inserted at a position that becomes a reference for insertion into the assumed guide hole, that is, when inserting so that the central axis C0 of the drill guide coincides with the central axis of the guide hole, the inner periphery of the guide hole The central axis of the drill guide is configured to be angularly displaceable with respect to the guide hole over the entire circumferential area of the surface.

Patent No. 4988693

  However, in the case of the conventional guide block, the allowable amount of displacement of the angle of the central axis of the drill guide with respect to the guide hole is too large, which may make it difficult to reduce the work load on the doctor.

  That is, from the viewpoint of enabling the screw to be inserted at various angles with respect to the plate, the angular displacement of the central axis of the drill guide in the entire circumferential direction of the hole (from the reference position where insertion of the drill guide is assumed While it is desirable to allow for angular displacement), on the other hand, interference between the inserted screws must be avoided.

  And in many cases, it is sufficient for the screw insertion angle to allow displacement within a certain predetermined range, and in such a case, if the allowable amount of angular displacement of the drill guide in the guide hole is too large, insertion can be made. It also increases the possibility of interference between the screws. That is, in some cases, it may be necessary to pay more attention to the interference between the screws, which may not help the doctor to reduce the workload.

  In view of such circumstances, the present invention is intended to provide a drill guide instrument capable of avoiding interference between screws while allowing the required angular displacement of the drill guide and reducing the work load on the doctor.

  According to the intensive researches of the present inventors, the above object is achieved by the following means.

  The present invention for achieving the above object is (1) a drill guide instrument for guiding a drill for drilling a bone when the implant member is disposed in the body, the position corresponding to the hole of the implant member And a plurality of guide holes penetrating from the first surface to the second surface of the drill guide device and into which the drill can be inserted and in which the drill can be inserted, at least one of the plurality of guide holes being deformed It is a guide hole, and at least one of the cross sections perpendicular to the central axis of the deformed guide hole is a displacement allowance that allows displacement of the insertion angle of the drill guide to be an amount biased in the circumferential direction of the guide hole. It is a cross section which has a guidance area | region, It is a drill guide instrument characterized by the above-mentioned.

  (2) In the invention, the displacement allowing guide area is an area which allows the insertion angle of the drill guide to be displaced only to a part of the entire area in the circumferential direction of the guide hole. It is a drill guide instrument as described in 1).

  (3) In the present invention, in the section having the displacement allowing guide region, the tolerance of the displacement of the insertion angle in one direction is a first tolerance, and the displacement of the insertion angle in the other direction The allowable amount is a second allowable amount, and the first allowable amount and the second allowable amount are different amounts, the drill guide according to the above (1) or (2). It is an instrument.

  (4) The present invention is also characterized in that the deformation guide hole has a plurality of cross sections having the displacement allowing guide region in the central axis direction, according to any one of the above (1) to (3). It is a drill guide instrument.

  (5) In the drill according to any one of (1) to (4), the present invention is also characterized in that the displacement allowing guide region is provided in a plurality in a spaced manner in the circumferential direction in one cross section. It is a guide device.

  (6) The present invention is also characterized in that the displacement of the insertion angle is a displacement from the insertion reference position of the drill guide set in the deformation guide hole. It is a drill guide instrument described in.

  (7) The present invention is also the drill guide instrument according to any one of the above (1) to (6), wherein a plurality of the deformation guide holes having different hole shapes are provided.

  (8) The present invention is also the drill guide tool according to any one of the above (1) to (7), characterized in that the deformed guide hole has an elongated conical shape.

  According to the hole structure of the present invention, it is possible to provide a drill guide instrument capable of avoiding interference between screws while allowing the required angular displacement of the drill guide and reducing the work load on the doctor.

It is an external view showing a guide block concerning an embodiment of the present invention, and is a front view of (A) one side, (B) a front view of the other side, (C) side view, and (D) a perspective view. It is the (A) partial front view which expands and shows a drill guide hole, (B)-(G) sectional drawing. (A) Front view of guide block, (B)-(I) It is sectional drawing which expands and shows a drill guide hole. It is a front view which shows the modification of a guide hole. It is a figure explaining the usage example of a guide block. It is a figure explaining the usage example of a guide block. It is a figure explaining the usage example of a guide block. It is a figure explaining the usage example of a guide block. It is a perspective view showing a plate member. It is a perspective view which expands and shows the same hole structure of a plate member. (A) is a front view of the hole structure, (B) is a bottom view of the hole structure, (C) is a cross-sectional view taken along the line C-C in (A), (D) is an arrow in D-D in (A) (E) is a cross-sectional view taken along the line E-E in (A). (A) is a front view which expands and shows a part of said hole structure, (B) is a BB arrow sectional drawing in (A). It is (A) front view which shows the formation process of the same hole structure, (B) It is sectional drawing. The (A) front view which shows the formation process of the same hole structure, (B) sectional drawing, (C) It is a front view. (A) and (B) are front views which show the formation process of the same hole structure. (A) and (B) are front views which show the formation process of the same hole structure. (A) (B) is the front view and side view which show the screw used when fixing the same plate member. It is sectional drawing which shows the hole structure of a mutually coaxial state, and the screwing state of a 2nd screw. (A) front view showing the hole structure of the mutually inclined state and the screwed state of the second screw, (B) is a B-B arrow sectional view in (A), (C) is a C-C arrow in (A) FIG. (A) front view which becomes another structural example of the hole structure, (B) is a BB arrow sectional view in (A), (C) is a CC arrow sectional view in (A). (A) (B) is sectional drawing which shows the screwing state of the hole structure and the 2nd screw which become another structural example.

  Hereinafter, embodiments of the present invention will be described with reference to the attached drawings. In this embodiment, as the implant member, a plate (bone plate) used to fix a fracture of a long bone such as a femur, a tibia, a humerus, and a calcaneus is exemplified, and a drill for drilling a bone is used. The guide block is illustrated as a drill guide instrument for guiding the guide. Moreover, the case where a screw is used as an external thread member which fastens a plate is illustrated.

<Overall description>
FIG. 1 is a view showing a drill guide apparatus (guide block) 100 of the present embodiment, and FIG. 1 (A) is a front view of one side of the appearance of the guide block 100, and FIG. It is a front view of the other side, the figure (C) is a side view, and the figure (D) is an appearance perspective view.

  The drill guide device (guide block) 100 of the present embodiment is attached to the plate 10 when the fractured portion is fixed with the plate 10 (see FIG. 5B), and the direction of the drill guide for guiding the drill for drilling a bone. Make it easy to

  Although the details of the plate 10 will be described later, a plurality of holes (insertion holes) having a surface in contact with bone and a surface facing away from the bone and receiving an external screw member (screw) are provided between these two surfaces. It is provided.

  When inserting and fixing a screw in the insertion hole of a plate, long bones are previously drilled using a drill (bone drill). The guide block 100 is fixed to (the head portion 10B of) the plate 10 (see FIG. 5C) in order to facilitate the drilling process at the time of drilling.

  FIG. 1A is a front view of the guide block 100 viewed from the outside, FIG. 1B is a front view viewed from the inside, and FIG. 1C is a side view with the left side as the distal side. It is a figure, and the figure (D) is a perspective view which made the upper side the distal side and made the lower side proximal. Here, in the present specification, "proximal" means closer to the heart, and "distal" means farther from the heart. "Inside" means toward the center of the body or to the center of the bone (opposite to the bone), and "outside" means away from the center of the body or center of the bone (on the bone) It means the opposite side to the opposite side). Further, any shape in the following description means a shape intended in design, and includes slight deformation due to processing error.

  As shown in FIGS. 6A and 6B, the guide block 100 is provided with a plurality of guide holes 103 and 105, and a drill guide for guiding the drill is inserted into the guide holes 103 and 105. This facilitates the orientation of the drill guide (and thus the drill and the screw securing the plate 10).

  The guide block 100 has, for example, a substantially trapezoidal shape in which the distal side is wider than the proximal side in a plan view, and has a first surface Sf1 facing outward and a second surface Sf2 facing inward. The second surface Sf2 is used so as to face the plate.

  As shown in FIG. 6C, in the side view, the distal end of the guide block 100 is directed outward beyond the proximal end in any of the first surface Sf1 and the second surface Sf2. Are high, inclined generally distally higher and proximally lower. In this example, each of the first surface Sf1 and the second surface Sf2 is not a flat surface, and has a small curvature, and the curvature is also a curved surface slightly displaced depending on the portion. In addition, depending on the region except the distal end and the proximal end of the guide block 100, the proximal side is more outer than the distal side in the first surface Sf1 (the second surface Sf2 is the same). There may be a site that is inclined to be higher toward the.

