Surgical instrument, medical instrument assembly, and implantation method

Abstract

Provided is a surgical instrument that easily enables approximation of the coracoid process to the neck of the scapula. The surgical instrument (1) of the present invention includes a handle (2) extending in a first direction and a beveled portion (3) extending from the front end of the handle (2) in a second direction. The second direction in which the beveled portion (3) extends is inclined at an angle α of 95° or more and 115° or less with respect to the first direction in which the handle (2) extends, and a notch (10) for a screw to pass through is formed in the outer edge of the beveled portion (3).

Description

Technical Field

[0001] This invention relates to a surgical instrument for transplanting the coracoid process to the neck of the scapula, a medical device assembly having the surgical instrument, and a method for transplanting the coracoid process to the neck of the scapula. Background Technology

[0002] Previously, as a surgical procedure for recurrent shoulder dislocation, a coracoid process of the scapula was transplanted to the neck of the scapula (hereinafter referred to as coracoid process transfer). When this coracoid process transfer is performed in an open (direct vision) manner, there are problems of invasive damage to the muscles and postoperative joint contractures, making it difficult for athletes to return to competition when these symptoms occur. To overcome these problems, arthroscopic coracoid process transfer is useful. As such an arthroscopic coracoid process transfer, the transfer technique disclosed in Non-Patent Document 1 is known. In this transfer technique, the following steps A to G are performed.

[0003] Process A: such as Figure 32 As shown, by moving the exchange rod 101, which penetrates the subscapularis muscle 100, incision 102 is formed in the subscapularis muscle 100. Figure 32 (A) shows the state before the exchange rod 101 penetrates the subscapularis muscle 100. Figure 32 (B) shows the state in which the exchange rod 101, which runs through the subscapularis muscle 100, is tilted upwards. Figure 32 (C) shows the state in which the exchange rod 101, which runs through the subscapularis muscle 100, is tilted downwards.

[0004] Process B: such as Figure 33 (A) and Figure 33 As shown in (B), a guidewire 105 is inserted into the body through a first inlet 104 formed in the skin directly above the coracoid process 103. The guidewire 105 is then inserted into the coracoid process 103. With the guidewire 105 passed through the cavity of the hollow screw 106, the hollow screw 106 is moved toward the coracoid process 103 along the guidewire 105, and the hollow screw 106 is screwed into the coracoid process 103. The guidewire 105 is then pulled out of the body from the first inlet 104. Figure 33 (A) shows the operation of screwing the first hollow screw 106 into the beak 103. Figure 33 (B) shows the operation of screwing the second hollow screw 106 into the beak 103.

[0005] Process C: such as Figure 34 As shown, the coracoid process 103 is cut from the scapula 108 using a bone chisel 107 inserted from the first inlet 104 (at this time, the coracoid process 103 is cut while the common tendon 109 is attached to the coracoid process 103).

[0006] Process D: such as Figure 35(A) and (B) of the present application, the coracoid process 103 is gripped with forceps 110 inserted into the body from the first entrance 104, the forceps 110 is moved to the lower side, and the coracoid process 103 is moved to the front of the incision 102. Figure 35

[0007] Step E: As shown in (A) and (B) of the present application, the coracoid process 103 is gripped with forceps 110 inserted into the body from the first entrance 104, the forceps 110 is moved to the lower side, and the coracoid process 103 is moved to the front of the incision 102. Figure 36 Figure 36

[0008] Step F: As shown in (A) of the present application, the coracoid process 103 is put into the incision 102 and located in the vicinity of the scapular neck 108a by advancing the barrel 112. Figure 37

[0009] Step G: As shown in (A) of the present application, the long screw 113 that has passed through the hollow 112a of the barrel 112 is passed through the hollow of the screw 106 and screwed into the coracoid process 103, and then the barrel 112 is pulled out of the body from the second entrance 111. Figure 37 Figure 37

[0010] Prior Art Documents

[0011] Non-Patent Documents

[0012] Non-Patent Document 1: Laffosse L, Lejeune E, Bourchard A, et al., The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy: The Journal of Arthroscopy and Related Surgery, Vol 23, No 11 (November), 2007: pp 1242.e1-1242.e5. SUMMARY

[0013] Problems to be Solved by the Invention

[0014] For the above-described conventional coracoid process transfer procedure, in Step E, Figure 36 ​​​​​​) is very difficult (it is very difficult to put the head of the screw 106 into the opening 113 of the cylinder 112 in the state where the coracoid process 103 is floating in the body fluid). Therefore, the conventional coracoid process transposition surgery takes a long time to make the coracoid process 103 approach the scapular neck 108a. In addition, since the above-described procedure E is very difficult, there are cases where the operation under the arthroscope is abandoned and the operation under the forward-viewing endoscope is changed.

[0015] Further, in the above-described conventional coracoid process transposition surgery, as a result of advancing the cylinder 112 in procedure G Figure 37 ), the nervous and vascular system 200 located in the vicinity of the shoulder joint is sandwiched in the front and back directions by the subscapularis muscle 100 and the common tendon 109 (the above-described nervous and vascular system 200 includes the musculocutaneous nerve 200a, the axillary nerve 200b, the subclavian artery 200c, etc.). Moreover, in the case where the sandwiching is strong, there is a possibility that a complication due to the damage of the nervous and vascular system 200 occurs. For example, in the case where the musculocutaneous nerve 200a is damaged due to the above-described strong sandwiching, there is a possibility that a complication in which the elbow becomes unable to be bent occurs. In addition, in the case where the axillary nerve 200b is paralyzed due to the above-described strong sandwiching, there is a possibility that a complication in which the shoulder becomes unable to be lifted up occurs.

[0016] The present application is made in view of the above-described matters, and an object thereof is to provide a surgical instrument by which the coracoid process is easily made to approach the scapular neck and a medical instrument assembly (also referred to as a medical machine assembly) provided with the surgical instrument. In addition, another object of the present application is to provide a coracoid process transplantation method by which the coracoid process is made to approach the scapular neck without damaging the nervous and vascular system.

[0017] Means for solving the problem

[0018] In order to achieve the above-described objects, the present application includes the technical solutions of the following items. (Translator's note: The term "wire" in this application corresponds to the English "wire", which should be understood as a wire-like material including a metal wire that can be applied to the present application)

[0019] Item 1. A surgical instrument for transplanting a coracoid process to a scapular neck,

[0020] The surgical instrument is provided with: a handle extending in a first direction; and an inclined portion extending from a front end of the handle in a second direction; and

[0021] The second direction in which the inclined portion extends is inclined at an angle of 95° or more and 115° or less with respect to the first direction in which the handle extends,

[0022] A notch through which a screw passes is formed in an outer edge of the inclined portion.

[0023] Item 2. The surgical instrument according to item 1, wherein a through-hole through which a screw passes is formed in the inclined portion.

[0024] Item 3. The surgical instrument according to item 2, wherein a protrusion that protrudes outward is formed at a lateral position of the through-hole of the inclined portion.

[0025] Item 4. The surgical instrument according to any one of items 1 to 3, wherein a grip portion that becomes a handle is connected to a base end side of a handle main body of the handle,

[0026] the inclined portion extends from a front end of the handle main body toward the second direction,

[0027] a length of a range of the handle main body between the grip portion and the inclined portion is 8 cm or more and 12 cm or less.

[0028] Item 5. A medical instrument set comprising:

[0029] the surgical instrument according to item 4; and

[0030] a cutting tool for cutting off the coronoid process,

[0031] the cutting tool is connected by a thick wall portion used as a handle and a thin wall portion thinner than the thick wall portion, and a blade that is thinnest is formed at a front end of the thin wall portion farthest from the thick wall portion,

[0032] a length of the thin wall portion is 6 cm or more and 8 cm or less.

[0033] Item 6. A medical instrument set comprising: the surgical instrument according to any one of items 1 to 4, a first wire, a second wire, a third wire, and a first sleeve; wherein

[0034] the first wire, the second wire, the third wire, and the first sleeve are respectively capable of passing through the gap of the surgical instrument,

[0035] the first wire is a hollow cylinder capable of passing the third wire through a hollow of the first wire, and a groove that extends spirally is formed at an outer peripheral surface of a front end portion of the first wire,

[0036] a front end portion of the second wire is rounded,

[0037] a front end portion of the third wire is angular,

[0038] the first sleeve is a hollow cylinder capable of passing the first wire, the second wire, and the third wire through a hollow of the first sleeve.

[0039] Item 7. A medical instrument set (medical device set) comprising: the surgical instrument according to any one of items 1 to 4, an abrading tool, a second sleeve, a third sleeve, a fourth sleeve, a fourth wire, and a fifth wire; wherein

[0040] the second sleeve, the third sleeve, the fourth sleeve, and the abrading tool are each a hollow cylinder, and

[0041] the third sleeve is capable of being passed through the hollow of the second sleeve, the fourth sleeve is capable of being passed through the hollow of the third sleeve, the fourth wire or the fifth wire is capable of being passed through the hollow of the fourth sleeve, and the abrading tool is capable of being passed through the hollow of the second sleeve,

[0042] the fourth wire is capable of being passed through the hollow of the abrading tool and the hollow of the fourth sleeve, a front end portion of the fourth wire is rounded,

[0043] the fifth wire is capable of being passed through the hollow of the abrading tool, the hollow of the fourth sleeve, and the notch of the surgical instrument, a front end portion of the fifth wire is tapered with an angular front end,

[0044] the electric power tool is operated in a state in which the base end portion of the abrading tool is connected to the electric power tool, whereby the abrading tool is capable of being rotated around the central axis, the abrading tool is rotated in a state in which the front end surface of the abrading tool is in contact with the surface of the scapular neck portion, whereby the surface of the scapular neck portion is capable of being abraded by the front end surface of the abrading tool.

[0045] Item 8. The medical instrument set according to item 7, wherein the front end portion of the third sleeve and the front end portion of the fourth sleeve are each tapered with an angular front end.

