JP5412334B2 - Hip replacement surgery support system - Google Patents

Description

  The present invention relates to an artificial hip joint replacement operation support system particularly suitable for installing an artificial hip joint component on the pelvic acetabulum side.

  Conventionally, using a medical device called a medical navigation system, the positional relationship between the patient's position and the surgical instrument during the operation of the three-dimensional empty arm is recognized and displayed by infrared information etc. with a camera unit equipped with multiple CCD cameras. Thus, a technique for performing an operation for installing an artificial joint based on a preoperative plan has been established.

  However, the medical navigation system itself is expensive, and since it is a large-scale system deployment such as installation of each device at the operating room level, facilities that can be introduced are limited.

  Separately from the medical navigation system described above, a guide member having a shape that matches the shape of the patient's joint is prepared for the installation of an artificial joint, and one guide pin is provided according to the guide pin holding portion provided in the guide member. A technique for performing an operation for installing an artificial joint using a guide pin installed as an index is considered in the vicinity of a patient's joint. (Non-Patent Document 1)

THE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Int J Med Robotics Comput Assist Surg 2009; 5: 164-169. Published online 26 February 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002 / rcs.243

  The technique described in the above-mentioned non-patent document is to perform artificial joint installation using a single guide pin installed by a guide member as an index, specifically, reaming the pelvic side acetabulum of the hip joint. . However, the guide pin is an index that indicates the position and direction of installation to the practitioner (surgeon), and after the guide pin is installed, reaming is performed after removing the guide member. For this reason, the exact position and direction in which the practitioner performs reaming or the like in order to install the artificial joint in the three-dimensional space is not given by numerical values based on the guide pins. Depends on the proficiency level.

  The present invention has been made in view of the above-described circumstances, and the object of the present invention relates to artificial hip joint replacement surgery, and appropriately reflects the individual differences of patients before the operation, reaming operation in the pelvic acetabulum, etc. It is an object of the present invention to provide an artificial hip joint replacement operation support system that can accurately determine the position, direction, amount of excavation, and the like, accurately reproduce the determined contents during the operation, and manage the surgical operation.

  One aspect of the present invention has an outer peripheral spherical surface that matches the hip acetabular shape of a patient subject to artificial joint replacement surgery, a through-hole in a drilling direction determined by a three-dimensional preoperative plan for the acetabulum, and a cup rim described below A substantially hemispherical acetabular cup model manufactured by three-dimensional molding, each formed with a dock portion for contacting the model, a plurality of guide pins for fixing to the patient's iliac bone, and the substantially hemispherical acetabular cup The lower surface of the hip joint acetabular rim of the patient can be combined with the model dock, and the plurality of guide pins are parallel to the axial direction of the through hole of the acetabular cup model. A cup rim model manufactured by three-dimensional molding, in which a plurality of through-holes to be attached are formed, guiding an arcuate lower end edge contacting the dock portion as an installation level, and a plurality of cup rim models A guide pin holding guide portion for holding the plurality of guide pins mounted in the through hole, and a shaft portion having a tip inserted into a through hole of the acetabular cup model and penetrating a drill; A parallel guide to be attached to the model and the cup rim model, and a plurality of guide pins attached to the patient's iliac, and the guide protrusion urged by the elastic body from the center of the tip of the hemispherical reamer The acetabular reamer is provided with an indicator that indicates the protruding length of the guide protrusion that protrudes and contracts with reaming, and moves along a plurality of guide pins attached to the patient's iliac bone. The formed hemispherical hole has an impactor for driving a acetabular cup shell, which is a part of an artificial hip joint determined in the three-dimensional preoperative plan for the acetabulum. And butterflies.

  According to the present invention, regarding hip replacement surgery, the position, direction, and amount of excavation in the pelvic acetabulum are accurately determined and appropriately determined by appropriately reflecting individual differences among patients before the operation. The operation can be managed accurately by reproducing the contents accurately during the operation.

