Surgical instrument, medical device set, and transplantation method

Abstract

Provided is a surgical instrument with which it is possible to easily bring a coracoid process close to the scapula and the neck.　This surgical instrument comprises a design 2 that extends in a first direction, and an inclined part 3 that extends in a second direction from the distal end of the design 2. The second direction in which the inclined part 3 extends is inclined at an angle α of 95-115 degrees (inclusive) relative to the first direction in which the design 2 extends. A notch 10 through which a screw is passed is formed in the outer edge of the inclined part 3.

Description

Technical Field

[0001] The present invention relates to a surgical instrument used for transplanting the coracoid process to the scapular neck, a medical instrument set including the surgical instrument, and a method for transplanting the coracoid process to the scapular neck.

Background Art

[0002] Conventionally, as a surgery for recurrent shoulder dislocation, a surgery for transplanting the coracoid process of the scapula to the scapular neck (hereinafter referred to as coracoid transfer surgery) has been performed. When the coracoid transfer surgery is performed under direct vision, there is a risk of muscle invasion and postoperative joint contracture. When these symptoms occur in athletes, it has been difficult to return to competition. In order to overcome the above problems, arthroscopic coracoid transfer surgery is useful, and as this arthroscopic coracoid transfer surgery, a transfer surgery disclosed in Non-Patent Document 1 is known. In this transfer surgery, the following steps A to G are performed.

[0003] Step A: As shown in FIG. 32, by moving the switching stick 101 penetrating the subscapular muscle 100 in the vertical direction, an incision 102 is formed in the subscapular muscle 100 (FIG. 32(A) shows a state before the switching stick 101 penetrates the subscapular muscle 100, FIG. 32(B) shows a state where the switching stick 101 penetrating the subscapular muscle 100 is tilted upward, and FIG. 32(C) shows a state where the switching stick 101 penetrating the subscapular muscle 100 is tilted downward). Procedure B: As shown in FIGS. 33(A) and 33(B), a guide wire 105 is inserted into the body through a first portal 104 formed in the skin at a position directly above the coracoid process 103, and the guide wire 105 is pierced into the coracoid process 103. Thereafter, with the guide wire 105 passing through the cavity of the hollow helix 106, the hollow helix 106 is moved along the guide wire 105 toward the coracoid process 103, and the hollow helix 106 is screwed into the coracoid process 103. Thereafter, the guide wire 105 is pulled out of the body from the first portal 104 (FIG. 33(A) shows the operation of screwing the first hollow helix 106 into the coracoid process 103, and FIG. 33(B) shows the operation of screwing the second hollow helix 106 into the coracoid process 103). Procedure C: As shown in FIG. 34, the coracoid process 103 is cut from the scapula 108 using a bone chisel 107 inserted through the first portal 104 (in this case, the coracoid process 103 is cut while the conjoint tendon 109 remains attached to the coracoid process 103). Procedure D: As shown in FIGS. 35(A) and 35(B), the coracoid process 103 is grasped with forceps 110 inserted into the body through the first portal 104, and the coracoid process 103 is moved in front of the incision 102 by moving the forceps 110 downward. Procedure E: As shown in FIGS. 36(A) and 36(B), after removing the coracoid process 103 from the forceps 110 and floating the coracoid process 103 in the body fluid, a plastic cylinder 112 is inserted into the body through a second portal 111 formed at the position of the skin in front of the incision 102, and the head of the helix 106 is inserted into the opening 113 at the tip of the cylinder 112. Procedure F: As shown in FIG. 37(A), by advancing the cylinder 112, the coracoid process 103 is inserted into the incision 102 and brought close to the scapular neck 108a. Procedure G: As shown in FIG. 37(A), a long helix 113 passed through the cavity 112a of the cylinder 112 is passed through the cavity of the helix 106 and screwed into the coracoid process 103, and then the cylinder 112 is pulled out of the body from the second portal 111 (FIG. 37(B) shows the state after the cylinder 112 is pulled out of the body).

Prior Art Documents

Non-Patent Documents

[0004] [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, No11 (November), 2007: pp1242.e1-1242.e5. [Summary of the Invention] [Problems to be Solved by the Invention]

[0005] By the way, in the above-described conventional coracoid process transfer surgery, in step E (FIG. 36), it was very difficult to capture the coracoid process 103 floating in the body fluid with the cylindrical body 112 (it was very difficult to insert the head of the screw 106 into the opening 113 of the cylindrical body 112 in a state where the coracoid process 103 was floating in the body fluid). For this reason, the conventional coracoid process transfer surgery has required a long time to bring the coracoid process 103 close to the scapular neck 108a. In addition, due to the fact that the above step E is very difficult, the operation under arthroscopic vision has been abandoned, and a situation has occurred where the operation is changed to an operation under direct vision.

[0006] Furthermore, in the above-described conventional coracoid process transfer surgery, as a result of advancing the cylindrical body 112 in step G (FIG. 37), the neurovascular system 200 near the shoulder joint is pinched in the front-rear direction by the subscapular muscle 100 and the conjoint tendon 109 (the above neurovascular system 200 includes the musculocutaneous nerve 200a, the axillary nerve 200b, the subclavian artery 200c, etc.). And when this pinching is tight, complications may occur due to damage to the neurovascular system 200. For example, when the musculocutaneous nerve 200a is damaged due to the tight pinching, a complication in which the elbow cannot be bent may occur. Also, when the axillary nerve 200b is paralyzed due to the tight pinching, a complication in which the shoulder cannot be raised may occur.

[0007] The present invention has been made in view of the above matters, and an object of the present invention is to provide a surgical instrument capable of easily bringing the coracoid process close to the scapular neck, and a medical device set including the surgical instrument. Another object of the present invention is to provide a method for transplanting the coracoid process capable of bringing the coracoid process close to the scapular neck without damaging the neurovascular system.

Means for Solving the Problems

[0008] To achieve the above object, the present invention includes the subject matters described in the following items.

[0009] Item 1. A surgical instrument used for transplanting the coracoid process to the scapular neck, a handle extending in a first direction, and an inclined portion extending in a second direction from the tip of the handle, wherein 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, and a notch for passing a screw is formed on the outer edge of the inclined portion.

[0010] Item 2. The surgical instrument according to Item 1, wherein a through hole for passing a screw is formed in the inclined portion.

[0011] Item 3. The surgical instrument according to Item 2, wherein a protruding portion protruding outward is formed at a position on the side of the through hole in the inclined portion.

[0012] Item 4. The handle is connected to a grip portion serving as a handle on the proximal end side of the handle body, the inclined portion extends in the second direction from the tip of the handle body, and the length of the range of the handle body between the grip portion and the inclined portion is 8 cm or more and 12 cm or less. The surgical instrument according to any one of Items 1 to 3.

[0013] Item 5. The surgical instrument according to Item 4, and including a cutting tool used to cut the black mouth protrusion, the cutting tool is formed by connecting a thick part used as a handle and a thin part thinner than the thick part, and the tip of the thin part farthest from the thick part is the thinnest cutting edge, a medical instrument set in which the length of the thin part is 6 cm or more and 8 cm or less.

[0014] The surgical instrument according to any one of Items 6. 1 to 4, a first wire, a second wire, a third wire, a medical instrument set including a first sleeve, the first wire, the second wire, the third wire, and the first sleeve can each be passed through the notch of the surgical instrument, the first wire is a hollow cylinder, the third wire can be inserted into the cavity of the first wire, and a groove extending spirally is formed on the outer peripheral surface of the tip of the first wire, the tip of the second wire has a rounded shape, the tip of the third wire has a pointed and tapered shape, the first sleeve is a hollow cylinder, and the first wire, the second wire, and the third wire can each be inserted into the cavity of the first sleeve. A medical instrument set.

[0015] The surgical instrument according to any one of Items 7. 1 to 4, a grinding tool, a second sleeve, a third sleeve, a fourth sleeve, a fourth wire, a medical instrument set including a fifth wire, the second sleeve, the third sleeve, the fourth sleeve, and the grinding tool are each a hollow cylinder, Inserting the third sleeve into the cavity of the second sleeve, inserting the fourth sleeve into the cavity of the third sleeve, inserting the fourth wire or the fifth wire into the cavity of the fourth sleeve, and inserting the abrasive tool into the cavity of the second sleeve are possible. The fourth wire can be inserted into the cavity of the abrasive tool and the cavity of the fourth sleeve, and the tip of the fourth wire has a rounded shape. The fifth wire can be inserted into the cavity of the abrasive tool, the cavity of the fourth sleeve, and the notch of the surgical instrument, and the tip of the fifth wire has a pointed shape with corners. With the proximal end of the abrasive tool connected to a power tool, it is possible to rotate the abrasive tool around the central axis by operating the power tool. With the tip surface of the abrasive tool in contact with the surface of the scapular neck, by rotating the abrasive tool, it is possible to polish the surface of the scapular neck with the tip surface of the abrasive tool. A medical device set.

[0016] Item 8. The medical instrument set according to item 7, wherein the tip of the third sleeve and the tip of the fourth sleeve each have a tapered shape.

[0017] Item 9. A method of transplanting the coracoid process to the scapular neck using the surgical instrument according to any one of items 1 to 4, A first step of forming an incision in the subscapularis muscle in the vicinity of the scapular neck; A second step of inserting the surgical instrument into the body through a first portal formed in the skin at a position directly above the scapular neck and bringing the inclined portion into contact with the coracoid process; A third step of inserting one helix inserted into the body through the first portal through the notch of the inclined portion and screwing it into the coracoid process, thereby fastening the inclined portion to the coracoid process with the one helix; A fourth step of cutting the coracoid process from the scapula with a bone rasp inserted through the first portal while the common tendon is attached to the coracoid process; The fifth step of moving the surgical instrument downward to move the coracoid process downward, inserting the coracoid process into the incision, and bringing it close to the scapular neck. The sixth step of releasing the screwing of the first screw into the coracoid process, removing the first screw from the body through the second portal formed in the skin at a position in front of the incision, inserting a second screw longer than the first screw into the body through the second portal, passing it through the notch, and screwing it into the coracoid process and the scapular neck. A method having a seventh step of removing the surgical instrument from the second screw by moving the surgical instrument and removing the surgical instrument from the body through the first portal.

