JP2019072086A - stopper - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical screwdriver stopper capable of preventing a puncture accident due to a driver bit during a craniotomy operation even in a situation where a come-out phenomenon and a pull-out phenomenon are not physically resolved. SOLUTION: A stopper 10 or the like is formed in a convex shape from two disks 12 and 14 having different diameters, and is made of a transparent material as a whole. A screwdriver bit 50 or the like is inserted into both center holes 12H and 14H, and screws 70a or the like are fitted into the three screw holes 18a or the like formed in the internal disk 14, so that the stopper 10 or the like is a screwdriver 100 or the like. It is fixed to the shaft and rotates with the rotation of the screwdriver 100 and the like. The diameter D14 of the internal disk 14 was set to φ15 mm, which is approximately 1 mm larger than the maximum bone hole diameter (= 14 mm) created at the time of craniotomy. The width W14 of the side surface 14S of the internal disk 14 was set to 7.5 mm, which is substantially larger than the maximum thickness of the temporalis muscle or the thickness of the scalp that is turned over at the time of craniotomy. [Selection diagram] Fig. 1

Description

  The present invention relates to a stopper having a central hole penetrating a bottom surface and two disks of different diameters formed into a convex shape by combining both central holes, and in particular to a stopper used for a medical screwdriver.

  At the time of closure of neurosurgery, skull fixation is generally performed using fixation with a titanium plate (implant) in order to fix an open bone fragment to the skull. The titanium plate is of an external fixation type, and a titanium screw is used to fix the titanium plate to a bone. Recently, in order to shorten the operation time and simplify the operation procedure, a type of “self tapping screw” in which an internal thread is formed by its own thread is used, and most of the above-mentioned titanium screws are used. It has reached the share of

  FIG. 27 (A) illustrates an external fixation type titanium plate used in the skull fixation method using an implant, and FIG. 27 (B) illustrates a titanium screw (only four screws are shown for convenience) used in the fixation method. ) Is illustrated. The type of titanium screw shown in FIG. 27 (B) is the tapping screw. The external fixed type titanium plate has an advantage that it is easy to adjust its shape and is easy to be reopened.

  However, when fastening the tapping screw with a screwdriver, a phenomenon (cam out phenomenon) may occur where the tip of the screwdriver (driver bit) comes off from the screw head of the tapping screw (in the medical field, especially in neurosurgery) It is common to refer to a phenomenon that is out of the subject as slip-out, and therefore the term “screw driver slip-out” may be used instead of the term “cam-out” in this specification. Here, at the time of craniotomy, at first, circular bone holes are drilled at four or five places with a drill of 14 mm or the like, and then bones are cut from this bone hole with a cutter. If the above-mentioned come out (screw driver slipout) phenomenon occurs at the time of closing the head, the driver bit may be lost in the gap of the bone hole or the joint of the bone opened at the time of craniotomy. The resulting intracranial stings or stinging of the eye in the orbit are very dangerous and must be absolutely avoided.

  However, the come out phenomenon is a phenomenon that can not be physically avoided (see Non-Patent Document 1). As described above, the tapping screw has a characteristic that the screw itself forms an internal thread and performs fastening. In the internal thread forming process, a large "rotational torque" and a "screw formation force" are required (according to Non-Patent Document 1, "rotational torque" is a driving torque supplied from the screw driver side, "Screw forming force" is axial force which is a tightening force generated against thrust (Thrust force) or driving torque. In the screw fastening process, a large vertical axial force is required, and a reliable fastening operation is required. The cam out phenomenon (or effect) is a phenomenon where the driver bit comes out of the screw head of the male screw (tapping screw) when the driver bit can not withstand vertical axial force and rotational torque at the time of tapping screw tightening (screw This is a driver slipout phenomenon), and a pullout phenomenon that damages (destructs) the screw head of the worst external screw occurs (see non-patent documents 2 and 3).

  As described above, the cam out phenomenon and the pull out phenomenon physically can not be canceled if the axial force in the vertical direction and the rotational torque exist, and the “cam out force and pull out torque” (see Non-Patent Document 1). Occurs as a result of existence. In particular, the pullout torque exhibits a maximum value when the tapping screw is finally fastened, and a pullout phenomenon may occur if the value is exceeded. Therefore, physically, the cam out force and the pull out torque can not be made zero, and as an unavoidable phenomenon, the cam out phenomenon and the pull out phenomenon can occur. Therefore, even if the screw head is improved, as long as axial force and rotational torque in the vertical direction, and cam out force and pull out torque exist, the cam out phenomenon and the pull out phenomenon can not be fundamentally eliminated. .

  Control of the rotational torque and the axial force in the vertical direction in the fastening of a small tapping screw used in neurosurgery is a very difficult task. However, when the above-mentioned come-out phenomenon occurs, the driver bit still has a vertical thrust force, so the driver bit slippery bone outer plate is damaged at the stab itself or opened at the time of craniotomy It is expected that a serious stinging accident will occur that stings in a bone hole or bone joint or in the orbit. However, not only conventional drastic solutions have been taken, but surgery is performed daily in situations that are not recognized at all. That is, when the tapping screw is tightened with the current surgical instrument, the come out phenomenon and the pull out phenomenon are not physically solved, so the surgery is always performed with the risk of an intracranial sting accident caused by the screw driver slip out. The situation is

  As described above, physically, the cam out force and the pull out torque can not be made zero, and as an unavoidable phenomenon, the cam out phenomenon and the pull out phenomenon can occur. When fastening small tapping screws used in neurosurgery with current surgical tools, the come out and pull out phenomena have not been physically resolved, so there is always the risk of an intracranial sting accident due to screw driver slip out. There was a problem that it was the situation where it was operating while holding it.

