Osteotomy guide

Abstract

To provide an osteotomy guide in which a blade of an osteotomy tool can be inserted from a plurality of directions.SOLUTION: There is provided an osteotomy guide 1 used for cutting a distal end 2A of right and left femurs 2, including a first body part 11 and a second body part 12 extended at a right angle to the first body part 11, wherein a pair of parallel guide holes 19, 20 is formed in the first body part 11, a pair of parallel guide holes 47, 48 is formed in the second body part 12, the first body part 11 includes pin holes 21A-25A, 21B-25B for inserting fixing pins 28 between the pair of guide holes 19, 20, the second body part 12 includes pin holes 49A, 49B for inserting the fixing pins 28 between the pair of guide holes 47, 48. The first body part 11 is arranged on a front side of the femur 2 to be cut and the second body part 12 is arranged on an inner side of the femur 2 to be cut even when used for either of the right and left femurs.SELECTED DRAWING: Figure 14

Description

[Technical Field]

[0001] The present invention relates to an osteotomy guide for use in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). [Background technology]

[0002] Conventional surgical treatments for conditions such as osteoarthritis of the knee and osteonecrosis of the femur include total knee arthroplasty, in which the entire affected knee joint is replaced with an artificial joint, and unicompartmental knee arthroplasty, in which only part of the deformed knee joint is removed and replaced with an artificial joint.

[0003] In these total knee replacement surgeries, when placing the implant, a portion of the femur or tibia is first removed using a cutting instrument such as a bone saw, and the implant is then placed there. The coronal plane placement angle of the implant is an important factor that influences the postoperative outcome. Therefore, extremely precise operation is required for the osteotomy of the femur or tibia, which determines the final coronal and sagittal plane alignment of the implant. The general osteotomy method involves fixing an osteotomy guide to the femur or tibia, and then inserting a bone saw through the slot in the osteotomy guide to perform the osteotomy.

[0004] Patent Document 1 shows an example of a femoral osteotomy guide, which has a pin hole that fits over a positioning pin inserted into a drill hole drilled in the front part of the distal end of the femur, and a guide surface that guides a blade cutter to form a distal installation surface for an artificial knee joint on the femur.

[0005] Patent Document 2 discloses a surgical instrument for total knee replacement surgery that includes a resection guide that guides the resection direction of the proximal end of the tibia. The resection guide has a slit-like guide groove formed therethrough that guides the resection direction of the resection instrument, and the resection instrument is inserted along this guide groove to resect a portion of the proximal end of the tibia. [Prior art documents] [Patent documents]

[0006] [Patent Document 1] JP 2014-018437 A [Patent Document 2] JP 2016-140487 A Summary of the Invention [Problem to be solved by the invention]

[0007] However, with this type of guide, there is a slight gap between the slot and the cutting tool blade, and because the cutting tool blade is thin, the blade can wobble or deform during bone cutting, causing the expected bone cutting line to deviate. Furthermore, with the guides described in Patent Documents 1 and 2, the cutting tool blade can only be inserted from one direction (the front), and the further away from the guide it is from the rear, the greater the wobble of the cutting tool blade tends to be, resulting in a decrease in the accuracy of the bone cutting. In particular, in knees with deformities, the medial side of the knee often suffers from bone sclerosis, and the bone cutting in that area is farther from the guide, causing greater blade wobble and making it difficult to cut accurately.

[0008] SUMMARY OF THE INVENTION It is therefore an object of the present invention to solve the above problems and to provide a bone cutting guide into which the blade of a bone cutting tool can be inserted from multiple directions. [Means for solving the problem]

[0009] The bone cutting guide of the present invention is a bone cutting guide used for cutting the distal portions of the left and right femurs, and comprises a first main body portion and a second main body portion extending perpendicular to the first main body portion, wherein a pair of parallel first guide holes are formed in the first main body portion, a pair of parallel second guide holes are formed in the second main body portion, the first main body portion has a first pin hole between the pair of first guide holes for inserting a fixation pin, and the second main body portion has a second pin hole between the pair of second guide holes for inserting a fixation pin, and whether used for the left or right foot, the first main body portion is arranged in front of the femur to be cut, and the second main body portion is arranged on the inside of the femur to be cut. [Effects of the Invention]