  The guide block 100 penetrates from the first surface Sf1 to the second surface Sf2 at positions corresponding to the insertion holes 12 (12A to 12H, see FIG. 5B) of the head portion 10B of the plate 10. Guide holes 103 and 105 (for example, eight guide holes 105A to 105F, 103A and 103B) are provided. A drill guide can be inserted into the guide holes 103 and 105, and a drill for drilling a bone is inserted inside the axial center direction of the drill guide. The distance DD between the first surface Sf1 and the second surface Sf2 (that is, the thickness of the guide block 100) DD is larger than the thickness of the head portion 10B (for example, 5 mm or more), and the guide holes 103 and 105 depend on their depth and shape The drill guide can be oriented.

  In this example, four guide holes 103 and 105 are provided on the distal side (guide holes 105A to 105D) and four on the proximal side (guide holes 105E, 103A, 103B and 105F). The size of the plate 10) is appropriately selected according to the shape and size of the long bone to be fixed and the state of fracture. That is, the shape of the guide block 100 is not limited to the illustrated example of the present embodiment. Further, the number of guide holes 103 and 105 and the arrangement thereof also differ depending on the shape and size of the guide block 100, and are not limited to the illustrated example.

  A part of the plurality of guide holes 103 and 105 in the present embodiment is the first guide hole 103. The first guide hole 103 is, for example, a conventional (previously known) guide hole 103 formed in a truncated cone shape, and the other part is a second guide hole 105 different from the first guide hole 103. It is. More specifically, the first guide hole (ordinary guide hole) 103 in the present embodiment is a drill guide relative to a reference position (hereinafter referred to as an insertion reference position) when the drill guide is inserted. The guide hole is configured such that the insertion angle can not be displaced, or the guide hole is configured such that the insertion angle of the drill guide can be displaced with respect to the insertion reference position over the entire circumferential direction of the hole. is there.

  Here, the “insertion reference position” of the drill guide is a position serving as a reference for inserting the drill guide assumed in the guide holes 103 and 105 into the guide holes 103 and 105. The insertion reference position is, for example, a position corresponding to the insertion hole 12 formed in the plate 10 to which the guide block 100 is attached, and more specifically, the central axis of the insertion hole 12 of the plate 10 and the central axis of the drill guide It is the position where the drill guide is inserted so as to coincide.

  In the example of the figure, two guide holes 103A and 103B from the center of the short side of the long bone (the width direction of the guide block 100) on the proximal side are the first guide holes 103. The first guide hole 103 is a guide hole having a cylindrical shape in this example (the cross section perpendicular to the central axis of the guide hole is circular) in this example, and the first guide hole 103 is circular in the following description. It will be referred to as the guide hole 103 and described.

  On the other hand, in the second guide hole 105 in the present embodiment, at least one of the cross sections perpendicular to the central axis of the guide hole displaces the insertion angle of the drill guide to only a part of the entire region in the circumferential direction of the hole. The guide hole is a cross section having a displacement allowing guide area 102 for allowing the movement. Hereinafter, a cross section having the displacement allowable guide area 102 will be described as a guide cross section G.

  The displacement allowing guide region 102 is a region for allowing the displacement of the insertion angle of the drill guide but allowing the amount of the displacement to be deviated (nonuniform displacement) in the circumferential direction of the guide hole and guiding.

  Alternatively, the displacement allowable guide region 102 is a region that allows displacement of the insertion angle of the drill guide but limits (limits) the allowable region to a partial region in the circumferential direction of the hole.

  That is, the second guide hole 105 is a drill inserted in the insertion reference position because at least one of the cross sections perpendicular to the central axis of the guide hole is the guide cross section (the cross section having the displacement allowing guide region 102). When the insertion angle of the guide is to be displaced, the allowable amount of displacement (the end of the cross section of the guide and the distance to contact the inner wall surface of the hole) is uneven and uneven in the circumferential direction of the guide hole.

  Alternatively, the second guide hole 105 has a drill guide at the insertion reference position by at least one of the cross sections perpendicular to the central axis of the guide hole being the guide cross section (the cross section having the displacement allowing guide region 102). In the case of insertion, only within a partial region in the circumferential direction of the hole, displacement within a predetermined angle of the insertion angle becomes possible. In the following description, the second guide hole 105 is referred to as a deformed guide hole 105.

  In the example of the figure, the six guide holes except for the circular guide holes 103A and 103B are the deformed guide holes 105. Specifically, four guide holes 105A to 105D provided on the distal side, and two guide holes 105E on both ends of the short side of the long bone on the proximal side (the width direction of the guide block 100), 105 F is a deformation guide hole 105.

  This will be further described with reference to FIG. FIG. 6A is a partial front view of the guide block 100, and FIG. 6B is a cross section taken along line aa of the circular guide hole 103A shown in FIG. 7A, that is, a hole of the circular guide hole 103A. (C) is a cross-sectional view taken along the line bb of FIG. (B), that is, a cross-sectional view perpendicular to the central axis CC6 of the hole of the circular guide hole 103A. is there. Further, (D) of the figure is a cross-sectional view taken along the line c-c of the modified guide hole 105A shown in (A), ie, an axial cross section including the central axis CC1 of the hole of the modified guide hole 105A. In the same figure (E) to the same figure (G), the cross section of the line dd, the line e-e and the line f-f in the figure (D), that is, perpendicular to the central axis CC1 of the hole of the deformed guide hole 105A. FIG.

  As shown in FIGS. 6A to 6C, the hole shape of the circular guide hole 103A is a cylindrical shape, and the central axis CC6 of the hole in the vicinity of the first surface Sf1 and in the vicinity of the second surface Sf2. Both the vertical cross-sectional shape and the cross-sectional shape between the first surface Sf1 and the second surface Sf2 in the direction of the central axis CC6 of the hole are circular with the same diameter. The circular guide hole 103A has a slightly larger diameter than the drill guide so that the drill guide can be inserted and displacement of the insertion angle is not allowed. That is, the shape of the circular guide hole 103A is configured to substantially coincide with the insertion reference position BP (shown by a broken line in FIG. 6C) of the drill guide. That is, when the drill guide is inserted into the circular guide hole 103A, the central axis CC6 of the hole and the central axis C0 of the drill guide are oriented in one particular direction (insertion angle) that is coincident with the circular guide hole 103A The insertion angle of the drill guide can not be displaced in the state of being inserted into the insertion reference position BP).

  On the other hand, as shown in the same figure (D), the same figure (E), and the same figure (G), the modified guide hole 105A has the first surface Sf1 of the cross section perpendicular to the central axis CC6 of the hole. The hole shape in the closest (including a portion of the first surface Sf1) and the cross section closest to the second surface Sf2 (including a portion of the second surface Sf2), that is, perpendicular to the central axis CC1 of the hole The cross-sectional shape is an oval (or an oval (or similar) shape). The oval (first oval circle LC1) in the cross section closest to the first surface Sf1 is larger in size than the oval (second oval circle LC2) in the cross section closest to the second surface Sf2. Specifically, the first major circle LC1 has a major axis length LA1 longer than the major axis length LA2 of the second major circle LC2, and the first major circle LC1 has a minor axis length SA1. It is the same as the short axis length SA2 of the second long circle LC2.

  Further, as shown in FIG. 11F, the modified guide hole 105A has a cross-sectional shape perpendicular to the central axis CC1 of the guide hole (a cross-section between the first surface Sf1 and the second surface Sf2 in the central axis direction of the hole). Shape) is also an oval. The oval (third oval circle LC3) in the cross section is smaller than the first oval circle LC1 and larger than the second oval circle LC2. Specifically, the third major circle LC3 has a major axis length LA3 longer than the major axis length LA2 of the second major circle LC2, and a major axis length LA1 of the first major circle LC1. short. In addition, the length SA3 of the minor axis of the third oval circle LC3, the length SA1 of the minor axis of the first oval circle LC1, and the length SA2 of the minor axis of the second oval circle LC2 are the same. is there. That is, as shown to the same figure (C), the hole shape of the deformation | transformation guide hole 105A is a long truncated cone shape (or the elliptical frustum (following same thing)) which makes an upper surface and a bottom a long circle.

  Here, the insertion reference position BP of the drill guide in the deformation guide hole 105A is attached to, for example, the second surface Sf2 side of the guide block 100, as indicated by the broken lines in FIG. It is a position corresponding to the insertion hole 12 of the plate 10, and more specifically, the central axis of the insertion hole 12 (the center of the head of the screw inserted into the insertion hole 12) and the central axis C0 of the drill guide coincide It is a position. Further, in this example, the central axis CC1 of the deformed guide hole 105A and the central axis C0 of the drill guide coincide with each other.

  And, even if the deformed guide hole 105A has the smallest cross section (the cross section on the second surface Sf2 side shown in FIG. 6G), the insertion hole of the plate 10 to the extent that the substantial inclination of the drill guide is permitted. It has a shape larger than twelve.