[0046] Item 9. A grafting method of grafting the coracoid process to the scapular neck portion using the surgical instrument according to any one of items 1 to 4, wherein

[0047] the grafting method comprises:

[0048] a first step of forming an incision in the infraspinatus muscle in the vicinity of the scapular neck portion;

[0049] a second step of inserting the surgical instrument into the body from a first entrance formed in the skin at a position directly above the scapular neck portion so that the inclined portion is in contact with the coracoid process;

[0050] a third step of passing a first screw inserted into the body from the first entrance through the notch of the inclined portion and screwing the first screw into the coracoid process, whereby the inclined portion is fixedly connected to the coracoid process by the first screw;

[0051] a fourth step of cutting off the coracoid process from the scapula while keeping the common tendon attached to the coracoid process by using an osteotome inserted from the first entrance;

[0052] a fifth step of moving the surgical instrument downward, thereby moving the coracoid process downward, and placing the coracoid process into the incision to bring the coracoid process close to the scapular neck;

[0053] a sixth step of releasing the screwing of the first screw into the coracoid process, taking the first screw out of the body from a second entrance formed in the skin in front of the incision, and inserting a second screw longer than the first screw into the body from the second entrance, through the gap and screwing into the coracoid process and the scapular neck; and

[0054] a seventh step of moving the surgical instrument, thereby detaching the surgical instrument from the second screw, and taking the surgical instrument out of the body from the first entrance.

[0055] Item 10. The implantation method according to item 9, wherein,

[0056] in the third step, a first guide wire inserted into the body from the first entrance is passed through the gap of the inclined portion and pierced into the coracoid process, after which the first screw is moved along the first guide wire toward the gap in a state where the first guide wire passes through the hollow of the first screw, the first screw is passed through the gap and screwed into the coracoid process, after which the first guide wire is pulled out of the body from the first entrance;

[0057] in the sixth step, a second guide wire is inserted into the body from the second entrance, the second guide wire is passed through the hollow of the first screw and pierced into the scapular neck, after which the screwing of the first screw into the coracoid process is released and the first screw is moved along the second guide wire and taken out of the body from the second entrance, after which the second screw longer than the first screw is moved along the second guide wire toward the gap in a state where the second guide wire passes through the hollow of the second screw, the second screw is passed through the gap and screwed into the coracoid process and the scapular neck, after which the second guide wire is pulled out of the body from the second entrance.

[0058] Item 11. The implantation method according to item 9 or 10, wherein,

[0059] the surgical instrument is the surgical instrument according to item 2 or 3,

[0060] the implantation method further includes an eighth step implemented after the seventh step;

[0061] In the third process, a third screw inserted into the body from the first inlet is passed through the through-hole and screwed into the coracoid process, thereby fixing the inclined portion to the coracoid process with the third screw;

[0062] In the sixth process, the screwing of the third screw into the coracoid process is released, and the third screw is taken out of the body from the second inlet;

[0063] In the eighth process, a fourth screw longer than the third screw is inserted into the body from the second inlet, and the fourth screw is passed through the hole of the coracoid process screwed with the third screw and screwed into the coracoid process and the scapular neck.

[0064] Item 12. The implantation method according to item 11, wherein,

[0065] In the third process, a third guide wire inserted into the body from the first inlet is passed through the through-hole and pierced into the coracoid process, after which the third screw is moved along the third guide wire toward the through-hole in a state where the third guide wire passes through the hollow of the third screw, the third screw is passed through the through-hole and screwed into the coracoid process, after which the third guide wire is pulled out of the body from the first inlet;

[0066] In the sixth process, a fourth guide wire is inserted into the body from the second inlet, the fourth guide wire is passed through the hollow of the third screw and pierced into the scapular neck, after which the screwing of the third screw into the coracoid process is released and the third screw is moved along the fourth guide wire, taken out of the body from the second inlet, and the fourth guide wire is pulled out of the body from the second inlet;

[0067] In the eighth process, a fifth guide wire is inserted into the body from the second inlet, the fifth guide wire is passed through the hole of the coracoid process screwed with the third screw and the hole of the scapular neck pierced with the fourth guide wire, after which the fourth screw is moved along the fifth guide wire in a state where the fifth guide wire passes through the hollow of the fourth screw longer than the third screw, the fourth screw is passed through the hole of the coracoid process and the hole of the scapular neck, thereby screwed into the coracoid process and the scapular neck, after which the fifth guide wire is pulled out of the body from the second inlet.

[0068] Inventive Effects

[0069] According to the surgical instrument and the medical assembly of the present application, by inclining the inclined portion at an angle of 95° or more and 115° or less with respect to the shank main body, the inclined portion can be brought into contact with the coracoid process attached to the scapula, under the condition that the shank passes above the coracoid process which is adapted to form an entrance. Further, if the inclined portion is brought into contact with the coracoid process in this way, the operation of passing the screw through the gap and screwing it into the coracoid process can be performed in a state in which the coracoid process is attached to the scapula and stabilized. Therefore, the inclined portion can be easily connected to the coracoid process using the screw. Further, if the coracoid process is cut from the scapula in a state in which the inclined portion is connected to the coracoid process in this way, the coracoid process can be brought close to the neck of the scapula by a simple operation of moving the surgical instrument downward. For the above reasons, according to the surgical instrument and the medical assembly of the present application, the coracoid process can be easily brought close to the neck of the scapula.

[0070] According to the implantation method of the present application, the total tendon and the coracoid process are moved downward along with the movement of the surgical instrument downward and the coracoid process close to the neck of the scapula in the fifth step, and thus the nervous and vascular system located in the vicinity of the shoulder joint can be moved downward by the pressing of the total tendon or the coracoid process. Thereby, the nervous and vascular system of the subscapularis muscle and the total tendon in the front and back directions (horizontal direction) can be weakened, and thus the coracoid process can be brought close to the neck of the scapula without damaging the nervous and vascular system. Thereby, complications caused by the damage of the nervous and vascular system can be avoided. BRIEF DESCRIPTION OF DRAWINGS

[0071] Figure 1 is a perspective view (a photograph) of the surgical instrument of the present application.

[0072] Figure 2 (A) of is a plan view showing a state in which the surgical instrument is observed from a perpendicular direction with respect to the shank, (B) is a plan view showing a state in which the surgical instrument is observed from a perpendicular direction with respect to the inclined portion, and (C) is a side view of the surgical instrument.

[0073] Figure 3 is a schematic view showing a step of the coracoid process implantation method of the present application.

[0074] Figure 4 is a schematic view showing a step of the coracoid process implantation method of the present application.

[0075] Figure 5 is a schematic view showing a step of the coracoid process implantation method of the present application.

[0076] Figure 6 is a schematic view showing a step of the coracoid process implantation method of the present application.

[0077] Figure 7 is a schematic view showing a step of the coracoid process implantation method of the present application.

[0078] Figure 8 is a schematic diagram showing steps of a coracoid bone grafting method according to an embodiment of the present application.

[0079] Figure 9 is a schematic diagram showing steps of a coracoid bone grafting method according to an embodiment of the present application.

[0080] Figure 10 is a schematic diagram showing steps of a coracoid bone grafting method according to an embodiment of the present application.

[0081] Figure 11 (A) is a plan view of a cutting tool, and (B) is a side view of the cutting tool.

[0082] Figure 12 (A) is a side view of a first wire, (B) is a side view of a second wire, and (C) is a side view of a third wire.

[0083] Figure 13 is a side view of a first sleeve.

[0084] Figure 14 is a side view schematic diagram showing a front end portion of the first wire.

[0085] Figure 15 is a side view schematic diagram showing a front end portion of the second wire.

[0086] Figure 16 is a side view showing a surgical instrument, a grinding tool, a second sleeve, a third sleeve, and a fourth sleeve.

[0087] Figure 17 is a side view showing the grinding tool and the second sleeve.

[0088] Figure 18 is a side view showing the second sleeve, the third sleeve, and the fourth sleeve.

[0089] Figure 19 is a side view showing a fourth wire and a fifth wire.

[0090] Figure 20 is a photograph showing an operation performed in a planarization process.

[0091] Figure 21 is a photograph showing an operation performed in a planarization process.

[0092] Figure 22 is a photograph showing an operation performed in a planarization process.

[0093] Figure 23 is a photograph showing an operation performed in a planarization process.

[0094] Figure 24These are photographs showing the operations performed during the planarization process.

[0095] Figure 25 These are photographs showing the operations performed during the planarization process.

[0096] Figure 26 These are photographs showing the operations performed during the planarization process.

[0097] Figure 27 These are photographs showing the operations performed during the planarization process.

[0098] Figure 28 These are photographs showing the operations performed during the planarization process.

[0099] Figure 29 These are photographs showing the operations performed during the planarization process.

[0100] Figure 30 These are photographs showing the operations performed during the planarization process.

[0101] Figure 31 These are photographs showing the operations performed during the planarization process.

[0102] Figure 32 This is a schematic diagram illustrating the steps of a conventional coracoid process repositioning procedure.

[0103] Figure 33 This is a schematic diagram illustrating the steps of a conventional coracoid process repositioning procedure.

[0104] Figure 34 This is a schematic diagram illustrating the steps of a conventional coracoid process repositioning procedure.

[0105] Figure 35 This is a schematic diagram illustrating the steps of a conventional coracoid process repositioning procedure.

[0106] Figure 36 This is a schematic diagram illustrating the steps of a conventional coracoid process repositioning procedure.

[0107] Figure 37 This is a schematic diagram illustrating the steps of a conventional coracoid process repositioning procedure. Detailed Implementation

[0108] Below, refer to the appendix. Figure 1 The embodiments of the present invention will be described below.

[0109] Figure 2 This is a perspective view (photograph) of the surgical instrument 1 according to an embodiment of the present invention. Figure 2 (A) is a top view showing the state of the surgical instrument 1 as viewed from a vertical direction relative to the handle 2 described later. Figure 2(B) is a plan view showing a state of the surgical instrument 1 as viewed from a direction perpendicular to the inclined portion 3 described later. Figures 3-10 (C) is a side view of the surgical instrument 1. Figure 1 is a schematic view showing steps of a coracoid process 103 transplantation method performed under arthroscopy using the surgical instrument 1.

[0110] The surgical instrument 1 of the present embodiment is used for transplanting the coracoid process 103 to the scapular neck 108a (specifically, the surgical instrument 1 is used for bringing the coracoid process 103 close to the scapular neck 108a and fixing the coracoid process 103 to the scapular neck 108a with a screw). Figure 2 , Figure 1

[0111] As shown in Figure 2 and Figure 2 , the surgical instrument 1 includes a handle 2 extending in a first direction, and an inclined portion 3 extending from a front end of the handle 2 in a second direction. The second direction in which the inclined portion 3 extends is inclined at an angle a of 95° or more and 115° or less with respect to the first direction in which the handle 2 extends (for the angle a, refer to (C) of Figure 2 ).