[0018] Item 10. In the third step, a first guide wire inserted into the body through the first portal is passed through the notch of the inclined portion and stabbed into the coracoid process. After that, with the first guide wire passed through the cavity of the first screw, the first screw is moved along the first guide wire toward the notch, the first screw is screwed into the coracoid process through the notch, and then the first guide wire is pulled out of the body through the first portal. The method according to item 9, wherein in the sixth step, a second guide wire is inserted into the body through the second portal, the second guide wire is passed through the cavity of the first screw, and stabbed into the scapular neck. After that, the screwing of the first screw into the coracoid process is released, the first screw is moved along the second guide wire and taken out of the body through the second portal. Then, with the second guide wire passed through the cavity of the second screw longer than the first screw, the second screw is moved along the second guide wire toward the notch, the second screw is screwed into the coracoid process and the scapular neck through the notch, and then the second guide wire is pulled out of the body through the second portal.

[0019] Item 11. The surgical instrument is the surgical instrument described in item 2 or 3. It further has an eighth step carried out after the seventh step, In the third step, a triple helix inserted into the body from the first portal is passed through the through-hole and screwed into the coracoid process, whereby the triple helix fastens the inclined portion to the coracoid process. In the sixth step, the screwing of the triple helix into the coracoid process is released, and the triple helix is taken out of the body from the second portal. In the eighth step, a quadruple helix longer than the triple helix is inserted into the body from the second portal, and the quadruple helix is passed through the hole of the coracoid process into which the triple helix was screwed, and screwed into the coracoid process and the scapular neck. The method according to item 9 or 10.

[0020] Item 12. In the third step, a triple guide wire inserted into the body from the first portal is passed through the through-hole and stabbed into the coracoid process. After that, with the triple guide wire passed through the cavity of the triple helix, the triple helix is moved along the triple guide wire toward the through-hole, and the triple helix is passed through the through-hole and screwed into the coracoid process. After that, the triple guide wire is pulled out of the body from the first portal. In the sixth step, a quadruple guide wire is inserted into the body from the second portal, passed through the cavity of the triple helix, and stabbed into the scapular neck. After that, while releasing the screwing of the triple helix into the coracoid process, the triple helix is moved along the quadruple guide wire, taken out of the body from the second portal, and the quadruple guide wire is pulled out of the body from the second portal. In the eighth step, five guide wires are inserted into the body from the second portal, and the five guide wires are passed through the hole of the coracoid process where the three spirals are twisted and the hole of the scapular neck where the four guide wires are pierced. After that, with the five guide wires passed through the cavity of the four spirals that are longer than the three spirals, the four spirals are moved along the five guide wires to pass the four spirals through the hole of the coracoid process and the hole of the scapular neck, thereby twisting them into the coracoid process and the scapular neck. After that, the five guide wires are pulled out of the body from the second portal. The method according to item 11.

Advantages of the Invention

[0021] According to the surgical instrument and medical set of the present invention, since the inclined portion is inclined at an angle of 95° or more and 115° or less with respect to the handle body, under the condition that the handle passes through a position directly above the coracoid process suitable for forming a portal, the inclined portion can be brought into contact with the coracoid process attached to the scapula. And when the inclined portion is brought into contact with the coracoid process in this way, with the coracoid process being stably attached to the scapula, the operation of passing the spiral through the notch and twisting it into the coracoid process can be performed. Therefore, it is easy to connect the inclined portion to the coracoid process using the spiral. And in the state where the inclined portion is connected to the coracoid process in this way, if the coracoid process is cut off from the scapula, the coracoid process can be brought close to the scapular neck by a simple operation of moving the surgical instrument downward. For the above reasons, according to the surgical instrument and medical set of the present invention, the coracoid process can be easily brought close to the scapular neck.

[0022] According to the transplantation method of the present invention, when the surgical instrument is moved downward in the fifth step to bring the coracoid process close to the scapular neck, the conjoint tendon and the coracoid process move downward. Therefore, the neurovascular system near the shoulder joint can be moved downward by the pressure of the conjoint tendon or the coracoid process. As a result, the pinching of the neurovascular system in the anteroposterior direction (horizontal direction) by the subscapularis muscle and the conjoint tendon can be weakened, so that the coracoid process can be brought close to the scapular neck without damaging the neurovascular system. This can avoid the occurrence of complications due to damage to the neurovascular system.

Brief Description of the Drawings

[0023]

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Mode for Carrying Out the Invention

[0024] Hereinafter, embodiments of the present invention will be described with reference to the drawings.

[0025] FIG. 1 is a perspective view (photograph) showing a surgical instrument 1 according to an embodiment of the present invention. FIG. 2(A) is a plan view showing a state in which the surgical instrument 1 is viewed from a direction perpendicular to a handle 2 described later. FIG. 2(B) is a plan view showing a state in which the surgical instrument 1 is viewed from a direction perpendicular to an inclined portion 3 described later. FIG. 2(C) is a side view of the surgical instrument 1. FIGS. 3 to 10 are schematic diagrams showing the procedure of a method for transplanting an acromial eminence 103 under arthroscopic vision using the surgical instrument 1.

[0026] The surgical instrument 1 (FIGS. 1 and 2) according to the present embodiment is used for transplanting the acromial eminence 103 to the scapular neck 108a (specifically, the surgical instrument 1 is used to bring the acromial eminence 103 close to the scapular neck 108a and fix the acromial eminence 103 to the scapular neck 108a in a spiral manner).

[0027] As shown in FIGS. 1 and 2, the surgical instrument 1 includes a handle 2 extending in a first direction and an inclined portion 3 extending in a second direction from the tip of the handle 2. The second direction in which the inclined 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 (see FIG. 2(C) for the angle α).

[0028] The handle 2 has a gripping portion 5 serving as a handgrip connected to the proximal end side of the handle body 4.

[0029] The gripping portion 5 is a cylindrical body having an opening 6 (FIG. 2(B)) at its tip (one end), and is formed of a stainless alloy, a titanium alloy, or an aluminum alloy. The length L1 (FIG. 1) of the gripping portion 5 is, for example, 5 cm or more. The width H1 (FIG. 2(A)) of the gripping portion 5 is, for example, 1 cm or more and 2 cm or less. When using the surgical instrument 1, the user grips the gripping portion 5 to operate the surgical instrument 1.

[0030] The handle body 4 is a bar formed of a stainless alloy, a titanium alloy, or an aluminum alloy. The cross-section of the handle body 4 is rectangular, and the dimensions (width, height) of the cross-section of the gripping portion 5 are made larger than the dimensions (width, height) of the cross-section of the handle body 4. The connection of the gripping portion 5 to the proximal end side of the handle body 4 is performed by fixing the proximal end side of the handle body 4 to the gripping portion 5 in a state where the proximal end side of the handle body 4 is inserted into the gripping portion 5 from the opening 6 of the gripping portion 5. The inclined portion 3 extends from the tip of the handle body 4, and the length L2 (FIG. 1) of the range of the handle body 4 between the gripping portion 5 and the inclined portion 3 is 8 cm or more and 12 cm or less. The width H2 (FIG. 2(A)) of the handle body 4 is, for example, 0.4 cm or more and 0.8 cm or less.

[0031] Note that the shape of the cross-section of the handle body 4 may be other than rectangular (for example, the cross-section of the handle body 4 may be circular or elliptical). Also, the gripping portion 5 may be connected to the proximal end side of the handle body 4 by a known method other than the above. Further, the gripping portion 5 may be integrally formed with the handle body 4 so as to be connected to the proximal end side of the handle body 4. Also in this case, the dimensions (width, height) of the cross-section of the gripping portion 5 are made larger than the dimensions (width, height) of the cross-section of the handle body 4.

[0032] The inclined portion 3 is a plate-like body extending in the second direction from the tip of the handle body 4. The inclined portion 3 is made of a stainless steel alloy, a titanium alloy, or an aluminum alloy, and is molded integrally with the handle body 4. The length L3 (FIG. 1) of the inclined portion 3 is, for example, 1.5 cm or more and 2.5 cm or less, and the width H3 (FIG. 2(B)) of the inclined portion 3 is, for example, 1.2 cm or more and 1.5 cm or less (the width H3 of the inclined portion 3 means the maximum width of the inclined portion 3).

[0033] A notch 10 through which a spiral passes is formed on the outer edge of the tip side of the inclined portion 3. The notch 10 opens outward, and a spiral 21 (FIGS. 5 to 8) screwed into the coracoid process 103 and a spiral 26 (FIGS. 8 to 10) screwed into the coracoid process 103 and the scapular neck 108a are passed through the notch 10. In the example shown in FIG. 1 and FIG. 2, bifurcated portions 11, 11 are formed on the tip side of the inclined portion 3, and the notch 10 is constituted by the space between the bifurcated portions 11, 11, and the cross section of the notch 10 is semicircular.

[0034] A through hole 12 for passing a spiral is formed on the base end side (handle 2 side) of the inclined portion 3. The cross section of the through hole 12 is circular, and a spiral 23 (FIGS. 5 to 8) that is screwed into the coracoid process 103 is passed through the through hole 12. A protrusion 13 that protrudes outward is formed on the side of the through hole 12 in the inclined portion 3 (the above "side position of the through hole 12" means a position outside the width direction of the inclined portion 3 with respect to the through hole 12, and the above "width direction of the inclined portion 3" means a direction perpendicular to the longitudinal direction of the inclined portion 3). The protrusion 13 is provided as a mark for identifying the position of the through hole 12 when the surgical instrument 1 is used.

