JPH1147137A - Retractor pin with leg length measuring apparatus for use in total hip replacement arthroplasty - Google Patents

PROBLEM TO BE SOLVED: To provide an apparatus for measuring leg lengths in total hip replacement arthroplasty. SOLUTION: In total hip replacement arthroplasty (THA), one retractor pin is put on an ilium for the operation of digging a hole in the acetabular roof, and a gluteus is excluded, but one pin is unstable in that case. An apparatus to be developed can be secured to the ilium under more stable conditions by connecting two retractor pins together. An apparatus for measuring the distance to the greater trochanter and obtaining the accurate leg lengths is fabricated by using as indices the two pin retractors put on the ilium, and attaching a measuring rod thereto. The measuring rod is removable so as not to obstruct a surgical operation.

【発明の詳細な説明】DETAILED DESCRIPTION OF THE INVENTION

【０００１】[0001]

【発明の属する技術分野】人工股関節置換術（以下，Ｔ
ＨＡと略す。）において骨切除の範囲や使用機種の選定
による術前の計画にも拘わらず、手術後の脚長差はしば
しば発生し、そのため手術後に補高靴（脚長の短い方を
長い方に合わせるために靴底を高くする）の使用を余儀
なくされる場合が少なくない。これらをなくすため、こ
れまでの人工股関節置換術で用いられる手術器具の一つ
で、術中に殿筋を圧排するための通常は連結しない開創
ピンを応用し、極めて簡易な術中脚長計測器付き開創ピ
ン（Calipers Pin Retractor;以下ＣＰＲと略す。）を
発明した。BACKGROUND OF THE INVENTION [0002] Hip replacement surgery (hereinafter referred to as T
Abbreviated as HA. Regarding), despite the preoperative plan based on the range of bone resection and the selection of the model to be used, differences in leg length often occur after surgery. (To raise the bottom) is often required. To eliminate these, one of the surgical instruments used in conventional hip arthroplasty, a retracting pin that is not normally connected to remove the gluteal muscle during surgery is applied, and a very simple retractor with an intraoperative leg length measuring device is applied. A pin (Calipers Pin Retractor; hereinafter abbreviated as CPR) was invented.

【０００２】[0002]

【従来の技術】これまでには人工股関節置換術での左右
の足の長さを揃えるためには、手術の前にＸ線撮影によ
り大腿骨頸部の骨切除範囲の決定と、用いる人工関節の
種類によりおおよそ見当をつける。あるいは、人工関節
置換術が終了、すなわち人工臼蓋と大腿骨側の人工大腿
骨が挿入され、両者の整復後に下肢大腿骨側を徒手的に
牽引し、その緊張感により、緩ければ大腿骨の頸部のよ
り長いものを、きつければ大腿骨の頸部を再度切除する
か、人工関節の頸部を短いものに変えることによりおお
よその長さを合わせていた。一方、器具による方法とし
てはキルシュナー鋼線（K-wire）を用いる方法があり、
腸骨に直径２ないし３ｍｍの鋼線を刺入し、鋼線をコの
字に曲げることにより大腿骨の大転子部との間で計測す
る MacGee and Scott.Clin Ortop,194:269-270,1985.が
ある。 しかし、この方法では鋼線ワイヤーが刺入腸骨
より容易に逸脱したり、ワイヤー そのものが術中のじ
ゃまになり、しばしば、指さし事故がおきる。その他に
は、 Woolson and Harris. Clin Orthop,194:207-210,1
985.の術創部外の腸骨翼（腰骨）に固定ピンを立て下肢
全体にわたる計測器があるが、これは全長が約６０ｃｍ
以上の大がかりなもので、測定誤差が大きい。このよう
に、ＴＨＡにおいて術前の計画にも拘わらず、術後の脚
長差はしばしば発生し、そのため補高靴の使用を余儀な
くされる場合が少なくない。本出願のＣＰＲは、理論は
MacGee と同じではあるが、彼の計測法は単に細いワイ
ヤーを用いるものであり、その計測法を示したにすぎ
ず、古くからおこなわれていた。また、本ＣＰＲは計測
器としてだけではなく、手術中に殿筋を圧排するための
レトラクター（開創鈎）手術器具としても重要な役割が
あり、極めて簡便かつ安全なＴＨＡ脚長計測器として期
待される。2. Description of the Related Art Up to now, in order to equalize the lengths of the right and left legs in hip replacement surgery, it is necessary to determine the range of bone resection of the femoral neck by radiography before the operation and to use the artificial joint to be used. Approximately by type. Alternatively, when the artificial joint replacement is completed, that is, the artificial acetabular prosthesis and the artificial femur on the side of the femur are inserted. The neck of the femur was re-excised if tightened with a longer neck, or approximated by changing the neck of the prosthesis to a shorter one. On the other hand, as a method using instruments, there is a method using Kirschner steel wire (K-wire),
MacGee and Scott. Clin Ortop, 194: 269-270 A steel wire having a diameter of 2 to 3 mm is inserted into the iliac bone, and the steel wire is bent into a U-shape to measure between the greater trochanter of the femur. , 1985. However, in this method, the steel wire easily deviates from the penetrated iliac bone, and the wire itself becomes an obstacle during the operation, and a pointing accident often occurs. Others include Woolson and Harris. Clin Orthop, 194: 207-210,1
985. There is a measuring instrument with a fixation pin set on the iliac wing (hipbone) outside the surgical wound, which measures the entire lower limb.
The above-mentioned large scale has a large measurement error. Thus, despite the preoperative plan in THA, leg length differences often occur after the operation, which often necessitates the use of extra-high boots. The theory of CPR in this application is
Although the same as MacGee, his measurement method used only a thin wire, only showed the measurement method, and has been used for a long time. In addition, this CPR has an important role not only as a measuring instrument but also as a retractor (open wound hook) surgical instrument for excluding the gluteal muscle during surgery, and is expected to be an extremely simple and safe THA leg length measuring instrument. You.