[0112] The handle 2 is connected with a grip portion 5 that becomes a handle on a proximal end side of a handle body 4.

[0113] The grip portion 5 is a cylinder having an opening 6 ( (B) of Figure 1 ) at a front end (one end), and is formed of a stainless steel alloy, a titanium alloy, or an aluminum alloy. A length L1 ( (A) of Figure 2 ) of the grip portion 5 is, for example, 5 cm or more. A width H1 ( (A) of Figure 1 ) of the grip portion 5 is, for example, 1 cm or more and 2 cm or less. In use of the surgical instrument 1, a user holds the grip portion 5 and operates the surgical instrument 1.

[0114] The handle body 4 is a bar material formed of a stainless steel alloy, a titanium alloy, or an aluminum alloy. A cross section of the handle body 4 is rectangular, and a size (width, height) of a cross section of the grip portion 5 is larger than a size (width, height) of the cross section of the handle body 4. The proximal end side of the handle body 4 is fixed to the grip portion 5 in a state where the proximal end side of the handle body 4 is inserted into the inside of the grip portion 5 from the opening 6 of the grip portion 5, and thereby the connection of the grip portion 5 to the proximal end side of the handle body 4 is performed. The inclined portion 3 extends from the front end of the handle body 4, and a length L2 ( (A) of Figure 2 ) of a range of the handle body 4 between the grip portion 5 and the inclined portion 3 is 8 cm or more and 12 cm or less. A width H2 ( (A) of Figure 1 ) of the handle body 4 is, for example, 0.4 cm or more and 0.8 cm or less.

[0115] ​Furthermore, the cross-sectional shape of the handle body 4 can be other than rectangular (for example, the cross-section of the handle body 4 can be circular or elliptical). Alternatively, the grip portion 5 can be connected to the base end side of the handle body 4 using well-known methods other than those described above. Furthermore, the grip portion 5 can be integrally formed with the handle body 4 in a manner that connects to the base end side of the handle body 4. Even in this case, the dimensions (width, height) of the cross-section of the grip portion 5 are made larger than the dimensions (width, height) of the cross-section of the handle body 4.

[0116] The inclined portion 3 is a plate-like body extending in a second direction from the front end of the handle body 4. The inclined portion 3 is formed of stainless steel alloy, titanium alloy, or aluminum alloy and is integrally formed with the handle body 4. The length L3 of the inclined portion 3 is... Figure 2 For example, the width H3 of the inclined portion 3 is between 1.5cm and 2.5cm. Figures 5-8 (B) For example, it is 1.2cm or more and 1.5cm or less (the width H3 of the inclined part 3 means the maximum width of the inclined part 3).

[0117] A notch 10 is formed on the outer edge of the front end side of the inclined portion 3 for a screw to pass through. The notch 10 opens outward to allow the screw 21 of the beak protrusion 103 to be screwed in. Figures 8-10 ), screw 26 into the coracoid process 103 and the neck of the scapula 108a. Figure 1 (Passing through gap 10.) Figure 2 as well as Figures 5-8 In the example shown, two strands 11, 11 are formed on the front end side of the inclined portion 3, and the space between the two strands 11, 11 forms a gap 10, the cross-section of the gap 10 being semi-circular.

[0118] A through hole 12 is formed on the base end side (handle 2 side) of the inclined portion 3 for the screw to pass through. The through hole 12 has a circular cross-section, and the screw 23 of the beak protrusion 103 is screwed in. Figure 1 The through hole 12 passes through the inclined portion 3. A protruding portion 13 is formed at a lateral position to the through hole 12 of the inclined portion 3 (the "lateral position of the through hole 12" refers to a position on the outside of the inclined portion 3 relative to the width direction of the through hole 12, and the "width direction of the inclined portion 3" refers to a direction orthogonal to the long side direction of the inclined portion 3). The protruding portion 13 is provided as a marker for determining the position of the through hole 12 when using the surgical instrument 1.

[0119] Further, the shape of the notch 10 can be any shape having an opening through which the screws 21, 26 can pass. Further, the shape of the through-hole 12 can be any shape through which the screw 23 can pass. Specifically, the screws 21, 23, 26 described above are screws in which a small-diameter threaded portion extends from a large-diameter head portion, the shape of the notch 10 is such that the threaded portion of the screw 21, 26 can pass through the opening, and the shape can be such that the head portion of the screw 21, 26 can abut against the surface of the inclined portion 3 located around the notch 10 in a state in which the threaded portion of the screw 21, 26 passes through the notch 10. Further, the shape of the through-hole 12 can be such that the head portion of the screw 23 can abut against the surface of the inclined portion 3 located around the through-hole 12 in a state in which the threaded portion of the screw 23 passes through the through-hole 12.

[0120] Further, the position of the notch 10 and the position of the through-hole 12 are not limited to those shown in Figure 2 , Figures 3-10 . For example, the notch 10 can also be formed in the outer edge of the base end side (handle 2 side) of the inclined portion 3. Further, the through-hole 12 can also be formed in the front end side of the inclined portion 3. Further, a plurality of notches 10 can also be formed in the inclined portion 3, and a plurality of through-holes 12 can also be formed in the inclined portion 3.

[0121] Further, the through-hole 12 and the protruding portion 13 are not necessarily required, and the through-hole 12 and the protruding portion 13 can not be formed in the inclined portion 3.

[0122] Next, a method of transplanting the coracoid process 103 toward the scapular neck 108a (a method of approximating the coracoid process 103 to the scapular neck 108a and fixing the coracoid process 103 to the scapular neck 108a with a screw) using the surgical instrument 1 described above will be described with reference to Figure 3

[0123] First, a first process of forming an incision 102 in the subscapular muscle 100 in the vicinity of the scapular neck 108a is performed (see Figure 3 ). In the first process, for example, as shown in Figure 3 , the exchange rod 20 that passes through the subscapular muscle 100 is moved in the up-and-down direction, and the incision 102 is formed in the subscapular muscle 100 (see (A) of Figure 3 , (B) of Figure 3 , and (C) of Figure 4 ). Further, in the first process, the incision 102 can also be formed using a method other than that described above.

[0124] Incidentally, as shown in Figure 1 ​The second process of inserting the surgical instrument 1 into the body and bringing the inclined portion 3 into abutment with the coracoid process 103 from a position directly above the coracoid process 103 where the first entrance 104 is formed in the skin is shown. Specifically, the user inserts the handle main body 4 and the inclined portion 3 into the body from the first entrance 104 by holding the grip portion 5 ( Figure 2 , Figure 1 ) and operating the surgical instrument 1, and brings the inclined portion 3 into abutment with the coracoid process 103. The first entrance 104 is formed in a position directly above the coracoid process 103 from the viewpoint of shortening the distance between the first entrance 104 and the coracoid process 103 and reducing the burden on the patient.

[0125] Further, as shown in the example shown in Figure 2 and Figure 4 , when the through-hole 12 and the protruding portion 13 are formed in the inclined portion 3, in the second process ( Figure 5 ), the protruding portion 13 is used as a marker for positioning the through-hole 12, and the through-hole 12 is disposed at a desired position of the coracoid process 103.

[0126] Incidentally, the third process of inserting a screw 21 of a hollow structure into the body from the first entrance 104, passing the screw 21 through the gap 10 of the inclined portion 3 and screwing it into the coracoid process 103, thereby fixedly connecting the inclined portion 3 to the coracoid process 103 with the screw 21 is performed ( Figure 5 ). At this time, as shown in (A) of Figure 5 , a guide wire 22 inserted into the body from the first entrance 104 is passed through the gap 10 and inserted into the coracoid process 103. Also, thereafter, with the guide wire 22 passing through the hollow of the screw 21, the screw 21 is moved along the guide wire 22 toward the gap 10, the screw 21 is passed through the gap 10 and screwed into the coracoid process 103, and thereafter the guide wire 22 is pulled out of the body from the first entrance 104 (the state after the guide wire 22 is pulled out of the body is shown in (B) of Figure 1 ). Further, in the third process, in a state where the threaded portion of the screw 21 is passed through the gap 10 of the inclined portion 3 and screwed into the coracoid process 103, the inclined portion 3 is sandwiched between the head of the screw 21 and the coracoid process 103, thereby fixedly connecting the inclined portion 3 to the coracoid process 103 with the screw 21.

[0127] Further, as shown in the example shown in Figure 2 and Figure 5 , when the through-hole 12 is formed in the inclined portion 3, in the third process, a screw 23 of a hollow structure is inserted into the body from the first entrance 104 ( Figure 5 (B)), the screw 23 is passed through the through-hole 12 of the inclined portion 3 and screwed into the coracoid process 103, thereby also performing the operation of fixedly connecting the inclined portion 3 to the coracoid process 103 with the screw 23. In this operation, as shown in Figure 5(B) shows the state just before the screw 23 is inserted through the through-hole 12), and the screw 23 is inserted through the through-hole 12 and screwed into the coracoid process 103 after the screw 23 is moved along the guide wire 24 toward the through-hole 12 in a state where the guide wire 24 is inserted through the hole of the screw 23 (C) shows the state just after the screw 23 is inserted through the through-hole 12), and the guide wire 24 is pulled out from the first entrance 104 to the outside of the body after the screw 23 is inserted through the through-hole 12 and screwed into the coracoid process 103. Figure 6 (B) shows the state just before the screw 23 is inserted through the through-hole 12), and the screw 23 is inserted through the through-hole 12 and screwed into the coracoid process 103 after the screw 23 is moved along the guide wire 24 toward the through-hole 12 in a state where the guide wire 24 is inserted through the hole of the screw 23 (C) shows the state just after the screw 23 is inserted through the through-hole 12), and the guide wire 24 is pulled out from the first entrance 104 to the outside of the body after the screw 23 is inserted through the through-hole 12 and screwed into the coracoid process 103.

[0128] After the above-mentioned third process, as shown in Figure 7 , a fourth process of cutting the coracoid process 103 from the scapula 108 with a bone chisel 25 inserted from the first entrance 104 while the total tendon 109 is kept attached to the coracoid process 103 is carried out. At this time, the bone chisel 25 is inserted into the shoulder joint along the shank body 4. Thereafter, the head portion of the bone chisel 25 (the base end portion of the bone chisel 25) is struck with a hammer in a state where the bone chisel 25 is made to slide along the shank body 4, and the coracoid process 103 is cut with the bone chisel 25.