  Therefore, the object of the present invention is to solve the above-mentioned problems, and even if the come out phenomenon and the pull out phenomenon are not physically resolved, the sting by the driver bit at the time of closing operation. An object of the present invention is to provide a stopper which can prevent an accident and can perform a census operation of a brain surgery more safely.

  A second object of the present invention is to provide a stopper capable of performing a claudication operation in brain surgery more simply by eliminating the need for a retractor used to retract the skin when tightening a tapping screw. is there.

  The stopper according to the present invention is a stopper in which a first disk having a central hole penetrating the bottom surface and a second disk are formed into a convex shape by combining both central holes, and the diameter of the bottom surface of the first disk is the first diameter. The width of the side is a first width, the diameter of the bottom of the second disk is a second diameter smaller than the first diameter, the width of the side is a second width larger than the first width, and the second diameter is created at the time of craniotomy The second width is set to the thickness of the temporal muscle or to the thickness of the scalp at the time of craniotomy (when craniotomy). It is characterized by

  Here, in the stopper of the present invention, the second diameter of the second disk can be made approximately 1 mm larger than the largest bone hole diameter created at the time of craniotomy (when craniotomy).

  Here, in the stopper according to the present invention, the second width of the second disk is approximately greater than the maximum thickness of the temporal muscle or the thickness of the scalp (reversed when it is cranscribed) that is reversed at the time of craniotomy Can.

  Here, in the stopper of the present invention, a screw hole may be provided which extends from the side surface of the second disk to the central hole of the second disk.

  Here, in the stopper according to the present invention, a screw may be further provided which is screwed (threaded) into the screw hole, and a driver bit is directed from the central hole on the first disk side toward the central hole on the second disk side. The stopper may be fixable at a predetermined position of the driver bit by the screw.

  Here, in the stopper of the present invention, the predetermined position can be a position where the length from the tip of the driver bit to the surface of the second disk is equal to or less than the thickness of the skull.

  Here, in the stopper of the present invention, when the stopper is fixed at the predetermined position of the driver bit, the stopper can rotate with the rotation of the driver bit.

  Here, in the stopper of the present invention, the stopper can be formed of a transparent material.

  The stopper of the present invention is composed of an outer disk and an inner disk of different diameters, and is formed of a transparent material as a whole. The stopper is formed in a convex shape by combining the central hole of the outer disk with the central hole of the inner disk. The driver bit can be fixed by inserting the driver bit into both center holes of the stopper and inserting (screwing) the screw into the three screw holes formed in the inner disk. The stopper is firmly fixed to the shaft (driver bit) of the screw driver and rotates with the rotation of the screw driver. The stopper can be fixed at the desired position of the shaft (driver bit) of the screwdriver by means of the three screws described above. As a result, there is an effect that the length of the driver bit which protrudes from the tip side (bottom side of the inner disk) of the stopper can be adjusted steplessly according to the thickness of the skull of each case.

  Since the maximum diameter of the bone hole created at the time of craniotomy is 14 mm universally, the size of the diameter of the inner disk is set to φ 15 mm, which is approximately 1 mm larger than the largest bone hole diameter (= 14 mm) created at the time of craniotomy. As a result, even if the cam out (screw driver slip out) phenomenon occurs, there is no possibility that the driver bit may get lost in a bone hole or the like, so an intracranial sting accident or an accident that stings the eyeball in the orbit is effectively made. There is an effect that it can be prevented.

  The size of the width of the side surface of the internal disk was set to be 7.5 mm, which is approximately larger than the maximum thickness of the temporal muscle or the thickness of the scalp turned at craniotomy. The normal tapping screw fastening requires a retractor for retracting the scalp (including the muscles under the scalp and above the skull), but the above-mentioned thickness of 7.5 mm also serves as a retractor for the scalp can do. As a result, the use of the retractor conventionally used becomes unnecessary. That is, there is an effect that the stopper itself can also serve as the retractor.

It is a perspective photography figure in the substantially use condition of the stopper 10 of this invention. It is a figure which illustrates the actual use condition of the stopper 10 of this invention. It is a plane photography figure of stopper 10 of the present invention. It is a perspective photography figure of stopper 10 of the present invention. It is a top view of stopper 10 of the present invention. FIG. 6 is a cross-sectional view of the stopper 10 shown in FIG. 5 taken along the line AA (left side). FIG. 5 is a right side view of the stopper 10; It is BB sectional drawing (plane side) of the stopper 10 shown by FIG. FIG. 5 is a perspective view of another size large stopper 20 of the present invention. It is a top view of the large sized stopper 20 of this invention. FIG. 11 is a cross-sectional view of the large-sized stopper 20 shown in FIG. 10 taken along the line AA (left side). 5 is a right side view of the large stopper 20. FIG. It is BB sectional drawing (plane side) of the large sized stopper 20 shown by FIG. FIG. 5 is a perspective view of the stopper 10 shown in FIG. 4 from which the screws 70 a and the like have been removed. It is an enlarged view of screw 70a grade | etc.,. It is a figure which shows the state which mounted | worn the stopper 10 grade | etc., Of this invention with the driver bit 50 set to the electric (rotation) type screw driver 100. FIG. It is a figure which shows the state which mounted | wore the driver bit 50 set to the manual (rotation) type | formula screw driver 110 with the stopper 10 of this invention. It is a figure which shows the condition which has fastened the tapping screw to the skull using the electrically driven screwdriver 100. FIG. It is a figure which shows the condition which has fastened the tapping screw 210 to the skull using the manual screw driver 110. FIG. A picture showing that the internal disk 14 of the stopper 10 never falls into the bone hole even if the screw driver slipout occurs and the tip of the driver bit 60 may get lost into the bone hole FIG. It is a figure which shows the number of diseases and the number of cases for which craniotomy was performed. It is a figure which shows the implant total used by surgery. It is a figure which shows the number of times which a screw driver slipout occurred. It is a three-dimensional bar graph which shows the ratio which produced screw driver slipout based on the result of FIG. It is a three-dimensional bar graph which shows the number of times of having generated screw driver slipout seen by operation. It is a three-dimensional bar graph which shows the frequency | count of having produced screw driver slipout seen by maker of the screw driver main body. It is a figure which illustrates the external fixation type titanium plate and titanium screw which are used by the skull fixation method using an implant.