[0035] Note that the shape of the notch 10 can be any shape having an opening through which the spirals 21 and 26 can be inserted and removed. Also, the shape of the through-hole 12 can be any shape through which the spiral 23 can pass. Specifically, the above-described spirals 21, 23, and 26 have a large-diameter head from which a small-diameter spiral portion extends. The shape of the notch 10 is such that the spiral portions of the spirals 21 and 26 can be inserted and removed from the opening, and with the spiral portions of the spirals 21 and 26 passed through the notch 10, the head of the spirals 21 and 26 can be brought into contact with the surface of the inclined portion 3 around the notch 10. Also, the shape of the through-hole 12 is such that with the spiral portion of the spiral 23 passed through the through-hole 12, the head of the spiral 23 can be brought into contact with the surface of the inclined portion 3 around the through-hole 12.

[0036] Also, the position of the notch 10 and the position of the through-hole 12 are not limited to the positions shown in FIGS. 1 and 2. For example, the notch 10 may be formed at the outer edge on the proximal end side (handle 2 side) of the inclined portion 3. Also, the through-hole 12 may be formed at the distal end side of the inclined portion 3. Also, a plurality of notches 10 may be formed in the inclined portion 3, and a plurality of through-holes 12 may be formed in the inclined portion 3.

[0037] Also, the through-hole 12 and the protrusion 13 are not necessarily required and may not be formed in the inclined portion 3.

[0038] Hereinafter, a method of "transplanting the coracoid process 103 to the scapular neck 108a under arthroscopic vision using the above-described surgical instrument 1 (a method of bringing the coracoid process 103 close to the scapular neck 108a and fixing the coracoid process 103 to the scapular neck 108a with a spiral)" will be described with reference to FIGS. 3 to 10.

[0039] First, in the vicinity of the scapular neck 108a, a first step of forming an incision 102 in the subscapular muscle 100 is performed (FIG. 3). In this first step, for example, as shown in FIG. 3, by moving the switching stick 20 penetrating the subscapular muscle 100 in the vertical direction, the incision 102 is formed in the subscapular muscle 100 (FIG. 3(A) shows the state before the switching stick 20 penetrates the subscapular muscle 100, FIG. 3(B) shows the state where the switching stick 20 is tilted upward, and FIG. 3(C) shows the state where the switching stick 20 is tilted downward). In the first step, the incision 102 may be formed by a known method other than the above.

[0040] Next, as shown in FIG. 4, a second step is performed in which the surgical instrument 1 is inserted into the body through the first portal 104 formed in the skin at a position directly above the coracoid process 103, and the inclined portion 3 is brought into contact with the coracoid process 103. Specifically, the user grips the gripping portion 5 (FIGS. 1 and 2) and operates the surgical instrument 1 to insert the handle main body 4 and the inclined portion 3 into the body through the first portal 104 and bring the inclined portion 3 into contact with the coracoid process 103. From the viewpoint of shortening the distance between the first portal 104 and the coracoid process 103 and reducing the burden on the patient, the first portal 104 is formed at a position directly above the coracoid process 103.

[0041] Also, as in the example shown in FIGS. 1 and 2, when the through-hole 12 and the protrusion 13 are formed in the inclined portion 3, in the second step (FIG. 4), the protrusion 13 is used as a mark for positioning the through-hole 12, and the through-hole 12 is arranged at a desired position of the coracoid process 103.

[0042] Next, the spiral 21 with a hollow structure is inserted into the body from the first portal 104, and the spiral 21 is passed through the notch 10 of the inclined portion 3 and screwed into the anus protrusion 103, so that the third step of fastening the inclined portion 3 to the anus protrusion 103 by the spiral 21 is carried out (Fig. 5). At this time, as shown in Fig. 5(A), the guide wire 22 inserted into the body from the first portal 104 is passed through the notch 10 and stabbed into the anus protrusion 103. Then, after passing the guide wire 22 through the cavity of the spiral 21, the spiral 21 is moved along the guide wire 22 toward the notch 10, the spiral 21 is passed through the notch 10 and screwed into the anus protrusion 103, and then the guide wire 22 is pulled out of the body from the first portal 104 (Fig. 5(B) shows the state after the guide wire 22 is pulled out of the body). Also, in the third step, with the spiral portion of the spiral 21 passed through the notch 10 of the inclined portion 3 and screwed into the anus protrusion 103, the inclined portion 3 is sandwiched between the head of the spiral 21 and the anus protrusion 103, so that the inclined portion 3 is fastened to the anus protrusion 103 by the spiral 21.

[0043] Also, as in the examples shown in FIGS. 1 and 2, when the through-hole 12 is formed in the inclined portion 3, in the third step, the spiral 23 (FIG. 5(B)) of the hollow structure is inserted into the body from the first portal 104, and the spiral 23 is passed through the through-hole 12 of the inclined portion 3 and screwed into the spout protrusion 103, so that the inclined portion 3 is fastened to the spout protrusion 103 by the spiral 23. In this operation, as shown in FIG. 5(B), the guide wire 24 inserted into the body from the first portal 104 is passed through the through-hole 12 and pierced into the spout protrusion 103. Then, after passing the guide wire 24 through the cavity of the spiral 23, the spiral 23 is moved along the guide wire 24 toward the through-hole 12, the spiral 23 is passed through the through-hole 12 and screwed into the spout protrusion 103, and then the guide wire 24 is pulled out of the body from the first portal 104 (FIG. 5(B) shows the state immediately before passing the spiral 23 through the through-hole 12). Also, in the above operation, the spiral portion of the spiral 23 is passed through the through-hole 12 of the inclined portion 3 and screwed into the spout protrusion 103, so that the inclined portion 3 is sandwiched between the head of the spiral 23 and the spout protrusion 103, and the inclined portion 3 is fastened to the spout protrusion 103 by the spiral 23.

[0044] After the above third step, as shown in FIG. 6, a fourth step is performed in which the spout protrusion 103 is cut from the scapula 108 with the bone chisel 25 inserted from the first portal 104 while the common tendon 109 remains attached to the spout protrusion 103. At this time, the bone chisel 25 is inserted into the shoulder joint along the handle body 4. Then, with the bone chisel 25 along the handle body 4, the head of the bone chisel 25 (the proximal end portion of the bone chisel 25) is struck with a hammer, and the bone chisel 25 is slid along the handle body 4 to cut the spout protrusion 103 with the bone chisel 25.

[0045] Next, as shown in FIGS. 7(A), 7(B), and 7(C), by moving the surgical instrument 1 downward, the coracoid process 103 with the conjoined tendon 109 is moved downward, and the coracoid process 103 is inserted into the incision 102 of the subscapularis muscle 100 and brought close to the scapular neck 108a, and a fifth step is performed. At this time, due to the pressing of the conjoined tendon 109 or the coracoid process 103 moving downward, the neurovascular system 200 near the shoulder joint also moves downward. The neurovascular system 200 includes the musculocutaneous nerve 200a, the axillary nerve 200b, and the subclavian artery 200c. FIG. 7 shows a state in which the musculocutaneous nerve 200a, the axillary nerve 200b, and the subclavian artery 200c move downward due to the pressing of the conjoined tendon 109.

[0046] Next, the screwing of the screw 21 into the coracoid process 103 is released, and the screw 21 is taken out of the body through the second portal 111 formed in the skin at a position in front of the incision 102. At the same time, a screw 26 that is longer than the screw 21 and has a hollow structure is inserted into the body through the second portal 111, passed through the notch 10, and screwed into the coracoid process 103 and the scapular neck 108a, and a sixth step is performed (FIG. 8). At this time, a guide wire 27 inserted into the body through the second portal 111 is passed through the cavity of the screw 21 and pierced into the scapular neck 108a. Then, after that, the screwing of the screw 21 into the coracoid process 103 is released, and the screw 21 is moved along the guide wire 27 and taken out of the body through the second portal 111 (FIG. 8(A) shows a state when the screw 21 is moving toward the second portal 111 along the guide wire 27, and FIGS. 8(B) and 8(C) show states after the screw 21 has been taken out of the body). Then, after that, with the guide wire 27 passed through the cavity of the screw 26, the screw 26 is moved along the guide wire 27 toward the notch 10, and the screw 26 is passed through the notch 10 and screwed into the coracoid process 103 and the scapular neck 108a. After that, the guide wire 27 is pulled out of the body through the second portal 111 (FIGS. 8(B) and 8(C) show a state in which the screw 26 has been passed through the notch 10 and screwed into the coracoid process 103 and the scapular neck 108a).

[0047] Also, as shown in FIGS. 8(A) and 8(B), when the screw 23 is screwed into the coracoid process 103, in the sixth step, the screwing of the screw 23 into the coracoid process 103 is released, and the screw 23 is taken out of the body from the second portal 111. In this operation, as shown in FIGS. 8(A) and 8(B), the guide wire 28 inserted into the body from the second portal 111 is passed through the cavity of the screw 23 and stabbed into the scapular neck 108a. Then, as shown in FIG. 8(C), the screwing of the screw 23 into the coracoid process 103 is released, and the screw 23 is moved along the guide wire 28, taken out of the body from the second portal 111, and the guide wire 28 is pulled out of the body from the second portal 111.

[0048] Next, as shown in FIG. 9, the seventh step of removing the surgical instrument 1 from the screw 26 and taking out the surgical instrument 1 from the body through the first portal 104 is performed by moving the surgical instrument 1. At this time, since there is an opening in the notch 10 through which the screw 26 passes, the surgical instrument 1 can be easily removed from the screw 26 (that is, the surgical instrument 1 can be removed from the screw 26 by performing a simple operation of moving the surgical instrument 1 so that the screw 26 comes out from the notch 10 (between the bifurcated portions 11, 11)).