[0010] According to the bone cutting guide of the present invention, the blade of the bone cutting tool can be inserted from a plurality of directions, and the femur can be cut from a plurality of directions. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is a front view of a bone resection guide according to an embodiment of the present invention. [Figure 2] 1 is a plan view of a bone resection guide according to an embodiment of the present invention. FIG. [Figure 3] FIG. 1 is a left side view of a bone resection guide according to an embodiment of the present invention. [Figure 4] FIG. 2 is a right side view of the bone resection guide according to the embodiment of the present invention. [Figure 5] FIG. [Figure 6] FIG. 1 is a perspective view of the distal portion of the femur of the left leg. [Figure 7] 1 is a perspective view showing an intramedullary rod according to an embodiment of the present invention inserted into a femur. [Figure 8] 1 is a perspective view showing a state in which a valgus guide according to an embodiment of the present invention is attached to a femur. FIG. [Figure 9] 10A and 10B are perspective views showing a process of attaching the osteotomy guide of one embodiment of the present invention to the eversion guide. [Figure 10] 1 is a perspective view showing a state in which an osteotomy guide according to an embodiment of the present invention is attached to an eversion guide. FIG. [Figure 11] FIG. 10 is a perspective view showing a state in which a front fixing pin of one embodiment of the present invention is inserted to fix the bone resection guide. [Figure 12] FIG. 10 is a perspective view showing a state in which the front fixing pin and the side fixing pin of the embodiment of the present invention are inserted to fix the bone resection guide. [Figure 13] 1 is a perspective view showing a state in which the osteotomy guide of one embodiment of the present invention has been fixed to the femur and the intramedullary rod has been removed. FIG. [Figure 14] 1 is a perspective view showing a state in which the osteotomy guide of one embodiment of the present invention has been fixed to the femur and the valgus guide has been removed. FIG. [Figure 15] FIG. 10 is a plan view of a first main body portion according to another embodiment of the present invention. [Figure 16] FIG. 10 is a front view of a first main body portion according to another embodiment of the present invention. [Figure 17] FIG. 10 is a plan view of a second main body portion according to another embodiment of the present invention. [Figure 18] FIG. 10 is a front view of a second main body portion according to another embodiment of the present invention. [Figure 19] FIG. 10 is a left side view of a second main body portion according to another embodiment of the present invention. [Figure 20] This is a top view of the proximal region of the tibia of the right leg. [Figure 21] FIG. 10 is a plan view showing a state in which a first main body portion according to another embodiment of the present invention is attached to a tibia. [Figure 22] 10A and 10B are plan views illustrating a process of attaching a second body portion to a first body portion according to another embodiment of the present invention. [Figure 23] FIG. 10 is a plan view showing a state in which a second main body portion according to another embodiment of the present invention is attached to a tibia. [Figure 24] 10A to 10C are plan views showing a process of cutting a tibia using a bone cutting guide according to another embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0012] Preferred embodiments of the present invention will be described with reference to the accompanying drawings. Note that the embodiments described below do not limit the content of the present invention as defined in the claims. Furthermore, not all of the configurations described below are necessarily essential requirements of the present invention. Hereinafter, the terms anterior, posterior, upper, lower, one side, and other side refer to the anterior, posterior, upper, lower, inner side of the knee, and outer side of the knee of a human patient when the osteotomy guides 1 and 1A are attached to the femur 2 and tibia 4.

[0013] 1 to 4, the bone cutting guide 1 of this embodiment is a guide used when cutting the distal portion 2A (see FIG. 6, etc.) of a human femur 2, and is integrally formed with a first main body portion 11 and a second main body portion 12. The second main body portion 12 is connected to a lower end portion 15 of the first main body portion 11 and extends at a right angle to the first main body portion 11.

[0014] The first main body portion 11 has a front end portion 13, a rear end portion 14, a lower end portion 15, an upper end portion 16, one end portion 17, and the other end portion 18. The first main body portion 11 also has two guide holes 19, 20, a plurality of pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, 25B, and two mounting grooves 26, 27 formed therein.

[0015] The guide holes 19, 20 are elongated through-holes that penetrate the first main body portion 11 in the front-rear direction, and the blade portion 3A (see FIG. 5) of a bone cutting tool 3 such as a bone saw is inserted into these guide holes 19, 20. The lengths G1, G2 of the guide holes 19, 20 in the short side direction are formed slightly longer than the thickness D of the blade portion 3A. In other words, the guide holes 19, 20 are formed so that there is a slight play when the thin plate-shaped blade portion 3A is inserted.

[0016] Guide hole 19 is formed closer to lower end 15 than pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B, and guide hole 20 is formed closer to upper end 16 than pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B. Guide holes 19 and 20 constitute a pair of first guide holes of the present invention.

[0017] The pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B are circular through-holes that penetrate the first main body portion 11 in the front-to-rear direction, and receive fixation pins 28 that fix the osteotomy guide 1 to the femur 2. As shown in FIG. 2 , the pin holes 21A and 21B are formed as a pair at a predetermined interval M1 in the longitudinal direction of the first main body portion 11. The pin holes 22A and 22B are formed as a pair at a predetermined interval M2 in the longitudinal direction of the first main body portion 11. The pin holes 23A and 23B are formed as a pair at a predetermined interval M3 in the longitudinal direction of the first main body portion 11. The pin holes 24A and 24B are formed as a pair at a predetermined interval M4 in the longitudinal direction of the first main body portion 11. The pin holes 25A and 25B are formed in pairs at a predetermined interval M5 in the longitudinal direction of the first main body portion 11. The intervals M1, M2, M3, M4, and M5 are all formed to be the same length. Note that the intervals M1, M2, M3, M4, and M5 can be set to any desired length as long as the osteotomy guide 1 can be reliably fixed to the femur 2.