  Hereinafter, embodiments will be described in detail with reference to the drawings.

  The inventor made extensive efforts to make it possible to perform the census operation of the brain surgery more safely, and the medical screw driver stopper (hereinafter referred to as a medical screw driver stopper as an instrument for preventing a sting accident attached to the tip of the medical screw driver). I just developed "stopper". Hereinafter, the shape, size, and principle of adopting the stopper will be described.

  First, an overview of the stopper is shown. FIG. 1 shows a perspective view of the stopper 10 of the present invention in a substantially used state. As shown in FIG. 1, the stopper 10 is composed of two disks 12 (first disk) and a disk 14 (second disk), and is formed of a transparent material as a whole. Here, in general, a disk refers to a cylinder whose side width is thin among cylinders, and may include one having a rounded bottom, but the disk in the present specification has a rounded bottom. Shall not be included. Hereinafter, the disk 12 will be referred to as the outer disk 12 and the disk 14 having a diameter smaller than that of the outer disk 12 will be referred to as the inner disk 14. The outer disk 12 has a central hole 12H penetrating the bottom surface 12B, and the inner disk 14 also penetrates the central hole 14H penetrating the bottom surface 14B. Have. The stopper 10 is formed in a convex shape by combining the outer disk 12 having the center hole 12H and the inner disk 14 having the center hole 14H with the both center holes 12H and 14H. That is, both center holes 12H and 14H are formed integrally. As shown in FIG. 1, a driver bit 50 passes through both center holes 12H and 14H of the stopper 10, and screws (not shown) are fitted in screw holes 18a, 18b and 18c formed in the internal disk 14. By screwing in, the driver bit 50 can be fixed (the driver bit 50 has no blade at its tip for convenience of showing the entire image of the stopper 10). In FIG. 1, for convenience of explanation, the driver bit 50 is inserted from the bottom surface 14B longer than usual, but the stopper 10 can be fixed at an arbitrary position of the driver bit 50 as described later.

  FIG. 2 illustrates the actual use of the stopper 10 of the present invention. Since the part which attached | subjected the code | symbol same as FIG. 1 in FIG. 2 shows the same element, description is abbreviate | omitted. As shown in FIG. 2, the driver bit 60 passes through both center holes 12 H and 14 H of the stopper 10, and a blade 60 E formed at the tip of the driver bit 60 is applied to the skull SKL. As shown in FIG. 2, the stopper 10 is fixed at a position closer to the blade 60E of the driver bit 60.

  FIG. 3 shows a plan view of the stopper 10 of the present invention. Since the parts in FIG. 3 to which the same reference numerals as in FIG. 1 are given indicate the same elements, the description will be omitted. In FIG. 3, the shape in which both central holes 12H and 14H are integrally formed is clearly shown, and the screw holes 18a, 18b and 18c formed in the internal disk 14 are also in the shape of the screw grooves Is clearly shown. As shown in FIG. 3, the outer disk 12 has a bottom surface 12B set to a diameter D12 (first diameter), and the inner disk 14 has a bottom surface 14B set to a diameter D14 (second diameter). The diameter D14 is smaller than the diameter D12. As will be described in detail later, the diameter D14 is set to a value based on the bone hole diameter created at the time of craniotomy.

  FIG. 4 shows a perspective view of the stopper 10 of the present invention. Since the parts in FIG. 4 to which the same reference numerals as in FIG. 3 are given indicate the same elements, the description will be omitted. As shown in FIG. 4, the outer disk 12 has a side surface 12S set to a width W12 (first width), and the outer disk 14 has a side surface 14S set to a width W14 (second width). The width W14 is larger than the width W12. As described in detail later, the width W14 is set to a value based on the thickness of the temporal muscle or the thickness of the scalp at the time of craniotomy. FIG. 4 shows that the screws 70a and 70c are screwed into the screw holes 18a and 18c, respectively. The screw 70b is screwed into the screw hole 18b, but is not shown in FIG. 4 because it is the rear side. As shown in FIG. 4, all of the screws 70a and so forth, including the screw heads, have a length that enters into the screw holes 18a and so forth (i.e., into the internal disk 14).

  Next, the specific size of the stopper 10 and the principle (reason) of adopting those sizes will be described using the design drawing of the stopper 10. FIG. 5 shows a plan view of the stopper 10 of the present invention. The parts denoted by the same reference numerals in FIG. 5 as in FIG. 3 indicate the same elements, and thus the description thereof will be omitted. In FIG. 5, the screw holes 18a and the like are omitted for the convenience of description. As shown in FIG. 5, the size of the diameter D14 of the inner disk 14 was set to 15 mm. The reason is as follows. There are many manufacturers of electric drills or air drills used at the time of craniotomy, but only one manufacturer of disposable drill tips for skull puncturing is worldwide (Johnson End Johnson (registered trademark) Ltd.) Instead, the trade name of the cutting edge of the drill is called Codman® disposable perforator. The diameter of the cutting edge of the drill is only three types of 8, 11 and 14 mm. Therefore, the maximum diameter of the bone hole created at the time of craniotomy is 14 mm universally. From the above, if the size of diameter D14 of internal disk 14 is set to φ 15 mm (minimum necessary diameter) which is approximately 1 mm larger than the maximum bone hole diameter (= 14 mm) created at craniotomy, the bone hole is punctured by internal disk 14 There is nothing to do. That is, the diameter D14 of the inner disk 14 is preferably φ15 mm, which is approximately 1 mm larger than the maximum bone hole diameter (= 14 mm) created at the time of craniotomy. As described above, even if the above-mentioned come out (screw driver slip out) phenomenon occurs, there is no risk that the driver bit may get lost in a bone hole or the like, and therefore an intracranial sting accident or an accident that punctures the eyeball in the orbit. It can be effectively prevented.