  Specifically, the first oval circle LC1, the second oval circle LC2, and the third oval circle LC3 in a plurality of cross sections perpendicular to the central axis CC1 of the hole of the deformation guide hole 105A are either Also have lengths LA1, LA2, LA3 sufficiently larger than the diameter of the drill guide.

  On the other hand, the lengths SA1 to SA3 of the minor axes of the first oval circle LC1, the second oval circle LC2, and the third oval circle LC3 are all capable of inserting the drill guide and are smaller than the diameter of the drill guide. It has a slightly larger length (minimum length necessary for insertion of the drill guide). More specifically, although the minor axis lengths SA1 to SA3 do not interfere with the insertion of the drill guide, if the inserted drill guide is to be moved (tilted) in the minor axis direction, it contacts the guide hole and moves Is the regulated length.

  That is, when the drill guide is inserted at the insertion reference position BP of the drill guide of the deformed guide hole 105A, the insertion angle of the drill guide is displaced with respect to the insertion reference position BP in the minor axis direction. The central axis C0 of the drill guide can not be displaced so as to incline with respect to the central axis. Strictly speaking, although the displacement of the insertion angle is not necessarily 0 due to the nature of the drill guide, it can be said that substantial displacement can not be performed from the viewpoint of the freedom of the insertion angle of the drill guide.

  On the other hand, the insertion angle of the drill guide can be displaced in a plurality in the range of a predetermined angle (the taper angle of the side surface of the long truncated cone) in the long axis direction.

  In this manner, (the central axis C0 of) the drill guide is displaced within the cross section including the long axis of the deformed guide hole 105A (within the trapezoidal plane (fan plane) of the long truncated cone) to displace the insertion angle Be oriented to be able to

  Here, as shown in the same figure (E) to the same figure (G), the cross-sectional shape perpendicular to the central axis CC1 of the hole (first oval circle LC1, second oval circle LC2, third oval circle LC3 The hatched area outside the insertion reference position BP displaces the insertion angle of the drill guide with respect to the insertion reference position BP (in this example, the central axis of the insertion hole 12 of the plate 10). It is a displacement tolerant guide area 102 that allows the central axis C0 of the drill guide to be displaced so as to incline with respect to it.

  Thus, in the modified guide hole 105A, the cross-sectional shape perpendicular to the central axis CC1 of the hole is an oval (in this case, the first oval LC1, the second oval LC2, the third oval LC3). When these cross-sectional shapes are viewed in plan from the direction of the central axis CC1 of the hole, the insertion angle of the drill guide is only at part of the entire area in the circumferential direction of the hole (both ends in the long axis direction). A displacement allowing guide area 102 is provided which allows displacement relative to the insertion reference position BP. On the other hand, the displacement of the insertion angle of the drill guide is restricted in an area other than the displacement allowable guide area 102 (for example, both ends in the minor axis direction).

  The deformed guide hole 105A is a guide cross section G in which all cross sections perpendicular to the central axis CC1 of the hole are directed so as to limit the drill guide to a predetermined area and allow displacement of the insertion angle.

  As shown in FIG. 2C, the cross section perpendicular to the center axis CC6 of the circular guide hole 103 of this embodiment can not displace the insertion angle of the inserted drill guide with respect to the insertion reference position BP. To regulate. However, it is not included in the guide cross section G of the present embodiment because it only regulates the displacement of the insertion angle and does not have a displacement allowing region (displacement permitting guide region 102).

  In other words, in the guide cross section G, when trying to displace the insertion angle of the drill guide inserted in the insertion reference position BP, the allowable amount of the displacement (the end of the guide cross section G and the inner wall surface of the hole The distance is not uniform in the circumferential direction of the hole.

Specifically, when it is intended to move the drill guide in one direction in the guide cross section G (in the direction of the minor axis of each oval circle LC1 to LC3), the end of the guide cross section G (inner wall surface of the hole immediately) Of the insertion angle of the drill guide (the displacement of the insertion angle with respect to the insertion reference position BP) in the one direction (the In a substantial range the displacement is approximately zero). On the other hand, the allowable amount (second allowable amount) of displacement of the insertion angle in the other direction (long axis direction of each oval LC1 to LC3) in the guide cross section G is the first allowable amount in the minor axis direction. It is set larger.

  With such a configuration, when the drill guide is inserted into the insertion reference position BP (for example, the insertion hole 12 of the plate 10) of the deformation guide hole 105A, the insertion angle of the drill guide can be displaced while It is possible to restrict the area allowing displacement to a part of the entire area in the circumferential direction of the hole (in this example, the long axis direction of the oval). That is, the drill guide is guided by the deformation guide hole 105A so as to be able to displace the insertion angle with a predetermined directivity. For example, the insertion angle of the drill guide can be displaced only in a fan-like plane including the long axis of the deformation guide hole 105A.

  As described above, the guide block 100 of the present embodiment is preferably used in combination with the plate 10 described later. Although the details will be described later, the insertion hole 12 of the plate 10 has a hole structure 1 by which the screw (second screw 30) inserted into the hole (hole 50) can be inclined with respect to the axial direction of the hole 50 See FIGS. 18 and 19).

  And when the guide block 100 of this embodiment is attached to the plate 10 and the drill guide is inserted into the insertion hole 12 of the plate 10 through the second guide hole 105 of the guide block 100, the drill guide is the insertion standard of the guide hole The position, i.e. the insertion angle can be displaced relative to the insertion hole 12 of the plate 10. Specifically, the insertion angle of the drill guide is set to incline the central axis of the drill guide (the insertion angle of the drill guide) from the position where the central axis of the insertion hole 12 of the plate 10 and the central axis of the drill guide coincide. It can be displaced. Further, the region in which the insertion angle of the drill guide is displaced can be restricted to a partial region in the circumferential direction of the guide hole.

  As described above, since the second guide hole 105 is a guide hole configured such that the insertion of the drill guide has a predetermined direction and the displacement of the insertion angle is permitted in the direction, the plate is a plate. Even when the screw (second screw 30) inserted into the 10 insertion holes 12 (hole 50) is inclined with respect to the axial direction of the hole 50, it is erroneously unnecessary (for example, the screws interfere with each other) Can be prevented from drilling in the same direction.

  In this example, all the cross sections perpendicular to the direction of the central axis CC1 of the hole of the deformed guide hole 105A are oblong holes whose sizes gradually decrease from the first long circle LC1 to the second long circle LC2, The shape is a long truncated cone, but the displacement allowing guide region 102 of this embodiment may be provided in at least one of the cross sections perpendicular to the central axis of the deformed guide hole 105. That is, at least one guide cross section G for orienting the drill guide may be provided in the central axis direction of the deformed guide hole 105 as long as the shape is smaller than the shapes of the other cross sections. If one of the cross sections perpendicular to the central axis of the guide hole (minimum cross section) is a guide cross section G having a displacement allowable guide region 102, the drill guide can be oriented at the portion of the guide cross section G. .

  Further, the length in the central axis direction of the guide hole contributes to the orientation of the drill guide, and a longer direction (deep guide hole) enables more reliable orientation. That is, it is preferable that the formation depth (length along the central axis direction) of the deformation guide hole 105 be longer. Therefore, the deformation guide hole 105 is provided with the displacement allowing guide regions 102 in a plurality of cross sections separated in the central axis direction of the guide hole (having a plurality of guide cross sections G separated in the central axis direction of the hole). Better if configured.

  For example, in the deformed guide hole 105A, a cross section closest to the first surface Sf1 most separated in the direction of the central axis CC1 of the guide hole and a cross section closest to the second surface Sf2 are, for example, a guide cross section G of an oval. In the direction of the central axis CC1, the guide cross section G of the oval is such that the size of the opening gradually decreases (increases) between the two surfaces, and there is no cross section that hinders the orientation between the two surfaces. ing.

  The deformation guide holes 105B to 105F other than the deformation guide hole 105A are also deformed except for the size and the shape of the oval (the major axis, the length of the minor axis, the depth of the hole, and the inclination angle of the central axis of the hole). The configuration is the same as that of the guide hole 105A. That is, in each of the deformation guide holes 105B to 105F, at least one of the cross sections perpendicular to the central axis of the holes is a guide cross section G having the displacement allowable guide region 102 (for example, the same length as the deformation guide hole 105A In order to make the insertion angle of the inserted drill guide inclined relative to the insertion reference position BP of the guide hole (for example, While the central axis C0 can be displaced so as to be inclined with respect to the central axis of the insertion hole 12 of the plate 10, a region allowing the displacement is a part of the entire region in the circumferential direction of the guide hole (this In the example, only the long axis direction of the oval is used), and it can be regulated so that displacement can not be performed in other areas.