1A and 1B are diagrams showing a basic configuration of an acetabular cup model according to an embodiment of the present invention, in which FIG. 1A is a top view and FIG. 1B is along the line I-I in FIG. Sectional drawing. The perspective view which shows the structure which combined the acetabular cup model and cup rim model which concern on one Embodiment of this invention. The perspective view which shows the state which installed the acetabular cup model and cup rim model which concern on one Embodiment of this invention in the bone model. The perspective view which shows the state which installed the acetabular cup model and cup rim model which concern on one Embodiment of this invention in the bone model. The perspective view which shows the external appearance structure of the parallel guide which assembled | attached the acetabular cup model and cup rim model which concern on one Embodiment of this invention. The perspective view which shows the state of the parallel guide which assembled | attached the acetabular cup model and the cup rim model at the time of the drilling which concerns on one Embodiment of this invention. The perspective view explaining the composition of the acetabular reamer concerning one embodiment of the present invention. The perspective view explaining the structure of the acetabular reamer and impactor which concern on one Embodiment of this invention.

Hereinafter, an embodiment of an artificial hip joint replacement surgery support system in which the present invention is applied to an artificial joint placed on a acetabulum on the hip pelvis side will be described with reference to the drawings.
FIG. 1 shows a basic configuration of a acetabular cup model 10 that is temporarily installed on a patient's acetabulum during surgery. 1A is a top view of the substantially hemispherical acetabular cup model 10, and FIG. 1B is a cross-sectional view of the acetabular cup model 10 taken along line II in FIG. 1A. The configuration is shown.

  As shown in the figure, the acetabular cup model 10 has a substantially hemispherical central axis position as a two-stage through-hole. The larger-diameter through-hole portion 10A on the cut surface side has a predetermined diameter and depth, for example, a diameter of 8.1 [mm] and a depth of 10.2 [mm]. Further, the through-hole portion 10B having a smaller diameter on the outer peripheral curved surface side has a fixed diameter, and is, for example, 5.0 [mm].

  The acetabular cup model 10 is represented as a smooth curved surface like that of a true sphere in the drawing, but the actual product has a size that matches the individual acetabular shape at the stage of preoperative planning. It shall have thickness and uneven shape.

  On the cut surface of the acetabular cup model 10, a substantially fan-shaped dock portion 10 </ b> C for contacting and combining a cup rim model 20 described later is integrally formed so as to protrude on the cut surface. The dock portion 10C has a unified central angle, width, and protruding ridge (thickness). For example, the central portion has a central angle of 90 °, a width of 28 [mm], and a protruding amount of 10 [mm]. To do.

  Furthermore, as shown in the drawing, both sides of the acetabular cup model 10 are notched on both sides along an arcuate curved surface parallel to the axial direction of the through holes 10A and 10B with the through holes 10A and 10B interposed therebetween. Shape.

  Except for the notched portion, flange-shaped rim portions 10D and 10E having a constant width and thickness, for example, both 2 [mm] are formed at the cut end portion of the acetabular cup model 10. . The rim portions 10D and 10E can also have a configuration in which a wave is partially absent if necessary in accordance with the acetabular shape of each patient.

  The acetabular cup model 10 has a shape and size that match the acetabulum of the patient as described above, and uses a 3D printer by rapid prototyping (RP) technology (three-dimensional molding) before operation. For example, it is made of acrylic photo-curing resin, ABS resin, starch, or gypsum.

  It should be noted that the 3D image data of the joint part is constructed from a plurality of 2D image data such as X-ray CT image and MRI image of the affected part of the patient, and the optimal operation for the size and installation of the artificial joint component on it. As for the technology itself for determining the position, direction, etc. of the computer, for example, Japanese Patent Application Laid-Open No. 2009-082444 and Japanese Patent Application Laid-Open No. 2009-195490 are well-known techniques in computer-aided orthopedics, and detailed description thereof is omitted. To do.

  Also in the present invention, the acetabular cup model 10 determines the size of the acetabular cup as a component of the artificial joint and the axial direction of the acetabular cup with respect to the three-dimensional image data of the acetabular portion of the patient. The direction and position of the through-hole portions 10A and 10B, which are the central axes, and the cut surface perpendicular to the axial direction are determined.

A cup rim model 20 is used as one of the jigs combined with the acetabular cup model 10.
FIG. 2 is a perspective view showing a combination of the acetabular cup model 10 and the cup rim model 20 in a partially transparent state. As shown in the figure, the acetabular cup model 10 has a plate-like structure having the same thickness as the protruding amount of the dock portion 10C of the acetabular cup model 10, for example, 10 [mm], and the upper surface of the rim portion 10D and the dock portion 10C. It is combined with the acetabular cup model 10 in a state of being in contact with the arcuate outer peripheral surface.