  The size of the diameter D12 of the outer disk 12 shown in FIG. 5 was set to φ 22 mm. The reason for this is empirical and may be of another size which is suitable for narrow surgical applications. The outer disk 12 plays a role of a safety stopper in case the inner disk 14 falls into a bone hole, and has a role of minimizing intracranial sting accident.

  6 is a cross-sectional view of the stopper 10 shown in FIG. 5 taken along the line AA (left side). Since the parts in FIG. 6 to which the same reference numerals as in FIG. 4 are given indicate the same elements, the description will be omitted. As shown in FIG. 6, the size of the width W14 of the side surface 14S of the inner disk 14 was set to 7.5 mm. The reason is as follows. In the case of the scalp, the thickness of the scalp (skin) at the time of craniotomy is doubled as usual because it is turned and craniotomy. The thickness of the temporal muscle is not usually 7-8 mm or more. Therefore, it was 7.5 mm. That is, the size of the width W14 of the side surface 14S of the inner disk 14 is preferably 7.5 mm, which is substantially larger than the maximum thickness of the temporal muscle or the thickness of the scalp to be turned at the time of craniotomy. The normal tapping screw fastening requires a retractor for retracting the scalp (including the muscles under the scalp and above the skull), but the above-mentioned thickness of 7.5 mm also serves as a retractor for the scalp It is not necessary to use a retractor that has been used conventionally. That is, the stopper 10 itself can also serve as the retractor. As shown in FIG. 6, the combined size (W12 + W14) of the width W14 (7.5 mm) of the side 14S of the inner disk 14 and the width W12 of the side 12S of the outer disk 12 is set to 10.5 mm. Therefore, the size of the width W12 is 3 mm. In FIG. 6, the shape in which the central hole 12H of the outer disk 12 and the central hole 14H of the inner disk 14 are integrally formed is clearly shown, and the diameter of both central holes 12H and 14H is set to φ 3.0 mm. did. The reason is that the size of this diameter can be used for off-the-shelf screwdrivers from most manufacturers. Although the size of the diameter of the screw hole 18a etc. is not shown in FIG. 6, the diameter of the screw 70a screwed into the screw hole 18a etc. is set to φ3 mm as described later. In FIG. 6, the cut surface is shown by oblique lines in order to emphasize the screw hole 18a and the central holes 12H and 14H, but the oblique line part is also transparent (however, the thread groove portion formed on the inner wall of the screw hole 18a) Except). The symbol C0.3 shown in FIG. 6 is the chamfering amount (mm) of the corners of the outer disk 12, the inner disk 14, etc., and R0.2 is the rounded corner between the outer disk 12 and the inner disk 14. Arc radius (mm) of

  FIG. 7 is a right side view of the stopper 10. Parts in FIG. 7 to which the same reference numerals as in FIG. 4 are attached indicate the same elements, and thus the description thereof will be omitted. As shown in FIG. 7, the distance between the bottom surface 14B of the inner disk 14 and the center of the screw hole 18b was set to 3.75 mm. This length is half the size (= 7.5 mm) of the width W14 of the side surface 14S of the inner disk 14 described above. In FIG. 7, the chamfering of the corners of the outer disk 12, the inner disk 14 and the like described above is clearly shown.

  FIG. 8 is a cross-sectional view (plane side) of the stopper 10 shown in FIG. 7 taken along the line BB. Since the parts in FIG. 8 to which the same reference numerals as in FIG. 4 are given indicate the same elements, the description will be omitted. As mentioned in the description of FIGS. 1 and 2, the driver bits 50, 60 pass through both central holes 12H and 14H of the stopper 10 and into the threaded holes 18a, 18b, 18c formed in the inner disc 14. The driver bits 50, 60 can be fixed by inserting the screws 70a, 70b, 70c, respectively. That is, the stopper 10 is provided with screw holes 18a and the like reaching from the side surface 14S of the inner disk 14 to the central hole 14H of the inner disk 14, and the screws 70a and the like screwed into these screw holes 18a It is a shaft fixing screw for fixing. As shown in FIG. 8, three of each of the screw holes 18a, 18b and 18c for (shaft grip) screws 70a, 70b and 70c (not shown) are equally distributed at an angle of 120 ° (equally distributed) And prevent the shaft from shaking when the driver bit rotates. As noted in FIG. 8, the screws 70a etc. are M3 (diameter 3 mm with a metric screw). More specifically, the screws 70a and the like are hexagonal holed imoscrews, and a hexagonal wrench is used for fixation. The screws 70a and so forth, including the screw heads, have a length that enters into the screw holes 18a and so on (that is, into the internal disk 14), so there is no concern that the surrounding tissue will be damaged at the time of fastening. In FIG. 8, the cut surface is shown by oblique lines in order to emphasize the screw hole 18 a and the central hole 14 H (12 H), but the oblique line part is also transparent (however, the thread groove formed in the inner wall portion of the screw hole 18 a Part is excluded). The stopper 10 is firmly fixed to the shaft (driver bit) of a screw driver (not shown) by the three screws 70a and the like as described above, and rotates with the rotation of the screw driver. For example, in the case where a small diameter driver bit is fixed at only one place of the screw 70a, when the screw driver rotates, axial deviation in which the stopper 10 itself is shaken occurs. The axial shake can be said to be "rotational shake of the stopper 10" if it is expressed accurately. Since the stopper 10 itself plays a role of muscle fistula (it is mainly used for traction of subcutaneous tissue and muscle layer and retraction of tissue after retracting), it is not permitted for the stopper 10 to cause rotational blurring. Although three screw holes 18 a and the like are shown in FIG. 8, three or more screw holes 18 a and the like may be used to prevent the stopper 10 from rotating and shaking. As described above, since the stopper 10 rotates with the rotation of the screw driver, the shape of the inner disk 14 needs to be a disk shape.