<Method of forming deformation guide hole>
The shape of the deformation guide hole and the method of forming the same will be further described with reference to FIG. The numerical values shown below are all examples and do not limit the present embodiment. FIG. 3 (A) is a front view of the first surface Sf1 side of the guide block 100, and FIG. 3 (B) to FIG. 3 (I) are line gg and h- of FIG. It is sectional drawing of h line | wire, i-i line | wire, jj line | wire, kk line | wire, 1-l line | wire, mm line | wire, and nn line | wire.

  In this embodiment, for example, six deformation guide holes 105A to 105F and two circular guide holes 103A and 103B are provided in one guide block 100. The six deformation guide holes 105A to 105F are formed in different shapes to correspond to the insertion position and insertion direction of the screws for fixing the plate. Also, as described above, the first surface Sf1 and the second surface Sf2 are surfaces in which a plurality of curved surfaces having a large curvature are mixed, and the thickness of the first surface Sf1 and the second surface Sf2 (the first surface Sf1 and the first The second surface Sf2) is different. Therefore, by making the forming position and forming direction of each guide hole different, the depths of the guide holes contributing to the orientation of the drill guide are also made different.

  As shown in FIG. 6B, the deformation guide hole 105A is formed, for example, in a shape in which a part of two cylinders (indicated by thin broken lines) having a diameter of 3 mm to 4 mm (for example, 3.56 mm) is overlapped. . The two cylinders are overlapped, for example, such that their central axes intersect at an imaginary reference point P1, and a part of each circumferential surface is in contact in the hatched area shown.

  The virtual reference point P1 in this case is, for example, the center point of the insertion hole 12 of the plate 10 corresponding to the deformation guide hole 105A, or the center point of the head of the screw inserted into the insertion hole 12 (shaft of screw Is a central point for displacing the angle when the angular displacement can be made with respect to the central axis of the insertion hole 12) (the same is true for virtual reference points P2 to P6 below).

  The angle between the central axis CC1 of the deformed guide hole 105A and the designed reference plane pl is β1 (for example, 80 ° to 85 ° (preferably 82 °)). In addition, the distance from the intersection point (the hole reference position) of the reference plane pl and the central axis CC1 of the hole to the virtual reference point P1 is D1 (for example, 5 mm to 6 mm (preferably 5.4 mm)).

  In the modified guide hole 105A, a cross section perpendicular to the central axis CC1 of the hole closest to the first surface Sf1 is a first oval circle LC1, and a cross section perpendicular to the central axis CC1 of the hole closest to the second surface Sf2 It becomes a second oval circle LC2 smaller than the first oval circle LC1, and a hole shape of a long truncated cone having the first oval circle LC1 and the second oval circle LC2 as the upper surface and the lower surface (or vice versa) See Figure 2). Further, in this example, the insertion reference position BP of the deformation guide hole 105A is a position corresponding to the insertion hole 12 of the plate 10 corresponding to the deformation guide hole 105A (the central axis C0 of the drill guide and the central axis of the insertion hole 12 coincide (The same applies in FIG. 3), and the central axis C0 of the drill guide and the central axis CC1 of the guide hole are set to coincide with each other.

  Thereby, when the drill guide is inserted into the insertion reference position BP of the deformation guide hole 105A (the central axis C0 of the drill guide is aligned with the central axis of the deformation guide hole 105A (the central axis passing through the virtual reference point P1) CC1 Case), the predetermined angle α (distal direction from the central axis CC1 only in the major axis direction of the deformation guide hole 105A (with the virtual reference point P1 as a center) with respect to the central axis C0 of the drill guide (In the proximal direction) at an angle α / 2). The predetermined angle α is, for example, 10 ° to 20 ° (preferably, 14 °).

  As shown in FIG. 6C, the deformation guide hole 105B also has a shape in which a part of two cylinders (not shown) with a diameter of 3 mm to 4 mm (for example, 3.56 mm) is overlapped similarly to the deformation guide hole 105A. It is formed. The two cylinders are overlapped, for example, such that their central axes intersect at an imaginary reference point P2, and parts of their circumferential surfaces abut. Here, the virtual reference point P2 is a central point of the head of the screw inserted into the hole of the plate corresponding to the deformation guide hole 105B to fix the plate and the bone, and of the deformation guide 105A in the deformation guide hole 105B. This is a reference point corresponding to the virtual reference point P1.

  The angle between the central axis CC2 of the deformed guide hole 105B and the designed reference plane pl is β2 (eg 70 ° -80 ° (preferably 75 ° preferably)). In addition, the distance from the intersection point (the hole reference position) of the reference plane pl and the central axis CC2 of the hole to the virtual reference point P2 is D2 (for example, 4 mm to 5 mm (preferably, 4.1 mm).

  The modified guide hole 105B has an oval shape in both the cross section perpendicular to the central axis of the hole in the first surface Sf1 and the cross section perpendicular to the central axis of the hole in the second surface Sf2, and the two ovals are respectively It becomes a hole shape of the long truncated cone which makes an upper surface and a lower surface. Although the plan view of the hole is omitted, the insertion reference position BP of the deformation guide hole 105B is a position corresponding to the insertion hole 12 of the plate 10 corresponding to the deformation guide hole 105B, similarly to the deformation guide hole 105A, The central axis C0 of the drill guide and the central axis CC2 of the guide hole are set to coincide with each other.

  Thereby, thereby, when the drill guide is inserted into the insertion reference position BP of the deformation guide hole 105B (the central axis C0 of the drill guide is the central axis of the deformation guide hole 105B (the central axis passing through the virtual reference point P2) CC2 And the center axis C0 of the drill guide can be displaced at a predetermined angle α only in the major axis direction of the deformation guide hole 105B with respect to the center axis CC2 of the hole.

  As shown in FIG. 6D, the deformation guide hole 105C also has a shape in which a part of two cylinders (not shown) with a diameter of 3 mm to 4 mm (for example, 3.56 mm) is overlapped similarly to the deformation guide hole 105A. It is formed. The two cylinders are overlapped, for example, such that their central axes intersect at an imaginary reference point P3 and parts of their circumferential surfaces abut. Here, the virtual reference point P3 is a reference point corresponding to the virtual reference point P1 of the deformation guide 105A in the deformation guide hole 105C.

  The angle between the central axis CC3 of the deformation guide hole 105C and the designed reference plane pl is β3 (eg, 70 ° to 75 ° (preferably 73 °)). Further, the distance from the intersection point (the hole reference position) of the reference plane pl and the central axis CC3 of the hole to the virtual reference point P3 is D3 (eg 4 mm to 5 mm (preferably 4.5 mm)).

  The deformed guide hole 105C has an oval shape in both of a cross section perpendicular to the central axis of the hole in the first surface Sf1 and a cross section perpendicular to the central axis of the hole in the second surface Sf2. It becomes a hole shape of the long truncated cone which makes an upper surface and a lower surface. Although the plan view of the hole is omitted, the insertion reference position BP of the deformation guide hole 105C is a position corresponding to the insertion hole 12 of the plate 10 corresponding to the deformation guide hole 105C, similarly to the deformation guide hole 105A, The central axis C0 of the drill guide and the central axis CC3 of the guide hole are set to coincide with each other.

  Thereby, thereby, when the drill guide is inserted into the insertion reference position BP of the deformation guide hole 105C (the central axis C0 of the drill guide is the central axis of the deformation guide hole 105C (the central axis passing through the virtual reference point P3) CC3 And the center axis C0 of the drill guide can be displaced at a predetermined angle α only in the long axis direction of the deformation guide hole 105C with respect to the center axis CC3 of the hole.

  As shown in FIG. 6E, the deformation guide hole 105D also has a shape in which a part of two cylinders (not shown) with a diameter of 3 mm to 4 mm (for example, 3.56 mm) is overlapped similarly to the deformation guide hole 105A. It is formed. The two cylinders are overlapped, for example, such that their central axes intersect at an imaginary reference point P4, and parts of their circumferential surfaces abut. Here, the virtual reference point P4 is a reference point corresponding to the virtual reference point P1 of the deformation guide 105A in the deformation guide hole 105D.

  The angle between the central axis CC4 of the deformation guide hole 105D and the designed reference plane pl is β4 (for example, 75 ° to 85 ° (preferably 80 °)). In addition, the distance from the intersection point (the hole reference position) of the reference plane pl and the central axis CC4 of the hole to the virtual reference point P4 is D4 (for example, 5 mm to 6 mm (preferably 5.3 mm)).

  The deformed guide hole 105D is an oval having a cross section perpendicular to the central axis of the hole in the first surface Sf1 and a cross section perpendicular to the central axis of the hole in the second surface Sf2, and the two ovals It becomes a hole shape of the long truncated cone which makes an upper surface and a lower surface. Although the plan view of the hole is omitted, the insertion reference position BP of the deformation guide hole 105D is a position corresponding to the insertion hole 12 of the plate 10 corresponding to the deformation guide hole 105D, similarly to the deformation guide hole 105A, The central axis C0 of the drill guide and the central axis CC4 of the guide hole are set to coincide with each other.