  In the cup rim model 20, a pair of guide pin through holes 20A, 20B are formed in an axial direction perpendicular to the plate surface, and a gripping through hole 20C is provided at substantially the center of the guide pin through holes 20A, 20B. Further, a temporary fixing through hole 20D is formed on the opposite side of the dock portion 10C with the middle point of the guide pin through holes 20A and 20B interposed therebetween.

  Since the guide pin through holes 20A and 20B and the gripping through hole 20C are all formed in an axial direction perpendicular to the plate surface, the axis of each through hole combines the cup rim model 20 with the acetabular cup model 10. In this state, the acetabular cup model 10 is set to be parallel to the through-hole portions 10A and 10B.

  On the other hand, the temporary fixing through hole 20D is formed in an axial direction that is intentionally inclined with respect to a direction perpendicular to the plate surface.

  The lower surface side of the cup rim model 20 shown in the figure, the vicinity of the rim portion 10D that is in contact with the rim portion 10D, if necessary, is formed into a shape that matches the shape of the rim around the individual acetabulum (a bone that rises in a circumferential shape).

  The positions of the guide pin through-holes 20A and 20B are determined by the practitioner, the three-dimensional image data of the pelvis including the acetabulum of the patient and the three-dimensional shapes of the acetabular cup model 10 and the cup rim model 20 before the operation. It is determined by matching with data and determining the iliac position suitable for fixation.

  Therefore, the length of the cup rim model 20 along the radial direction of the cut surface of the acetabular cup model 10 is determined by the bone shape near the acetabular portion of each patient and the will of the practitioner.

  As described above, the cup rim model 20 is similar to the acetabular cup model 10 by using a 3D printer by a rapid prototyping (three-dimensional molding) technique before operation, for example, acrylic photo-curing resin, ABS resin, starch. Or made of plaster.

  In FIG. 2, as shown in the figure, a rectangular groove for preventing rotation with respect to the through hole portion 10 </ b> A of the acetabular cup model 10 centering on a direction opposite to the direction in which the dock portion 10 </ b> C is formed by 180 °. 10F is formed. The groove 10F matches the shape of the tip of the parallel guide shaft described later, and when the tip of the shaft is inserted into the through hole 10A and the groove 10F, the angle of the parallel guide with respect to the acetabular cup model 10 is increased. Prevents rotation.

3 and 4 show an example in which the acetabular cup model 10 and the cup rim model 20 are manufactured together with the bone model PV11 of the left acetabular acetabular portion of the patient. (These figures are drawings of models made with plaster)
As shown in these drawings, a rim portion RM11 swelled in an inverted C shape is formed on the acetabular portion of the bone model PV11. Here, since a part of the rim part 10E of the acetabular cup model 10 interferes with the rim part RM11 on the bone side, only a part (the left side in the figure) is formed.

  In addition, the portion in contact with the bone model PV11 on the lower surface side of the cup rim model 20 has a shape that matches the shape of the rim portion RM11 of the bone model PV11 as described above.

  In consideration of these points, a model combining the acetabular cup model 10 and the cup rim model 20 can be reliably installed on the acetabular portion of the bone model PV11.

  Thus, prior to the operation, not only the acetabular cup model 10 and the cup rim model 20 but also the bone model PV11 of the patient is manufactured together, and the acetabular cup model 10 and the cup rim model 20 are installed. Before the operation, the through-hole portions 10A and 10B of the lid cup model 10 can reliably guide the drilling (drilling) process prior to the reaming process for installing the artificial joint component (acetabular cup). Can be verified.

  FIG. 5 is a perspective view showing a configuration of the parallel guide 30 in which the acetabular cup model 10 and the cup rim model 20 are assembled. The parallel guide 30 has a guide pin holding portion 32 attached to the lower end side and a grip portion 33 attached to the upper end side with the shaft portion 31 as the center.