[0129] Incidentally, as shown in Figure 7 (A), Figure 7 (B), Figure 7 (C), a fifth process of moving the coracoid process 103 to which the total tendon 109 is attached downward by moving the surgical instrument 1 downward, and placing the coracoid process 103 in the incision 102 of the subscapularis muscle 100 and approaching the scapular neck portion 108a is carried out. At this time, the nervous vascular system 200 in the vicinity of the shoulder joint is also moved downward by the pressing of the total tendon 109 or the coracoid process 103 which is moved downward. The nervous vascular system 200 includes the musculocutaneous nerve 200a, the axillary nerve 200b, and the subclavian artery 200c, Figure 8 (A) shows the state just before the screw 23 is inserted through the through-hole 12), and the screw 23 is inserted through the through-hole 12 and screwed into the coracoid process 103 after the screw 23 is moved along the guide wire 24 toward the through-hole 12 in a state where the guide wire 24 is inserted through the hole of the screw 23 (C) shows the state just after the screw 23 is inserted through the through-hole 12), and the guide wire 24 is pulled out from the first entrance 104 to the outside of the body after the screw 23 is inserted through the through-hole 12 and screwed into the coracoid process 103.

[0130] Incidentally, a sixth process of releasing the screw 21 from the coracoid process 103, taking the screw 21 out to the outside of the body from a second entrance 111 formed in the skin at a position in front of the incision 102, and inserting a screw 26 which is longer than the screw 21 and has a hollow structure into the body from the second entrance 111, through the gap 10, and into the coracoid process 103 and the scapular neck portion 108a is carried out. Figure 8At this point, the guide wire 27, inserted into the body through the second inlet 111, passes through the hole in the screw 21 and pierces the neck 108a of the scapula. Then, the screw 21 is released from its screwing toward the coracoid process 103, and the screw 21 is moved along the guide wire 27 and removed from the body through the second inlet 111. Figure 8 (A) shows the screw 21 approaching the second inlet 111 along the guide wire 27. Figure 8 (B) Figure 8 (C) shows the state after screw 21 has been removed from the body. Furthermore, with guide wire 27 passed through the hole of screw 26, screw 26 is moved along guide wire 27 toward notch 10, passing screw 26 through notch 10 and screwed into the coracoid process 103 and the neck of the scapula 108a. Then, guide wire 27 is pulled out from the second inlet 111. Figure 8 (B) Figure 8 (C) shows the state in which screw 26 passes through notch 10 and is screwed into coracoid process 103 and scapular neck 108a.

[0131] In addition, such as Figure 8 (A) and Figure 8 As shown in (B), with screw 23 screwed into the beak 103, in the sixth step, the screwing of screw 23 into the beak 103 is also released, and screw 23 is removed from the body through the second inlet 111. In this operation, as... Figure 8 (A) and Figure 8 As shown in (B), the guide wire 28, inserted into the body from the second inlet 111, passes through the hole in the screw 23 and pierces the neck 108a of the scapula. Furthermore, thereafter, as... Figure 9 As shown in (C), the screw 23 is released from the beak 103 and the screw 23 is moved along the guide wire 28 to be removed from the second inlet 111 and the guide wire 28 is pulled out from the second inlet 111.

[0132] By the way, such as Figure 8 As shown, the seventh step is performed: by moving the surgical instrument 1, the surgical instrument 1 is disengaged from the screw 26, and the surgical instrument 1 is removed from the body through the first inlet 104. At this time, the notch 10 through which the screw 26 passes has an opening, thereby allowing the surgical instrument 1 to be easily disengaged from the screw 26 (that is, by simply moving the surgical instrument 1, the surgical instrument 1 can be disengaged from the screw 26 in a way that allows the screw 26 to exit through the notch 10 (between the two prongs 11, 11)).

[0133] Through the above operations, the coracoid process 103 is transplanted to the neck of the scapula 108a (the coracoid process 103 is fixed to the neck of the scapula 108a using screws 26).

[0134] In addition, in the sixth process ( Figure 9 In the seventh step, after the screw 23, which was screwed into the beak 103, is removed from the body, the process continues. Figure 10 After that, such as Figures 5-8 As shown, the eighth step is performed: a screw 29, which is longer than screw 23 and has a hollow structure, is inserted into the body through the second inlet 111, and the screw 29 is passed through and screwed into screw 23. Figure 10 The coracoid process 103 is inserted into the hole and screwed into the coracoid process 103 and the neck of the scapula 108a. At this time, as... Figure 8 As shown in (A), the guidewire 30 is inserted into the body through the second inlet 111, so that the guidewire 30 passes through the hole of the beak 103 screwed into the aforementioned screw 23 and through the guidewire 28 ( Figure 10 The foramen of the scapula neck 108a ( Figure 10 Moreover, thereafter, such as Figure 10 As shown in (B), with the guidewire 30 passed through the hole of the screw 29, the screw 29 is moved along the guidewire 30, causing it to pass through the hole in the coracoid process 103 and the hole in the neck of the scapula 108a, thereby being screwed into the coracoid process 103 and the neck of the scapula 108a. Then, the guidewire 30 is pulled out of the body from the second inlet 111. Figure 10 (C) shows the state after screw 29 is screwed into the coracoid process 103 and the neck of the scapula 108a and guide wire 30 is pulled out of the body. This is in the eighth step described above. Figure 5 In the case of ), in addition to using screw 26, screw 29 is also used to fix the coracoid process 103 to the neck of the scapula 108a.

[0135] Furthermore, by using a well-known screwdriver, it is possible to achieve the third step ( Figure 8 In the sixth process, screws 21 and 23 are screwed into the beak protrusion 103. Figure 8 In the sixth process, screws 21 and 23 are released from the screws and removed from the body. Figure 9 In the seventh step, screw 26 is screwed into the coracoid process 103 and the neck of the scapula 108a. Figure 2 Screw 29 is screwed into the coracoid process 103 and the neck of the scapula 108a. The screwdriver, for example, has a hole through which a guide wire can pass. The tip of the screwdriver is inserted into the hole of screws 21, 23, 26, or 29, thereby connecting screws 21, 23, 26, or 29 to the tip of the screwdriver. The hole of the screwdriver is open at the tip of the screwdriver. With screws 21, 23, 26, or 29 connected to the tip of the screwdriver, the opening at the tip of the screwdriver is located within the hole of screw 21, 23, 26, or 29, thus creating a communication between the hole of the screwdriver and the holes of screws 21, 23, 26, or 29.

[0136] When the screws 21, 23 are screwed into the coracoid process 103, the screws 26, 29 are screwed into the coracoid process 103 and the scapula neck portion 108a, first, the tip of the screwdriver is connected to the screw by inserting the tip of the screwdriver into the hole of the screw. Further, the screw and the screwdriver are inserted into the body along the guide wire in a state where the guide wire passes through the hole of the screw and the hole of the screwdriver, and become a state where the threaded portion of the screw hits the coracoid process 103. Further, the threaded portion of the screw is screwed into the coracoid process 103 or the threaded portion of the screw is screwed into the coracoid process 103 and the scapula neck portion 108a by rotating the screwdriver. Thereafter, the screw is detached from the tip of the screwdriver by making the screwdriver retreat along the guide wire, and the screwdriver is taken out of the body.

[0137] Further, when the screw 21, 23 is released from the screwing into the coracoid process 103 and taken out of the body, the screwdriver is inserted into the body along the guide wire in a state where the guide wire passes through the hole of the screwdriver, and the tip of the screwdriver is inserted into the hole of the screw, thereby connecting the screw to the tip of the screwdriver. Further, the screwing of the screw into the coracoid process 103 is released by rotating the screwdriver, and thereafter the screwdriver and the screw are taken out of the body by making the screwdriver and the screw retreat along the guide wire.

[0138] According to the surgical instrument 1 of the present embodiment, the inclined portion 3 is inclined with respect to the handle main body 4 at an angle a (C) of 95° or more and 115° or less, thereby enabling the inclined portion 3 to come into abutment with the coracoid process 103 in a state where the handle 2 passes through the first entrance 104 formed at a position directly above the coracoid process 103. Figure 4 Further, as shown in FIG. 6, if the inclined portion 3 comes into abutment with the coracoid process 103, the inclined portion 3 is connected to the coracoid process 103 in a state where the coracoid process 103 is attached to the scapula 108, thereby enabling the screw 21 to be screwed into the coracoid process 103 through the notch 10. Figure 4 Further, as shown in FIG. 6, if the inclined portion 3 comes into abutment with the coracoid process 103, the inclined portion 3 is connected to the coracoid process 103 in a state where the coracoid process 103 is attached to the scapula 108, thereby enabling the screw 21 to be screwed into the coracoid process 103 through the notch 10. Figure 5 Further, as shown in FIG. 6, if the inclined portion 3 comes into abutment with the coracoid process 103, the inclined portion 3 is connected to the coracoid process 103 in a state where the coracoid process 103 is attached to the scapula 108, thereby enabling the screw 21 to be screwed into the coracoid process 103 through the notch 10. Figure 6 Further, as shown in FIG. 6, if the inclined portion 3 comes into abutment with the coracoid process 103, the inclined portion 3 is connected to the coracoid process 103 in a state where the coracoid process 103 is attached to the scapula 108, thereby enabling the screw 21 to be screwed into the coracoid process 103 through the notch 10. Figure 7 Further, as shown in FIG. 6, if the inclined portion 3 comes into abutment with the coracoid process 103, the inclined portion 3 is connected to the coracoid process 103 in a state where the coracoid process 103 is attached to the scapula 108, thereby enabling the screw 21 to be screwed into the coracoid process 103 through the notch 10. Figure 7 Further, as shown in FIG. 6, if the inclined portion 3 comes into abutment with the coracoid process 103, the inclined portion 3 is connected to the coracoid process 103 in a state where the coracoid process 103 is attached to the scapula 108, thereby enabling the screw 21 to be screwed into the coracoid process 103 through the notch 10.