  FIG. 9 shows a perspective view of another size large stopper 20 of the present invention. Since the parts in FIG. 9 to which the same reference numerals as in FIG. 4 are given indicate the same elements, the description will be omitted. FIG. 9A shows the stopper 10 described above, and FIG. 9B shows the large stopper 20. The large stopper 20 is different from the stopper 10 in that the diameter D22 of the bottom 22B of the outer disk 22 in the large stopper 20 is the bottom 12B of the outer disk 12 in the stopper 10, as shown in FIGS. The point is set larger than the diameter D12. On the other hand, the width W12 of the side surface 22S of the outer disk 22 in the large stopper 20 is set equal to the width W12 of the side surface 12S of the outer disk 12 in the stopper 10.

  10 to 13 are design drawings of the large stopper 20, which correspond to the design drawings 5 to 8 of the stopper 10 described above. The large stopper 20 shown in FIGS. 10 to 13 has the same function, effect, etc. as the stopper 10 shown in FIGS. 5 to 8, and the reason for setting the size of each part is also almost the same. Hereinafter, the large-sized stopper 20 will be described centering on a point different from the stopper 10.

  FIG. 10 shows a plan view of the large stopper 20 of the present invention. Parts in FIG. 10 to which the same reference numerals as in FIGS. 5 and 9 indicate the same elements, and thus the description thereof will be omitted. In FIG. 10, as in FIG. 5, the screw holes 18a and the like are omitted for convenience of explanation. As shown in FIG. 10, the size of the diameter D22 of the outer disk 22 was set to 30 mm. The reason for this is empirical and may be another size that is suitable for a wide surgical field. The outer disk 22 also serves as a safer stopper than the outer disk 12 in the event that the inner disk 14 falls into the bone hole, and also serves to minimize intracranial sting incidents.

  FIG. 11 is a cross-sectional view of the large-sized stopper 20 shown in FIG. 10 taken along the line AA (left side). Parts in FIG. 11 to which the same reference numerals as in FIGS. 6 and 9 denote the same elements, and thus the description thereof will be omitted. As shown in FIG. 11, the width W12 of the side surface 22S of the outer disk 22 in the large stopper 20 is set equal to the width W12 of the side surface 12S of the outer disk 12 in the stopper 10 shown in FIG.

  FIG. 12 is a right side view of the large stopper 20. FIG. Parts in FIG. 12 to which the same reference numerals as in FIGS. 7 and 9 indicate the same elements, and thus the description thereof will be omitted. As shown in FIG. 12, the distance between the bottom surface 14B of the inner disk 14 and the center of the screw hole 18b is 3.75 mm, which is set similarly to the stopper 10 shown in FIG.

  FIG. 13 is a cross-sectional view (plane side) of the large-sized stopper 20 shown in FIG. 12 taken along the line BB. Parts in FIG. 13 to which the same reference numerals as in FIGS. 8 and 9 indicate the same elements, and thus the description thereof will be omitted. The driver bits 50 and 60 pass through both center holes 22H and 14H of the large stopper 20, as in the description of the stopper 10 in FIG. The large stopper 20 is also provided with screw holes 18a and the like reaching from the side surface 14S of the inner disk 14 to the central hole 14H of the inner disk 14, and these screws 70a screwed into these screw holes 18a are shafts of the driver bit 50 and the like. Is an axial fixing screw for fixing the The large stopper 20 is also firmly fixed to the shaft (driver bit) of a screw driver (not shown) by the three screws 70a and the like as described above, and rotates along with the rotation of the screw driver.

  FIG. 14 is a perspective view of the stopper 10 shown in FIG. 4 from which the screws 70a and the like have been removed. Parts in FIG. 14 having the same reference numerals as those in FIG. 4 indicate the same elements, and thus the description thereof will be omitted. In FIG. 14, in order to emphasize the state in which the screw 70 a and the like are removed, some reference numerals are omitted. As shown in FIG. 14, the screw holes 18a etc. are opaque due to the presence of the screw grooves.

  FIG. 15 shows an enlarged view of the screw 70a and the like. FIG. 15A shows a perspective view of the case where the screw 70a and the like are placed horizontally, and reference numeral 72 denotes a tip of the screw 70a and the like, and 74 denotes a screw head such as the screw 70a. FIG. 15 (B) shows a perspective view of the case where the tip 72 of the screw 70a etc. is placed vertically with the tip 72 up, and FIG. 15 (C) shows the case where the screw head 74 such as the screw 70a is placed vertically. Shows a perspective view of the As the screw head 74 of FIG. 15 (C) shows, the screws 70a etc. are imago screws with hexagonal holes, and a hexagonal wrench is used for fixation.

  FIG. 16 shows a state in which the stopper 10 or the like of the present invention is attached to a motor-driven (rotational) type (hereinafter, abbreviated as “motorized”) screw driver 100. 16A shows a state in which the large stopper 20 is attached to the driver bit 60 set in the motor-driven screwdriver 100, and FIG. 16B shows a stopper 10 in the driver bit 60 set for the motor-driven screwdriver 100. Indicates the condition of wearing. The electric screw driver 100 uses a Sun-A plate system power tool manufactured by San-A Seikei Co., Ltd. However, the electric screw driver 100 is not limited to the product.

  FIG. 17 shows a state in which the stopper 10 of the present invention is attached to a driver bit 60 set in a manual (rotational) type (hereinafter abbreviated as “manual type”) screw driver 110. For the manual screw driver 110, a Sun-A plate driver manufactured by San-A Seikei Co., Ltd. was used. However, the manual screw driver 110 is not limited to the product.