【０００３】[0003]

【発明が解決しようとする課題】上記の問題点を考慮し
て、簡便で安全で手術中の正しく脚長を計測し、かつ開
創鈎の役目を持つ手術器具の開発が望まれていた。In view of the above problems, it has been desired to develop a surgical instrument which is simple, safe, and capable of correctly measuring the length of a leg during surgery and serving as a retractor hook.

【０００４】[0004]

【課題を解決するための手段】このような状況下におい
て、本発明者は鋭意研究を行った結果、簡便で安全で手
術中に正しい脚長を計測し、かつ開創鈎の役目を持つ手
術器具（ＣＰＲ）の発明を完成するに至った。以下、本
発明について詳述する。本器具は９つの部品より構成さ
れる。まずは、図１に示す、腸骨に刺入される２本のピ
ン（１、２）は長さ１００ｍｍ直径６ｍｍ先端は鋭利と
なり、先端より約３０ｍｍはその表面はヤスリ状とし、
固定性を得やすくした。 ピン中枢部は約３０ｍｍにわ
たり、雄ネジがきられている。つぎに、この２本のピン
を幅２ｃｍの平衡ピンとするために、中枢部の雄ネジ部
に適合する、両側に雌ネジを切った本器具の肩（３）の
部分に相当する３７ｘ１２ｘ１２ｍｍの柱状のものを作
製した。そしてその肩の中央部には高さ２９ｍｍのバー
（本体の首に一致する；４）をつけ、その突起は打ち込
みの際の打ち込み棒との結合部でもあり、中央には抜去
時の直径２ｍｍの突起を持つ。もちろん、その首の先端
を直接打ちつけ、腸骨へ刺入ても良い。次に図２に示
す、計測棒（６）であるが、１２０ｘ５ｘ４ｍｍの柱状
でその一端は本体の肩（３）よりのびる首（４）の部分
にはめ込むべく、カラー（５）として直径６ｍｍの雌ネ
ジリングが開けられ肩あるい開創ピンと直角にはめ込ま
れる。これは手術中は取り外し可能とし、計測棒には計
測用の５ｍｍ間隔の数値を表示した。その計測棒には可
動する９ｘ９ｘ６ｍｍのブロック状ルーラー（７）があ
り、マーカー鋼線（８）（長さ、１００ｍｍないしは８
０ｍｍで 直径２ｍｍの鋼線）を直角に取り付け、その
鋼線の先端で大腿骨の大転子に計測のための位置ぎめを
おこなう。マーカー鋼線固定ネジ（９）は直径４ｍｍの
穴の中にマーカー鋼線を挿入しネジにより固定する（図
２）。図１は主に開創鈎としての役目をもち、図２は、
主に腸骨より人工関節をはさみ大転子までの距離を測る
役目を司る。 この両者を結合した斜位像を図３で示
す。そして、９つの部品を数字で示した。Under such circumstances, the present inventor has conducted intensive studies, and as a result, a surgical instrument (simple, safe, capable of measuring a correct leg length during surgery, and serving as a retractor hook). (CPR). Hereinafter, the present invention will be described in detail. The instrument is composed of nine parts. First, as shown in FIG. 1, the two pins (1, 2) inserted into the iliac bone have a length of 100 mm, a diameter of 6 mm, and a sharp tip, and a surface of about 30 mm from the tip has a file-like shape.
Easy to obtain fixation. The pin center extends approximately 30 mm and is externally threaded. Next, in order to make the two pins into a balanced pin having a width of 2 cm, a column having a size of 37 × 12 × 12 mm corresponding to the shoulder (3) of the instrument with female threads on both sides, which is adapted to the male screw part of the central part. Was prepared. A 29 mm high bar (corresponding to the neck of the main body; 4) is attached to the center of the shoulder, and the projection is also a connecting portion with the driving rod at the time of driving, and the center is 2 mm in diameter at the time of removal. With protrusions. Of course, the tip of the neck may be hit directly and pierced into the iliac bone. Next, the measuring rod (6) shown in FIG. 2 has a column shape of 120 × 5 × 4 mm, and one end thereof is a female having a diameter of 6 mm as a collar (5) so as to fit into the neck (4) extending from the shoulder (3) of the main body. The screw ring is opened and fitted at right angles to the shoulder or retraction pin. This was made removable during the operation, and the measurement bar displayed numerical values at 5 mm intervals for measurement. The measuring rod has a movable 9 × 9 × 6 mm block ruler (7) and a marker steel wire (8) (length, 100 mm or 8 mm).
(0 mm, 2 mm diameter steel wire) is attached at right angles, and the tip of the steel wire is used to position the greater trochanter of the femur for measurement. The marker steel wire fixing screw (9) inserts a marker steel wire into a hole having a diameter of 4 mm and fixes it with the screw (FIG. 2). FIG. 1 mainly serves as a retractor hook, and FIG.
Mainly responsible for measuring the distance to the greater trochanter with the artificial joint between the iliac bone. FIG. 3 shows an oblique image obtained by combining the two. The nine parts are indicated by numerals.