  Thereby, when the drill guide is inserted into the insertion reference position BP of the deformation guide hole 105C (the central axis C0 of the drill guide is aligned with the central axis of the deformation guide hole 105D (the central axis passing through the virtual reference point P4) CC4 ), The central axis C0 of the drill guide can be displaced at a predetermined angle α only in the long axis direction of the deformation guide hole 105D with respect to the central axis CC4 of the hole.

  As shown in FIG. 6F, the deformation guide hole 105E also has a shape in which a part of two cylinders (not shown) with a diameter of 3 mm to 4 mm (for example, 3.56 mm) is overlapped similarly to the deformation guide hole 105A. It is formed. The two cylinders are overlapped, for example, such that their central axes intersect at an imaginary reference point P5, and a part of their circumferential surfaces abut. Here, the virtual reference point P5 is a reference point corresponding to the virtual reference point P1 of the deformation guide 105A in the deformation guide hole 105E.

  The angle between the central axis CC5 of the deformed guide hole 105E and the designed reference plane pl is β5 (eg, 60 ° to 70 ° (preferably, 64 °)). In addition, the distance from the intersection point (the hole reference position) of the reference plane pl and the central axis CC5 of the hole to the virtual reference point P5 is D5 (for example, 3 mm to 4 mm (preferably 3.2 mm).

  The deformed guide hole 105E has an oval shape in both of a cross section perpendicular to the central axis of the hole in the first surface Sf1 and a cross section perpendicular to the central axis of the hole in the second surface Sf2, and the two ovals It becomes a hole shape of the long truncated cone which makes an upper surface and a lower surface. Although the plan view of the hole is omitted, the insertion reference position BP of the deformation guide hole 105E is a position corresponding to the insertion hole 12 of the plate 10 corresponding to the deformation guide hole 105E, similarly to the deformation guide hole 105A, The central axis C0 of the drill guide and the central axis CC5 of the guide hole are set to coincide with each other.

  Thereby, when the drill guide is inserted into the insertion reference position BP of the deformation guide hole 105C (the central axis C0 of the drill guide is aligned with the central axis of the deformation guide hole 105E (the central axis passing through the virtual reference point P5) CC5 ), The center axis C0 of the drill guide can be displaced at a predetermined angle α only in the long axis direction of the deformation guide hole 105E with respect to the center axis CC5 of the hole.

  As shown in the same figure (G) and the same figure (H), the circular guide holes 103A and 103B each have one cylindrical hole shape with a diameter of 3 mm to 4 mm (for example, 3.56 mm).

  The angles formed by the central axes CC6 and CC7 of the circular guide holes 103A and 103B and the designed reference plane pl are β6 and β7 (for example, 60 ° to 70 ° (preferably, 64 °)).

  The circular guide holes 103A and 103B are all circular in cross section perpendicular to the central axes CC6 and CC7 of the holes and do not have a guide cross section G, so when the drill guide is inserted, the insertion angle is displaced in any direction I can not let it go.

  As shown in FIG. 1I, the deformation guide hole 105F has a shape in which a part of two cylinders (not shown) with a diameter of 3 mm to 4 mm (for example, 3.56 mm) is overlapped similarly to the deformation guide hole 105A. It is formed. The two cylinders are overlapped, for example, such that their central axes intersect at an imaginary reference point P8, and a part of their respective circumferential surfaces abut. Here, the virtual reference point P8 is a reference point corresponding to the virtual reference point P1 of the deformation guide 105A in the deformation guide hole 105F.

  The angle between the central axis CC8 of the deformed guide hole 105F and the designed reference plane pl is β8 (for example, 35 ° to 45 ° (preferably 39 °)). In addition, the distance from the intersection of the reference plane pl and the central axis CC8 of the hole (the hole reference position) to the virtual reference point P8 is D8 (for example, 4.5 mm to 5.5 mm (preferably 5 mm).

  The deformed guide hole 105F is an oval in both the cross section perpendicular to the central axis of the hole in the first surface Sf1 and the cross section perpendicular to the central axis of the hole in the second surface Sf2, and the two ovals are respectively It becomes a hole shape of the long truncated cone which makes an upper surface and a lower surface. Although the plan view of the hole is omitted, the plan view of the hole is omitted similarly to the deformation guide hole 105A, but the insertion reference position BP of the deformation guide hole 105F is deformed similarly to the deformation guide hole 105A. At a position corresponding to the insertion hole 12 of the plate 10 corresponding to the guide hole 105F, the central axis C0 of the drill guide and the central axis CC8 of the guide hole are set to coincide with each other.

  Thereby, when the drill guide is inserted into the insertion reference position BP of the deformation guide hole 105E (the central axis C0 of the drill guide is aligned with the central axis of the deformation guide hole 105F (the central axis passing through the virtual reference point P8) CC8 ), The center axis C0 of the drill guide can be displaced at a predetermined angle α only in the long axis direction of the deformation guide hole 105F with respect to the center axis CC8 of the hole.

  Thus, although the shape of each of the deformation guide holes 105A to 105F is a long truncated cone, the shapes thereof are different. The present invention is not limited to this example, and a plurality of modified guide holes of the same truncated cone shape may be provided.

<Modification>
FIG. 4 is a view showing a modified example of the second guide hole (deformed guide hole) 105 of the present embodiment, and is a plan view showing an example of the guide cross section G (front view seen from the axial direction of the guide hole). is there. When a plurality of guide cross sections G are provided in the axial direction of the guide hole, this is an example of the shape of the minimum guide cross section G.

  As indicated by hatching in FIG. 2E to FIG. 2G, the guide cross section G of the modified guide hole 105A (the same applies to the modified guide holes 105B to 105F) is on both sides in the long axis direction, ie It is the structure which has two displacement tolerance guidance area | regions 102 spaced apart in direction.

  The guide cross section G of the deformation guide hole 105 may have a plurality of displacement allowing guide regions 102 in the circumferential direction, or may have a single displacement allowing guide region 102.

  FIGS. 4A and 4B show a guide cross section G in which the displacement allowing guide region 102 is provided in two directions and both are continuous. The displacement allowing guide region 102 is disposed such that the guide cross section G is L-shaped as shown in FIG. 6A, or the guide cross section G is substantially V-shaped as shown in FIG. It may be arranged as follows.

  In these cases, for example, a region indicated by a broken line is the insertion reference position BP of the drill guide (a position corresponding to the insertion hole 12 of the plate 10) (same in FIG. 4). Thus, the insertion reference position BP may be offset from the center position of the deformation guide hole 105.

  Further, as shown in FIG. 6C, the displacement allowing guide region 102 may be provided in three directions so that the guide cross section G has a T-shape, and as shown in FIG. The guide area 102 may be provided in four directions so that the guide cross section G has a cross shape.

  In the case of (D) in the figure, it is assumed that the displacement allowing guide region 102 exists all around the insertion reference position BP, and the displacement of the insertion angle of the drill guide is allowed all around the insertion reference position BP. It is shown. However, the allowable amount of displacement of the insertion angle in the virtual line V1 direction is different from the allowable amount of displacement of the insertion angle in the virtual line V2 direction.

  Further, in the virtual line V1 direction, the displacement of the substantial insertion angle is close to zero.

  Further, FIG. 6E is an example of a guide cross section having a single displacement allowing guide region 102 in one direction in the circumferential direction. The modified guide hole 105X has an upper surface and a lower surface in the shape of an elongated circular cone, and the guide cross section G has an elongated shape, but the insertion reference position BP is provided at one end in the long axis direction In the end portion, the side surface of the long truncated cone is formed substantially perpendicular to the reference plane pl. Thereby, the insertion angle of the drill guide can be displaced at a predetermined angle only in one of the longitudinal direction of the hole, for example, the distal direction or the proximal direction.

  Further, FIG. 11F is another example of the guide cross section G having a single displacement allowing guide region 102 in the circumferential direction. In this case, the guide cross section G is formed to be substantially fan-shaped. For example, in the above example, the guide cross section G is formed into an oval and the displacement of the insertion angle of the drill guide is permitted only in the long axis direction, while in this example the circumferential direction of the guide cross section G of the oval The displacement allowable guide area 102 is also extended in the minor axis direction in a part of.

  Further, FIG. 6G is a view showing a cross section along the central axis of the deformed guide hole 105, and one cross section perpendicular to the central axis is a guide cross section G (on the central axis of the deformed guide hole 105X). This is an example of the case where the displacement allowing guide region 102 is formed in one vertical cross section.

  In this case, the shape of the cross section in the first surface Sf1 and the second surface Sf2 is larger than the outer shape of the guide cross section G, and the shape is arbitrary, for example. In this case, the insertion angle of the drill guide can be displaced by the illustrated guide cross section G at one place.