  As shown in FIGS. 16 and 17, the stoppers 10, 20 of the present invention can be attached to both the motorized screwdriver 100 and the hand-held screwdriver 110. The thickness of the skull is completely different depending on the individual and even the same individual. The stopper 10 or the like of the present invention can be fixed at a desired position of the shaft (driver bit 60) of the screwdrivers 100 and 110 by the above-described three screws (impression screw with hexagonal hole) 70a or the like. That is, when the driver bit 50, 60 is passed from the center hole 12H on the outer disk 12 side to the center hole 14H on the inner disk 14 (see FIG. 1), the screw 70a screwed into the screw hole 18a etc. The stopper 10 or the like can be fixed at a predetermined position of the driver bit 50 or the like. Therefore, the length of the driver bit 50 or the like protruding from the tip side (the bottom surface 14B side of the inner disk 14) of the stopper 10 or the like can be adjusted steplessly according to the thickness of the skull of each case. In other words, if the thickness of the skull is 3 mm, the surface of the inner disk 14 may come to a position at which the distance from the tip of the driver bit 50 or the like to the surface (bottom surface 14B) of the inner disk 14 such as the stopper 10 is 3 mm or less. By fixing the stoppers 10 and the like with three screws (hexagonal holed screw screws) 70a and the like, theoretically, the blade 60E does not pierce the brain. Similarly, if the thickness of the skull is 10 mm, the surface of the internal disk 14 may come to a position at which the distance from the tip of the driver bit 50 or the like to the surface (bottom surface 14B) of the internal disk 14 such as the stopper 10 is 10 mm or less The stopper 10 and the like may be fixed with three screws (imscrews with hexagonal holes) 70a and the like. That is, the predetermined position of the driver bit 50 or the like is a position where the length from the tip of the driver bit 50 or the like to the surface (bottom surface 14B) of the internal disk 14 is equal to or less than the thickness of the skull. When the stopper 10 or the like is fixed at the predetermined position of the driver bit 50 or the like, the stopper 10 or the like rotates with the rotation of the driver bit 50 or the like.

  FIG. 18 shows a situation in which a tapping screw is fastened to the skull using the electric screwdriver 100. More specifically, it is a situation where the skin near the right temple is turned to the face side. As shown in FIG. 18, the stopper 10 is set to the driver bit 60 of the motor-driven screwdriver 100. In FIG. 18, reference numeral 200 is an implant (indicated by a white dotted circle), 210 is a tapping screw (already hit), 220 is a hook for turning the forehead skin forward (face side), and TEMP is a side It is a head and muscle. Below the implant 200 is a skull, and a motorized screwdriver 100 is used to secure the implant 200 with a tapping screw 210. The tapping screw 210 may be of the type described in the prior art (see FIG. 27B), and its screw head is generally a plus groove (rarely a square wrench type). As described above, since the material of the stopper 10 and the like is transparent (for example, using transparent acrylic), there is no problem in the visibility of the tapping screw 210, the implant 200, the temporal muscle TEMP, etc. from the operator. . As described above, since the visibility of the attachment of the stopper 10 or the like is secured by securing the transparency of the material of the stopper 10 or the like, even if the stopper 10 or the like is attached to the tip of the driver bit 60, It is possible to physically avoid a sting accident. In addition, since the thickness W14 of the side surface 14S of the inner disk 14 plays a role of retractor for the temporal muscle TEMP, it is possible to secure a field of view in a state where the retractor is unnecessary.

  FIG. 19 shows the situation in which the tapping screw 210 is fastened to the skull using a manual screwdriver 110. Since the parts in FIG. 19 to which the same reference numerals as in FIG. 18 are given indicate the same elements, the description will be omitted. As shown in FIG. 19, the stopper 10 is set to the driver bit 60 of the manual screwdriver 110. In FIG. 19, reference numeral 250 denotes a titanium mesh, which covers a relatively wide defect of the skull and has both the role of an artificial bone and the fixation with other bones. As in the case of the motor-driven screwdriver 100 described in FIG. 18, there is no problem in the visibility from the operator to the tapping screw 210, the titanium mesh 250, etc., and the thickness W14 of the side surface 14S of the internal disk 14 plays the role of retractor The effect of the two birds of one stone is seen that prevention of the sting accident by the driver bit 60 and the elimination of the retractor become unnecessary.

  FIG. 20 shows that the internal disk 14 of the stopper 10 never falls into the bone hole even if the screw driver slip-out occurs and the tip of the driver bit 60 may get lost into the bone hole. Show an acted picture. As shown in FIG. 20, the stopper 10 is set to the driver bit 60 of the manual screwdriver 110. In FIG. 20, symbol BH is a bone hole opened at the time of craniotomy. As described above, since the maximum diameter of the bone hole BH is 14 mm all over the world and the diameter D14 of the inner disk 14 is 15 mm, the inner disk 14 never falls into the bone hole BH, and an intracranial sting Accidents can be avoided. If the diameter D14 of the inner disk 14 is set to 16 mm or more, the role as a retractor will be impaired. FIG. 20 shows a relatively wide surgical field for convenience of explanation, but the actual surgical field is narrower, and if the diameter D14 of the internal disk 14 is 16 mm or more, it is too large for the operator's sense and interferes. From the above, it is preferable to set the diameter D14 of the internal disk 14 to 15 mm. Even if the inner disk 14 is dropped into the bone hole BH, since the drop is stopped at the outer disk 12 of the stopper 10, the sting in the brain can be minimized. As described above, if the length of the driver bit 60 put out of the inner disk 14 of the stopper 10 is adjusted to be equal to or less than the thickness of the skull, the surface of the brain is never damaged.