[0049] Through the above operations, the coracoid process 103 is transplanted to the scapular neck 108a (the state where the coracoid process 103 is fixed to the scapular neck 108a by the screw 26).

[0050] In the case where, in the sixth step (FIG. 8), the helix 23 that had been screwed into the orifice protrusion 103 is taken out of the body, after the seventh step (FIG. 9), as shown in FIG. 10, a helix 29 that is longer than the helix 23 and has a hollow structure is inserted into the body through the second portal 111, and the helix 29 is passed through the hole of the orifice protrusion 103 into which the helix 23 (FIGS. 5 to 8) had been screwed, and an eighth step of screwing the helix 29 into the orifice protrusion 103 and the scapular neck 108a is carried out. At this time, as shown in FIG. 10(A), a guide wire 30 is inserted into the body through the second portal 111, and the guide wire 30 (FIG. 10) is passed through the hole of the orifice protrusion 103 into which the above helix 23 had been screwed and the hole of the scapular neck 108a into which the guide wire 28 (FIG. 8) had been pierced. Then, after that, as shown in FIG. 10(B), with the guide wire 30 passed through the cavity of the helix 29, the helix 29 is moved along the guide wire 30, and the helix 29 is passed through the hole of the above orifice protrusion 103 and the hole of the scapular neck 108a, whereby the helix 29 is screwed into the orifice protrusion 103 and the scapular neck 108a. Then, after that, the guide wire 30 is pulled out of the body through the second portal 111 (FIG. 10(C) shows the state after the helix 29 has been screwed into the orifice protrusion 103 and the scapular neck 108a and the guide wire 30 has been pulled out of the body). When the above eighth step (FIG. 10) is carried out, in addition to the helix 26, the orifice protrusion 103 is fixed to the scapular neck 108a also by the helix 29.

[0051] Also, in the third step (Fig. 5), screwing the screws 21 and 23 into the obtuse protrusion 103, in the sixth step (Fig. 8), unscrewing the screws 21 and 23 from the obtuse protrusion 103 and taking the screws 21 and 23 out of the body, in the sixth step (Fig. 8), screwing the screw 26 into the obtuse protrusion 103 and the scapular neck 108a, and in the seventh step (Fig. 9), screwing the screw 29 into the obtuse protrusion 103 and the scapular neck 108a can be achieved by using a known driver. The driver has, for example, a cavity through which a guide wire can be inserted. By inserting the tip of the driver into the cavities of the screws 21, 23, 26, and 29, it is possible to connect the screws 21, 23, 26, and 29 to the tip of the driver. The cavity of the above driver opens at the tip of the driver. When the screws 21, 23, 26, and 29 are connected to the tip of the driver, the opening at the tip of the driver is located within the cavities of the screws 21, 23, 26, and 29, so that the cavity of the driver and the cavities of the screws 21, 23, 26, and 29 are in a communicating state.

[0052] When screwing the screws 21 and 23 into the obtuse protrusion 103 or when screwing the screws 26 and 29 into the obtuse protrusion 103 and the scapular neck 108a, first, the tip of the driver is inserted into the cavity of the screw to connect the screw to the tip of the driver. Then, with the guide wire passed through the cavity of the screw and the cavity of the driver, the screw and the driver are inserted into the body along the guide wire until the helical part of the screw abuts against the obtuse protrusion 103. Then, by rotating the driver, the helical part of the screw is screwed into the obtuse protrusion 103 or the helical part of the screw is screwed into the obtuse protrusion 103 and the scapular neck 108a. After that, by retracting the driver along the guide wire, the screw is removed from the tip of the driver and the driver is taken out of the body.

[0053] When releasing the screwing of the spirals 21 and 23 into the coracoid process 103 and removing the spirals 21 and 23 outside the body, with the guide wire passed through the cavity of the driver, the driver is inserted into the body along the guide wire, and the tip of the driver is inserted into the cavity of the spiral, so that the spiral is connected to the tip of the driver. Then, by rotating the driver, the screwing of the spiral into the coracoid process 103 is released. After that, by retracting the driver and the spiral along the guide wire, the driver and the spiral are removed outside the body.

[0054] According to the surgical instrument 1 according to this embodiment, since the inclined portion 3 is inclined at an angle α (FIG. 2(C)) of 95° or more and 115° or less with respect to the handle main body 4, as shown in FIG. 4, under the condition that the handle 2 passes through the first portal 104 formed at a position directly above the coracoid process 103, the inclined portion 3 can be brought into contact with the coracoid process 103. And as shown in FIG. 4, when the inclined portion 3 is brought into contact with the coracoid process 103, as shown in FIG. 5, since the coracoid process 103 is attached to the scapula 108 and the coracoid process 103 is in a stable state (that is, in the state before cutting the coracoid process 103 from the scapula 108), the operation of screwing the spiral 21 through the notch 10 into the coracoid process 103 can be performed. For this reason, it is possible to easily connect the inclined portion 3 to the coracoid process 103 using the spiral 21. And in the state where the inclined portion 3 is connected to the coracoid process 103 in this way, if the coracoid process 103 is cut from the scapula 108 as shown in FIG. 6, the coracoid process 103 can be brought close to the scapular neck 108a by a simple operation of moving the surgical instrument 1 downward as shown in FIG. 7. For the above reasons, according to the surgical instrument 1 of this embodiment, the coracoid process 103 can be easily brought close to the scapular neck 108a.

[0055] Also, according to the transplantation method according to the present embodiment, in the fifth step shown in FIG. 7, by moving the surgical instrument 1 downward, the common tendon 109 and the coracoid process 103 also move downward. Therefore, the neurovascular system 200 near the shoulder joint can be moved downward by the pressing of the common tendon 109 or the coracoid process 103. Thereby, the pinching of the neurovascular system 200 in the front-rear direction (horizontal direction) by the subscapularis muscle 100 and the common tendon 109 can be weakened, so that damage to the neurovascular system 200 can be prevented. Therefore, it is possible to avoid the occurrence of complications due to damage to the neurovascular system 200 (for example, since damage to the musculocutaneous nerve 200a can be prevented, the complication of the elbow not being able to bend can be avoided, and since damage to the axillary nerve 200b can be prevented, the complication of the shoulder not being able to rise can be avoided).

[0056] Also, according to the surgical instrument 1 of the present embodiment, since the protrusion 13 is formed at a position lateral to the through hole 12, the protrusion 13 can be used as a mark for positioning the through hole 12. Thereby, in the second step (FIG. 4), it is possible to easily arrange the through hole 12 at a desired position of the coracoid process 103.

[0057] Also, in order to implement the above-described transplantation method of the coracoid process 103, a medical instrument set including the surgical instrument 1 shown in FIGS. 1 and 2 and the cutting tool 40 shown in FIG. 11 can be used.

[0058] The cutting tool 40 can be used as a bone saw 25 for cutting the guttural process 103 in the fourth step shown in FIG. 6. The cutting tool 40 (FIG. 11) has a thick portion 41 used as a handle and a thin portion 42 thinner than the thick portion 41 connected thereto. The tip 42a of the thin portion 42 farthest from the thick portion 41 is the thinnest cutting edge, and the length L4 of the thin portion 42 is set to be 6 cm or more and 8 cm or less. If the above cutting tool 40 is used as a bone saw 25 (FIG. 6) for cutting the guttural process 103, the length L4 (FIG. 11) of the thin portion 42 is equal to or less than the length L2 (8 cm or more and 12 cm or less: FIG. 1) of the handle body 4, so that the head of the bone saw 25 (cutting tool 40) can be easily struck with a hammer with the bone saw 25 (cutting tool 40) along the handle body 4. Thereby, it is possible to easily cut the guttural process 103 along the extension line of the handle body 4. Therefore, the handle body 4 can be suitably used as a guide for determining the cutting position of the guttural process 103. As shown in FIG. 11, the thin portion 42 is preferably formed so as to gradually widen and gradually thin as it separates from the gripping portion 5. Further, as shown in FIG. 11(B), it is preferable that a warp is formed on the tip side of the thin portion 42.

[0059] It should be noted that the present invention does not require the use of the cutting tool 40, and other tools than the cutting tool 40 may be used as a bone saw for cutting the guttural process 103.

[0060] In addition, in order to implement the above-described transplantation method of the guttural process 103, a medical instrument set including the surgical instrument 1 shown in FIGS. 1 and 2, the first wire 50, the second wire 51, the third wire 52 shown in FIG. 12, and the first sleeve 53 shown in FIG. 13 can be used.

[0061] The first wire 50, the second wire 51, the third wire 52, and the first sleeve 53 can each be passed through the notch 10 and the through hole 12 of the surgical instrument 1.

[0062] The first sleeve 53 shown in Fig. 13 is a hollow cylindrical body and is formed of a stainless alloy, a titanium alloy, or an 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.

[0063] The above-mentioned first sleeve 53 is used to guide the movement of the wires 50, 51, and the wires 50, 51, 52 can be inserted into the cavity of the first sleeve 53 respectively.

[0064] The first wire 50 shown in Fig. 12(A) is a hollow cylindrical body and is formed of a stainless alloy, a titanium alloy, or an 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 groove 50a extending spirally is formed on the outer peripheral surface of the tip of the first wire 50.

[0065] The above-mentioned first wire 50 is used, for example, as the guide wires 22, 24 shown in Fig. 5 and the guide wires 27, 28 shown in Fig. 8, and the third wire 52 (Fig. 12(C)) can be inserted into the cavity of the first wire 50 (Fig. 12(A)).

[0066] The second wire 51 shown in Fig. 12(B) is formed of a stainless alloy, a titanium alloy, or an aluminum alloy, and the outer diameter of the second wire 51 is, for example, 2 mm or less. As shown in Fig. 14, the tip 51a of the second wire 51 has a rounded shape.