[0018] Pin holes 22A and 22B are located closer to the lower end 15 than pin holes 21A and 21B, pin holes 23A and 23B are located closer to the lower end 15 than pin holes 22A and 22B, pin holes 24A and 24B are located closer to the upper end 16 than pin holes 21A and 21B, and pin holes 25A and 25B are located closer to the upper end 16 than pin holes 24A and 24B.

[0019] Pin holes 22A and 22B are formed at positions offset 2 mm toward lower end 15 and 4 mm toward the other end 18 with respect to pin holes 21A and 21B. Pin holes 23A and 23B are formed at positions offset 2 mm toward lower end 15 and 4 mm toward the other end 18 with respect to pin holes 22A and 22B. Pin holes 24A and 24B are formed at positions offset 2 mm toward upper end 16 and 4 mm toward the other end 18 with respect to pin holes 21A and 21B. Pin holes 25A and 25B are formed at positions offset 2 mm toward upper end 16 and 4 mm toward the other end 18 with respect to pin holes 24A and 24B. In this embodiment, the offset amounts of pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B are set to 2 mm and 4 mm as described above, but the offset amounts can be set to any desired amount, such as 1 mm and 2 mm, or 2 mm and 3 mm.

[0020] The mounting grooves 26, 27 are portions for mounting the eversion guide 52, which will be described later, and have a bottomed groove shape. As shown in Figures 3 and 4, the mounting grooves 26, 27 have an inverted T-shape with vertical grooves 29, 30 and horizontal grooves 31, 32 when viewed from the one end 17 side and the other end 18 side, and the mounting groove 26 is formed so that it opens on the lower end 15 side, the one end 17 side, and the other end 18 side, while the mounting groove 27 is formed so that it opens on the upper end 16 side, the one end 17 side, and the other end 18 side.

[0021] 2 and 4, guide groove 19 is located closer to lower end 15 than pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B, and is located closer to upper end 16 than mounting groove 26. Also, guide groove 20 is located closer to upper end 16 than pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B, and is located closer to lower end 15 than mounting groove 27.

[0022] The second body portion 12 has a front end portion (not shown), a rear end portion 42, a lower end portion 43, an upper end portion 44, an inner end portion 45, and an outer end portion 46. The upper end portion is connected to the rear end portion 14 of the first body portion 11, and one side end portion 17 of the first body portion 11 and the outer end portion 46 of the second body portion 12 are flush with each other. The second body portion 12 also has two guide holes 47, 48 and a pair of pin holes 49A, 49B formed therein.

[0023] As shown in Figures 3 and 4, the guide holes 47, 48 are elongated through-holes that penetrate the second main body portion 12 in the inward / outward direction (left / right direction), and the blade portion 3A of the bone cutting tool 3 is inserted into these guide holes 47, 48. The short-side lengths G3, G4 of the guide holes 47, 48 are formed to be slightly longer than the thickness D of the blade portion. In this embodiment, the short-side lengths G3, G4 of the guide holes 47, 48 are the same as the short-side lengths G1, G2 of the guide holes 19, 20. The guide holes 47, 48 constitute a pair of second guide holes of the present invention.

[0024] Guide groove 19 and guide hole 47 do not communicate with each other, but are located on the same plane, and the longitudinal direction of guide groove 19 is perpendicular to the longitudinal direction of guide hole 47. Furthermore, guide groove 20 and guide hole 48 do not communicate with each other, but are located on the same plane, and the longitudinal direction of guide groove 20 is perpendicular to the longitudinal direction of guide hole 48.

[0025] The pin holes 49A and 49B are circular through-holes that penetrate the second main body portion 12 in the medial-lateral direction (left-right direction), and are used to insert fixing pins 28 that fix the osteotomy guide 1 to the femur 2. The pin holes 49A and 49B are formed as a pair with a predetermined interval M6 in the longitudinal direction of the second main body portion 12. Note that the interval M6 can be set to a desired length in relation to the intervals M1, M2, M3, M4, and M5 of the pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B as long as the osteotomy guide 1 can be reliably fixed to the femur 2.

[0026] Here, we will explain how to use the osteotomy guide 1 when performing osteotomy on the left femur 2. First, as shown in Fig. 6, the quadriceps tendon, patellar tendon, patella, etc. are incised to expose the distal part 2A of the femur 2, and then, as shown in Fig. 7, an intramedullary rod 51 is inserted into the medullary cavity 2B of the femur 2.

[0027] Next, as shown in FIG. 8 , a valgus guide 52 is attached to the intramedullary rod 51. The valgus guide 52 has a plate-shaped paddle 53 that abuts against the distal articular surface 2C of the femur 2, an attachment portion 54 that attaches the osteotomy guide 1 to the valgus guide 52, and a connecting portion 55 that connects the paddle 53 to the attachment portion 54. The paddle 53 is adjustable in its internal / external valgus angle relative to the distal articular surface 2C, and the attachment angle of the osteotomy guide 1 is determined by adjusting the angle of the paddle 53. After adjusting the attachment angle of the paddle 53, the valgus guide 52 is fixed by an angle fixing portion 56. The attachment portion 54 is formed in an inverted T-shape with a vertical plate portion 57 and a horizontal plate portion 58.