  The shaft portion 31 is mainly composed of a pipe shaft having an inner diameter that matches the outer diameter of the drill to be used. On the lower end side of the shaft portion 31 and the outer surface of the tip portion protruding from the guide pin holding portion 32, a rectangular rotation stop 31A that matches the groove 10F of the acetabular cup model 10 is formed. The axial length of the portion formed with the rotation stopper 31 </ b> A protruding ahead of the guide pin holding portion 32 is the thickness of the dock portion 10 </ b> C and the cup rim model 20 of the acetabular cup model 10, and the acetabular cup model 10. It is a numerical value that combines the depth of the through-hole portion 10A.

  The guide pin holding part 32 includes a fixed part 32A fixed to the rotation stopper 31A and the shaft part 31, and a slide part 32B that slides freely along the fixed part 32A in a direction orthogonal to the axial direction of the shaft part 31. And have.

  The slide portion 32B has pin holder portions 32C and 32D for holding two guide pins 41 and 42, which will be described later, through the guide pin through holes 20A and 20B of the cup rim model 20, respectively.

  That is, the pin holder portion is adjusted by adjusting the position of the slide portion 32B with respect to the fixed portion 32A according to the radial size of the acetabular cup model 10 and the length of the cup rim model 20 combined with the acetabular cup model 10. The guide pins 41 and 42 can be attached by matching the axial positions of the guide pin through holes 20A and 20B of the cup rim model 20 with 32C and 32D.

  On the upper end side of the guide pin holding part 32, a drill holder part 31B for holding a drill, which will be described later, inserted in the shaft part 31 is provided. The drill holder portion 31B is operated to insert a drill into the shaft portion 31 of the parallel guide 30 to which the acetabular cup model 10 and the cup rim model 20 are assembled, and the tip of the drill is the through-hole portion 10B of the acetabular cup model 10. By tightening the drill holder portion 31B in a state where it coincides with the distal end surface on the side and temporarily holding the position of the drill, the drilling start position of the drill can be held.

  The grip portion 33 is attached to the shaft portion 31 and is gripped by handling such as attaching the acetabular cup model 10 and the cup rim model 20 to the acetabular portion of the patient's pelvis, and damping the parallel guide 30 when drilling. Part.

  Next, FIG. 6 shows a state of the parallel guide 30 in which the acetabular cup model 10 and the cup rim model 20 are assembled at the time of drilling.

  FIG. 6 shows a state in which the parallel guide 30 in the state shown in FIG. 5 is installed on the patient's pelvic acetabulum. In that case, the length of the guide pins 41 and 42 protruding downward from the guide pin holding part 32 in advance was adjusted to the length to the surface of the patient's pelvic iliac bone determined in the three-dimensional preoperative plan. It fixes with pin holder part 32C, 32D above.

  Next, the acetabular cup model 10 is pressed against the patient's pelvic acetabulum and adjusted to a position where both shapes match. After the adjustment, a fixing pin 43 having a diameter of, for example, 3.2 [mm] is inserted into the temporary fixing through hole 20D of the cup rim model 20, and the guide pins 41 and 42 and the through hole portion 10A of the acetabular cup model 10 are inserted. , 10B, the parallel guide 30 assembled with the acetabular cup model 10 and the cup rim model 20 is temporarily fixed.

  Furthermore, the pin holder portions 32C and 32D of the guide pin holding portion 32 of the parallel guide 30 and the two guide pins 41 and 42 already mounted in the guide pin through holes 20A and 20B of the cup rim model 20 are sequentially connected to the pin holder portion. After releasing the fixation at 32C and 32D, it is driven into the patient's iliac bone and fixed.

  In this state, the tip of a drill 46 with an automatic stopper shown in FIG. 6 is inserted from the drill holder portion 31B, and the tip of the drill 46 is on the tip side of the through-hole portion 10B of the acetabular cup model 10 and in the patient acetabulum. It adjusts so that it may become a position which touches the surface, and it fixes with the drill holder part 31B. At the same time, the automatic stopper of the drill is adjusted in accordance with the size (depth) of the acetabular cup which is the artificial joint component determined in the preoperative plan.

  Thereafter, the drill holder 31B is released, and the grip 46 of the parallel guide 30 is firmly held, and the drill 46 is drilled in the center of the patient's pelvic acetabulum to the depth corresponding to the expected cup size. Drill to form a pilot hole.