[0067] The above-mentioned second wire 51 is used to guide the movement of the first sleeve 53. Also, the second wire 51 can be used as the guide wire 30 shown in Fig. 10.

[0068] The third wire 52 shown in FIG. 12(C) is made of a stainless alloy, a titanium alloy, or an aluminum alloy, and the outer diameter of the third wire 52 is, for example, 2 mm or less. As shown in FIG. 15, the tip 52a of the third wire 52 has a pointed and tapered shape with corners.

[0069] The above-mentioned third wire 52 is used to form holes in the coracoid process 103 and the scapular neck 108a. By pushing the first wire 50 (FIG. 12(A)) into the holes formed in the coracoid process 103 and the scapular neck 108a by the third wire 52, the diameter of the holes formed by the third wire 52 can be expanded to form holes suitable for twisting a helix.

[0070] When a medical instrument set including the surgical instrument 1, the first wire 50, the second wire 51, the third wire 52, and the first sleeve 53 is used, in the third step shown in FIG. 5, in order to achieve a state where the helix 21 is twisted into the coracoid process 103 through the notch 10 of the inclined portion 3, the following operations 1 to 5 are sequentially performed.

[0071] Operation 1: Insert the second wire 51 (FIG. 12(B)) into the body from the first portal 104 (FIG. 5) toward the coracoid process 103, and position the tip of the second wire 51 at the notch 10 of the inclined portion 3. Operation 2: With the second wire 51 (FIG. 12(B)) passed through the cavity of the first sleeve 53 (FIG. 13), move the first sleeve 53 along the second wire 51 to insert the first sleeve 53 into the body and guide it to the coracoid process 103, and position the tip of the first sleeve 53 at the notch 10. Then, pull out the second wire 51 from the body through the first portal 104 (FIG. 5) (pull out the second wire 51 from the cavity of the first sleeve 53). Operation 3: Pass the third wire 52 (FIG. 12(C)) through the cavity of the first sleeve 53 to insert the third wire 52 into the body and guide it to the coracoid process 103, and pierce the third wire 52 protruding from the tip of the first sleeve 53 through the notch 10 and into the coracoid process 103 to form a hole in the coracoid process 103. Operation 4: While passing the first wire 50 (Fig. 12(A)) through the cavity of the first sleeve 53 and passing the third wire 52 through the cavity of the first wire 50, the first wire 50 is inserted into the body and guided to the beak projection 103, and the first wire 50 protruding from the tip of the first sleeve 53 is passed through the notch 10 and pierced into the beak projection 103, thereby expanding the hole of the beak projection 103 formed in Operation 3 with the first wire 50 to form a hole suitable for screwing in the helix 21 in the beak projection 103. Operation 5: After pulling out the first sleeve 53 from the first portal 104 (Fig. 5), with the first wire 50 (corresponding to the guide wire 22) passed through the cavity of the helix 21, the helix 21 is moved along the first wire 50 toward the notch 10, and the helix 21 is screwed into the hole of the beak projection 103 formed in Operation 4 through the notch 10. Thereafter, the wires 50 and 52 are pulled out of the body from the first portal 104.

[0072] Also, in the third step shown in Fig. 5, in order to realize the state where the helix 23 is passed through the through hole 12 of the inclined portion 3 and screwed into the beak projection 103, the following Operations 6 to 10 are sequentially performed.

[0073] Operation 6: Insert the second wire 51 (Fig. 12(B)) from the first portal 104 (Fig. 5) into the body toward the beak projection 103, and position the tip of the second wire 51 at the through hole 12 of the inclined portion 3. Operation 7: While passing the second wire 51 (Fig. 12(B)) through the cavity of the first sleeve 53 (Fig. 13), move the first sleeve 53 along the second wire 51 to insert the first sleeve 53 into the body and guide it to the beak projection 103, and position the tip of the first sleeve 53 at the through hole 12. Thereafter, pull out the second wire 51 from the body from the first portal 104 (pull out the second wire 51 from the cavity of the first sleeve 53). Operation 8: By passing the third wire 52 (Fig. 12(C)) through the cavity of the first sleeve 53, the third wire 52 is inserted into the body and guided to the beak projection 103. Then, the third wire 52 protruding from the tip of the first sleeve 53 is passed through the through-hole 12 and pierced into the beak projection 103 to form a hole in the beak projection 103. Operation 9: While passing the third wire 52 through the cavity of the first wire 50, the first wire 50 (Fig. 12(A)) is passed through the cavity of the first sleeve 53. By doing so, the first wire 50 is inserted into the body and guided to the beak projection 103. Then, the first wire 50 protruding from the tip of the first sleeve 53 is passed through the through-hole 12 and pierced into the beak projection 103. By this, the hole in the beak projection 103 formed in Operation 8 is enlarged by the first wire 50, and a hole suitable for screwing in the helix 23 is formed in the beak projection 103. Operation 10: After pulling out the first sleeve 53 from the first portal 104 (Fig. 5), with the first wire 50 (corresponding to the guide wire 24) passed through the cavity of the helix 23, the helix 23 is moved along the first wire 50 toward the through-hole 12. Then, the helix 23 is passed through the through-hole 12 and screwed into the hole in the beak projection 103 formed in Operation 9. After that, the wires 50 and 52 are pulled out of the body from the first portal 104.

[0074] Also, in the sixth step shown in Fig. 8, in order to realize the state where the helix 26 is passed through the notch 10 and screwed into the beak projection 103 and the scapular neck 108a, the following Operations 11 to 15 are sequentially performed.

[0075] Operation 11: The second wire 51 (Fig. 12(B)) is inserted into the body from the second portal 111 (Fig. 8) toward the beak projection 103, and the tip of the second wire 51 is positioned in the cavity of the helix 21 (Fig. 8(A)). Operation 12: With the second wire 51 (Fig. 12(B)) passed through the cavity of the first sleeve 53 (Fig. 13), move the first sleeve 53 along the second wire 51 to insert the first sleeve 53 into the body and guide it to the orifice protrusion 103, and position the tip of the first sleeve 53 in the cavity of the helix 21. After that, pull the second wire 51 out of the body from the second portal 111 (Fig. 8) (pull the second wire 51 out of the cavity of the first sleeve 53). Operation 13: Pass the third wire 52 (Fig. 12(C)) through the cavity of the first sleeve 53 to insert the third wire 52 into the body and guide it to the orifice protrusion 103, and pass the third wire 52 protruding from the tip of the first sleeve 53 through the cavity of the helix 21 (Fig. 8(A)) and pierce the scapular neck 108a to form a hole in the scapular neck 108a. Operation 14: Pass the first wire 50 (Fig. 12(A)) through the cavity of the first sleeve 53 while passing the third wire 52 through the cavity of the first wire 50 to insert the first wire 50 (corresponding to the guide wire 27) into the body and guide it to the orifice protrusion 103, and pass the first wire 50 protruding from the tip of the first sleeve 53 through the cavity of the helix 21 and pierce the scapular neck 108a to expand the hole in the scapular neck 108a formed in Operation 13 with the first wire 50, and form a hole suitable for screwing in the helix 26 in the scapular neck 108a. Operation 15: After pulling the first sleeve 53 out of the body from the second portal 111, release the screwing of the helix 21 into the orifice protrusion 103, and move the helix 21 along the first wire 50 (corresponding to the guide wire 27) and take it out of the body from the second portal 111. Operation 16: With the first wire 50 (corresponding to the guide wire 27) passed through the cavity of the helix 26 (Fig. 8(B), Fig. 8(C)), move the helix 26 along the first wire 50 toward the notch 10, pass the helix 26 through the notch 10, and screw the helix 26 into the hole in the orifice protrusion 103 where the helix 21 was screwed in and the hole in the scapular neck 108a formed in Operation 14. After that, pull the wires 50, 52 out of the body from the second portal 111.

[0076] In the sixth step shown in FIG. 8, in order to release the winding of the helix 23 into the stoma protrusion 103 and take out the helix 23 outside the body, the following operations 17 to 21 are sequentially performed.

[0077] Operation 17: Insert the second wire 51 (FIG. 12(B)) from the second portal 111 (FIG. 8) into the body toward the stoma protrusion 103, and position the tip of the second wire 51 in the cavity of the helix 23 (FIG. 8(A)). Operation 18: With the second wire 51 passed through the cavity of the first sleeve 53 (FIG. 13), move the first sleeve 53 along the second wire 51 to insert the first sleeve 53 into the body and guide it to the stoma protrusion 103, and position the tip of the first sleeve 53 in the cavity of the helix 23. After that, pull out the second wire 51 from the second portal 111 (FIG. 8) outside the body (pull out the second wire 51 from the cavity of the first sleeve 53). Operation 19: Pass the third wire 52 (FIG. 12(C)) through the cavity of the first sleeve 53 to insert the third wire 52 into the body and guide it to the stoma protrusion 103, and pass the third wire 52 protruding from the tip of the first sleeve 53 through the cavity of the helix 23 and pierce the scapular neck 108a to form a hole in the scapular neck 108a. Operation 20: Pass the first wire 50 (FIG. 12(A)) through the cavity of the first sleeve 53 while passing the third wire 52 through the cavity of the first wire 50, so as to insert the first wire 50 (corresponding to the guide wire 28) into the body and guide it to the stoma protrusion 103, and pass the first wire 50 protruding from the tip of the first sleeve 53 through the cavity of the helix 23 and pierce the scapular neck 108a, thereby expanding the hole in the scapular neck 108a formed in Operation 19 with the first wire 50 to form a hole suitable for screwing in the helix 29 (FIG. 10) in the scapular neck 108a. Operation 21: After pulling the first sleeve 53 out of the body from the second portal 111, the screwing of the helix 23 into the stoma protrusion 103 is released, and the helix 23 is moved along the first wire 50 (corresponding to the guide wire 28) and taken out of the body from the second portal 111. After that, the wires 50 and 52 are pulled out of the body from the second portal 111.