[0028] Next, as shown in Fig. 9, the osteotomy guide 1 is attached to the attachment portion 54. At this time, the attachment portion 54 is slid and inserted into the attachment groove 26 so that the vertical plate portion 57 is positioned in the vertical groove portion 29 and the horizontal plate portion 58 is positioned in the horizontal groove portion 31. Furthermore, as shown in Fig. 10, by bringing the second main body portion 12 closer to the femur 2, the fixation accuracy of the fixation pin 28 can be improved.

[0029] Next, with fixing pin 28 attached to a drilling jig (not shown) such as an electric drill, fixing pin 28 is inserted into pin hole 21A, and the drilling jig is driven to insert and fix fixing pin 28 into femur 2 while scraping femur 2 with fixing pin 28. Similarly, fixing pin 28 is inserted into pin hole 21B, and fixing pin 28 is inserted and fixed into femur 2 (see FIG. 11).

[0030] Next, the fixing pins 28 attached to the drilling jig are inserted into the pin holes 49A and 49B in order, and the drilling jig is driven to insert and fix the fixing pins 28 into the femur 2 while scraping the femur 2 with the fixing pins 28 (see Figure 12). In this way, the osteotomy guide 1 is fixed to the femur 2 from two directions, the front side and the side side (inside of the knee), by the fixing pins 28, and is therefore reliably fixed.

[0031] Next, as shown in Figures 13 and 14, the intramedullary rod 51 is pulled out from the medullary cavity 2B, the angle fixing part 56 is removed, and the eversion guide 52 is removed from the osteotomy guide 1, completing the installation of the osteotomy guide 1. In this state, the blade portion 3A of the osteotomy tool 3 is inserted into the guide holes 19 and 47 to cut the distal portion 2A of the femur 2 and resect a portion of the distal portion 2A. Because the guide hole 19 of the first body part 11 and the guide hole 47 of the second body part 12 are located on the same plane, the cut surface when the blade portion 3A of the osteotomy tool 3 is inserted into the guide hole 19 and the femur 2 is cut is the same as the cut surface when the blade portion 3A is inserted into the guide hole 47 and the femur 2 is cut. Note that the guide hole 20 of the first body part 11 and the guide hole 48 of the second body part 12 are located on the same plane. After the osteotomy is completed, all the fixing pins 28 are pulled out and the osteotomy guide 1 is removed.

[0032] In some cases, after partially resecting the distal portion 2A of the femur 2 using the above-described method, it may be necessary to further increase the amount of bone resection in the distal portion 2A. In such cases, the lateral fixation pins 28 are pulled out of the pin holes 49A and 49B, and the osteotomy guide 1 is removed from the front fixation pin 28 while the front fixation pin 28 remains fixed to the femur 2. Depending on the amount of resection desired, either pin holes 22A and 22B or pin holes 23A and 23B are selected, and the front fixation pin 28 is inserted into the selected pin holes 22A and 22B or pin holes 23A and 23B, thereby reattaching the osteotomy guide 1 to the front fixation pin 28. If the resection amount is 2 mm, use the pin holes 22A and 22B; if the resection amount is 4 mm, use the pin holes 23A and 23B. Then, the lateral fixation pins 28 are inserted into the pin holes 49A and 49B and the insertion holes. In this state, the blade portion 3A of the bone cutting tool 3 is inserted into the guide holes 19, 47, and the distal portion 2A of the femur 2 is further cut.

[0033] The osteotomy guide 1 is a guide for both right and left use that can also be used for osteotomy of the femur 2 of the right leg. When using it for osteotomy of the femur 2 of the right leg, the osteotomy guide 1 is fixed to the femur 2 so that the second main body portion 12 is positioned on the inside of the right knee. At this time, the eversion guide 52 is attached using the attachment groove 27. Then, the blade portion 3A of the osteotomy tool 3 is inserted into the guide holes 20, 48, and the distal portion 2A of the femur 2 is cut. When making an additional cut in the distal portion 2A, the pin holes 24A, 24B or the pin holes 25A, 25B are used.

[0034] The change of the pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B to be used as described above may be made not only during the additional cut but also before the osteotomy of the femur 2. Furthermore, the pin holes 21A and 21B are usually used to attach the osteotomy guide 1 to the femur 2 at a position where the second main body portion 12 is close to the inside of the femur 2. Therefore, when changing the pin hole to be used and moving the position of the osteotomy guide 1 in the proximal direction of the femur 2, the osteotomy guide 1 (second main body portion 12) may come into contact with the femur 2 and may not be able to be moved parallel in one direction (the direction of the white arrow Y1 or Y2 in FIG. 2 ). Therefore, in this embodiment, the pin holes 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B are formed closer to the other end 18 than the pin holes 21A and 21B, and when the pin holes 21A and 21B are changed to the pin holes 22A, 22B, 23A, and 23B, the bone resection guide 1 can be attached by translating it in a diagonal direction (the direction of the white arrow Y3 in FIG. 2 ) in the direction in which the second main body portion 12 moves slightly away from the femur 2 and in the one direction (the direction of the white arrow Y1 in FIG. 2 ). Furthermore, when the pin holes 21A and 21B are changed to the pin holes 24A, 24B, 25A, and 25B, the bone resection guide 1 can be attached by translating it in a diagonal direction (the direction of the white arrow Y4 in FIG. 2 ) in the direction in which the second main body portion 12 moves slightly away from the femur 2 and in the one direction (the direction of the white arrow Y2 in FIG. 2 ).