  For example, in the case of the deformed guide hole 105A, any cross-sectional shape in the direction of the central axis CC1 of the hole is an oval as shown in FIG. 2 (E) to FIG. 2 (G). If it is a cross section such as a circular shape that is larger than an oval, for example, the region having a cross sectional shape of the oval (a portion of the guide cross section G) is limited to a predetermined range (for example, the long axis direction of the oval) The insertion angle of the drill guide can be displaced to be inclined with respect to the insertion reference position BP of the hole (for example, the central axis C0 of the drill guide is inclined to the central axis CC1 of the hole).

  More specifically, in the deformed guide hole 105A, the cross-sectional shape perpendicular to the central axis of the hole closest to the first surface Sf1 and the second surface Sf2 is circular, and on the central axis of the hole between both surfaces. The cross section at a certain point may be a guide cross section G (a shape is, for example, a third oval LC3). However, in this case, the cross-sectional shape (circular shape) closest to the first surface Sf1 and the second surface Sf2 has an outer shape larger than the guide cross section G (third oval LC3).

  Alternatively, the cross-sectional shape perpendicular to the central axis of the hole closest to the first surface Sf1 and the second surface Sf2 is larger than the third oval LC3 which is the guide cross section G, and is similar to the third oval It may be.

  That is, as long as the minimum cross sectional shape is a cross section (guide cross section G) having the displacement allowing guide region 102 as the shape of the cross section perpendicular to the central axis of the hole, the deformation guide hole 105 can be oriented in the drill guide It becomes.

  As described above, the displacement allowing guide region 102 of the present embodiment may be configured such that the displacement of the insertion angle of the drill guide becomes an amount that is offset in the circumferential direction of the guide hole. Such a displacement allowing guide region In the guide cross section G having 102, when it is intended to displace the insertion angle of the drill guide inserted in the insertion reference position BP, the allowable amount of displacement (the end of the guide cross section G, until it contacts the inner wall surface of the hole) The distance “d” should not be uniform in the circumferential direction of the guide hole.

  For example, in one guide block 100, the deformation guide hole 105A or the like of the long truncated cone shown in FIG. 3 and the deformation guide hole 105X of FIG. 4 may be mixed.

  Further, the number of guide holes (deformed guide holes 105 and circular guide holes 103) can be appropriately selected according to the size of the guide block 100. For example, only one circular guide hole 103 may be provided in one guide block 100, or all the guide holes of the guide block 100 may be used as the deformed guide holes 105.

  Further, the shape and size of the deformed guide hole 105 are appropriately selected according to the shapes of the hole 50 and the hole structure 1 of the plate 10 used in combination with the guide block 100.

<How to use guide block>
Next, a method of using the guide block 100 of the present embodiment will be described with reference to FIGS. 5 to 8. The guide block 100 of this embodiment is used by being fixed to the plate 10 which is an implant member.

  The plate 10 has a body 10A disposed proximal to the long bone and a head 10B disposed distally. The main body portion 10A is a substantially rectangular portion along the longitudinal direction of the long bone, and a plurality of insertion holes 11 (11A, 11B) are formed along the longitudinal direction. The head portion 10B is expanded in the planar direction as compared with the main body portion 10A, and a plurality of (eight in this example) insertion holes 12 (12A to 12H) are provided.

  In order to insert a screw into these insertion holes 11 and 12, long bones are previously drilled using a drill (bone drill). The guide block 100 of the present embodiment is fixed to the head portion 10B of the plate 10 in order to facilitate the drilling process in the case of the drilling (in particular, the drilling of the head portion 10A).

  Although the details will be described later, the plate 10 has a predetermined hole structure 1 so that a part of screws for fixing the plate 10 to a bone, the central axis of which is with respect to the central axis of the hole 50 of the plate 10 Even if it is inclined in a predetermined direction (in the direction of the recess 62 of the hole structure 1), it is possible to fasten in a state in which it is freely inclined in that direction (see FIGS. A1 and A11).

  On the other hand, in the guide block 100 of the present embodiment, the displacement of the drill guide in the insertion direction more than necessary is restricted by the deformation guide hole 105 (drill guide only in a partial region in the circumferential direction of the deformation guide hole 105 Can be avoided) and it is possible to avoid drilling at a position where the screws interfere with each other, and it is possible to reduce the possibility of placing an excessive burden on the doctor. Moreover, after drilling the bone by orienting the drill guide using the guide block of the present embodiment and drilling the bone, the screw is inclined within an appropriate range by the hole structure 1 of the plate 10 described below. It is possible to conclude with

  The guide holes 103 and 105 of the guide block 100 have shapes corresponding to the respective holes 50 at the positions corresponding to the respective holes 50 formed in the plate 10 (the direction of the tip of the drill guide in each hole 50 is appropriately The shape that can be applied is a shape that can be drilled into a bone at a desired trajectory in accordance with the holes 50 of the plate 10.

  First, the guide block 100 is fixed to the head portion 10B of the plate 10 as shown in FIGS. The guide block 100 has a shape substantially overlapping the head portion 10B of the plate 10, and is disposed such that the second surface Sf2 faces and abuts the head portion 10B. The guide block 100 has a non-removable fixing screw 107 and is fixed to a predetermined position of the plate 10 by the fixing screw 107. The plate 10 to which the guide block 100 is fixed is fixed to the long bone using a K wire (not shown) or the like.

  Next, as shown in FIG. 6A, the drill guide 120 is inserted into the guide hole (for example, the deformed guide hole 105A).

  At this time, displacement of the insertion angle of the drill guide 120 with respect to the insertion reference position BP of the hole (for example, the central axis of the drill guide 120 is inclined with respect to the central axis of the insertion hole 12 of the plate 10 by the deformation guide hole 105A). The displacement of the insertion angle is possible only in a predetermined area. Specifically, the range in which the insertion angle of the drill guide 120 is displaced is limited only to the long axis direction of the long hole by the long conical truncated deformation guide hole 105A in which the cross section perpendicular to the central axis of the guide hole is an oval. Be done. On the other hand, the insertion angle of the drill guide 120 can be arbitrarily displaced in the long axis direction of the elongated hole of the deformed guide hole 105A. Therefore, even if it is possible to fasten in a state in which the screws are freely inclined in the direction of the recess 62 of the hole structure 1 of the plate 10, for example, the holes are drilled in such a position that the screws interfere with each other. Since the drill guide 120 can be arbitrarily oriented in a predetermined direction (long-axis direction of the long hole), it is possible to reduce the burden on the doctor who works.

  On the other hand, the drill guide 120 inserted into the circular guide hole 103A can not displace its insertion angle.

  Properly orienting the drill guide 120 by means of the deformation guide hole 105A, the drill guide 120 is fixed in the hole 50 of the plate 10. The tip of the drill guide 120 is provided with a thread 120A of a helical thread corresponding to the hole structure 1 of the plate 10. The screw thread portion 120A is formed with, for example, a thread similar to the male screw portion of the head portion 32 of the second screw 30 described below, and can be screwed into the hole 50 of the plate 1.

  Next, as shown in FIG. 6B, a sleeve 122 for K wire is attached to the rear of the drill guide 120. In FIG. 6B, the sleeve 122 is attached to the drill guide 120 of the circular guide hole 103B, but the sleeve 122 is attached to the drill guide 120 of the deformed guide hole 105A as well. The central hole of the sleeve 122 is formed to coincide with the central axis of the drill guide 120.

  Thereafter, as shown in FIG. 7A, the K wire 124 is inserted into the center hole of the sleeve 122, the direction is confirmed, and the tip thereof is punched into the bone. In FIG. 6A, the K wire 124 is inserted through the sleeve 122 of the circular guide hole 103B, but the K wire 124 is also inserted through the sleeve 122 of the drill guide 120 of the deformed guide hole 105A. As a result, the K wire 124 is driven into the inside of the bone that is an extension of the central axis of the drill guide 120. Thereafter, the sleeve 122 is removed from the drill guide 120 (the same figure (B)). In the subsequent figures, the illustration of the circular guide hole 103B is omitted.

  Next, as shown in FIG. 8A, the hollow drill 126 is attached with the K wire 124 as a guide. That is, the hollow drill 126 is attached to the drill guide 120 by inserting it into the axial hole of the hollow drill 126. The K-wire 124 can attach the hollow drill 126 to the drill guide 120 with the central axis of the hollow drill 126 aligned with the central axis of the drill guide 120.

  The bone is drilled to a predetermined depth by the hollow drill 126. When drilling is complete, the hollow drill 126 is removed from the drill guide 120 and the drill guide 120 is removed from the guide block.

  Thereafter, as shown in FIG. 6B, a screw (for example, a second screw 30 not shown here) is fastened to the hole 50 of the plate 10 through the deformation guide hole 105A.

  After all necessary screws are fastened to the other holes 50 of the plate 10 in the same manner as described above, the guide block 100 is removed from the plate 10 (the same figure (C)).