  Drilling by the drill 46 is completed, leaving only the cup rim model 20 fixed by the guide pins 41 and 42 and the pin 43 on the patient's pelvis (iliac bone), leaving the acetabular cup model 10, the parallel guide 30, and the drill 46. Is removed from the pelvic acetabulum.

Next, the configuration of the acetabular reamer 50 used in the reaming process will be described with reference to FIG.
The acetabular reamer 50 is provided with a reamer head 52 in a replaceable manner at the tip located on the lower end side of the multi-stage columnar reamer body 51 in the drawing.

  The reamer head 52 is provided with irregularities for excavation on a hemispherical outer peripheral curved surface so as to rotate along a plane perpendicular to the axial direction of the acetabular reamer 50. [Mm], and then gradually changing to the same shape (hemispherical) with a larger radius while continuing the reaming process, the pelvic acetabular part is hemispherically until the size determined in the preoperative plan Drill into a shape.

Regardless of the size of the reamer head 52, the protrusion anchor portion 53 is formed to protrude from the center of the tip of the reamer head 52.
The projection anchor portion 53 is provided inside the reamer body 51 and is urged by an elastic body such as a coil spring to protrude from the tip of the reamer head 52. To reduce.

  The protrusion / reduction length of the protrusion anchor portion 53 at the tip of the reamer head 52 is displayed by an indicator 54 provided on the upper end side opposite to the reamer body 51.

  Further, a guide pin reference scope 55 and a grip part 56 are attached to the reamer body 51.

  The guide pin reference scope 55 is composed of a U-shaped metal piece, and a pair of parallel two sides 55A and 55B are detachably sandwiched between the reamer body 51, thereby remaining 1 between the two sides 55A and 55B. The distance between the position of the side 55C and the reamer body 51 can be adjusted.

  A guide groove matching the distance between the guide pins 41 and 42 is formed on the side surface of the one side 55C where the two sides 55A and 55B are not provided.

  That is, the guide pin reference scope 55 is adjusted in accordance with the distance between the pilot hole drilled in the bottom of the acetabulum of the patient's pelvis and the guide pins 41, 42 on the surface perpendicular to the axial direction of the guide pins 41, 42. The acetabulum is fixed by being sandwiched between the reamer body 51 and the guide groove of the guide pin reference scope 55 is brought into contact with the guide pins 41 and 42 in a state where the projection anchor portion 53 of the acetabular reamer 50 is inserted into the pilot hole. The axial direction of the reamer 50 and the axial directions of the guide pins 41 and 42 are accurately positioned in parallel.

  Therefore, at the beginning of the reaming process, in the process of performing reaming by mounting the reamer head 52 with the minimum diameter on the acetabular reamer 50, the practitioner grips the grip portion 56, and one side 55C of the guide pin reference scope 55 is guided. By pressing the acetabular reamer 50 downward so as to move along the pins 41 and 42, reaming is sequentially performed in a state where the protrusion anchor portion 53 is inserted into the pilot hole.

  In this case, the protrusion length of the protrusion anchor portion 53 protruding from the tip of the reamer head 52 is mechanically displayed on the indicator 54 as it is. Therefore, the completion timing of the reaming using the reamer head 52 can be determined in a state where the protrusion length of the protrusion anchor portion 53 is “0 (zero)”, that is, in a state where the reaming to the bottom of the pilot hole is completed.

  FIG. 8A shows the state of the acetabular reamer 50 used in such a reaming process, together with the bone model PV12, the cup rim model 20, and the guide pins 41 and. In FIG. 5A, the indicator 54 is particularly enlarged.

  In the indicator 54, the slider 54 </ b> D moves in a window 54 </ b> C formed along the axial direction between the two constricted portions 54 </ b> A and 54 </ b> B provided on the upper end side of the reamer body 51.

  Here, since the widths of the constricted portions 54A and 54B and the width of the line provided at the center of the slider 54D are made to coincide with each other, the projection length of the projection anchor portion 53 at the tip of the reamer head 52 can be visually very accurately indicated by the indicator 54. Can be reproduced and displayed.