[0035] As described above, the bone cutting guide 1 of this embodiment has the first main body portion 11 and the second main body portion 12, the first main body portion 11 is disposed on the front side of the femur 2 to be cut, the second main body portion 12 is disposed on the lateral side of the femur 2, the first main body portion 11 is formed with the guide holes 19, 20, and the second main body portion 12 is formed with the guide holes 47, 48, so that the blade portion 3A of the bone cutting tool 3 can be inserted from the front side using the guide holes 19, 20 to cut the femur 2 from the front side, and the blade portion 3A of the bone cutting tool 3 can be inserted from the lateral side (the medial side of the knee) using the guide holes 47, 48 to cut the femur 2 from the lateral side (the medial side of the knee). Therefore, even if the medial side of the femur 2 is sclerotic, the second main body portion 12 is close to the medial side of the femur 2, so the blade portion 3A is less likely to wobble, and the medial part of the femur 2 can be cut with high precision.

[0036] Furthermore, in the bone cutting guide 1 of this embodiment, the guide holes 19, 20 are elongated through-holes that penetrate the first main body portion 11 in the front-rear direction, and the guide holes 47, 48 are elongated through-holes that penetrate the second main body portion 12 in the left-right direction, and the guide holes 19, 20 and the second guide holes 47, 48 are located on the same plane, so that the cutting surface when the blade portion 3A of the bone cutting tool 3 is inserted into the guide hole 19 to cut the femur 2 is flush with the cutting surface when the blade portion 3A is inserted into the guide hole 47 to cut the femur 2. Furthermore, the cutting surface when the blade portion 3A of the bone cutting tool 3 is inserted into the guide hole 20 to cut the femur 2 is flush with the cutting surface when the blade portion 3A is inserted into the guide hole 48 to cut the femur 2.

[0037] Furthermore, in the bone cutting guide 1 of this embodiment, the longitudinal direction of the guide holes 19, 20 and the longitudinal direction of the guide holes 47, 48 are perpendicular to each other, so that the blade portion 3A of the bone cutting tool 3 can be inserted into the guide holes 19, 20 and the guide holes 47, 48 at angles that differ by 90 degrees to cut the femur 2. Therefore, the portion of the femur 2 that is cut at a position distant from the bone cutting guide 1 is reduced, and cutting accuracy can be improved.

[0038] Furthermore, in the bone resection guide 1 of this embodiment, the first main body portion 11 has pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B through which the fixation pin 28 is inserted, the second main body portion 12 has pin holes 49A and 49B through which the fixation pin 28 is inserted, the guide holes 19 and 20 are a pair of guide holes 19 and 20 formed in parallel, the guide holes 47 and 48 are a pair of guide holes 47 and 48 formed in parallel, the first pin holes 21A, 21B, 22A, 22B, 23A, 23B, 24A, 24B, 25A, and 25B are formed between the pair of guide holes 19 and 20, and the pin holes 49A and 49B are formed between the pair of guide holes 47 and 48, and therefore the bone resection guide 1 can be used for osteotomy of the left and right femurs 2.

[0039] Figures 15 to 24 show another embodiment. The bone cutting guide 1A of this embodiment shown in Figures 15 to 19 is a guide used when cutting the proximal portion 4A of a human tibia 4, and is configured to have a first main body portion 61 and a second main body portion 62.

[0040] As shown in FIGS. 15 and 16 , the first main body 61 integrally includes a front guide portion 63 and a connecting protrusion 64. The front guide portion 63 has a front end portion 65, a rear end portion 66, an upper end portion 67, a lower end portion 68, and an other end portion 69. The front end portion 65 has a front curved portion 70 curved rearward, and the rear end portion 66 has a rear curved portion 71 curved rearward. The front curved portion 70 and the rear curved portion 71 are connected at the end opposite the other end portion 69, and this connecting portion, i.e., one end portion 72, has a tapered shape in the plan view shown in FIG. 15 . The front guide portion 63 also has one guide hole 73 and two pin holes 74A and 74B.

[0041] The guide hole 73 is a long, narrow through-hole that penetrates the front guide part 63 in the front-rear direction, and the blade part 3A (see FIG. 5) of the bone cutting tool 3 is inserted into this guide hole 73. The length G5 of the guide hole 73 in the short side direction is formed to be slightly longer than the thickness D of the blade part 3A. In other words, the guide hole 73 is formed so that there is a slight play when the thin-plate-shaped blade part 3A is inserted.

[0042] The guide hole 73 is formed closer to the upper end portion 67 than the pin holes 74A and 74B, and has a length that is approximately 90% of the length of the front guide portion 63 in the longitudinal direction.

[0043] The pin holes 74A and 74B are circular through-holes that pass through the front guide portion 63 in the front-rear direction, and allow the fixing pins 28 that fix the front guide portion 63 to the tibia 4 to pass through.

[0044] The connecting protrusion 64 protrudes forward from the lower portion of the front curved portion 70. The connecting protrusion 64 extends in a direction substantially perpendicular to the longitudinal direction of the front guide portion 63. The connecting protrusion 64 has a front side portion 75, a rear side portion (not shown), an upper side portion 76, a lower side portion 77, an inner side portion 78, and an outer side portion 79. The connecting protrusion 64 is formed in a horizontally elongated rectangular shape in a front view shown in FIG. 16. The thickness H1 of the connecting protrusion 64 is approximately ¼ of the thickness H2 of the front guide portion 63, and the lower side portion 77 of the connecting protrusion 64 is flush with the lower end portion 68 of the front guide portion 63. The tip corners 80A and 80B of the connecting protrusion 64 are formed in an arc shape in a plan view shown in FIG. 15. The rear side portion of the connecting protrusion 64 is connected to the front curved portion 70 of the front guide portion 63. In this embodiment, the connecting protrusion 64 has a width W1 of 10 mm, a length L of 20 mm at its longest point, and a thickness H1 of 3 mm, but the dimensions may be changed as long as the first main body portion 61 and the second main body portion 62 can be reliably attached and detached.

[0045] As shown in FIGS. 17 to 19, the second main body portion 62 integrally includes an inner guide portion 81 and a connection receiving portion 82. The inner guide portion 81 has an upper end portion 83, a lower end portion 84, one end portion 85, the other end portion 86, and a rear end portion 87. A curved one-side curved portion 88 is formed in the front portion of the one end portion 85 (the portion on the connection receiving portion 82 side), and a curved other-side curved portion 89 is formed in the front portion of the other end portion 86 (the portion on the connection receiving portion 82 side). As shown in FIG. 18, the lower end portion 84 of the inner guide portion 81 is inclined so that the one end portion 85 side is thinner than the other end portion 86 side.

[0046] The inner guide portion 81 is formed with one guide hole 90 and one pin hole 91. The guide hole 90 is a long, narrow through-hole that penetrates the inner guide portion 81 in the inward-outward direction (left-right direction), and the blade portion 3A (see FIG. 5) of the bone cutting tool 3 is inserted into this guide hole 90. The length G6 of the guide hole 90 in the short side direction is slightly longer than the thickness D of the blade portion 3A. In other words, the guide hole 90 is formed so that there is a slight amount of play when the thin-plate-shaped blade portion 3A is inserted. The guide hole 90 is formed closer to the upper end portion 83 than the pin hole 91, and has a length that is approximately 90% of the longitudinal length of the inner guide portion 81.

[0047] The guide groove 73 and the guide hole 90 do not communicate with each other, but are located on the same plane, and the longitudinal direction of the guide groove 73 and the longitudinal direction of the guide hole 90 are perpendicular to each other.

[0048] The pin hole 91 is formed at the tip 81A of the inner guide portion 81 and is a circular through hole that penetrates the inner guide portion 81 in the inward-outward direction (left-right direction), and is used to insert a fixation pin 28 that fixes the second main body portion 62 to the tibia 4.

[0049] The connecting receiving portion 82 is disposed in a lower portion of the second main body portion 62 and has an upper side surface portion 92, a lower side surface portion 93, an inner side surface portion 94, an outer side surface portion 95, a front side surface portion 96, and a rear side surface portion 97. The connecting receiving portion 82 is formed with a connecting insertion hole 98, which is a rectangular through-hole that penetrates the connecting receiving portion 82 in the front-to-rear direction. The rear end portion 97 is curved in the plan view shown in FIG. 17, and is formed so that the one side end portion 94 side is longer in the front-to-rear direction than the other side end portion 95 side. The connecting receiving portion 82 and the connecting insertion hole 98 are formed in a horizontally elongated rectangular shape in the front-to-rear view shown in FIG.

[0050] The connecting insertion hole 98 is formed larger than the outer shape of the connecting protrusion 64. When the connecting protrusion 64 is inserted into the connecting insertion hole 98, the connecting protrusion 64 is movable in the left-right direction within the connecting insertion hole 98, but the upper side surface portion 76 and the lower side surface portion 77 of the connecting protrusion 64 abut against the inner surface of the connecting insertion hole 98 to prevent rattling in the up-down direction. In this embodiment, the left-right length W2 of the connecting insertion hole 98 is formed to be about 1.5 times the left-right width W1 of the connecting protrusion 64 (approximately 15 mm), but this dimension is not limited to approximately 15 mm and can be determined appropriately in relation to the width W1 of the connecting protrusion 64.

[0051] The thickness H3 of the connecting receiving portion 82 is approximately 1 / 3 of the thickness H4 of the thickest part of the inner guide portion 81, and the lower side surface portion 93 of the connecting receiving portion 82 is continuous with the lower end portion 84 of the inner guide portion 81.

[0052] Here, a method of using the osteotomy guide 1A when performing osteotomy on the tibia 4 of the right leg will be described. First, as shown in Fig. 20, the quadriceps tendon, patellar tendon, patella, etc. are incised to expose the proximal portion 4A of the tibia 4, and an adjuster (not shown) is used to determine the attachment position of the first main body portion 61. A conventional adjuster can be used as this adjuster, and although not shown, the first main body portion 61 has a mechanism that allows it to be attached to the adjuster.

[0053] Next, as shown in Figure 21, the first main body part 61 is placed at the mounting position, the fixing pin 28 attached to the drilling jig is inserted sequentially into the pin holes 74A and 74B, the drilling jig is driven, and the fixing pin 28 is inserted and fixed to the tibia 4 while scraping the tibia 4 with the fixing pin 28.

[0054] 22 , the second main body portion 62 is moved in the direction of the white arrow Y5 to insert the connecting protrusion 64 into the connecting insertion hole 98, and the second main body portion 62 is attached to the first main body portion 61. At this time, the rear end portion 87 of the medial guide portion 81 can push aside soft tissue (not shown) on the medial side of the tibia 4. It is preferable that the connecting protrusion 64 be fully inserted into the connecting insertion hole 98 so that the front curved portion 70 of the front guide portion 63 abuts against the rear side surface portion 97 of the connecting receiver 82. However, if the rear end portion 87 interferes with soft tissue or the like and the connecting protrusion 64 cannot be fully inserted into the connecting insertion hole 98, the insertion may be stopped midway.

[0055] Next, as shown in Figure 23, the second main body portion 62 is moved in the direction of the white arrow Y6 to adjust the position of the second main body portion 62 in the medial-lateral direction (left-right direction), the fixing pin 28 attached to the drilling jig is inserted into the pin hole 91, the drilling jig is driven, and the fixing pin 28 is inserted and fixed to the tibia 4 while scraping the tibia 4 with the fixing pin 28. In this way, the osteotomy guide 1A is fixed to the tibia 4 from two directions, the front side and the lateral side (the inside of the knee), by the fixing pin 28, and is therefore reliably fixed. This completes the installation of the osteotomy guide 1A. In addition to fixing the second main body portion 62, the fixing pin 28 can also function as a retractor for the soft tissue on the inside of the tibia 4.

[0056] In this state, the blade portion 3A of the osteotomy tool 3 is inserted into the guide holes 73 and 90, and the proximal portion 4A of the tibia 4 is cut to resect a portion of the proximal portion 4A. As shown in FIG. 24 , by inserting the blade portion 3A into the guide hole 90, the osteotomy can be performed with the tip of the blade portion 3A facing the soft tissue (not shown) present on the anterior-lateral side of the tibia 4. Therefore, the osteotomy can be performed up to a position close to the soft tissue without damaging the soft tissue. When the osteotomy guide 1A is installed, the guide hole 73 of the first main body portion 61 and the guide hole 90 of the second main body portion 62 are positioned on the same plane. Therefore, the cut surface when the blade portion 3A of the osteotomy tool 3 is inserted into the guide hole 73 and the tibia 4 are cut will be on the same plane as the cut surface when the blade portion 3A is inserted into the guide hole 90 and the tibia 4 is cut. After the osteotomy is completed, all the fixation pins 28 are pulled out, and the osteotomy guide 1A is removed.

[0057] In the bone cutting guide 1A of this embodiment, the connecting protrusion 64 is provided on the lower part of the first main body part 61. Therefore, when using the bone cutting tool 3 shown in FIG. 5 and inserting the blade part 3A into the guide hole 73 to perform bone cutting, the blade holding part 3B of the bone cutting tool 3 may come into contact with the second main body part 62. In this case, by using the bone cutting tool 3 upside down, the blade mounting part 3C, which is lower in height than the blade holding part 3B, is on the lower side, making it less likely to come into contact with the second main body part 62. Note that the femur 2 and tibia 4 may be cut using other bone cutting tools instead of the bone cutting tool 3 shown in FIG. 5.

[0058] As described above, the bone cutting guide 1A of this embodiment has the first main body portion 61 and the second main body portion 62, the first main body portion 61 is disposed on the front side of the tibia 4 to be cut, the second main body portion 62 is disposed on the lateral side of the tibia, the guide hole 73 is formed in the first main body portion 61, and the guide hole 90 is formed in the second main body portion 62, so that the blade portion 3A of the bone cutting tool 3 can be inserted from the front side using the guide hole 73 to cut the tibia 4 from the front side, and the blade portion 3A of the bone cutting tool 3 can be inserted from the lateral side (the medial side of the knee) using the guide hole 90 to cut the tibia 4 from the lateral side (the medial side of the knee). Therefore, even if the medial side of the tibia 4 is hardened, the second main body portion 62 is close to the medial side of the tibia 4, so the blade portion 3A is less likely to wobble, and the medial part of the tibia 4 can be cut with high precision. Furthermore, since the tip of the blade portion 3A can be directed toward soft tissue such as the patellar tendon that is present on the front and outer sides of the tibia 4, bone cutting can be performed without damaging the soft tissue.