<Plate>
Next, with reference to FIGS. 9 to 21, a plate 10 suitable for use with the guide block 100 will be described.

  FIG. 9 shows a plate 10 for fixing a fractured long bone (in the following example, a rib). The plate 10 is attached to the ribs by a first screw 20, a second screw 30 and a third screw 15.

  The plate 10 has a body portion 10A disposed proximal to ribs and a head portion 10B disposed distally. In the main body 10A, two insertion holes 11 are formed along the longitudinal direction, and the third screw 15 having an external thread formed at its tip is inserted, whereby the main bone 10A and the rib are fastened. The head portion 10B extends in the planar direction as compared to the main body portion 10A, and three insertion holes 12A are provided along the distal end edge of the rib. Further, two insertion holes 12B are provided on the proximal side of the insertion hole 12A and adjacent thereto. In the present embodiment, the hole structure 1 of the present embodiment is applied to the two proximal insertion holes 12B.

  In addition, the K wire hole 19 is formed in the plate 10, and it is also possible to determine in advance the relative position of the plate 10 and the ribs using the K wire.

<Description of hole structure>
The pore structure 1 is shown enlarged in FIGS. 10 and 11. The hole structure 1 has a hole 50 and a plurality of screwing projections 52 formed on the inner circumferential surface of the hole 50. Further, the plurality of screwing projections 52 form a row projection group 60. A plurality of row projections 60 are arranged in the circumferential direction of the hole 50. In addition, in order to increase the fastening force with the second screw 30, the row projection group 60 is preferably configured by at least three or more screwing projections 52.

  As shown in FIG. 11C, the hole 50 has a tapered shape (or a mortar shape), and the diameter in the axial outer direction Ao side is large and the diameter in the axial inner direction Ai (bone side) is small.

  As shown in FIG. 12A in an enlarged manner, the inner peripheral edge 52A of the screwing projection 52 positioned outermost in the axial outer direction Ao of the hole 50 is a distance R1, R2, R3 from the center C of the hole 50. Gradually changes along the circumferential direction. The distance R2 from the center C of the hole 50 is closest to the tip end 53 of the screwing projection 52, and the distance from the center C of the inner peripheral edge of the screwing projection 52 as it moves outward from the tip 53 as a starting point R1 and R3 become large. As a result, when the hole 50 is viewed in an axial direction, the screwing projection 52 protrudes radially inward on the basis of a virtual perfect circle.

  The contour of the inner peripheral edge 52A of the screwing projection 52 is configured to have a concave first partial arc E1 at the center C1 and a second partial arc E2 at the center C2.

  The center C1 is disposed at a position approaching radially toward the screwing projection 52 at a position having a phase of about 45 ° in the circumferential direction from the radial direction connecting the center C of the hole 50 and the projecting end 53. The radius of curvature RE1 is set equal to or less than the distance R2 between the center C and the end 53.

  The center C2 is located at a position different from the center C1, specifically, toward the screwing projection 52 at a position having a phase of about −45 ° in the circumferential direction from the radial direction connecting the center C of the hole 50 and the tip 53. It is disposed at a position approaching radially. The radius of curvature RE2 is set equal to or less than the distance R2 between the center C and the end 53, and coincides with the radius of curvature RE1. As a result, the first partial arc E1 and the second partial arc E2 continue (intersect) at the end 53. In addition, although the case where 1st partial arc E1 and 2nd partial arc E2 become a positive arc is illustrated, you may comprise by partial arcs, such as an ellipse, and may be another shape.

  When the axial cross section along the radial direction from the center C of the hole 50 toward the projecting end 53 is defined as a reference axial cross section, the shape of the cross section of the screw projection 52 in the reference axial direction is as shown in FIG. It has a mountain shape as shown. Therefore, the screwing projection 52 constitutes a part of a female screw for screwing with a male screw member (details will be described later) of the screw 30.

  Furthermore, as compared with the height of the internal thread at the end 53, the height of the internal thread 52 decreases as it is separated from the end 53 in the circumferential direction. Specifically, as can be seen from the comparison of FIGS. 11C to 11E, the base surface KA of the screwing projection 52 (expressed as a valley bottom when expressed by a female thread), and the inner circumferential surface of the hole 50 The height of the internal thread toward the radially inward direction, which can also be defined, is the highest at the end 53 (see FIG. 11C), and + 45 ° or −45 ° circumferentially from the position of the end 53 The height of the internal thread is the lowest at the place of the phase (see FIGS. 11 (D) and (E)). However, even at the place where the height of the female thread is the smallest, the female thread itself is present, in other words, the thread groove 54 is always formed in a spiral shape between adjacent female threads.

  As shown in FIG. 11C, a plurality of screwing projections 52 are juxtaposed from the outer side (Ao) in the axial direction toward the inner side (Ai). The shapes of these juxtaposed screwing projections 52 are substantially the same. The holes 50 are tapered. The plurality of screwing projections 52 constitute a row projection group 60.

  Further, as shown in FIG. 11A, a plurality of (here, four) row protrusion groups 60 are disposed in the circumferential direction of the hole 50. More specifically, at least a pair of row-shaped projection groups 60 are disposed to face the center C of the hole 50 in the radial direction. Here, a total of two pairs of row-shaped protrusion groups 60 face each other by arranging four row-shaped protrusion groups 60 at equal intervals (that is, 90 ° intervals) in the circumferential direction.

  Further, as shown in FIGS. 11 (C) to (E) and FIG. 12 (B), each screw-on projection 52 has a predetermined lead angle, and as a result, a plurality of row projections 60 are It constitutes a part of female thread. That is, on the inner peripheral surface of the hole 50, a female screw is formed by the row projection group 60 and the screw groove 54. Here, two internal threads are formed, and in this case, even-numbered internal threads match or approximate the shapes of the row projections 60 radially opposed with respect to the center C on the inner circumferential surface of the hole 50. Processing error can be reduced.

  Partially cylindrical or partially elliptic cylindrical (and tapered) concave portions 62 are formed between the row-shaped protrusion groups 60 disposed adjacent to each other in the circumferential direction. The space of the recess 62 can be used to incline the second screw 30. The number of the row projections 60 is preferably 2 or more, more preferably 3 or more in the circumferential direction, and still more preferably 4 or more in the rows 60. Since the number of recesses 62 formed between them increases, the inclination direction can be diversified. On the other hand, in order to incline the second screw 30 into the recess 62, it is necessary to secure a circumferential angle range of the recess 62 to a certain extent, so the number of the recesses 62 is preferably five or less. Is 4 or less. In addition, it is preferable that the row projections 60 be arranged at equal intervals in the circumferential direction. For example, in the case of two row projections 60, three row projections 60 with a phase difference of 180 °. In the case of the above, it is preferable to arrange them with a phase difference of 120 °.

  This hole structure 1 will be described from another point of view with reference to FIG.

  As shown in FIG. 11C, a spiral internal thread 55 is continuously formed on the inner peripheral surface KA of the tapered hole 50 which is a perfect circle. As shown in FIG. 11A, the height of the internal thread 55 repeatedly increases and decreases along the circumferential direction, whereby a plurality of high mountain regions 55A and low mountain regions 55B are formed. In addition, the circumferential phase of the high mountain region 55A which is circulated and repeated is made to coincide with each other, and the circumferential phase of the low mountain region 55B which is circularly repeated is made to coincide with each other. In this way, the row-shaped projection group 60 is formed by the plurality of high mountain regions 55A arranged in parallel in the axial direction in the same phase. The recess 62 is formed by the plurality of low mountain regions 55B axially arranged in parallel in the same phase.

  Next, an example of the formation procedure of the hole structure 1 will be described with reference to FIG.

  First, as shown in FIG. 13, general internal thread 55 having two threads is spirally formed on the inner peripheral surface of the opening formed in the plate 10 by cutting, rolling or the like. In this process, tapered holes 50 are also formed at the same time.

  Then, as shown in FIGS. 14A and 14B, a cutting locus S1 in a state in which the virtual cone S having a similar shape smaller than the hole 50 is offset in the radial direction and interferes with the internal thread 55 is obtained. As a result, part of the internal thread 55 is removed. As a result, as shown in FIG. 14C, a recess 62 is formed by scraping a part of the internal thread 55 radially outward. Similarly, as shown in FIG. 15A, a part of the internal thread 55 is deleted so as to obtain a cutting trajectory S2 in which the phase in the offset direction of the virtual cone S is 180 ° opposite to that in FIG. Do. As a result, as shown in FIG. 15 (B), a second concave portion 62 is formed by scraping a part of the internal thread 55 radially outward.