  In the process of replacing the reamer head 52 with a larger size and performing reaming in the same manner as described above, the indicator corresponding to the protrusion length of the protrusion anchor portion 53 until the reamer head 52 reaches the bottom of the acetabulum excavated immediately before. The display at 54 is similarly valid.

  Further, since the lower edge of the arc-shaped surface of the rim model 20 is made to coincide with the size of the acetabular cup, it is a measure of the direction, depth, and size when reaming.

  Therefore, when the reaming with the reamer head 52 having a size adapted to the size of the acetabular cup, which is the artificial joint component determined in the three-dimensional preoperative plan, is completed, the reaming process is finished.

  As the reaming process ends, the acetabular reamer 50 is removed from the pelvic acetabulum.

  FIG. 8B shows an external configuration of the impactor 60 used in the cup driving process subsequent to the reaming process, together with the bone model PV12, the cup rim model 20, and the guide pins 41 and.

  The impactor 60 attaches the acetabular cup shell 71 to be driven to the distal end of the multi-stage cylindrical impactor body 61 located on the lower end side in the drawing.

  Further, a guide pin reference scope 62 and a grip part 63 are attached to the impactor body 61.

  The guide pin reference scope 62 has the same configuration as that of the guide pin reference scope 55, and a description thereof will be omitted.

  That is, as shown in the figure, the main part related to the attachment of the impactor 60 is to share many parts with the acetabular reamer 50. By sharing these parts, the guide pin reference scope 62 (for the impactor 60) The trouble of position adjustment etc. of 55) can be omitted.

  At the beginning of the cup driving process, the impactor 60 is installed after the acetabular cup shell 71 is installed at the acetabular position. At this time, the practitioner grips the grip portion 63 and pushes the impactor 60 downward so that the guide pin reference scope 62 moves along the guide pins 41 and 42, thereby driving the acetabular cup shell 71 from the correct direction. be able to.

  The acetabular cup shell 71 has a size determined in the three-dimensional preoperative plan.

  Here, the acetabular cup shell 71 constitutes the outer shell of the acetabular cup, which is an artificial joint component. Here, a large number of spike portions formed on the outer surface portion (not shown) are driven by the impactor 60 to drive the pelvic acetabulum. The lid is fixed by biting into a hemispherical hole formed by the acetabular reamer 50.

  By installing a resin liner (not shown) on the driven acetabular cup shell 71, the installation of the artificial joint component on the acetabular side having a two-piece structure is completed.

  When the impactor 60 is driven, the direction and depth level of the acetabular cup shell 71 can be confirmed by driving to a level where the lower end edge of the rim model 20 and the outer periphery of the acetabular cup shell 71 coincide.

  As described above in detail, according to the present embodiment, regarding hip replacement surgery, the position, direction, excavation amount, and the like of the reaming operation on the pelvic acetabulum are accurately reflected by appropriately reflecting individual differences of patients before the operation. It is possible to manage the surgical operation by accurately reproducing the determined contents during the operation.

  In the above-described embodiment, the case where guidance is performed using two parallel guide pins 41 and 42 has been described. However, the present invention does not limit the number of guide pins to two, and three are used for maintenance. It is good as a thing.

  Moreover, in the said embodiment, although rim | limb part 10D, 10E shall be provided in the acetabular cup model 10, this improves the compatibility with the shape of a patient's pelvic acetabulum, and can make the precision of a drill position higher.

  Furthermore, in the said embodiment, since the acetabular cup model 10 was made into the shape which notched both sides from the substantially hemispherical shape, when an operator installs the acetabular cup model 10, it can make it easy to visually recognize the acetabular inner surface.

  In the above embodiment, the length of the cup rim model 20 in the radial direction of the acetabular cup model 10 can be arbitrarily set, and the length is adjusted by adjusting the slide portion 32B in the guide pin holding portion 32 of the parallel guide 30. Therefore, in a preoperative plan, the practitioner can increase the degree of freedom to arbitrarily select the position where the guide pins 41 and 42 are installed from the shape of the patient's pelvis, and a higher-precision operation can be expected.

  Further, in the above embodiment, the arc-shaped lower edge of the lower edge of the rim model 20 indicates the cup size, the reaming level in the acetabular reamer 50, and the cup driving amount level in the impactor 60. Thereby, confirmation of reaming amount and direction, or cup driving amount and direction can be provided in a form that is very easy to visually recognize.