[0078] Also, in the eighth step shown in FIG. 10, in order to realize the state where the helix 29 is screwed into the stoma protrusion 103 and the scapular neck 108a, the following operations 22 to 24 are sequentially performed.

[0079] Operation 22: Insert the second wire 51 (FIG. 12(B)) from the second portal 111 (FIG. 10) into the body toward the stoma protrusion 103, and pass the second wire 51 through the hole of the stoma protrusion 103 into which the helix 23 (FIGS. 5 to 8) was screwed and the hole of the scapular neck 108a formed in operation 20 (the hole of the scapular neck 108a through which the guide wire 28 shown in FIG. 8 was pierced). Operation 23: With the second wire 51 (corresponding to the guide wire 30) passed through the cavity of the helix 29, move the helix 29 along the second wire 51 toward the stoma protrusion 103, and screw the helix 29 into the hole of the stoma protrusion 103 into which the helix 23 (FIGS. 5 to 8) was screwed and the hole of the scapular neck 108a formed in operation 20 (the hole of the scapular neck 108a through which the guide wire 28 shown in FIG. 8 was pierced). Operation 24: Pull the second wire 51 out of the body from the second portal 111.

[0080] According to the medical instrument set including the surgical instrument 1 (FIGS. 1 and 2), the wires 50, 51, and 52 (FIG. 12), and the first sleeve 53 (FIG. 13), in operations 3, 8, 13, and 19, the third wire 52 (FIG. 12(C)) is passed through the cavity of the first sleeve 53 (FIG. 13), and in operations 4, 9, 14, and 20, the first wire 50 (FIG. 12(A)) is passed through the cavity of the first sleeve 53, so that the wires 52 and 50 can be smoothly guided to the stoma protrusion 103 without damaging the inside of the body by the wires 52 and 50.

[0081] Also, in Operations 2, 7, 12, and 18, by passing the second wire 51 (Fig. 12(B)) through the cavity of the first sleeve 53 (Fig. 13), the first sleeve 53 can be smoothly guided to the anvil projection 103.

[0082] Also, as shown in Fig. 14, since the tip 51a of the second wire 51 has a rounded shape, in Operations 1, 6, 11, 17, and 22, the second wire 51 can be moved toward the anvil projection 103 without damaging the inside of the body by the second wire 51.

[0083] When the through-hole 12 is not formed in the surgical instrument 1, Operations 6 to 10, Operations 17 to 21, and Operations 22 to 24 are omitted.

[0084] Also, in the method for migrating the anvil projection 103 of the present invention, before the fifth step (Fig. 7) of bringing the anvil projection 103 close to the scapular neck 108a, a flattening step of flattening the surface of the scapular neck 108a by polishing the surface of the scapular neck 108a may be performed. In this case, in the fifth step (Fig. 7), the anvil projection 103 is brought close to the scapular neck 108a so that the surface of the scapular neck 108a flattened in the flattening step and the surface of the anvil projection 103 are in contact with each other.

[0085] And when the above-mentioned flattening step is performed, in order to carry out the method for migrating the anvil projection 103 of the present invention, the surgical instrument 1 shown in Figs. 1 and 2, the polishing tool 60 shown in Figs. 16 and 17, the second sleeve 63 shown in Figs. 16, 17, and 18, the third sleeve 64 shown in Figs. 16 and 18, the fourth sleeve 65 shown in Figs. 16 and 18, and the fourth wire 66 and fifth wire 67 shown in Fig. 19 may be used as a medical instrument set.

[0086] The second sleeve 63, the third sleeve 64, the fourth sleeve 65, and the abrasive tool 60 are each a hollow cylindrical body. It is possible to insert the third sleeve 64 into the cavity of the second sleeve 63, insert the fourth sleeve 65 into the cavity of the third sleeve 64, insert the fourth wire 66 or the fifth wire 67 into the cavity of the fourth sleeve 65, insert the abrasive tool 60 into the cavity of the second sleeve 63, or insert the fourth wire 66 or the fifth wire 67 into the cavity of the abrasive tool 60. Also, it is possible to pass the fifth wire 67 (FIG. 19(B)) through the notch 10 and the through hole 12 (FIGS. 1 and 2) of the surgical instrument 1.

[0087] The second sleeve 63 includes a second sleeve main body portion 63a having a constant inner diameter and outer diameter, and an annular flange 63b that projects annularly from the outer surface of the proximal end of the second sleeve main body portion 63a.

[0088] The third sleeve 64 is such that, from the distal end side toward the proximal end side (from the right side to the left side in FIG. 18), the third sleeve distal end portion 64a and the third sleeve main body portion 64b are continuous in this order. The length L6 of the third sleeve main body portion 64b is made equal to or greater than the length L5 of the second sleeve main body portion 63a, and the outer diameter of the third sleeve main body portion 64b is made equal to or less than the inner diameter of the second sleeve main body portion 63a. The outer diameter and the inner diameter of the third sleeve distal end portion 64a gradually decrease as approaching its distal end.

[0089] The fourth sleeve 65 is such that, from the tip side toward the base end side (from the right side to the left side in Fig. 18), the fourth sleeve tip portion 65a, the fourth sleeve main body portion 65b, and the fourth sleeve base end portion 65c are continuous in this order. The length L8 of the fourth sleeve main body portion 65b is made equal to or greater than the length L7 of the third sleeve 64, and the outer diameter of the fourth sleeve main body portion 65b is made equal to or less than the diameter of the tip opening of the third sleeve tip portion 64a. The outer diameter and the inner diameter of the fourth sleeve tip portion 65a gradually decrease as approaching the tip thereof. The outer diameter and the inner diameter of the fourth sleeve base end portion 65c gradually decrease as approaching the base end thereof. Note that the fourth sleeve 65 can also be used as the first sleeve 53 shown in Fig. 13 (in the illustrated example, the fourth sleeve 65 (Figs. 16, 18) and the first sleeve 53 (Fig. 13) are assumed to have the same structure).

[0090] The abrasive tool 60 is such that, from the tip side toward the base end side (from the right side to the left side in Fig. 17), the abrasive tool tip portion 60a and the abrasive tool main body portion 60b are continuous in this order. The length L9 of the abrasive tool main body portion 60b is made equal to or greater than the length L5 of the second sleeve main body portion 63a. The outer diameter of the abrasive tool tip portion 60a gradually increases as approaching the tip thereof, and the outer diameter of the tip of the abrasive tool tip portion 60a is made equal to or less than the inner diameter of the second sleeve main body portion 63a.

[0091] With the base end portion of the abrasive tool 60 (the base end portion of the abrasive tool main body portion 60b) connected to the power tool 70, it is possible to rotate the abrasive tool 60 around the central axis by operating the power tool 70. Also, with the tip surface of the abrasive tool 60 (the tip surface of the abrasive tool tip portion 60a) in contact with the surface of the scapular neck portion 108a, it is possible to polish the surface of the scapular neck portion 108a with the tip surface of the abrasive tool 60 by rotating the abrasive tool 60.

[0092] The fourth wire 66 shown in Fig. 19(A) is a wire that can be inserted into the cavity of the abrasive tool 60 and the cavity of the fourth sleeve 65. The fourth wire 66 is formed of a stainless alloy, a titanium alloy, or an aluminum alloy. The outer diameter of the fourth wire 66 is, for example, 2 mm or less, and the tip 66a of the fourth wire 66 has a rounded shape. The fourth wire 66 is used to guide the movement of the fourth sleeve 65.

[0093] Note that the fourth wire 66 can also be used as the second wire 51 shown in Figs. 12(B) and 14 (in the illustrated example, the fourth wire 66 (Fig. 19(A)) and the second wire 51 (Figs. 12(B), 14) are assumed to have the same structure).

[0094] The fifth wire 67 shown in Fig. 19(B) is a wire that can be inserted into the cavity of the abrasive tool 60, the cavity of the fourth sleeve 65, and the notch 10 and the through hole 12 of the surgical instrument 1. The fifth wire 67 is formed of a stainless alloy, a titanium alloy, or an aluminum alloy. The outer diameter of the fifth wire 67 is, for example, 2 mm or less. The tip 67a of the fifth wire 67 has a pointed shape with corners. The fifth wire 67 is used to pierce the coracoid process 103 and the scapular neck 108a.

[0095] Note that the fifth wire 67 can also be used as the third wire 52 shown in Figs. 12(C) and 15 (the fifth wire 67 (Fig. 19(B)) and the third wire 52 (Figs. 12(C), 15) are assumed to have the same structure).

[0096] When a medical instrument set including a surgical instrument 1, a grinding tool 60, sleeves 63, 64, 65, and wires 66, 67 is used, in order to flatten the surface of the scapular neck 108a in the flattening process, after the following operations 25 to 43 are sequentially performed, in the fifth step (Fig. 7), the acromial process 103 is brought close to the scapular neck 108a. The flattening process uses two fifth wires 67 (Fig. 19(B)). Hereinafter, the first fifth wire 67 is denoted as "fifth wire 67-1", and the second fifth wire 67 is denoted as "fifth wire 67-2".