[0139] Further, according to the grafting method of the present embodiment, in the case where the coracoid process 103 is connected to the scapula 108, the coracoid process 103 is connected to the scapula 108 in a state where the inclined portion 3 is connected to the coracoid process 103. Figure 4In the fifth step shown, the total tendon 109 and the coracoid process 103 are moved downward by moving the surgical instrument 1 downward, and thus the neurovascular system 200 located in the vicinity of the shoulder joint is also moved downward by the pressing of the total tendon 109 or the coracoid process 103. Thus, the neurovascular system 200 is less likely to be pinched between the subscapularis muscle 100 and the total tendon 109 in the front-back direction (horizontal direction), and thus the neurovascular system 200 is less likely to be damaged. Therefore, complications caused by the damage to the neurovascular system 200 can be prevented (for example, since the damage to the musculocutaneous nerve 200a is prevented, a complication in which the elbow becomes unable to bend is prevented, and since the damage to the axillary nerve 200b is prevented, a complication in which the shoulder becomes unable to be lifted is prevented).

[0140] Further, according to the surgical instrument 1 of the present embodiment, since the protrusion 13 is formed at the side of the through-hole 12, the protrusion 13 can be used as a marker for positioning the through-hole 12. Thus, in the second step ( Figure 1 ) of the present embodiment, the through-hole 12 can be easily positioned at the desired position of the coracoid process 103.

[0141] Further, in order to perform the coracoid process 103 transplantation method described above, a medical instrument set including the surgical instrument 1 shown in Figure 2 , Figure 11 and the cutting tool 40 shown in Figure 6 may be used.

[0142] The cutting tool 40 can be used as the osteotome 25 for cutting the coracoid process 103 in the fourth step shown in Figure 11 . The cutting tool 40 ( Figure 6 ) is a tool in which a thick wall portion 41 serving as a handle is connected to a thin wall portion 42 thinner than the thick wall portion 41. The tip 42a of the thin wall portion 42 farthest from the thick wall portion 41 is the thinnest blade, and the length L4 of the thin wall portion 42 is 6 cm or more and 8 cm or less. If the cutting tool 40 described above is used as the osteotome 25 for cutting the coracoid process 103 ( Figure 11 ), the length L4 of the thin wall portion 42 ( Figure 1 ) is the length L2 of the handle body 4 (8 cm or more and 12 cm or less: Figure 11 ), and thus the head of the osteotome 25 (cutting tool 40) can be easily struck with a hammer while the osteotome 25 (cutting tool 40) is aligned with the handle body 4. Thus, the coracoid process 103 can be easily cut along the extension line of the handle body 4. Therefore, the handle body 4 can be appropriately used as a guide for determining the cutting position of the coracoid process 103. Further, as shown in Figure 11 , it is preferable that the thin wall portion 42 be formed so as to gradually widen and thin as it moves away from the grip portion 5. Further, as shown in Figure 1As shown in (B) of FIG. 1, preferably, a bend is formed on the front end side of the thin-walled portion 42.

[0143] In addition, the present application is not limited to using the cutting tool 40, and a chisel other than the cutting tool 40 can be used as the chisel for cutting the coracoid process 103.

[0144] In addition, in order to implement the above-described coracoid process 103 transplantation method, a medical instrument set including Figure 2 and Figure 12 the surgical instrument 1, Figure 13 the first wire 50, the second wire 51, the third wire 52, and Figure 13 the first sleeve 53 shown in FIG. 1.

[0145] The first wire 50, the second wire 51, the third wire 52, and the first sleeve 53 can respectively pass through the notch 10 and the through-hole 12 of the surgical instrument 1.

[0146] Figure 12 The first sleeve 53 shown in FIG. 1 is a hollow cylinder formed of stainless steel alloy, titanium alloy, or aluminum alloy. The outer diameter of the first sleeve 53 is, for example, 8 mm or less, and the inner diameter of the first sleeve 53 is, for example, 2 mm or less.

[0147] The above-described first sleeve 53 is used to guide the movement of the wires 50 and 51, and the wires 50, 51, and 52 can respectively pass through the hollow of the first sleeve 53.

[0148] Figure 5 The first wire 50 shown in (A) of FIG. 1 is a hollow cylinder formed of stainless steel alloy, titanium alloy, or aluminum alloy. The outer diameter of the first wire 50 is, for example, 4 mm or less, and the inner diameter of the first wire 50 is, for example, 2 mm or less. A helically extending groove 50a is formed on the outer peripheral surface of the front end portion of the first wire 50.

[0149] The above-described first wire 50 can be used, for example, as Figure 8 the guide wire 22 and 24 shown in FIG. 1, and Figure 12 the guide wire 27 and 28 shown in FIG. 1, and the third wire 52 Figure 12 shown in (C) of FIG. 1 can pass through the hollow of the first wire 50 Figure 12 shown in (A) of FIG. 1.

[0150] Figure 14 The second wire 51 shown in (B) of FIG. 1 is formed of stainless steel alloy, titanium alloy, or aluminum alloy, and the outer diameter of the second wire 51 is, for example, 2 mm or less. As shown in (B) of FIG. 1, the front end portion 51a of the second wire 51 has a rounded shape. Figure 10

[0151] The above-described second wire 51 is used to guide the movement of the first sleeve 53. In addition, the second wire 51 can also be used as Figure 12 ​The guidewire 30 shown is used.

[0152] Figure 15 The third wire 52 shown in (C) is formed of stainless steel alloy, titanium alloy, or aluminum alloy, and the outer diameter of the third wire 52 is, for example, less than 2 mm. Figure 12 As shown, the front end 52a of the third filament 52 has a shape that tapers towards the tip with sharp angles.

[0153] The aforementioned third wire 52 is used to form a hole in the coracoid process 103 and the neck of the scapula 108a, by means of the first wire 50 ( Figure 5 (A)) is pressed into the hole formed in the coracoid process 103 and the neck of the scapula 108a using the third wire 52, thereby enlarging the diameter of the hole formed using the third wire 52, and thus forming a hole suitable for screwing in the screw.

[0154] When using a medical device assembly including surgical instrument 1, first wire 50, second wire 51, third wire 52, and first cannula 53, in Figure 5 In the third step shown, in order to achieve the state where the screw 21 passes through the notch 10 of the inclined part 3 and is screwed into the beak 103, the following operations 1 to 5 are performed in sequence.

[0155] Operation 1: From the first entry point 104 ( Figure 12 ) the second filament 51 ( Figure 12 (B) is inserted into the body toward the beak 103, and the front end of the second wire 51 is positioned at the notch 10 of the inclined part 3.

[0156] Operation 2: When the second wire 51 ( Figure 13 (B) passed through the first sleeve 53 ( Figure 5 In the hollow state of the cavity, the first sleeve 53 is moved along the second wire 51, thereby inserting the first sleeve 53 into the body and guiding it toward the beak 103, and positioning the front end of the first sleeve 53 at the notch 10, and then from the first inlet 104 ( Figure 12 Pull the second wire 51 out of the body (pull the second wire 51 out of the hole in the first sleeve 53).

[0157] Operation 3: Place the third wire 52 ( Figure 12 (C) passes through the cavity of the first sleeve 53, thereby inserting the third wire 52 into the body and guiding it toward the beak 103, and the third wire 52 protruding from the front end of the first sleeve 53 passes through the notch 10 and pierces the beak 103, forming a hole in the beak 103.

[0158] Operation 4: Pass the third wire 52 through the hole in the first wire 50 along the edge. Figure 5(A) passes through the hole in the first sleeve 53, thereby inserting the first wire 50 into the body and guiding it toward the beak 103. The first wire 50, which protrudes from the front end of the first sleeve 53, passes through the notch 10 and pierces the beak 103. Thus, the diameter of the hole in the beak 103 formed in operation 3 is enlarged by the first wire 50, forming a hole in the beak 103 suitable for screwing in the screw 21.

[0159] Operation 5: Insert the first sleeve 53 from the first inlet 104 ( Figure 5 After being pulled out of the body, with the first wire 50 (equivalent to guide wire 22) passing through the hole of screw 21, the screw 21 is moved along the first wire 50 toward the notch 10. The screw 21 is then screwed through the notch 10 and into the hole of the beak 103 formed in operation 4. After that, the wires 50 and 52 are pulled out of the body from the first inlet 104.

[0160] In addition, Figure 5 In the third process shown, in order to achieve the state where the screw 23 passes through the through hole 12 of the inclined part 3 and is screwed into the beak 103, the following operations 6 to 10 are performed in sequence.

[0161] Operation 6: From the first entry point 104 ( Figure 12 ) the second filament 51 ( Figure 12 The (B) is inserted into the body toward the beak 103, and the front end of the second wire 51 is positioned in the through hole 12 of the inclined part 3.

[0162] Operation 7: When the second wire 51 ( Figure 13 (B) passed through the first sleeve 53 ( Figure 5 In the hollow state of the cavity, the first sleeve 53 is moved along the second wire 51, thereby inserting the first sleeve 53 into the body and guiding it toward the beak 103 and positioning the front end of the first sleeve 53 in the through hole 12, and then from the first inlet 104 ( Figure 12 Pull the second wire 51 out of the body (pull the second wire 51 out of the hole in the first sleeve 53).

[0163] Operation 8: Place the third wire 52 ( Figure 12 (C) passes through the cavity of the first sleeve 53, thereby inserting the third wire 52 into the body and guiding it toward the beak 103, and the third wire 52 protruding from the front end of the first sleeve 53 passes through the through hole 12 and pierces the beak 103, thereby forming a hole in the beak 103.

[0164] Operation 9: While threading the third wire 52 through the hole of the first wire 50, simultaneously thread the first wire 50... Figure 5(A) passes through the hole in the first sleeve 53, thereby inserting the first wire 50 into the insert body and guiding it toward the beak 103. The first wire 50, which protrudes from the front end of the first sleeve 53, passes through the through hole 12 and pierces the beak 103. The diameter of the hole in the beak 103 formed in operation 8 is enlarged by the first wire 50, forming a hole in the beak 103 suitable for screwing in the screw 23.

[0165] Operation 10: The first sleeve 53 is inserted from the first inlet 104 ( Figure 8 After being pulled out of the body, with the first wire 50 (equivalent to guide wire 24) passing through the hole of screw 23, screw 23 is moved along the first wire 50 toward the through hole 12, and screw 23 through the through hole 12 into the hole of the beak 103 formed in operation 9. Then wires 50 and 52 are pulled out of the body from the first inlet 104.

[0166] In addition, Figure 8 In the sixth step shown, in order to achieve the state in which the screw 26 passes through the notch 10 and is screwed into the coracoid process 103 and the neck of the scapula 108a, the following operations 11 to 15 are performed in sequence.