【０００５】[0005]

【発明の実施の形態】BEST MODE FOR CARRYING OUT THE INVENTION

【実施例】ＴＨＡの手術は股関節前方あるいは側方進入
である。皮膚の切開の後にはまず骨頭の受け皿である臼
蓋（屋根）の掘削操作をおこなう。そして人工股関節臼
蓋の設置には臼蓋の全容を観察するために、その前後の
みならず臼蓋の頭側の筋肉（小殿筋の付着部でその上を
中殿筋がおおっている）を腸骨より剥離する。本出願の
ＣＰＲはこの殿筋群を手術のじゃまに成らないように、
体を側臥位にした場合には臼蓋頭側数センチ上の腸骨に
垂直に立てる事により視野を確保する役目をする（図４
は立位像として示す）。２本の連結した開創ピンを腸骨
に打ち込む際は中枢部が本体の肩（３）と１、２の中枢
部分でネジにより高さを調整し腸骨の形状に合うように
して用いる。危険をさけるべく、打ち込む深さは３０ｍ
ｍ以内とするようピンの先端のヤスリ加工部を目安とし
た（図１の１、２の先端部分）。この腸骨に立てられた
ＣＰＲを基準位置とするが、本体の肩中央の首に計測棒
を設置し、５ｍｍ間隔の数値を表示した計測棒（６）を
すべるルーラー（７）に取り付けたマーカー鋼線（８）
の先端で大転子近辺に電気メスあるいはノミ、色素によ
りマーキングし長さを計測しておく（図４左）。そして
実際の臼蓋の掘削操作の際は開創ピンはそのままにし、
計測棒は手術中には取り外しておく。人工臼蓋を設置の
後に、Ｘ線でラフに計測した長さの頸部を残し大腿骨の
骨頭を含め切除する。そして、人工骨頭ステム（胴の部
分）を大腿骨髄腔に設置すべく頸部切除部より髄内を掘
削する。この操作により人工関節置換術の操作がほぼ完
了し、仮（トライアル）の人工関節が挿入されれば、計
測棒とルーラー鋼線ーを再度取り付け、手術直後に付け
た大転子部のマーキングまでの距離を計測する。その結
果、人工関節の頸部の長さの変更あるいは頸部の骨切り
により、正しい脚長を決定する（図４右）。DETAILED DESCRIPTION OF THE INVENTION THA surgery is anterior or lateral hip arthroplasty. After incision of the skin, first, an excavation operation of the acetabular (roof), which is a tray for the head of the head, is performed. In order to observe the entire volume of the acetabular prosthesis when installing the artificial hip acetabular, not only before and after that, but also on the head-side muscles of the acetabular (the gluteus medius muscle covers it over the attachment of the gluteus medius) From the iliac bone. The CPR of the present application will prevent the gluteal muscles from interfering with surgery.
When the body is in the supine position, it stands up perpendicular to the iliac a few centimeters above the acetabular head to serve to secure the visual field (FIG. 4).
Is shown as a standing image). When the two connected retracting pins are driven into the iliac bone, the central part is adjusted with a screw at the central part of the shoulder (3) of the main body and the central part of the main body (1) and (2) so as to match the shape of the iliac bone. The driving depth is 30m to avoid danger
The end of the pin is filed so that it is within m (the tip portions 1 and 2 in FIG. 1). The CPR set on the iliac bone is used as a reference position, but a measuring rod is placed on the neck at the center of the shoulder of the main body, and a marker attached to the sliding ruler (7) is provided with a measuring rod (6) displaying numerical values at 5 mm intervals. Steel wire (8)
Mark the length near the greater trochanter with an electric scalpel, chisel, or dye at the tip of, and measure the length (Fig. 4, left). And during the actual acetabular excavation operation, leave the retracting pin as it is,
The measuring rod is removed during the operation. After the artificial acetabular lid is set, the femoral head is resected including the neck of the femur, leaving the neck length roughly measured by X-ray. Then, an intramedullary excavation is performed from a cervical excision to set the artificial head stem (portion of the torso) in the femoral medullary cavity. With this operation, the operation of the artificial joint replacement is almost completed, and when the temporary (trial) artificial joint is inserted, the measuring rod and the ruler steel wire are re-attached, and the marking of the greater trochanter attached immediately after the operation Measure the distance of As a result, the correct leg length is determined by changing the length of the neck of the artificial joint or osteotomy of the neck (FIG. 4, right).