[0097] Operation 25: Insert the fourth wire 66 (Fig. 19(A)) into the body from the second portal 111 (Fig. 7) toward the scapular neck 108a, and bring the tip of the fourth wire 66 into contact with the surface of the scapular neck 108a (see Fig. 20). Operation 26: As shown in Fig. 21, with the fourth wire 66 passed through the cavity of the fourth sleeve 65, move the fourth sleeve 65 along the fourth wire 66 to insert the fourth sleeve 65 into the body and guide it to the scapular neck 108a. Then, pull out the fourth wire 66 from the cavity of the fourth sleeve 65. Operation 27: Pass the fifth wire 67-1 (Fig. 19(B)) through the cavity of the fourth sleeve 65 to insert the fifth wire 67 into the body and guide it to the scapular neck 108a, and pierce the fifth wire 67-1 protruding from the tip of the fourth sleeve 65 into the scapular neck 108a to form a hole in the scapular neck 108a. Operation 28: With the fourth sleeve 65 passed through the cavity of the third sleeve 64 (Fig. 18), move the third sleeve 64 along the fourth sleeve 65 to insert the third sleeve 64 into the body and guide it to the scapular neck 108a. Then, with the third sleeve 64 passed through the cavity of the second sleeve 63 (Fig. 18), move the second sleeve 63 along the third sleeve 64 to insert the second sleeve 63 into the body and guide it to the scapular neck 108a. Operation 29: Pull the third sleeve 64 and the fourth sleeve 65 out of the body from the second portal 111 (Fig. 7) so that only the fifth wire 67-1 passes through the cavity of the second sleeve 63 (Fig. 22 shows the state after Operation 29 is performed). Operation 30: With the proximal end side of the abrasive tool body 60b (Figs. 16 and 17) connected to the power tool 70 (Fig. 23), pass the abrasive tool 60 through the cavity of the second sleeve 63 while passing the fifth wire 67-1 through the cavity of the abrasive tool 60, thereby inserting the abrasive tool 60 into the body and guiding it to the coracoid process 103, and protruding the tip end portion 60a of the abrasive tool from the tip end of the second sleeve 63, and bringing the tip end surface of the tip end portion 60a of the abrasive tool into contact with the surface of the scapular neck 108a (see Fig. 23). Operation 31: Rotate the abrasive tool 60 by driving the power tool 70 to polish the surface of the scapular neck 108a with the tip end surface of the tip end portion 60a of the abrasive tool to flatten the surface of the scapular neck 108a, and then pull out the abrasive tool 60 and the second sleeve 63 from the body through the second portal 111 (Fig. 7). Operation 32: With the fifth wire 67-1 passed through the notch 10 of the surgical instrument 1, move the surgical instrument 1 along the fifth wire 67-1 to insert the surgical instrument 1 into the body (more specifically, insert the handle body 4 and the inclined portion 3 of the surgical instrument 1 into the body), and bring the inclined portion 3 of the surgical instrument 1 into contact with the surface of the coracoid process 103 (Fig. 24 shows the state after the inclined portion 3 of the surgical instrument 1 is brought into contact with the surface of the coracoid process 103). Operation 33: Insert the fourth wire 66 (Fig. 19(A)) into the body from the second portal 111 (Fig. 7) toward the scapular neck 108a, pass the tip end portion 66a of the fourth wire 66 through the through hole 12 of the surgical instrument 1, and bring it into contact with the surface of the scapular neck 108a. Operation 34: With the fourth wire 66 passed through the cavity of the fourth sleeve 65 (Fig. 18), move the fourth sleeve 65 along the fourth wire 66 to insert the fourth sleeve 65 into the body and guide it to the scapular neck 108a, and then pull out the fourth wire 66 from the cavity of the fourth sleeve 65. Operation 35: Insert the fifth wire 67-2 (Figs. 24, 19(b)) into the body by passing it through the cavity of the fourth sleeve 65, guide the fifth wire 67-2 to the scapular neck 108a, and pierce the scapular neck 108a by passing the fifth wire 67-2 protruding from the tip of the fourth sleeve 65 through the through-hole 12 of the surgical instrument 1 to form a hole in the scapular neck 108a (Fig. 24 shows the state where the fifth wire 67-2 is passed through the through-hole 12 and pierced into the scapular neck 108a. In Fig. 24, the illustration of the fourth sleeve 65 is omitted). Operation 36: After pulling out the fourth sleeve 65 and the fifth wire 67-2 from the body through the second portal 111 (Fig. 7), move the surgical instrument 1 to remove the surgical instrument 1 from the fifth wire 67-1, take out the surgical instrument 1 from the body through the second portal 111, and then pull out the fifth wire 67-1 from the body through the second portal 111 (see Fig. 25). Operation 37: Insert the fourth wire 66 (Fig. 19(A)) into the body through the second portal 111 (Fig. 7) toward the scapular neck 108a, and insert the tip of the fourth wire 66 into the hole in the scapular neck 108a formed in Operation 35 (see Fig. 26). Operation 38: With the fourth wire 66 (Fig. 26) passed through the cavity of the fourth sleeve 65 (Fig. 18), move the fourth sleeve 65 along the fourth wire 66 to insert the fourth sleeve 65 into the body and guide it to the scapular neck 108a (see Fig. 26). Operation 39: With the fourth sleeve 65 passed through the cavity of the third sleeve 64 (Fig. 18), move the third sleeve 64 along the fourth sleeve 65 to insert the third sleeve 64 into the body and guide it to the scapular neck 108a (see Fig. 27). Then, with the third sleeve 64 passed through the cavity of the second sleeve 63 (Fig. 18), move the second sleeve 63 along the third sleeve 64 to insert the second sleeve 63 into the body and guide it to the scapular neck 108a (see Fig. 28). Operation 40: Pull out the third sleeve 64 and the fourth sleeve 65 from the body through the second portal 111 (Fig. 7) so that only the fourth wire 66 passes through the cavity of the second sleeve 63 (see Fig. 29). Operation 41: With the proximal end side of the abrasive tool body portion 60b (Figs. 16 and 17) connected to the power tool 70 (Fig. 30), pass the abrasive tool 60 through the cavity of the second sleeve 63 while passing the fourth wire 66 through the cavity of the abrasive tool 60, thereby inserting the abrasive tool 60 into the body and guiding it to the scapular neck portion 108a, and protruding the tip portion 60a of the abrasive tool from the tip of the second sleeve 63 and bringing the tip surface of the tip portion 60a of the abrasive tool into contact with the surface of the scapular neck portion 108a (see Fig. 30). Operation 42: By rotating the abrasive tool 60 by driving the power tool 70, the surface of the scapular neck portion 108a is polished by the tip surface of the tip portion 60a of the abrasive tool, and the surface of the scapular neck portion 108a is made flat. Operation 43: Pull out the abrasive tool 60, the second sleeve 63, and the fourth wire 66 from the second portal 111 (Fig. 7) to the outside of the body (Fig. 31 shows the state where the abrasive tool 60 has been pulled out from the second sleeve 63).

[0098] According to the medical instrument set including the surgical instrument 1 (Figs. 1 and 2), the abrasive tool 60 (Figs. 16 and 17), the sleeves 63, 64, 65 (Figs. 16, 17, and 18), and the wires 66, 67 (Fig. 19), by inserting the second sleeve 63 into the body, a space through which the abrasive tool 60 can pass can be secured in the body. The second sleeve 63 can be inserted into the body using the third sleeve 64 as a guide, the third sleeve 64 can be inserted into the body using the fourth sleeve 65 as a guide, and the fourth sleeve 65 can be inserted into the body using the fourth wire 66 as a guide. Therefore, the work of securing a space through which the abrasive tool 60 can pass in the body can proceed smoothly.

[0099] Also, since the tip portion 65a of the fourth sleeve 65 and the tip portion 64a of the third sleeve 64 each have a tapered shape (the outer diameter of the tip portion 65a of the fourth sleeve and the tip portion 64a of the third sleeve gradually decreases as they approach their tips), the fourth sleeve 65 and the third sleeve 64 can be smoothly inserted into the body. From this point as well, the work of securing a space for passing the abrasive tool 60 can proceed smoothly.

[0100] In addition, since the tip 66a of the fourth wire 66 (Fig. 19(A)) has a rounded shape, in operations 25, 33, and 37, the fourth wire 66 can be moved toward the scapular neck 108a without damaging the inside of the body.

[0101] When the above operations 27 to 42 are performed, in the sixth step shown in Fig. 8, the guide wire 27 inserted into the body from the second portal 111 is passed through the cavity of the helix 21 and the hole of the scapular neck 108a formed in operation 27, so that the guide wire 27 pierces the scapular neck 108a. The guide wire 28 inserted into the body from the second portal 111 is passed through the cavity of the helix 23 and the hole of the scapular neck 108a formed in operation 35, so that the guide wire 28 is assumed to have pierced the scapular neck 108a. Then, in the eighth step shown in Fig. 10, the guide wire 30 inserted into the body from the second portal 111 is passed through the hole of the coracoid process 103 into which the helix 23 (Figs. 5 to 8) was screwed and the hole of the scapular neck 108a formed in operation 35.

[0102] By doing so, surely, with the surface of the coracoid process 103 in contact with the surface of the scapular neck 108a flattened in the flattening process, the coracoid process 103 can be fixed to the scapular neck 108a by the helix 26 (Figs. 8 to 10) and the helix 29 (Fig. 10).

[0103] When the through hole 12 is not formed in the inclined portion 3, operations 32 to 43 are omitted, and operation 31 is changed as shown below.

[0104] Example of change in operation 31: By rotating the polishing tool 60 by driving the power tool 70, the surface of the scapular neck 108a is polished by the tip surface of the polishing tool tip 60a to flatten the surface of the scapular neck 108a. After that, the polishing tool 60, the second sleeve 63, and the fifth wire 67-1 are pulled out of the body from the second portal 111 (Fig. 7).

[0105] In the above case, in the sixth step shown in FIG. 8, by passing the guide wire 27 inserted into the body from the second portal 111 through the cavity of the screw 21 and the hole in the scapular neck 108a formed by the operation 27, if the guide wire 27 is pierced into the scapular neck 108a, surely, with the surface of the coracoid process 103 in contact with the surface of the scapular neck 108a flattened in the flattening step, the coracoid process 103 can be fixed to the scapular neck 108a by the screw 26 (FIGS. 8 to 10).