[0167] Operation 11: From the second entry point 111 ( Figure 12 ) the second filament 51 ( Figure 8 (B) is inserted into the body toward the beak 103, positioning the front end of the second wire 51 on the screw 21. Figure 12 The void of (A)).

[0168] Operation 12: When the second wire 51 ( Figure 13 (B) passed through the first sleeve 53 ( Figure 8 In the hollow state of the screw 21, the first sleeve 53 is moved along the second wire 51, thereby inserting the first sleeve 53 into the body and guiding it toward the beak 103 and positioning the front end of the first sleeve 53 in the hole of the screw 21, and then from the second inlet 111 ( Figure 12 Pull the second wire 51 out of the body (pull the second wire 51 out of the hole in the first sleeve 53).

[0169] Operation 13: Place the third wire 52 ( Figure 8 (C) passes through the cavity of the first sleeve 53, thereby inserting the third wire 52 into the body and guiding it toward the beak 103, and the third wire 52 protruding from the front end of the first sleeve 53 passes through the screw 21. Figure 12 The cavity of (A) is inserted into the neck of the scapula 108a, thereby forming a hole in the neck of the scapula 108a.

[0170] Operation 14: While threading the third wire 52 through the hole of the first wire 50, simultaneously thread the first wire 50... Figure 8(A) passes through the hole of the first sleeve 53, thereby inserting the first wire 50 (equivalent to guide wire 27) into the body and guiding it toward the coracoid process 103. The first wire 50, which protrudes from the front end of the first sleeve 53, passes through the hole of the screw 21 and pierces the neck of the scapula 108a. The diameter of the hole in the neck of the scapula 108a formed in operation 13 is enlarged by the first wire 50, forming a hole in the neck of the scapula 108a suitable for screwing in the screw 26.

[0171] Operation 15: After pulling the first sleeve 53 out of the body from the second inlet 111, release the screw 21 from the beak 103 and move the screw 21 along the first wire 50 (equivalent to the guide wire 27) to remove it out of the body from the second inlet 111.

[0172] Operation 16: After passing the first wire 50 (equivalent to guide wire 27) through the screw 26 ( Figure 8 (B) Figure 8 In the state of the (C) hole, the screw 26 is moved along the first wire 50 toward the notch 10, so that the screw 26 passes through the notch 10 and is screwed into the hole of the coracoid process 103 of the screw 21 and the hole of the scapular neck 108a formed in operation 14, and then the wires 50, 52 are pulled out of the body from the second inlet 111.

[0173] In addition, Figure 8 In the sixth step shown, in order to release the screw 23 from the beak 103 and remove the screw 23 from the outside, the following operations 17 to 21 are performed in sequence.

[0174] Operation 17: From the second entry point 111 ( Figure 12 ) the second filament 51 ( Figure 8 (B) is inserted into the body toward the beak 103, positioning the front end of the second wire 51 on the screw 23. Figure 13 The void of (A)).

[0175] Operation 18: After passing the second wire 51 through the first sleeve 53 ( Figure 8 In the hollow state of the second thread 51, the first sleeve 53 is moved along the second thread 51, thereby inserting the first sleeve 53 into the body and guiding it toward the beak 103 and positioning the front end of the first sleeve 53 in the cavity of the screw 23, and then from the second inlet 111 ( Figure 12 Pull the second wire 51 out of the body (pull the second wire 51 out of the hole in the first sleeve 53).

[0176] Operation 19: Place the third wire 52 ( Figure 12The third wire 52 is inserted into the body and guided toward the coracoid process 103 through the hole of the first sleeve 53 and through the hole of the screw 23 into the neck of the scapula 108a, thereby forming a hole in the neck of the scapula 108a.

[0177] Operation 20: While threading the third wire 52 through the hole of the first wire 50, simultaneously thread the first wire 50... Figure 10 (A) passes through the cavity of the first sleeve 53, thereby inserting the first wire 50 (equivalent to guide wire 28) into the body and guiding it toward the coracoid process 103. The first wire 50, which protrudes from the front end of the first sleeve 53, passes through the cavity of the screw 23 and pierces into the scapular neck 108a. Thus, the diameter of the hole in the scapular neck 108a formed in operation 19 is enlarged by the first wire 50, forming a suitable hole in the scapular neck 108a for screwing in the screw 29. Figure 10 ) hole.

[0178] Operation 21: After pulling the first sleeve 53 out of the body from the second inlet 111, release the screw 23 from the beak 103 and move the screw 23 along the first wire 50 (equivalent to the guide wire 28) to be taken out of the body from the second inlet 111. Then pull the wires 50 and 52 out of the body from the second inlet 111.

[0179] In addition, Figure 10 In the eighth step shown, in order to achieve the state of screwing screw 29 into the coracoid process 103 and the neck of the scapula 108a, the following operations 22 to 24 are performed in sequence.

[0180] Operation 22: From the second entry point 111 ( Figure 12 ) the second filament 51 ( Figures 5-8 (B) is inserted into the body toward the beak 103 and the second wire 51 is passed through and screwed into the screw 23. Figure 8 The foramen of the coracoid process 103, and the foramen of the scapular neck 108a formed in operation 20 ( Figures 5-8 The guide wire 28 shown is inserted through the hole 108a in the neck of the scapula.

[0181] Operation 23: With the second wire 51 (equivalent to guide wire 30) passed through the hole of screw 29, move screw 29 along the second wire 51 toward the beak protrusion 103, and screw screw 29 in through screw 23 ( Figure 8 The foramen of the coracoid process 103, and the foramen of the scapular neck 108a formed in operation 20 ( Figure 1 The guide wire 28 shown is inserted through the hole 108a in the neck of the scapula.

[0182] Operation 24: Pull the second wire 51 out of the body from the second inlet 111.

[0183] According to the medical instrument assembly including the surgical instrument 1 ( Figure 2 、 Figure 12 ), the wires 50, 51, 52 ( Figure 13 ), and the first sleeve 53 ( Figure 12 ), the third wire 52 ( Figure 13 (C)) is passed through the hollow of the first sleeve 53 ( Figure 12 ) in the operations 3, 8, 13, 19, and the first wire 50 ( Figure 12 (A)) is passed through the hollow of the first sleeve 53 in the operations 4, 9, 14, 20, whereby the wires 52, 50 can be smoothly guided toward the coracoid process 103 without causing damage to the body by the wires 52, 50.

[0184] In addition, the second wire 51 ( Figure 13 (B)) is passed through the hollow of the first sleeve 53 ( Figure 14 ) in the operations 2, 7, 12, 18, whereby the first sleeve 53 can be smoothly guided toward the coracoid process 103.

[0185] In addition, as shown in Figure 7 , the front end portion 51a of the second wire 51 is rounded, whereby the second wire 51 can be moved toward the coracoid process 103 without causing damage to the body by the second wire 51 in the operations 1, 6, 11, 17, 22.

[0186] In addition, when the through-hole 12 is not formed in the surgical instrument 1, the operations 6 to 10, the operations 17 to 21, and the operations 22 to 24 are omitted.

[0187] In addition, in the displacement method of the coracoid process 103 of the present application, before the fifth process ( Figure 7 ) of bringing the coracoid process 103 close to the scapular neck portion 108a, a flattening process of flattening the surface of the scapular neck portion 108a by polishing the surface of the scapular neck portion 108a can also be performed. In this case, in the fifth process ( Figure 1 ), the coracoid process 103 is brought close to the scapular neck portion 108a in such a manner that the surface of the scapular neck portion 108a flattened in the flattening process is brought into contact with the surface of the coracoid process 103.

[0188] Furthermore, in the case where the above-mentioned flattening process is performed, in order to perform the displacement method of the coracoid process 103 of the present application, the surgical instrument 1 shown in Figure 2 and Figure 16 , the polishing tool 60 shown in Figure 17 and Figure 16 , the second sleeve 63 shown in Figure 17 、 Figure 18 、 Figure 16 , Figure 18 may be used.Figure 16 The third sleeve 64 is shown; Figure 18 , Figure 19 The fourth sleeve 65 shown; and Figure 19 The fourth filament 66 and the fifth filament 67 shown are medical device components.

[0189] The second sleeve 63, the third sleeve 64, the fourth sleeve 65, and the grinding tool 60 are all hollow cylinders. The third sleeve 64 can pass through the cavity of the second sleeve 63, the fourth sleeve 65 can pass through the cavity of the third sleeve 64, the fourth wire 66 or the fifth wire 67 can pass through the cavity of the fourth sleeve 65, the grinding tool 60 can pass through the cavity of the second sleeve 63, and the fourth wire 66 or the fifth wire 67 can pass through the cavity of the grinding tool 60. Additionally, the fifth wire 67 (… Figure 1 (B)) through the notch 10 and through hole 12 of the surgical instrument 1 Figure 2 , Figure 18 ).

[0190] The second sleeve 63 includes: a second sleeve body portion 63a with a fixed inner and outer diameter; and an annular flange 63b that protrudes annularly from the outer surface of the base end of the second sleeve body portion 63a.

[0191] The third sleeve 64 faces from the front end side toward the base end side (from...) Figure 18 The third sleeve (facing left) is formed by the continuous connection of the front end 64a of the third sleeve and the main body 64b of the third sleeve. The length L6 of the main body 64b of the third sleeve is greater than or equal to the length L5 of the main body 63a of the second sleeve, and the outer diameter of the main body 64b of the third sleeve is less than or equal to the inner diameter of the main body 63a of the second sleeve. The outer and inner diameters of the front end 64a of the third sleeve gradually decrease as it approaches its front end.

[0192] The fourth sleeve 65 faces from the front end side to the base end side (from...) Figure 13 The fourth sleeve (facing left) is formed by the sequential formation of the fourth sleeve front end 65a, the fourth sleeve body 65b, and the fourth sleeve base end 65c. The length L8 of the fourth sleeve body 65b is greater than or equal to the length L7 of the third sleeve 64, and the outer diameter of the fourth sleeve body 65b is less than or equal to the diameter of the opening at the front end of the third sleeve front end 64a. The outer and inner diameters of the fourth sleeve front end 65a gradually decrease as it approaches its front end. The outer and inner diameters of the fourth sleeve base end 65c gradually decrease as it approaches its base end. Additionally, the fourth sleeve 65 can also be used as… Figure 16 The first sleeve 53 shown is used (in the example shown, the fourth sleeve 65 is used). Figure 18 , Figure 13 ) and the first sleeve 53 ( Figure 17 (They have the same structure).