Verification:
The inventor conducted a survey as shown below in order to verify the effect of actually using the stopper 10 and the like. All persons involved in this surgery and investigation have a confidentiality obligation with respect to the present invention. A total of 48 cases of 19 men and 29 women who underwent (craniotomy) surgery at the university hospital to which the inventor belongs during a predetermined period are subjects. Age is 31-83, median age is 57, all patients are Japanese, surgery is a single surgery. FIG. 21 shows the number of diseases and the number of diseases for which craniotomy was performed. The total number is 51, which is more than the total number of cases above, because some patients have multiple disease names.

The inventor determined the number of implants used in the operation and the total number of tapping screws based on the operation record and the operation slip, and the number of screw driver slipouts from the operation video. Furthermore, the difference between the case where the electric screw driver 100 is used and the case where the manual screw driver 110 is used, and the case where the stopper 10 or the like of the present invention is used separately by the manufacturer of the main body such as the screw driver 100 (A to E). We examined the difference between

  FIG. 22 shows the total number of implants used in surgery. As shown in FIG. 22, 109 titanium plates, 53 titanium meshes, 496 tapping screws, and 24 cymbal types are used.

  FIG. 23 shows the number of screw driver slipouts that occurred. As shown in FIG. 23, the number with the electric screwdriver 100 is 13 times / 432 times (3.1%), and the number with the manual screwdriver 110 is 4 times / 64 times (6.3%). In the case where the motor-driven screwdriver 100 is stopped halfway and then re-fastened with the manual screwdriver 110, it is 0 times / 16 times. The ratio of screw driver slipout with the manual screw driver 110 was rather high. There was no screw driver slipout in the case of switching from the electric screwdriver 100 to the manual screwdriver 110. The total number was 17 times / 512 times (3.3%). That is, a total of 17 screw driver slipouts occurred. However, no cases had actually led to an intracranial sting accident. FIG. 24 is a three-dimensional bar graph showing the ratio of occurrence of screw driver slipout based on the results of FIG. In FIG. 24, the vertical axis represents the ratio (%), and the horizontal axis represents the items of FIG. 23. In the original drawing, the red solid bar graph (which occupies almost the whole) has no screwdriver slipout (driver dislodgement), and a blue solid Bar graph has screw driver slipout (driver dislodgement).

  FIG. 25 is a three-dimensional bar graph showing the number of screw driver slipouts observed for each operation. In FIG. 25, the vertical axis is the number of times, and the horizontal axis is the name of the operation. The operation name is from the left side of the horizontal axis in Fig. 25; brain tumor excision, brain tumor excision (Giliadel (registered trademark) indwelling case: Giriad (registered trademark) is a drug to be placed in the brain containing an anticancer agent) Photodynamic therapy), cerebral aneurysm clipping surgery, cranioplasty. In the original drawing, as in FIG. 24, a red solid bar (almost occupying the whole) has no screwdriver slipout (driver dislodgement), and a blue solid bar has screw driver slipout (driver dislodgement).

FIG. 26 shows, in a three-dimensional bar graph, the number of occurrences of screw driver slipout seen by the manufacturer of the screw driver main body. In FIG. 26, the vertical axis represents the number of times, and the horizontal axis represents the manufacturer (company A to company E). In the original drawing, similarly to FIGS. 24 and 25, the red solid bar (almost occupied) has no screwdriver slipout (driver dislodgement), and the blue solid bar has screw driver slipout (driver dislodgement). As shown in FIG. 26, a large difference in the proportion of five with screwdriver slip out of A~E Inc. was observed (chi ² test: p = 0.997). When the stopper 10 and the like were used for the screw driver 100 and the like of the five companies in total, the screw driver 100 and the like of any manufacturer could be attached and detached and had versatility. In addition, since the material of the stopper 10 and the like is transparent acrylic, visibility is good even when attaching a tapping screw using a screw driver 100 of any manufacturer, and a retractor is not necessary when fastening, There was no open question in sex. Although this study is a study only in neurosurgery, the stopper 10 etc. of the product of the present invention has the advantage of being applicable to all operations using other implants.

  As a result of the above investigations, 17 (3.3%) screw driver slipouts occurred out of a total of 512 times. However, no cases had actually led to an intracranial sting accident.

  Summarizing the above, the stopper 10 or the like of the present invention is composed of the outer disk 12 (first disk) and the inner disk 14 (second disk), and is formed of a transparent material as a whole. The outer disk 12 has a central hole 12H penetrating its bottom surface 12B, and the inner disk 14 also has a central hole 14H penetrating its bottom surface 14B. The stopper 10 is formed in a convex shape by combining the outer disk 12 having the center hole 12H and the inner disk 14 having the center hole 14H with the both center holes 12H and 14H. Driver bit 50 or the like is inserted through both central holes 12H and 14H of stopper 10, and three screws 70a, 70b and 70c are respectively fitted in screw holes 18a, 18b and 18c formed in internal disk 14 Thus, the driver bit 50 and the like can be fixed. The stopper 10 is firmly fixed to the shaft (driver bit 50 or the like) of the screw driver 100 or the like by the three screws 70a or the like as described above, and rotates with the rotation of the screw driver 100 or the like.

  The largest diameter of the bone hole created at the time of craniotomy is 14 mm universally. Therefore, if the diameter D14 of the inner disk 14 is set to a diameter of φ15 mm (minimum diameter necessary) which is approximately 1 mm larger than the largest bone hole diameter (= 14 mm) created at the time of craniotomy, the bone hole is punctured by the inner disk 14 There is nothing to do. Therefore, the size of the diameter D14 of the internal disk 14 is set to φ15 mm, which is approximately 1 mm larger than the maximum bone hole diameter (= 14 mm) created at the time of craniotomy. As a result, even if the cam out (screw driver slip out) phenomenon occurs, there is no risk of the driver bit 50 etc. getting lost in the bone hole BH etc., so there is an intracranial sting accident or an accident that stings the eyeball in the orbit. Can be effectively prevented.