  As shown in FIG. 16A, by performing the same steps as those in FIGS. 14 and 15 with a 90 ° offset direction shifted, as shown in FIG. 16A, a part of the internal thread 55 so that cutting paths S3 and S4 can be obtained. Remove As a result, as shown in FIG. 16B, two recesses 62 are newly formed by scraping a part of the internal thread 55 radially outward. The recessed part 62 is formed in four places of the circumferential direction by the above process, As a result, the row-shaped projection group 60 is created between the recessed parts 62. As shown in FIG. In addition, this cutting order can be changed suitably.

  Although the insertion hole 12A on the distal side is smaller in size than the insertion hole 12B on the proximal side, the hole structure of the insertion hole 12A is an internal thread with two threads on the inner peripheral surface of the tapered hole. Are only formed, and detailed illustration and explanation here will be omitted.

<Description of screw>
The first screw 20 and the second screw 30 will be described with reference to FIG. In addition, since both screws 20 and 30 are similar shape small compared with the 2nd screw 30 except the axial direction length, while making the last digit of a mutual code correspond, Here, the description of the first screw 20 is omitted by describing the second screw 30.

  The second screw 30 has a head 32 and a shaft 34. The head portion 32 has a large diameter in the axial direction outside, and a tapered shape with a small diameter on the shaft portion 34 side (tip end side). On the circumferential surface of the head portion 32, male screw portions 36 of two spiral strips having the same lead angle as the hole structure 1 are formed. Further, on the end face of the head 32, a hole 32A of a hexagonal shape or a six star shape is formed, and it can be engaged with a hexagonal bar wrench or the like to be tightened. In addition, although the case where the screw part is not formed in the surrounding surface of the axial part 34 is illustrated in this embodiment, this invention is not limited to this.

<Function of hole structure>
Next, the screwing aspect of the hole structure 1 and the second screw 30 will be described. As shown in FIG. 18, when the central axis J1 of the hole structure 1 and the central axis J2 of the second screw 30 are coaxial, the head 32 of the second screw 30 penetrates to the deeper side of the hole structure 1, All row projections 60 and female screw grooves 54 are screwed and fastened to the male screw portion 36.

  On the other hand, as shown in FIG. 19, when the central axis J2 of the second screw 30 is inclined (inclined in the direction of the recess 62 of the hole structure 1) with respect to the central axis J1 of the hole structure 1, the head of the second screw 30 is While the portion 32 remains at the shallow position of the hole structure 1, as shown in FIG. 19C, the male screw portion 36 and the row projection group 60 are screwed together and fastened. At this time, as shown in FIG. 19B, although the female screw groove 54 formed in the concave portion 62 in the inclined direction partially abuts on the male screw portion 36, it is not screwed. Since the contact area is increased by the male screw portion 36 partially abutting (abutted) on the female screw groove 54, the fastening between the hole and the screw is made stronger than in the case where the female screw groove is not formed in the recess 62. Is possible. Further, as described above, the height of the internal thread becomes lower as it is separated from the end 53 in the circumferential direction as compared with the height of the internal thread at the end 53. That is, a clearance occurs between the female screw groove 54 and the male screw portion 36, and this clearance allows the second screw 30 to incline with respect to the hole. Therefore, according to the hole structure 1 of the present embodiment, it is possible to fasten the second screw 30 in a state of being freely inclined in the direction of the four concave portions 62.

  According to the hole structure 1 of the present embodiment described above, the plurality of rows of projections are formed by the screwing projections 52 protruding inward in the radial direction so that the distance from the center C of the holes 50 gradually changes along the circumferential direction. Since the projection group 60 is configured, even when the second screw 30 is inclined with respect to the axial direction of the hole 50, the second screw 30 can be screwed with the male screw portion 36.

  In particular, since the contour of the inner side of the projection 52 when viewed from the axial direction of the hole 50 includes the first partial arc E1 and the second partial arc E2, the first screw connection projection 52 has the first partial arc E1 or the second partial arc E1. The recess 32 formed by the partial arc E2 allows the head 32 of the second screw 30 to be received smoothly.

  Further, since at least a pair of row-like protrusion groups 60 are disposed to face in the radial direction of the hole 50, the second screw 30 can be inclined in the radial direction orthogonal to the radial direction. Moreover, since the shape of the axial cross section of the projecting end 53 has a mountain shape and this linear projection group 60 can function as a part of a female screw thread, it is possible to enhance the fastening force with the second screw 30 It becomes.

  Furthermore, in the screwing projection 52 of the present embodiment, the height of the internal thread of the projecting end 53 is the highest, and the height of the internal thread becomes gradually lower as it is separated in the circumferential direction, and the recess 62 can be formed. ing. As a result, while the hole structure 1 exerts the function of the female screw, the recess 62 can secure an allowance space for the second screw 30 for tilting.

  Further, since the hole 50 of the present hole structure 1 has a tapered shape such as a partial cone, when the hole 50 is coaxial with the male screw portion 36, the hole 50 receives the male screw portion 36 to the back in the axial direction and is screwed together. On the other hand, when the male screw portion 36 is inclined, the male screw portion 36 can be screwed in a shallow position with respect to the hole 50.

  In the above embodiment, as shown in FIG. 11, the locus of the valley bottom surface KA of the internal thread 55 is made a substantially circular shape, and the height of the internal thread 55 is changed in the circumferential direction to form the projection 52 for screwing. Although the case has been illustrated, the present invention is not limited thereto. For example, as shown in FIG. 20, the distance from the center of the hole 50 to the valley bottom KB of the spiral internal thread 55 may repeat increase and decrease along the circumferential direction. In this way, even if the height of the internal thread 55 is not changed, it is possible to form the plurality of projecting areas 56A and the retreating area 56B by the displacement on the valley bottom KB side. When the circumferential phases of the plurality of projecting regions 56A coincide with one another and the circumferential phases of the plurality of withdrawal regions 56B coincide with one another, it is possible to form the row-shaped projection group 60 and the recess 62. As a result, as shown in FIG. 21, it is possible to screw with the inclined second screw 30.

  Moreover, although the guide block 100 of this embodiment is suitably used with the plate 10 in which the several hole 50 which has said hole structure 1 was provided, the hole structure conventionally known (hole other than said hole structure 1) It may be used with a plate provided with a hole having a structure).

  As mentioned above, although the drill guide instrument of this invention was demonstrated, this invention is not limited to these embodiment, A various change can be added in the range which does not deviate from the summary of this invention.

Reference Signs List 1 hole structure 10 plate 10A main body portion 10B head portion 12A insertion hole 12B insertion hole 15 screw 19 wire hole 20 first screw 30 second screw 32 head 32A hole 34 shaft portion 50 hole 52 screwing projection 52A inner peripheral edge 53 projecting end 54 Groove 55 Female thread 55A High mountain area 55B Low mountain area 56A Protrusion area 56B Retraction area 60 Line-like projection group 62 Concave part 100 Guide block 102 Displacement allowable guide area 103 First guide hole (circular guide hole)
105 Second guide hole (deformed guide hole)
120 drill guide 122 sleeve 124 wire 126 hollow drill BP insertion reference position G guide surface C center E1 first part arc E2 second part arc KA base surface S virtual cone

Claims (8)

A drill guide for guiding a drill for drilling a bone when the implant member is disposed in the body, comprising:
It has a plurality of guide holes which can be penetrated from the first surface to the second surface of the drill guide tool at positions corresponding to the holes of the implant member and into which the drill guide can be inserted.
At least one of the plurality of guide holes is a deformation guide hole,
At least one of the cross sections perpendicular to the central axis of the deformed guide hole is:
It is a cross section having a displacement allowing guide region that allows displacement of the insertion angle of the drill guide to be an amount that is biased in the circumferential direction of the guide hole.
A drill guide instrument characterized in that. The displacement allowing guide region is a region allowing displacement of the insertion angle of the drill guide only to a part of the entire region in the circumferential direction of the guide hole.
The drill guide according to claim 1, characterized in that: The cross section having the displacement allowable guide area is
The tolerance of displacement of the insertion angle in one direction is the first tolerance,
The tolerance of displacement of the insertion angle in the other direction is a second tolerance,
The first tolerance and the second tolerance are different amounts,
The drill guide instrument according to claim 1 or 2, characterized in that: The deformation guide hole is
A plurality of cross sections having the displacement allowing guide region in the central axis direction,
The drill guide instrument according to any one of claims 1 to 3, characterized in that: A plurality of the displacement allowing guide regions are provided spaced apart in the circumferential direction in one cross section,
The drill guide instrument according to any one of claims 1 to 4, characterized in that: The displacement of the insertion angle is a displacement from the insertion reference position of the drill guide set in the deformed guide hole.
The drill guide instrument according to any one of claims 1 to 5, characterized in that: A plurality of the modified guide holes having different hole shapes are provided,
The drill guide instrument according to any one of claims 1 to 6, characterized in that: The deformation guide hole is
The hole shape is a long truncated cone shape,
The drill guide instrument according to any one of claims 1 to 7, characterized in that: