Screw reinforcement inserter

Abstract

To provide an inserter which is an insertion device (inserter) of a reinforcement material of a percutaneous screw and can insert rod-like body hydroxyapatite.SOLUTION: An inserter of a reinforcement material of a screw comprises: an inserter body of a reinforcement material of a screw which separately has a lumen for guide member insertion for inserting a guide member that guides a screw into a bone hole and a lumen for reinforcement material insertion for inserting a reinforcement material into the bone hole; and a piston for pushing the reinforcement material into the bone hole.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The present invention relates to an inserter for inserting a reinforcing material such as artificial bone into a screw hole from a screw insertion hole in order to reinforce the fixation of a screw in spinal fixation or the like.

Background Art

[0002] In spinal fixation, fixation of the spine with screws is known as a standard surgical technique. However, since screw fixation is highly invasive, it causes significant tissue damage to muscles, ligaments, etc. around the spine, resulting in an increase in intraoperative bleeding and exacerbation of postoperative wound pain. Fig. 8(a) shows the state of screw fixation in a conventional typical spinal fixation. As shown in the figure, in order to widely expose the spine by greatly expanding the incision A, after the surgeon creates a bone hole while visually confirming the bone morphology, it is possible to reliably insert a rod-shaped hydroxyapatite known as artificial bone for screw fixation into the screw hole.

[0003] On the other hand, due to the recent demand for minimally invasive spinal fixation, MISt (Minimally Invasive spine Stabilization) has become popular as a technique for achieving spinal stability by minimally invasively fixing and immobilizing various pathological conditions such as spinal instability and imbalance caused by spinal deformity. Along with this, fixation with percutaneous screws, which are less burdensome on patients compared to conventional screws and allow minimally invasive percutaneous insertion, has become widespread.

[0004] However, when inserting a percutaneous screw, it is difficult to visually confirm the screw insertion hole on the bone surface because the surgical wound is small. Furthermore, the guide wire or the like inserted into the screw hole becomes an obstacle, making it impossible to insert a rod-shaped artificial bone into the screw hole. Therefore, it is not possible to directly apply the reinforcement of screw fixation using a conventional rod-shaped artificial bone to percutaneous screw fixation.

[0005] Under these circumstances, the inventor has developed a percutaneous screw reinforcing material insertion device (inserter) that can reliably and easily insert reinforcing material into a screw hole, regardless of the difficulty of directly viewing the screw insertion hole or the obstruction of reinforcing material insertion by a guide member placed in the screw hole (Patent Document 1). The percutaneous screw reinforcing material insertion device is generally as shown in Figure 8(b), and consists of a guide member 102 capable of guiding the screw, an inner cylinder 103 and an outer cylinder 101, each of which can slide relative to each other when inserted into each other, and the outer cylinder 101 is configured to have a funnel-shaped opening for introducing reinforcing material 104. [Prior art documents] [Patent Documents]

[0006] [Patent Document 1] Japanese Patent Publication No. 2018-027264 [Overview of the project] [Problems that the invention aims to solve]

[0007] In the percutaneous screw reinforcement insertion device disclosed in Patent Document 1, screw insertion and reinforcement are performed by the following procedure, as shown in Figures 9(a) to 9(j). (a) Using a needle or the like (not shown), insert the guide wire 102 into the insertion point B and position it. (b) After inserting the guide wire 102, the soft tissue C and bone tissue D are sequentially expanded by tapping, starting from the screw insertion hole E, to form the screw hole F. (c) Insert the outer tube 101 along the guide wire 102 and position the distal end of the outer tube 101 in the screw hole F. (d) Granular artificial bone 104 is introduced into the lumen of the outer cylinder 101 through the artificial bone inlet at the proximal end of the outer cylinder 101, and the artificial bone 104 is fed toward the screw hole F. (e) Insert the distal end of the inner tube 103 along the guide wire 102 through the artificial bone insertion port at the proximal end of the outer tube 101, and slide the inner tube 103 within the lumen of the outer tube 101. (f) The pressing surface of the distal end of the inner cylinder 103 is brought into contact with the inserted artificial bone 104, and the inner cylinder 103 is pushed distally, pressing the artificial bone 104 into the screw hole F. (g) Slide the inner tube 103 along the guide wire 102 within the lumen of the outer tube 101 and remove it. Then remove the outer tube 101 along the guide wire 102. Alternatively, the inner tube 103 and outer tube 101 may be removed at the same time. (h) Insert the screw 106 into the screw hole F along the guide wire 102. (i) Screw the screw 106 in with a screwdriver (not shown). This installs the screw 106 together with the artificial bone 104 into the screw hole F. (j) The guide wire 102 is withdrawn. At this time, the screw 106 is held in the screw hole F together with the artificial bone 104.

[0008] With such a percutaneous screw reinforcement insertion device, the outer cylinder 101 facilitates the introduction of the artificial bone 104 into the screw hole F, and the pressing surface of the inner cylinder 103 presses the artificial bone 104 positioned in the lumen of the outer cylinder 101 introduced toward the screw hole F, thereby more efficiently inserting the artificial bone 104 into the screw hole F. On the other hand, as an alternative to the granular artificial bone 104, the inventors have also proposed a block-shaped reinforcement material that avoids interference with the guide wire 102, such as a ring-shaped or bamboo-ring-shaped material with a hollow portion, a C-shaped material with a notch in part, or a columnar material with an axial groove.

[0009] However, manufacturing artificial bone with a special shape that avoids interference with these guide wires 102 is not practical in terms of efficiency and cost, and in practice, granular artificial bone 104 is widely used in the percutaneous screw reinforcement insertion device disclosed in Patent Document 1.

[0010] Furthermore, in the percutaneous screw reinforcement insertion device disclosed in Patent Document 1, since the guide wire 102 and granular artificial bone 104 are both contained within the same hollow structure in the insertion device, friction occurs between the granular artificial bone 104 and the guide wire 102 during insertion, hindering the smooth insertion of the artificial bone 104 and causing the guide wire 102 to shift position or become dislodged. If the artificial bone 104 cannot be inserted smoothly, it becomes necessary to apply excessive force to the device or bone during surgery, increasing the risk of fracture or nerve / vascular damage. Also, shifting or dislodging of the guide wire 102 increases the risk of blood vessel / tissue damage by the guide wire 102, or accidental screw insertion.

[0011] Therefore, the present invention aims to solve the aforementioned conventional problems and provide an inserter that, while being a percutaneous screw reinforcing material insertion device (inserter), enables the insertion of rod-shaped hydroxyapatite.

[0012] Furthermore, the aim is to provide an inserter that allows for easy insertion of reinforcing material (artificial bone) into the appropriate position in the screw hole, regardless of the difficulty in directly visualizing the screw insertion hole due to the screw guide member or the obstruction of screw reinforcing material insertion by a guide wire installed in the screw hole.

[0013] Ultimately, the goal is to enable percutaneous reinforcement using minimally invasive techniques without compromising the minimally invasive nature of percutaneous screw fixation. [Means for solving the problem]

[0014] The screw reinforcing inserter of the present invention has a lumen for inserting a guide member for inserting a guide member that guides the screw into the bone hole, and rod-shaped The screw comprises a reinforcement inserter body having a separate lumen for inserting the reinforcement material, and a piston for pushing the reinforcement material into the bone tunnel. The internal cavity for inserting the guide member and the internal cavity for inserting the reinforcing member are in a straight line from the entrance to the exit.It is characterized by the following. As the guiding member, in addition to a guide wire, a steel wire or the like can be used. Further, as the reinforcing material, in addition to an artificial bone, autologous bone collected from the patient himself / herself, allogeneic bone collected from a human other than the patient, materials such as bone cement that hardens after insertion can be used.

[0016] Further, the inserter body of the inserter for the reinforcing material of the screw of the present invention has a lumen for inserting a guiding member for inserting a screw to the inside of a bone hole and a lumen for inserting a reinforcing material for inserting a reinforcing material into the bone hole separately. rod-shaped It is characterized by having them separately. Furthermore, the internal cavity for inserting the guide member and the internal cavity for inserting the reinforcing material are in a straight line from the entrance to the exit. It is characterized by the above.

[0017] The present invention includes a first form to a third form based on the above basic configuration.

[0018] (First form) In the first form, the cylindrical inserter body has a flange portion on the proximal end side of the operator, and the piston has a bulging portion on the proximal end side of the operator.

[0019] The flange portion is configured to rest on the back of the operator's hand when the operator holds the cylindrical portion of the inserter body while fixing his / her hand to the patient's body surface, thereby maintaining a stable posture of the inserter body.

[0020] (Second form) In the second form, the cylindrical inserter body has a constricted portion on the distal end side of the operator.

[0021] The constricted portion smoothens the insertion of the inserter body into the soft tissue, and when the inserter body reaches the bone tissue, it gives the operator a feeling to that effect. Also, depending on the type and material of the reinforcing material, there may be cases where it is better for the tip of the inserter to enter deep into the bone hole, and the constricted portion also contributes to making it easier for the tip of the inserter to enter the entrance portion of the bone hole.

[0022] (Third form) In the third embodiment, the lumen for inserting the guide member and the lumen for inserting the reinforcing member are provided so as to be respectively offset to the opposite side in the radial direction of the cylindrical inserter body. However, the center of the cylindrical inserter body is positioned within the lumen for inserting the reinforcing member.

[0023] Due to the positional relationship among the inserter body, the lumen for inserting the guide member, and the lumen for inserting the reinforcing member, the guide member can guide a slide hammer that strikes the piston.

Brief Description of the Drawings

[0024] [Figure 1] It is a diagram for explaining the configuration of an inserter for a screw reinforcing material according to the first embodiment of the present invention. [Figure 2] It is a diagram for explaining the first half process of an operation example of an inserter for a screw reinforcing material according to the first embodiment of the present invention. [Figure 3] It is a diagram for explaining the second half process of an operation example of an inserter for a screw reinforcing material according to the first embodiment of the present invention. [Figure 4] It is a diagram for explaining the configuration of an inserter for a screw reinforcing material according to the second embodiment of the present invention. [Figure 5] It is a diagram for explaining the configuration of a modified example of an inserter for a screw reinforcing material according to the second embodiment of the present invention. [Figure 6] It is a diagram for explaining the first half process of an operation example of an inserter for a screw reinforcing material according to the second embodiment of the present invention. [Figure 7] It is a diagram for explaining the second half process of an operation example of an inserter for a screw reinforcing material according to the second embodiment of the present invention. [Figure 8] It is a diagram showing the state of screw reinforcement in conventional spinal fixation surgery, where (a) shows a surgical procedure by normal incision, and (b) shows a surgical procedure previously invented by the present inventor in percutaneous screws. [Figure 9]This diagram illustrates an example of the operation of a screw reinforcing material insertion device previously invented by the present inventor in percutaneous screw insertion. [Modes for carrying out the invention]

[0025] The embodiments of the present invention will be described in detail below with reference to the figures. The schematic configuration and operation example of the screw reinforcement inserter according to the first embodiment will be described using Figures 1, 2, and 3, and the schematic configuration and operation example of the screw reinforcement inserter according to the second embodiment of the present invention will be described using Figures 4, 5, and 6. In the following configuration examples, artificial bone will be described as an example of the reinforcement material, but the reinforcement material is not limited to artificial bone; autologous bone collected from the patient, allogeneic bone collected from a person other than the patient, bone cement that hardens after insertion, and other materials can be used. Although the following configuration examples are described assuming the use of a guide wire as a guide member, a guide wire with some flexibility is also acceptable as long as it can maintain straightness during insertion (in other words, a guide wire that is so flexible that it conforms to curves is unsuitable), and a rigid material such as steel wire is also acceptable.

[0026] (First Embodiment) Figure 1 is a schematic diagram illustrating the configuration of a screw reinforcing inserter according to the first embodiment of the present invention, and Figures 2 and 3 are diagrams illustrating an example of the operation of a screw reinforcing inserter according to the first embodiment of the present invention.

[0027] In the first embodiment, a rod-shaped hydroxyapatite (hereinafter referred to as "HA stick") is used as the artificial bone for reinforcement, but this does not preclude the use of other types of artificial bone. It is natural to use artificial bone of the shape and condition that is deemed best for the patient's condition, and for example, it is also possible to use artificial bone in the form of granules, powder, paste, or liquid.

[0028] Figure 1 shows a schematic diagram of the configuration of the first embodiment. In Figure 1, the main components are the inserter body 1, the guide wire 2, and the piston 3.

[0029] As mentioned above, the artificial bone used in the first embodiment is the HA stick 4. It is possible to use the same artificial bone that is widely used to reinforce screw fixation using conventional incision methods.

[0030] The inserter body 1 consists of a cylindrical portion 11, a lumen 12 for inserting a guide member, a lumen 13 for inserting a reinforcing material, a flange portion 14, and a constricted portion 15. In the first embodiment, the cylindrical portion 11 is cylindrical, but it can also be made into a square shape such as a regular hexagon or a regular octagon. However, if it is made into a square shape, it is preferable to chamfer it.

[0031] The length of the cylindrical portion 11 is set so that, for a standard adult patient, it extends approximately the length of the surgeon's hand from the bone tunnel opening in the spine to the patient's body surface, and a flange portion 14 is provided on the surgeon's proximal end of the inserter body 1. Surgical positions typically involve the patient lying prone to allow for confirmation of the anterior and lateral views of the spine at the surgical site using intraoperative fluoroscopy. In this position, the surgeon grasps the cylindrical portion 11 and fixes their hand to the patient's body surface, stabilizing the inserter body 1 and facilitating the procedure. When the length of the cylindrical portion 11 is set as described above, the flange portion 14 rests precisely on the back of the surgeon's hand upon completion of inserting the inserter body 1, thus enabling a more stable position for the inserter body 1 (see also Figure 2(b)).

[0032] The inserter body 1 is provided with a tapered constriction 15 on the distal end to the surgeon. In the first embodiment, the constriction 15 is an extension of the cylindrical tube portion 11 and is therefore frustoconical in shape, but if the tube portion 11 is square, it will be a corresponding frustoconical shape. The constriction 15 facilitates the insertion of the inserter body into the soft tissue and also contributes to making it easier for the inserter tip to enter the entrance of the bone tunnel. That is, when the inserter body reaches the bone tissue, it gives the surgeon a tactile sensation to that effect, and when performing surgery while confirming the lateral view of the spine at the surgical site with X-ray fluoroscopy, the insertion depth can be confirmed by the characteristic shape of the constriction 15. It should be noted that for reinforcing materials of a type or material that does not require the inserter tip to penetrate deep into the bone tunnel, the constriction may not be necessary, and it is sufficient to provide the constriction as needed.

[0033] The cylindrical portion 11 is provided with two separate holes: a small hole 12 for inserting the guide member and a large hole 13 for inserting the reinforcing material. The guide wire 2 and the HA stick 4 can be inserted percutaneously through these respective holes.

[0034] The guidewire 2 is a linear member that guides the screw 6, but a hook portion may be provided at the proximal end for easier grasping by the surgeon. This function will be described later. The piston 3 has an outer diameter that is slightly smaller than the inner diameter of the lumen 13 for inserting the reinforcing material, but a bulge (not shown) is provided at the proximal end for the surgeon, which serves to restrict the piston 3 from entering the lumen 13 for inserting the reinforcing material more than necessary.

[0035] The percutaneous screw reinforcement insertion device previously invented by the present inventor has a structure in which a guide member 102, an inner cylinder 103, and an outer cylinder 101 are inserted into each other (see Figures 8 and 9). Based on verification results from actual surgical experience using this insertion device (Patent Document 1), the dimensions of each element of the inserter in the first embodiment of the present invention can be set within the following range. HA stick: Diameter 2mm~3mm Guide wire: Approximately 1.5 mm in diameter Bone tunnel (screw thickness): 4.5-7.0 mm in diameter The diameter of the inserter body determined in this way is 4.0 to 6.5 mm.

[0036] The lumen 12 for inserting the guide member and the lumen 13 for inserting the reinforcing material are positioned offset to opposite radial sides of the cylindrical inserter body 1. However, the center of the cylindrical inserter body 1 is located within the lumen 13 for inserting the reinforcing material. Due to this arrangement of the elements, the guide wire 2 also functions as a guide member for the slide hammer 5 when striking the piston 3 with the slide hammer 5, which will be described later.

[0037] (Example of operation of the first embodiment) Using Figures 2 and 3, an example of the operation of a screw reinforcing inserter according to the first embodiment of the present invention will be explained.

[0038] In Figure 2(a), the guidewire 2 is inserted into the insertion point using a needle or the like (not shown). At this time, the position is confirmed under fluoroscopy as needed to determine the location where the bone hole should be created. After inserting the guidewire 2, the soft tissue and bone tissue are sequentially expanded by tapping to form the screw hole.

[0039] Once the screw hole is formed, insert the inserter body 1 along the guide wire 2, as shown in Figure 2(b). At this time, the operator keeps their hand fixed on the patient's body surface and grasps the cylindrical part 11 to feed the inserter body 1 in.

[0040] As shown in Figure 2(b), the insertion of the inserter body 1 is completed when the flange portion 14 rests precisely on the back of the operator's hand, allowing the operator to be aware of the completion of insertion. More precisely, insertion is completed by confirming, through touch and lateral view of X-ray fluoroscopy, that the constricted portion 15 provided on the distal end of the inserter body 1 is positioned at the entrance of the bone tunnel.

[0041] Next, as shown in Figure 2(c), the HA stick 4 is inserted into the lumen 13 for inserting the reinforcing material, which is another hole provided in the inserter body 1. At this time, the guide wire 2 remains inserted into the lumen 12 for inserting the guide member.

[0042] In the percutaneous screw reinforcement insertion device disclosed in Patent Document 1, although the material is granular, friction still occurred between the artificial bone 104 and the guide wire 102, as shown in Figure 8(d), which sometimes hindered the smooth insertion of the artificial bone 104. However, in the screw reinforcement inserter according to the first embodiment of the present invention, the HA stick 4 is inserted through a dedicated hole, so there is no room for friction with the guide wire 2. Naturally, there is no need to worry about the guide wire 2 shifting or coming loose.

[0043] By applying appropriate vibration to the inserter body 1, once the HA stick 4 has penetrated to a suitable depth, as shown in Figure 3(a), the piston 3 is inserted into the lumen 13 for inserting the reinforcing material, and then the piston 3 is struck with the slide hammer 5 to push the HA stick 4 into the bone tunnel. The slide hammer 5 has a notch in part and is configured to be guided by the guide wire 2.

[0044] In this case, it is desirable to avoid excessive friction between the notch of the slide hammer 5 and the guide wire 2. In the percutaneous screw reinforcement insertion device disclosed in Patent Document 1, the guide wire remains inserted inside the inner cylinder 103 corresponding to the piston 3 of the present invention, and the inner cylinder 103 is struck. As a result, a considerable frictional force acts between the inner cylinder 103 and the guide wire, which posed a risk of the guide wire accidentally penetrating the vertebra and damaging the patient's internal tissues. In the first embodiment, such a risk can be avoided.

[0045] If the HA stick 4 is properly positioned within the bone tunnel, the piston 3 is slid out from within the lumen 13 of the inserter body 1 for inserting the reinforcing material, as shown in Figure 3(b). Then the inserter body 1 is removed along the guide wire 2. Alternatively, the piston 3 and the inserter body 1 may be removed simultaneously.

[0046] Then, as shown in Figure 3(c), once the screw 6 is inserted into the screw hole along the guide wire 2, the screw 6 is screwed in with a screwdriver (not shown). This installs the screw 6 together with the HA stick 4 inside the screw hole.

[0047] Although not shown in the diagram, finally, the guide wire 2 is withdrawn, but the screw 6 remains in the screw hole together with the HA stick 4.

[0048] The first embodiment has been described above, but the details of the shape and function of each part are not limited thereto. For example, a funnel shape may be adopted as an alternative to the flange portion 14 to facilitate the use of granular artificial bone, or these bulging parts may be omitted. One of the objectives of the first embodiment is to obtain a configuration that can handle the HA stick 4, but as mentioned above, it is also possible to use artificial bone in the form of granules, powders, pastes, liquids, etc. The surgical procedure is usually determined by appropriately changing the inner diameter size of the screw hole according to the patient's body shape and symptoms, and the amount of artificial bone to be inserted will also be adjusted according to the inner diameter size of the screw hole.