  In the case of the scalp, the thickness of the scalp (skin) at the time of craniotomy is doubled as usual because it is turned and craniotomy. The thickness of the temporal muscle is not usually 7-8 mm or more. Therefore, the size of the width W14 of the side surface 14S of the internal disk 14 is set to 7.5 mm. That is, it is preferable that the size of the width W14 of the side surface 14S of the internal disk 14 be substantially larger than the maximum thickness of the temporal muscle or the thickness of the scalp to be turned at the time of craniotomy. The normal tapping screw fastening requires a retractor for retracting the scalp (including the muscles under the scalp and above the skull), but the above-mentioned thickness of 7.5 mm also serves as a retractor for the scalp It is not necessary to use a retractor that has been used conventionally. That is, the stopper 10 itself can also serve as the retractor.

  The thickness of the skull is completely different depending on the individual and even the same individual. The stopper 10 and the like of the present invention can be fixed at a desired position on the shaft (driver bit 50 and the like) of the screw driver 100 and the like by the three screws (imscrews with hexagonal holes) 70a and the like described above. That is, when the driver bit 50 or the like passes from the central hole 12H on the outer disk 12 side to the central hole 14H on the inner disk 14 side, the stopper 10 or the like is a driver bit by the screw 70a etc screwed into the screw hole 18a described above. It can be fixed at a predetermined position such as 50 degrees. Therefore, the length of the driver bit 50 or the like protruding from the tip side (the bottom surface 14B side of the inner disk 14) of the stopper 10 or the like can be adjusted steplessly according to the thickness of the skull of each case.

  As described above, according to the first embodiment of the present invention, it is possible to prevent a sting accident caused by the driver bit 50 or the like at the time of closing operation even in a situation where the come out phenomenon and the pull out phenomenon are not physically eliminated. Can be provided, and the stopper 10 etc. that can perform the claudication operation of the brain surgery more safely. In addition, it is possible to provide the stopper 10 or the like capable of performing the claudication operation of the brain surgery more simply by eliminating the need for a retractor used to retract the skin at the time of tightening the tapping screw.

  As an application example of the present invention, the stopper 10 and the like can be attached to the tip of the driver bit 50 and the like set in the screw driver 100 and the like used for the claudication operation of the brain surgery. The stopper 10 and the like of the present invention can be applied not only to neurosurgery but also to medical screw drivers used in all operations using other implants.

  10, 20 stopper, 12 external disk, 12B external disk bottom, 12H external disk central hole, 12S external disk side surface, 14 internal disk, 14B internal disk bottom, 14H internal disk central hole, 14S internal disk side, 18a, 18b, 18c Screw hole, 22 large external disc, 22B large external disc bottom, 22H large external disc center hole, 22S large external disc side, 50, 60 driver bit, 60E blade of driver bit 60, 70a, 70b, 70c (immo) screw, 72 screw tips, 74 screw heads, 100 motorized screwdrivers, 110 manual screwdrivers, 200 implants, 210 tapping screws, 220 hooks, 250 titanium mesh.

  BH bone hole, D12 outer disk diameter, D14 inner disk diameter, D22 large outer disk diameter, SKL skull, TEMP temporal muscle, W12 outer disk side width, W14 inner disk side width.

Fukawa M. “Fujikawa Masayuki” “Characteristics of Applied Forces for Tapping Self-Tapping Screw Joints”, Chuo University Academic Information Repository, 2013. “Tapping force characteristics in tapping screw fastening”, [online], [June 15, 2017 Search], Internet, <URL: http://ir.c.chuo-u.ac.jp/repository/search/binary/p/5106/s/2494/> Adler, W. Alexander 3. “Testing and Understanding Screwdriver Bit Wear”, Virginia Tech Digital Library and Archives (M.Sc.). Virginia Tech. Pp. 5-9, 1998. Kimura T. "Study Kimura" "Study on Cam-out Behavior in Tapping-Screw Tighting", Chuo University Academic Information Repository, 2010. "Study of the come-out phenomenon in tapping screw fastening", [online], [June 15, 2017] Day Search], Internet, <URL: http://ir.c.chuo-u.ac.jp/repository/search/binary/p/3215/s/914/>

Claims (8)

A stopper having a first disk having a central hole penetrating the bottom and a second disk formed into a convex shape by combining the two central holes,
The diameter of the bottom surface of the first disk is a first diameter, and the width of the side surface is a first width,
The second disk has a second diameter smaller than the first diameter and a second width larger than the first width on the bottom surface, and the second diameter is set to a value based on the bone hole diameter created at the time of craniotomy A stopper characterized in that the second width is set to a value based on thickness of temporal muscle or thickness of scalp at craniotomy. The stopper according to claim 1, wherein the second diameter of the second disk is approximately 1 mm larger than the largest bone hole diameter created at the time of craniotomy. The stopper according to claim 1 or 2, wherein the second width of the second disc is substantially greater than the maximum thickness of the temporal muscle or the thickness of the scalp to be turned at the time of craniotomy. The stopper according to any one of claims 1 to 3, further comprising a screw hole extending from a side surface of the second disk to a central hole of the second disk. 5. The stopper according to claim 4, further comprising a screw which is fitted into the screw hole, and the driver bit is passed through the driver bit from the central hole on the first disc side toward the central hole on the second disc side. A stopper characterized in that it can be fixed at a predetermined position of the driver bit by a screw. The stopper according to claim 5, wherein the predetermined position is a position where a length from a tip of the driver bit to a surface of the second disk is equal to or less than a thickness of a skull. The stopper according to claim 6, wherein when the stopper is fixed at the predetermined position of the driver bit, the stopper is rotated as the driver bit rotates. The stopper according to any one of claims 1 to 7, wherein the stopper is made of a transparent material.