[0193] The grinding tool 60 is from the front end side toward the base end side (from) Figure 19 The grinding tool (facing left) is formed by the front end 60a and the main body 60b of the grinding tool in sequence. The length L9 of the main body 60b of the grinding tool is greater than or equal to the length L5 of the main body 63a of the second sleeve. The outer diameter of the front end 60a of the grinding tool gradually increases as it approaches its front end, and the outer diameter of the front end of the front end 60a of the grinding tool is less than or equal to the inner diameter of the main body 63a of the second sleeve.

[0194] With the base end of the grinding tool 60 (the base end of the grinding tool body 60b) connected to the power tool 70, the grinding tool 60 can be rotated around its central axis by operating the power tool 70. Furthermore, with the front end face of the grinding tool 60 (the front end face of the grinding tool front end 60a) in contact with the surface of the scapular neck 108a, rotating the grinding tool 60 allows the front end face of the grinding tool 60 to grind the surface of the scapular neck 108a.

[0195] Figure 12 The fourth wire 66 shown in (A) is a wire capable of passing through the cavity of the grinding tool 60 and the cavity of the fourth sleeve 65. The fourth wire 66 is formed of stainless steel alloy, titanium alloy or aluminum alloy, and the outer diameter of the fourth wire 66 is, for example, 2 mm or less. The front end 66a of the fourth wire 66 is rounded. The fourth wire 66 is used to guide the movement of the fourth sleeve 65.

[0196] Additionally, the fourth filament 66 can also be used as Figure 14 (B) and Figure 19 The second wire 51 shown (in the example illustrated, the fourth wire 66) Figure 12 (A) and the second filament 51 ( Figure 14 (B) Figure 19 (They have the same structure).

[0197] Figure 12 The fifth wire 67 shown in (B) is capable of penetrating the cavity of the grinding tool 60, the cavity of the fourth sleeve 65, and the notch 10 and through hole 12 of the surgical instrument 1. The fifth wire 67 is formed of stainless steel alloy, titanium alloy, or aluminum alloy, and its outer diameter is, for example, less than 2 mm. The front end 67a of the fifth wire 67 has a shape that tapers towards the tip with angular edges. The fifth wire 67 is used to insert into the coracoid process 103 and the neck 108a of the scapula.

[0198] Additionally, the fifth thread 67 can also be used as... Figure 15 (C) and Figure 19 The third filament 52 shown is used (to make the fifth filament 67 ( Figure 12 (B) and the third filament 52 ( Figure 15 (C) Figure 7(They have the same structure).

[0199] When using a medical instrument assembly including surgical instrument 1, grinding tool 60, cannulas 63, 64, 65, and wires 66, 67, in order to flatten the surface of the scapular neck 108a in the flattening process, after performing the following operations 25 to 43 in sequence, in the fifth process ( Figure 19 In the process, the coracoid process 103 is brought close to the neck 108a of the scapula. The planarization process uses two fifth wires 67 ( Figure 7 (B) In the following, the first fifth thread 67 is recorded as "fifth thread 67-1" and the second fifth thread 67 is recorded as "fifth thread 67-2".

[0200] Operation 25: From the second entry point 111 ( Figure 19 ) the fourth filament 66 ( Figure 20 (A)) is inserted into the body toward the neck of the scapula 108a, so that the front end of the fourth wire 66 abuts against the surface of the neck of the scapula 108a (see reference). Figure 21 ).

[0201] Operation 26: For example Figure 19 As shown, with the fourth wire 66 passed through the hole of the fourth sleeve 65, the fourth sleeve 65 is moved along the fourth wire 66, thereby inserting the fourth sleeve 65 into the body and guiding it toward the neck 108a of the scapula, and then the fourth wire 66 is pulled out from the hole of the fourth sleeve 65.

[0202] Operation 27: Place the fifth wire 67-1 ( Figure 18 (B) passes through the hole of the fourth sleeve 65, thereby inserting the fifth wire 67 into the body and guiding it toward the neck of the scapula 108a, and the fifth wire 67-1 protruding from the front end of the fourth sleeve 65 is inserted into the neck of the scapula 108a, forming a hole in the neck of the scapula 108a.

[0203] Operation 28: After passing the fourth sleeve 65 through the third sleeve 64 ( Figure 18 In the hollow state of the fourth sleeve 65, the third sleeve 64 is moved along the fourth sleeve 65, thereby inserting the third sleeve 64 into the body and guiding it toward the scapular neck 108a, after which the third sleeve 64 is passed through the second sleeve 63. Figure 7 In the hollow state, the second sleeve 63 is moved along the third sleeve 64, thereby inserting the second sleeve 63 into the body and guiding it toward the scapular neck 108a.

[0204] Operation 29: Connect the third sleeve 64 and the fourth sleeve 65 from the second inlet 111 ( Figure 22 It is pulled out of the body, leaving only the fifth wire 67-1 passing through the hole of the second sleeve 63. Figure 16 The state after operation 29 is shown.

[0205] Operation 30: When the grinding tool body part 60b ( Figure 17 , Figure 23 The base side of the power tool 70 ( Figure 23 In the connected state, while passing the fifth wire 67-1 through the hole of the grinding tool 60, the grinding tool 60 is passed through the hole of the second sleeve 63, thereby inserting the grinding tool 60 into the body and guiding it toward the coracoid process 103, and causing the front end 60a of the grinding tool to protrude from the front end of the second sleeve 63, so that the front end face of the front end 60a of the grinding tool abuts against the surface of the scapular neck 108a (see reference). Figure 7 ).

[0206] Operation 31: The grinding tool 60 is rotated by the drive of the power tool 70, thereby grinding the surface of the scapular neck 108a through the front end face of the grinding tool 60a, making the surface of the scapular neck 108a flat. Afterwards, the grinding tool 60 and the second sleeve 63 are inserted from the second inlet 111 ( Figure 24 It is pulled out of the body.

[0207] Operation 32: With the fifth wire 67-1 passed through the notch 10 of the surgical instrument 1, the surgical instrument 1 is moved along the fifth wire 67-1, thereby inserting the surgical instrument 1 into the body (more specifically, inserting the handle body 4 and the inclined part 3 of the surgical instrument 1 into the body), so that the inclined part 3 of the surgical instrument 1 abuts against the surface of the beak 103. Figure 7 The image shows the state after the inclined portion 3 of the surgical instrument 1 comes into contact with the surface of the coracoid process 103.

[0208] Operation 33: From the second entry point 111 ( Figure 19 ) the fourth filament 66 ( Figure 18 The (A) is inserted into the body toward the neck of the scapula 108a, and the front end 66a of the fourth wire 66 passes through the through hole 12 of the surgical instrument 1 and abuts against the surface of the neck of the scapula 108a.

[0209] Operation 34: After passing the fourth wire 66 through the fourth sleeve 65 ( Figure 24 In the hollow state of the fourth sleeve 65, the fourth sleeve 65 is moved along the fourth wire 66, thereby inserting the fourth sleeve 65 into the body and guiding it toward the neck 108a of the scapula, and then the fourth wire 66 is pulled out from the hollow of the fourth sleeve 65.

[0210] Operation 35: Place the fifth filament 67-2 ( Figure 19 , Figure 24the fifth wire 67-2 is inserted into the body and guided toward the scapula neck portion 108a and the fifth wire 67-2 protruding from the front end of the fourth cannula 65 is passed through the through-hole 12 of the surgical instrument 1 and is stuck into the scapula neck portion 108a, thereby forming a hole in the scapula neck portion 108a Figure 24 The state in which the fifth wire 67-2 is passed through the through-hole 12 and stuck into the scapula neck portion 108a is shown. In addition, the illustration of the fourth cannula 65 is omitted in Figure 7

[0211] Operation 36: After the fourth cannula 65 and the fifth wire 67-2 are pulled out of the body from the second inlet 111 Figure 7 ), the surgical instrument 1 is moved, thereby disengaging the surgical instrument 1 from the fifth wire 67-1, and the surgical instrument 1 is taken out of the body from the second inlet 111, after which the fifth wire 67-1 is pulled out of the body from the second inlet 111 Figure 25 Figure 7

[0212] Operation 37: The fourth wire 66 Figure 19 Figure 26 is inserted into the body toward the scapula neck portion 108a, and the front end portion of the fourth wire 66 is inserted into the hole in the scapula neck portion 108a formed in the operation 35 (refer to Figure 26

[0213] Operation 38: The fourth cannula 65 is moved along the fourth wire 66 in a state in which the fourth wire 66 Figure 18 is passed through the hollow of the fourth cannula 65 Figure 26 , thereby inserting the fourth cannula 65 into the body and guiding it toward the scapula neck portion 108a (refer to Figure 18

[0214] Operation 39: The third cannula 64 is moved along the fourth cannula 65 in a state in which the fourth cannula 65 is passed through the hollow of the third cannula 64 Figure 27 , thereby inserting the third cannula 64 into the body and guiding it toward the scapula neck portion 108a (refer to Figure 18 , after which the second cannula 63 is moved along the third cannula 64 in a state in which the third cannula 64 is passed through the hollow of the second cannula 63 Figure 28 , thereby inserting the second cannula 63 into the body and guiding it toward the scapula neck portion 108a (refer to Figure 7

[0215] Operation 40: The third cannula 64 and the fourth cannula 65 are pulled out of the body from the second inlet 111 Figure 29 , becoming a state in which only the fourth wire 66 is passed through the hollow of the second cannula 63 (refer to​​​​​​​Figure 16 ).

[0216] Operation 41 : With the base end side of the grinding tool main body portion 60b (60a) connected to the electric power tool 70 (70a), the grinding tool 60 is inserted into the body while being passed through the hollow of the second sleeve 63, and the front end portion 60a of the grinding tool 60 is made to protrude from the front end of the second sleeve 63, so that the front end face of the front end portion 60a comes into abutment with the surface of the scapular neck portion 108a (see Fig. 6). Figure 17 , Figure 30 ). Figure 30 Figure 7 Operation 42 : The grinding tool 60 is rotated by the drive of the electric power tool 70, so that the surface of the scapular neck portion 108a is ground flat by the front end face of the front end portion 60a of the grinding tool 60.

[0217] Operation 43 : The grinding tool 60, the second sleeve 63, and the fourth wire 66 are pulled out of the body from the second inlet 111 (111a) (see Fig. 6).