[0049] (Second Embodiment) Figure 4 is a schematic diagram illustrating the configuration of a screw reinforcing inserter according to a second embodiment of the present invention. Figure 4 also describes an embodiment using artificial bone other than the HA stick 4.

[0050] In Figure 4, the main components are the inserter body 1', the guide wire 2, and the filler 7.

[0051] The artificial bone used in the second embodiment is either originally in paste form or is a type of artificial bone that is made into a paste by mixing a powder and a liquid.

[0052] The inserter body 1' consists of a cylindrical portion 11, a lumen 12 for inserting a guide member, a lumen 13' for introducing a paste-like reinforcing material into the bone hole, a flange portion 14, and a constricted portion 15. However, the lumen 13' for introducing the paste-like reinforcing material into the bone hole is substantially the same as the lumen 13 for inserting the reinforcing material in the first embodiment.

[0053] As shown in Figure 4, the nozzle 71 of the filler 7 is inserted into the lumen 13' for introducing the paste-like reinforcing material into the bone tunnel. With a normal syringe, the nozzle is located in the center of the syringe body, so even if one tries to insert it into the lumen 13', the guide wire 2 gets in the way and it cannot be inserted. In the filler 7 used in the second embodiment, the nozzle 71 is positioned offset to one side radially relative to the filler 7 body, so as shown in the figure, it is possible to insert the nozzle 71 into the lumen 13' without interfering with the guide wire 2.

[0054] Another type of configuration is available to ensure that the guide wire 2 does not interfere with the device. Figure 5 shows that a long, slender, flexible nozzle 71 is attached to the tip of the filler, and the nozzle is inserted through the lumen 13'. From Figure 5, it can be seen that the nozzle 71 is set to be longer than the lumen 13'. In this case, although the nozzle 71 is interposed, the lumen 13' remains the lumen for introducing the paste-like reinforcing material into the bone tunnel.

[0055] Furthermore, various types of fillers can be used not only for the nozzle but also for the body of the filler itself. Figures 4 and 5 show a standard type of filler in which the piston is pushed in with a finger, but a gun-type filler with a trigger can also be used. In this case as well, the nozzle itself may be made of a soft material, or the nozzle may be long enough to penetrate the lumen 13'. In addition, it is also possible to use a type of filler 7 that is equipped with an auxiliary syringe, and the syringe and the auxiliary syringe can be connected to move and mix the powder and liquid materials that will become the paste-like artificial bone 4' between the two syringes.

[0056] (Example of operation of the second embodiment) Using Figures 6 and 7, an example of the operation of a screw reinforcing inserter according to the first embodiment of the present invention will be explained.

[0057] In Figure 6(a), the guidewire 2 is inserted into the insertion point using a needle or the like (not shown). At this time, the position is confirmed under fluoroscopy as needed to determine the location where the bone hole should be created. After inserting the guidewire 2, the soft tissue and bone tissue are sequentially expanded by tapping to form the screw hole.

[0058] Once the screw hole is formed, insert the inserter body 1' along the guide wire 2, as shown in Figure 6(b). At this time, the surgeon keeps their hand fixed on the patient's body surface and grasps the cylindrical part 11 to feed in the inserter body 1'. Up to this point, the operation is the same as the example of the inserter for screw reinforcement according to the first embodiment. In parallel with performing the operations in Figures 6(a) and (b), the paste-like artificial bone 4' is injected into the filler 7.

[0059] In the second embodiment, instead of inserting the HA stick 4, as shown in Figure 6(c), the nozzle 71 of the filler 7 is inserted into the lumen 13' provided in the inserter body 1', and the filler 7 is operated to inject the artificial bone into the lumen 13'.

[0060] The paste-like artificial bone 4' placed in the lumen 13' will fall due to its own weight. If necessary, the inserter body 1' may be lightly tapped to encourage the artificial bone to fall. Furthermore, if the fall is insufficient, the nozzle 71 of the filler 7 may be removed, the piston 3 may be inserted into the lumen 13', and the artificial bone may be fed into the screw hole by the piston 3. Figure 7(a) shows the filler 7 removed and the piston 3 attached. The paste-like artificial bone 4' can also be pushed in by hand.