【発明の効果】本発明により、これまでに単に手術中に
視野のじゃまにならないように殿筋を圧排するための１
本のピンレトラクター（開創ピン）を２本の連結棒と
し、開創鈎として腸骨にしっかり固定されるようになっ
た。かつ、その中央にメジャーを取り付けることによ
り、手術中に脚長の計測が可能となり、正に一挙両得と
いえる。According to the present invention, a method for removing the gluteal muscles so as not to obstruct the visual field during the operation has been described.
The pin retractor (retractor pin) was made into two connecting rods, and was fixed firmly to the iliac as a retractor hook. In addition, by attaching the measure to the center, it is possible to measure the length of the leg during the operation, and it can be said that it is exactly a double advantage.

【図面の簡単な説明】[Brief description of the drawings]

【図１】正面像：連結した開創ピン（１、２）が肩
（３）でネジ結合により連結され、１、２はその長さの
変更を可能とする。 肩中央より首（４）を作製し、同
部と後で述べる計測棒を連結する。 なを４には抜去時
に引っかかりの抜去用突起がある。FIG. 1 is a front view: the connected retracting pins (1, 2) are connected by a screw connection at a shoulder (3), and 1, 2 allow the length thereof to be changed. A neck (4) is made from the center of the shoulder, and the same part is connected to a measuring rod described later. The lug 4 has a pull-out protrusion that is caught at the time of pull-out.

【図２】（上図）：計測棒（６）は、その一端は本体の
図１に示す肩（３）よりのびる首（４）の部分にはめ込
むべく、カラー（５）作製し、肩あるい開創ピンと直角
にはめ込まれる。計測棒には５ｍｍ間隔でメジャーが書
き込まれている。 （下図）：側面像で示す計測棒にはブロック状ルーラー
（７）があり、マーカー鋼線（８）を直角に取り付け、
その鋼線の先端で大腿骨の大転子に計測のための位置ぎ
めをおこなう。マーカー鋼線固定ネジ（９）はマーカー
鋼線を挿入し固定する。FIG. 2 (upper view): The measuring rod (6) is made with a collar (5) so that one end of the measuring rod (6) is fitted to the neck (4) extending from the shoulder (3) shown in FIG. It is fitted at right angles to the retraction pin. Measures are written on the measuring rod at intervals of 5 mm. (Lower figure): The measuring rod shown in the side view has a block-shaped ruler (7), and a marker steel wire (8) is attached at a right angle.
The distal end of the steel wire is used to position the greater trochanter of the femur for measurement. The marker steel wire fixing screw (9) inserts and fixes the marker steel wire.

【図３】斜位像で開創ピンと計測棒を合体させた図でそ
れぞれの部品番号を示す。FIG. 3 is a view in which a retracting pin and a measuring rod are combined in an oblique image, and each part number is shown.

【図４】実際に使用する際の説明図である。左図は人工
関節設置前に腸骨に立てられたＣＲＰとマーキングした
大転子までの計測図を示す。右図は人工関節仮の設置時
における腸骨と大転子の距離を測定している。FIG. 4 is an explanatory diagram when actually used. The figure on the left shows the measurement up to the greater trochanter marked CRP placed on the iliac bone before the artificial joint was placed. The right figure measures the distance between the iliac bone and the greater trochanter when the artificial joint is placed.