[0218] Operation 44 : The first sleeve 64 is inserted into the body, so that the space for passing the grinding tool 60 is ensured in the body (see Fig. 7). Figure 31 Figure 1 The medical instrument assembly including the surgical instrument 1 (1a), the grinding tool 60 (60a), the sleeves 63, 64, 65 (63a, 64a, 65a), and the wires 66, 67 (66a, 67a) makes it possible to insert the second sleeve 63 into the body so that the space for passing the grinding tool 60 is ensured in the body, and as a result, it makes it possible to insert the second sleeve 63 into the body using the third sleeve 64 as a guide, to insert the third sleeve 64 into the body using the fourth sleeve 65 as a guide, and to insert the fourth sleeve 65 into the body using the fourth wire 66 as a guide, so that the operation of ensuring the space for passing the grinding tool 60 in the body can be performed smoothly.

[0219] Further, the front end portion 65a of the fourth sleeve 65 and the front end portion 64a of the third sleeve 64 are respectively tapered toward the front ends thereof (the fourth sleeve front end portion 65a and the third sleeve front end portion 64a are gradually reduced in outer diameter toward the front ends thereof), so that the fourth sleeve 65 and the third sleeve 64 can be inserted into the body smoothly. From this viewpoint, too, the operation of ensuring the space for passing the grinding tool 60 can be performed smoothly. Figure 2 Figure 16 Figure 17 Figure 16 Figure 17 Figure 18 Figure 19 Figure 19

[0220]

[0221] ​​​​​​​​​​​Additionally, because the fourth filament is 66 ( Figure 8 The anterior end 66a of (A) is rounded, so that the fourth filament 66 can be moved toward the neck 108a of the scapula without damaging the body during operations 25, 33, and 37.

[0222] Furthermore, when performing operations 27-42 above, in Figures 5-8 In the sixth step shown, the guide wire 27, inserted into the body from the second inlet 111, passes through the hole in the screw 21 and the hole in the scapular neck 108a formed in operation 27, thereby inserting the guide wire 27 into the scapular neck 108a. Similarly, the guide wire 28, inserted into the body from the second inlet 111, passes through the hole in the screw 23 and the hole in the scapular neck 108a formed in operation 35, thereby inserting the guide wire 28 into the scapular neck 108a. Furthermore, in Figures 8-10 In the eighth step shown, the guide wire 30, which is inserted into the body from the second inlet 111, is passed through and screwed into the screw 23. Figure 10 The foramen of the coracoid process 103 and the foramen of the scapular neck 108a formed in operation 35.

[0223] If described above, screws 26 can be used to reliably bring the surface of the coracoid process 103 into contact with the surface of the scapular neck 108a, which has been flattened in the planarization process. Figure 7 ) and screw 29 ( Figures 8-10 The coracoid process 103 is fixed to the neck of the scapula 108a.

[0224] In addition, if the through hole 12 is not formed in the inclined part 3, operations 32 to 43 are omitted, and operation 31 is changed as shown below.

[0225] A variation of operation 31: The grinding tool 60 is rotated by the drive of the power tool 70, and the surface of the scapular neck 108a is ground by the front end face of the grinding tool 60a to make the surface of the scapular neck 108a flat. Afterwards, the grinding tool 60, the second sleeve 63, and the fifth wire 67-1 are inserted from the second inlet 111 (…). Figure 5 It is pulled out of the body.

[0226] In the above circumstances, Figure 5 In the sixth step shown, if the guide wire 27 inserted from the second inlet 111 into the body passes through the hole of the screw 21 and the hole of the scapular neck 108a formed in operation 27, thereby inserting the guide wire 27 into the scapular neck 108a, then the screw 26 can be reliably used while the surface of the coracoid process 103 is in contact with the surface of the scapular neck 108a, which has been flattened in the flattening process. Figure 8 The coracoid process 103 is fixed to the neck of the scapula 108a.

[0227] Furthermore, this invention will not use guide wire 22 ( Figure 8 (A)), guidewire 24 ( Figure 10 (B)), guidewire 27 ( Figure 10 )), guidewire 28 ( Figure 5 ) and guidewire 30 ( Figure 5 (A) Figure 8 (B) is an essential condition. Alternatively, well-known methods other than guidewires can be used to perform the following operations: in the third step ( Figure 8 In the first inlet 104, screw 21 is inserted into the body, passed through notch 10, and screwed into beak 103; in the third process ( Figure 8 In the sixth process, screw 23 is inserted into the body through the first inlet 104, the screw 23 is passed through the through hole 12 and screwed into the beak 103; Figure 10 In the sixth process, the screw 21, which had been loosened from the beak 103, is removed from the body through the second inlet 111; ​ In the sixth step, screw 26 is inserted into the body through the second inlet 111, screw 26 is passed through the notch 10 and screwed into the coracoid process 103 and the neck of the scapula 108a; ​ In the eighth process, the screw 23, which had been released from its screwing into the beak 103, is removed from the body through the second inlet 111; ​ The screw 29 is inserted into the body through the second inlet, and the screw 29 is passed through the hole of the coracoid process 103 that has been screwed into the screw 23 and screwed into the coracoid process 103 and the neck 108a of the scapula. In addition, in cases where well-known methods other than guidewires do not utilize the cavity of the screw, the screws 21, 23, 26, and 29 may not have a hollow structure (the screws 21, 23, 26, and 29 may not have a cavity).

[0228] Explanation of reference numerals in the attached figures

[0229] 1: Surgical instrument; 2: Handle;

[0230] 3: Inclined section; 4: Handle body;

[0231] 5: Grip part; 12: Through hole;

[0232] 13: Protrusion;

[0233] 21: Screw (corresponding to the first screw described in the claims);

[0234] 22: Guide wire (corresponding to the first guide wire described in the claims);

[0235] 23: Screw (corresponding to the third screw described in the claims);

[0236] 24: guide wire (corresponding to the third guide wire described in the claims);

[0237] 25: bone chisel;

[0238] 26: screw (corresponding to the second screw described in the claims);

[0239] 27: guide wire (corresponding to the second guide wire described in the claims);

[0240] 28: guide wire (corresponding to the fourth guide wire described in the claims);

[0241] 29: screw (corresponding to the fourth screw described in the claims);

[0242] 30: guide wire (corresponding to the fifth guide wire described in the claims);

[0243] 40: cutting tool; 41: thick wall portion;

[0244] 42: thin wall portion; 42a: front end of thin wall portion

[0245] 50: first wire; 50a: groove of first wire;

[0246] 51: second wire; 51a: front end of second wire;

[0247] 52: third wire; 52a: front end of third wire;

[0248] 53: first sleeve; 60: grinding tool

[0249] 63: second sleeve; 64: third sleeve;

[0250] 64a: front end of third sleeve; 65: fourth sleeve;

[0251] 65a: front end of fourth sleeve; 66: fourth wire;

[0252] 66a: front end of fourth wire; 67: fifth wire

[0253] 67a: front end of fifth wire;

[0254] 100: subscapularis; 102: incision;

[0255] 103: coracoid process; 104: first inlet;

[0256] 108: scapula; 108a: neck of scapula;

[0257] 109: common tendon; 111: second inlet;

[0258] L2: Length of the range of the handle main body between the grip portion and the inclined portion;

[0259] L4: Length of the thin-walled portion.

Claims

1. A surgical instrument for transplanting the coracoid process to the neck of the scapula and for removing it externally after transplantation. The surgical instrument comprises: a handle extending in a first direction, and an inclined portion extending from the front end of the handle in a second direction; and The second direction in which the inclined portion extends is inclined at an angle of 95° or more and 115° or less relative to the first direction in which the handle extends. A notch is formed at the outer edge of the inclined portion for the screw to pass through.

2. The surgical instrument as described in claim 1, wherein, A through hole is formed in the inclined portion for the screw to pass through.

3. The surgical instrument as described in claim 2, wherein, A protrusion protruding outward is formed at a lateral position of the through hole in the inclined portion.

4. The surgical instrument as described in any one of claims 1 to 3, wherein, The handle has a gripping part connected to the base end of the handle body. The inclined portion extends from the front end of the handle body in the second direction. The length of the handle body between the grip portion and the inclined portion is 8 cm or more and 12 cm or less.

5. A medical device component comprising: The surgical instrument as described in claim 4; as well as A cutting tool used to sever the beak-like process. The cutting tool is composed of a thick-walled portion serving as a handle and a thin-walled portion with a thickness thinner than the thick-walled portion, wherein the tip of the thin-walled portion furthest from the thick-walled portion is formed as the thinnest blade. The length of the thin-walled portion is more than 6 cm and less than 8 cm.

6. A medical device component comprising: The surgical instrument according to any one of claims 1 to 4, comprising a first wire, a second wire, a third wire, and a first cannula; in The first wire, the second wire, the third wire, and the first cannula can be passed through the notch of the surgical instrument, respectively. The first wire is a hollow cylinder, through which the third wire can pass. A spirally extending groove is formed on the outer circumferential surface of the front end of the first wire. The leading end of the second filament is rounded. The leading end of the third filament has an angular shape that tapers towards the tip. The first sleeve is a hollow cylinder, which allows the first wire, the second wire, and the third wire to pass through the cavity of the first sleeve.

7. A medical device component comprising: The surgical instrument, grinding tool, second cannula, third cannula, fourth cannula, fourth wire, and fifth wire according to any one of claims 1 to 4; in The second sleeve, the third sleeve, the fourth sleeve, and the grinding tool are all hollow cylinders, and It is capable of passing the third sleeve through the cavity of the second sleeve, the fourth sleeve through the cavity of the third sleeve, the fourth wire or the fifth wire through the cavity of the fourth sleeve, and the grinding tool through the cavity of the second sleeve. The fourth wire can pass through the hole in the grinding tool and the hole in the fourth sleeve, and the front end of the fourth wire has a rounded shape. The fifth wire can pass through the cavity of the grinding tool, the cavity of the fourth sleeve, and the notch of the surgical instrument. The front end of the fifth wire has an angular shape that tapers towards the tip. With the base of the grinding tool connected to the power tool, the power tool is operated, thereby enabling the grinding tool to rotate about its central axis. With the front end face of the grinding tool in contact with the surface of the scapular neck, the grinding tool is rotated, thereby enabling the front end face of the grinding tool to grind the surface of the scapular neck.

8. The medical device assembly of claim 7, wherein, The front ends of the third sleeve and the fourth sleeve are respectively tapered at the front end.

Images