[0059] In addition, in the bone cutting guide 1A of this embodiment, the guide hole 73 is a long, thin through hole that penetrates the first main body portion 61 in the front-to-back direction, and the guide hole 90 is a long, thin through hole that penetrates the second main body portion 62 in the left-to-right direction.Since the guide holes 73 and 90 are located on the same plane, the cutting surface when the blade portion 3A of the bone cutting tool 3 is inserted into the guide hole 73 to cut the tibia 4 and the cutting surface when the blade portion 3A is inserted into the guide hole 90 to cut the tibia 4 are on the same plane.

[0060] Furthermore, in the bone cutting guide 1A of this embodiment, the longitudinal direction of the guide hole 73 and the longitudinal direction of the guide hole 90 are perpendicular to each other, so that the blade portion 3A of the bone cutting tool 3 can be inserted into the guide hole 73 and the guide hole 90 at angles that differ by 90 degrees to cut the tibia 4. Therefore, the portion of the tibia 4 that is cut at a position distant from the bone cutting guide 1A is reduced, and cutting accuracy can be improved.

[0061] Furthermore, in the bone resection guide 1A of this embodiment, the first main body portion 61 has a connecting protrusion 64, and the second main body portion 62 has a connecting receiver 82, which has a connecting insertion hole 98 formed therein, and the first main body portion 61 and the second main body portion 62 can be attached and detached by inserting and removing the connecting protrusion 64 into and from the connecting insertion hole 98. When the connecting protrusion 64 is inserted into the connecting insertion hole 98, the connecting protrusion 64 does not move up and down within the connecting insertion hole 98 but can move left and right. This makes it possible to adjust the position of the second main body portion 62 left and right after the first main body portion 61 is fixed to the anterior side of the tibia 4. Therefore, even if the size of the tibia 4 varies among individuals, positioning adapted to the size of the tibia 4 can be easily performed.

[0062] In addition, the bone resection guide 1A of this embodiment has a pin hole 91 formed at the tip 81A of the second main body portion 62, through which the fixing pin 28 is inserted, so that the tip 81A of the second main body portion 62 can push aside the soft tissue, and the fixing pin 28 inserted into the pin hole 91 can function as a retractor for the soft tissue.

[0063] Furthermore, in the bone cutting guide 1A of this embodiment, the connecting protrusion portion 64 is arranged on the lower part of the first main body portion 61 and the connecting receiving portion 82 is arranged on the lower part of the second main body portion 62, so that when the blade portion 3A of the bone cutting tool 3 is inserted into the guide hole 73 to perform bone cutting, the blade holding portion 3B and blade mounting portion 3C of the bone cutting tool 3 are less likely to come into contact with the second main body portion 62.

[0064] The present invention is not limited to the above-described embodiment, and various modifications are possible within the scope of the present invention. Therefore, as long as the same functions and effects are achieved, the outer shape of the bone resection guide can be changed without impairing its functionality, for example, by making the shape easier to grip or by chamfering the corners. [Explanation of symbols]

[0065] 1 Osteotomy Guide 2 Femur (bone) 2A Distal part 11 First main body part 12 Second main body part 19 Guide hole (first guide hole) 20 Guide hole (first guide hole) 21A Pinhole (1st pinhole) 21B Pinhole (First Pinhole) 22A Pinhole (1st Pinhole) 22B Pinhole (1st pinhole) 23A Pinhole (1st pinhole) 23B Pinhole (First Pinhole) 24A Pinhole (1st Pinhole) 24B Pinhole (1st pinhole) 25A pin hole (first pin hole) 25B pin hole (first pin hole) 26 Mounting groove 27 Mounting groove 28 Fixing pin 47 Guide hole (second guide hole) 48 Guide hole (second guide hole) 49A Pin hole (second pin hole) 49B Pin hole (second pin hole) 52 Valgus Guide 54 Mounting part

Claims

1. A bone cutting guide used to cut the distal portions of the left and right femurs, a first body portion and a second body portion extending perpendicularly to the first body portion; A pair of parallel first guide holes are formed in the first main body portion, A pair of parallel second guide holes are formed in the second main body portion, the first main body portion has a first pin hole between the pair of first guide holes through which a fixing pin is inserted, the second main body portion has a second pin hole between the pair of second guide holes through which a fixing pin is inserted, A bone cutting guide characterized in that, regardless of whether it is used for the left or right foot, the first main body portion is arranged in front of the femur to be cut, and the second main body portion is arranged on the inside of the femur to be cut.

2. 2. The bone resection guide according to claim 1, wherein the first pin holes are formed of a plurality of pairs of pin holes spaced equally apart in the left-right direction in the first main body portion.

3. 3. The bone resection guide according to claim 2, wherein the pin holes of each pair are offset in position toward the pair of first guide holes.

4. The osteotomy guide is attached to a valgus guide when attached to the femur; The eversion guide has an attachment portion, The bone resection guide according to any one of claims 1 to 3, characterized in that the upper and lower ends of the first main body portion are formed with mounting grooves that allow the first main body portion to be slid onto the mounting portion for mounting.

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