  In addition, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the invention in the implementation stage. Further, the functions executed in the above-described embodiments may be combined as appropriate as possible. The above-described embodiment includes various stages, and various inventions can be extracted by an appropriate combination of a plurality of disclosed constituent elements. For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, if the effect is obtained, a configuration from which the constituent requirements are deleted can be extracted as an invention.

10 ... acetabular cup model, 10A ... (large diameter) through hole portion, 10B ... (small diameter) through hole portion, 10C ... dock, 10D, 10E ... rim portion, 10F ... groove, 20 ... cup rim model, 20A, 20B ... through hole for guide pin, 20C ... through hole for holding, 20D ... through hole for temporary fixing, 30 ... parallel guide, 31 ... shaft part, 31A ... rotation stopper, 31B ... drill holder part, 32 ... guide pin holding part, 32A ... fixed part, 32B ... slide part, 32C, 32D ... pin holder part, 33 ... grip part, 41,42 ... guide pin, 43 ... fixed pin, 46 ... (with automatic stopper) drill, 50 ... acetabular reamer, 51 ... reamer body, 52 ... reamer head, 53 ... projection anchor part, 54 ... indicator, 54A, 54B ... constricted part, 54C ... window, 54D ... slider, 55 ... guy Pin reference scope, 56 ... grip part, 60 ... impactor, 61 ... impactor body, 62 ... guide pin reference scope, 63 ... grip part, 71 ... acetal cup shell, PV11, PV12 ... bone model, RM11 ... ) Rim part.

Claims (5)

The outer peripheral spherical surface that matches the hip joint acetabular shape of the patient subject to artificial joint replacement surgery, the through-hole in the drilling direction determined in the three-dimensional preoperative plan for the acetabulum, and the dock portion that contacts the cup rim model described below A substantially hemispherical acetabular cup model made by three-dimensional molding, each formed,
Multiple guide pins for fixation to the patient's iliac,
The lower half of the hip joint acetabular rim portion of the patient can be combined with the dock portion of the substantially hemispherical acetabular cup model, and the plurality of guide pins are inserted into the through hole of the acetabular cup model. A cup rim model formed by three-dimensional molding, in which a plurality of through holes to be mounted so as to be parallel to the axial direction of the arc, and an arcuate lower end edge contacting the dock part is guided as an installation level;
A guide pin holding guide portion for holding the plurality of guide pins mounted in a plurality of through holes of the cup rim model, and a shaft portion having a tip inserted into the through hole of the acetabular cup model and penetrating a drill A parallel guide to be mounted on the acetabular cup model and the cup rim model,
The guide protrusion that moves along a plurality of guide pins attached to the patient's iliac, protrudes from the center of the tip of the hemispherical reamer, and is reduced in accordance with the reaming. An acetabular reamer with an indicator indicating the protrusion length;
It moves along a plurality of guide pins attached to the patient's iliac bone, and in the hemispherical hole formed by the acetabular reamer, a part of the artificial hip joint determined in the three-dimensional preoperative plan for the acetabulum A hip replacement surgery support system comprising an impactor for driving a certain acetabular cup shell.   2. The artificial hip joint replacement surgery support system according to claim 1, wherein the acetabular cup model is formed with at least a partial rim contact portion that matches a shape of the hip acetabular rim portion of the patient.   2. The artificial hip joint replacement surgery support system according to claim 1, wherein the acetabular cup model has a shape in which both side portions are cut out along a plane parallel to the through hole with the through hole interposed therebetween. The cup rim model corresponds to the plurality of guide pin fixing positions determined in the three-dimensional preoperative plan for the acetabulum, and is combined with the acetabular cup model in the radial direction of the cup model cut section. Is determined,
The artificial hip joint according to claim 1, wherein the guide pin holding guide of the parallel guide can be adjusted in position along a direction orthogonal to the axis of the shaft portion according to the length of the cup rim model. Replacement surgery support system.   The artificial hip joint replacement surgery support system according to claim 1, wherein an arc-shaped lower end edge of the cup rim model indicates a reaming level and direction of the acetabular reamer and a driving level and direction of the impactor.

Images