[0061] The procedure after the artificial bone reaches the screw hole is the same as in the first embodiment. That is, as shown in Figure 7(b), if the piston 3 is in place, it is slid out from the lumen 13' of the inserter body 1'. Then the inserter body 1' is removed along the guide wire 2. The piston 3 and the inserter body 1' may be removed at the same time.

[0062] Subsequently, as shown in Figure 7(c), once the screw 6 is inserted into the screw hole along the guide wire 2, the screw 6 is screwed in with a screwdriver (not shown). This secures the screw 6 to the screw hole along with the paste-like artificial bone 4'.

[0063] Although not shown in the diagram, finally, the guide wire 2 is withdrawn, but the screw 6 remains in the screw hole along with the paste-like artificial bone 4'.

[0064] Although the screw reinforcing inserter according to the embodiments of the present invention has been described in detail above with reference to the drawings, the specific configuration is not limited to these embodiments, and any design changes, etc., that do not depart from the spirit of the present invention are also included. For example, the guide member can be a steel wire in addition to a guide wire, and the shape of the inserter body may be a rectangular tube instead of a cylindrical shape, as mentioned earlier. Similarly, the shape of the lumen for inserting the piston and reinforcing material can be rectangular instead of circular. As explained earlier, percutaneous surgery is perfectly possible even with an inserter body size of about 6.0 mm, but there is no doubt that it is preferable to make it smaller, and in that sense, making the shape of the lumen for inserting the piston and reinforcing material semicircular is also effective. It should be clearly understood that the fundamental technical concept of this invention is of great significance in that separate lumen for inserting guide members and lumen for inserting reinforcing materials are provided, enabling the insertion of artificial bone and the movement of guide members such as guide wires to be completely independent, thereby ensuring smooth insertion of artificial bone without hindrance and preventing misalignment or detachment of guide members. [Explanation of Symbols]

[0065] 1. Inserter unit 1' Inserter body 11 Cylinder part 12 Lumen for inserting guide member 13 Lumen for inserting reinforcing material 13' Lumen for introducing paste-like reinforcing material into the bone tunnel. 14 Flange section 15 Narrowed section 2 Guide wire (guide member) 3 pistons 4. HA Stick (Reinforcement material = Artificial bone) 4' Paste-like artificial bone 5. Slide Hammer 6 Screws 7 Filler 71 Nozzles 101 Outer cylinder 102 Guide wire (guide member) 103 Inner cylinder 104 Granular artificial bone (reinforcement material) 106 Screw A Incision wound B Penetration point C Soft tissue D Bone tissue E Screw insertion hole F Screw Hole

Claims

1. The screw reinforcement inserter body has a separate lumen for inserting a guide member to guide the screw into the bone hole, and a separate lumen for inserting a rod-shaped reinforcement into the bone hole, and a piston for pushing the reinforcement into the bone hole. A screw reinforcing inserter characterized in that the lumen for inserting the guide member and the lumen for inserting the reinforcing material are in a straight line from the entrance to the exit.

2. The screw reinforcing inserter according to Claim 1, characterized in that the diameter of the lumen for inserting the reinforcing insert is larger than the diameter of the lumen for inserting the guide member.

3. It has a separate lumen for inserting a guide member to guide the screw into the bone hole, and a separate lumen for inserting a rod-shaped reinforcing material to pass into the bone hole. The inserter body for a screw reinforcing material is characterized in that the lumen for inserting the guide member and the lumen for inserting the reinforcing material are in a straight line from the entrance to the exit.

4. An inserter body for inserting a rod-shaped reinforcing material or a piston into a bone hole, It comprises a cylindrical portion, a flange portion provided on the proximal end of the cylindrical portion toward the operator, and a constricted portion provided on the distal end of the cylindrical portion toward the operator. The inserter body for a screw reinforcement is characterized in that the cylindrical portion has two lumens of different sizes, which are straight from the inlet to the outlet.

Images