[0106] Also, the present invention does not necessarily require the use of the guide wires 22 (FIG. 5(A)), guide wire 24 (FIG. 5(B)), guide wire 27 (FIG. 8), guide wire 28 (FIG. 8), and guide wire 30 (FIGS. 10(A) and 10(B)). In the third step (FIG. 5), inserting the screw 21 into the body from the first portal 104, passing the screw 21 through the notch 10 and screwing it into the coracoid process 103, or in the third step (FIG. 5), inserting the screw 23 into the body from the first portal 104, passing the screw 23 through the through-hole 12 and screwing it into the coracoid process 103, or in the sixth step (FIG. 8), removing the screw 21 with the screwing into the coracoid process 103 released from the body through the second portal 111, or in the sixth step (FIG. 8), inserting the screw 26 into the body from the second portal 111, passing the screw 26 through the notch 10 and screwing it into the coracoid process 103 and the scapular neck 108a, or in the sixth step (FIG. 8), removing the screw 23 with the screwing into the coracoid process 103 released from the body through the second portal 111, or in the eighth step (FIG. 10), inserting the screw 29 into the body from the second portal and passing the screw 29 through the hole in the coracoid process 103 into which the screw 23 was screwed and screwing it into the coracoid process 103 and the scapular neck 108a may be performed using known means other than the guide wire. Also, when the known means other than the guide wire do not utilize the cavity of the screw, the screws 21, 23, 26, 29 do not necessarily have to have a hollow structure (the screws 21, 23, 26, 29 may not have a cavity).

Explanation of Reference Numerals

[0107] 1 Surgical instrument 2 Handle 3 Inclined part 4 Handle body 5 Gripping part 12 Through hole 13 Protruding part 21 Helix (corresponding to one helix described in the claims) 22 Guide wire (corresponding to one guide wire described in the claims) 23 Helix (corresponding to three helices described in the claims) 24 Guide wire (corresponding to three guide wires described in the claims) 25 Bone rasp 26 Helix (corresponding to two helices described in the claims) 27 Guide wire (corresponding to two guide wires described in the claims) 28 Guide wire (corresponding to four guide wires described in the claims) 29 Helix (corresponding to four helices described in the claims) 30 Guide wire (corresponding to five guide wires described in the claims) 40 Cutting tool 41 Thick part 42 Thin part 42a Tip of the thin part 50 First wire 50a Groove of the first wire 51 Second wire 51a Tip of the second wire 52 Third wire 52a Tip of the third wire 53 First sleeve 60 Polishing tool 63 Second sleeve 64 Third sleeve 64a Tip of the third sleeve 65 Fourth sleeve 65a Tip of the fourth sleeve 66 Fourth wire 66a Tip of the fourth wire 67 Fifth wire, 67a Tip of the fifth wire, 100 Subscapularis muscle, 102 Incision, 103 Coracoid process, 104 First portal, 108 Scapula, 108a Neck of the scapula, 109 Conjoint tendon, 111 Second portal, L2 Length of the range of the handle body between the gripping portion and the inclined portion, L4 Length of the thin part

Claims

1. A surgical instrument used for transplanting the acromial process to the scapular neck, having a handle extending in a first direction, and an inclined portion extending in a second direction from the tip of the handle, wherein 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, and a notch for passing a screw is formed on the outer edge of the inclined portion.

2. The surgical instrument according to claim 1, wherein a through hole for passing a screw is formed in the inclined portion.

3. The surgical instrument according to claim 2, wherein a protruding portion protruding outward is formed at a position on the side of the through hole in the inclined portion.

4. The handle is connected to a gripping portion serving as a handle on the proximal end side of the handle body, the inclined portion extends in the second direction from the tip of the handle body, and the length of the range of the handle body between the gripping portion and the inclined portion is 8 cm or more and 12 cm or less. The surgical instrument according to any one of claims 1 to 3.

5. The surgical instrument according to claim 4, and a cutting tool used for cutting the acromial process, wherein the cutting tool has a thick portion used as a handle and a thin portion thinner than the thick portion connected thereto, and the tip of the thin portion farthest from the thick portion is the thinnest cutting edge, and the length of the thin portion is 6 cm or more and 8 cm or less. A medical instrument set.

6. The surgical instrument according to any one of claims 1 to 4, a first wire, a second wire, a third wire, and a first sleeve. A medical instrument set, The first wire, the second wire, the third wire, and the first sleeve can each be passed through the notch of the surgical instrument. The first wire is a hollow cylinder, the third wire can be inserted into the cavity of the first wire, and a groove extending spirally is formed on the outer peripheral surface of the tip of the first wire. The tip of the second wire has a rounded shape. The tip of the third wire has a pointed shape with corners. The first sleeve is a hollow cylinder, and a medical instrument set in which the first wire, the second wire, and the third wire can each be inserted into the cavity of the first sleeve.

7. The surgical instrument according to any one of claims 1 to 4, An abrasive tool, A second sleeve, A third sleeve, A fourth sleeve, A fourth wire, A fifth wire, comprising a medical instrument set, The second sleeve, the third sleeve, the fourth sleeve, and the abrasive tool are each a hollow cylinder. It is possible to insert the third sleeve into the cavity of the second sleeve, insert the fourth sleeve into the cavity of the third sleeve, insert the fourth wire or the fifth wire into the cavity of the fourth sleeve, and insert the abrasive tool into the cavity of the second sleeve. The fourth wire can be inserted into the cavity of the abrasive tool and the cavity of the fourth sleeve, and the tip of the fourth wire has a rounded shape. The fifth wire can be inserted into the cavity of the abrasive tool, the cavity of the fourth sleeve, and the notch of the surgical instrument, and the tip of the fifth wire has a pointed shape with corners. With the base end portion of the abrasive tool connected to the power tool, it is possible to rotate the abrasive tool around the central axis by operating the power tool. With the tip surface of the abrasive tool in contact with the surface of the scapular neck, it is possible to polish the surface of the scapular neck with the tip surface of the abrasive tool by rotating the abrasive tool. A medical device set.

8. The medical instrument set according to claim 7, wherein the tip end portions of the third sleeve and the fourth sleeve each have a tapered shape.

9. A method of transplanting the coracoid process to the scapular neck using the surgical instrument according to any one of claims 1 to 4, In the vicinity of the scapular neck, a first step of forming an incision in the subscapular muscle; A second step of inserting the surgical instrument into the body through a first portal formed in the skin at a position directly above the scapular neck and bringing the inclined portion into contact with the coracoid process; A third step of inserting one screw inserted into the body through the first portal through the notch in the inclined portion and screwing it into the coracoid process, thereby fastening the inclined portion to the coracoid process with the one screw; A fourth step of cutting the coracoid process from the scapula with a bone rasp inserted through the first portal while the common tendon remains attached to the coracoid process; A fifth step of moving the surgical instrument downward to move the coracoid process downward, inserting the coracoid process into the incision, and bringing it close to the scapular neck; and releasing the screwing of the one screw into the coracoid process, removing the one screw from the body through a second portal formed in the skin in front of the incision, and inserting a second screw longer than the one screw into the body through the second portal, passing it through the notch, and screwing it into the coracoid process and the scapular neck; A seventh step of removing the surgical instrument from the second screw by moving the surgical instrument and removing the surgical instrument from the body through the first portal. A transplantation method having.

10. In the third step, one guide wire inserted into the body from the first portal is passed through the notch of the inclined portion and stabbed into the coracoid process. After that, with the one guide wire passed through the cavity of the one helix, the one helix is moved along the one guide wire toward the notch, and the one helix is twisted into the coracoid process through the notch. After that, the one guide wire is pulled out of the body from the first portal. In the sixth step, two guide wires are inserted into the body from the second portal, and the two guide wires are passed through the cavity of the one helix and stabbed into the scapular neck. After that, the twisting of the one helix into the coracoid process is released, and the one helix is moved along the two guide wires and taken out of the body from the second portal. After that, with the two guide wires passed through the cavity of the two helix longer than the one helix, the two helix is moved along the two guide wires toward the notch, and the two helix is twisted into the coracoid process and the scapular neck through the notch. After that, the two guide wires are pulled out of the body from the second portal. The transplantation method according to claim 9.

11. The surgical instrument is the surgical instrument according to claim 2 or 3. It further has an eighth step implemented after the seventh step. In the third step, three helices inserted into the body from the first portal are passed through the through hole and twisted into the coracoid process, so that the inclined portion is fastened to the coracoid process by the three helices. In the sixth step, the twisting of the three helices into the coracoid process is released, and the three helices are taken out of the body from the second portal. In the eighth step, four helices longer than the three helices are inserted into the body from the second portal, and the four helices are passed through the hole of the coracoid process into which the three helices were twisted and twisted into the coracoid process and the scapular neck. The transplantation method according to claim 9 or 10.

12. In the third step, the third guide wire inserted into the body from the first portal is passed through the through hole and stabbed into the coracoid process. After that, with the third guide wire passed through the cavity of the third helix, the third helix is moved along the third guide wire toward the through hole, and the third helix is screwed into the coracoid process through the through hole. After that, the third guide wire is pulled out of the body from the first portal. In the sixth step, a fourth guide wire is inserted into the body from the second portal, and the fourth guide wire is passed through the cavity of the third helix and stabbed into the scapular neck. After that, the screwing of the third helix into the coracoid process is released, and the third helix is moved along the fourth guide wire and taken out of the body from the second portal, and the fourth guide wire is pulled out of the body from the second portal. In the eighth step, a fifth guide wire is inserted into the body from the second portal, and the fifth guide wire is passed through the hole of the coracoid process where the third helix was screwed in and the hole of the scapular neck where the fourth guide wire was stabbed. After that, with the fifth guide wire passed through the cavity of the fourth helix that is longer than the third helix, the fourth helix is moved along the fifth guide wire, and the fourth helix is screwed into the coracoid process and the scapular neck by passing through the hole of the coracoid process and the hole of the scapular neck. After that, the fifth guide wire is pulled out of the body from the second portal. The transplantation method according to claim 11, wherein this is performed.

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