JP5474000B2 - Surgical drilling instrument - Google Patents

Description

  The present invention relates to a surgical drilling instrument used for drilling bone in a ligament reconstruction operation or the like in which a ligament is transplanted and reconstructed inside a knee joint or the like.

  The femur and tibia are connected by an anterior cruciate ligament, a posterior cruciate ligament, and the like, and the joints are kept stable without shifting both bones forward, backward, left and right. When a strong impact is applied to the knee joint, these anterior or posterior cruciate ligaments may rupture. In such a case, ligament reconstruction surgery for transplanting a transplanted ligament in order to stabilize the knee joint at an early stage is widely performed. In ligament reconstruction surgery, a ligament taken from a site different from an artificial ligament or an affected part is transplanted to a torn ligament site, a hole is made in the femur and tibia to fix the ligament to the bone, and the end of the ligament is removed. It is inserted into this hole.

  The anterior cruciate ligament and the posterior cruciate ligament are located in the joint space between the femur and the tibia, and a hole can be opened from the opposite side of the joint space to fix the end. However, if a hole that is large enough to insert the graft ligament is formed over the entire length, the bone will be cut more than necessary.Therefore, using a special drilling device, the joint cavity side has a size that allows the graft ligament to be inserted. However, on the side opposite to the joint space, a hole having a smaller cross section may be formed. This drilling tool forms a small-diameter through hole by pressing while drilling (hereinafter referred to as push-cutting), and then drilling while increasing the diameter of the cutting blade (exactly expanding the diameter; hereinafter referred to as pulling). And a large diameter hole is enlarged on the outlet side of the through hole.

  As such a drilling device, a male screw is formed on the outer peripheral surface of the drill with a cutting blade formed at the tip, and after cutting a through hole, a large-diameter cutting member is screwed onto the tip of the drill. (See Patent Document 1). Also known is a drill bit (see Patent Documents 2 and 3) in which a drill bit serving both as a hole drill and a large hole drill is integrally provided at the tip of a drilling device. In this drilling tool, a drill bit is provided at the tip of a shaft so as to be rotatable, and a cylindrical rocking tube is provided around the shaft so that the drill bit is aligned with the axis of the shaft. The corners and the second rotation angle for drilling a large hole that do not align with the axis of the shaft can be fixed.

US Pat. No. 7,637,910 US Patent Application Publication No. 2009/0171359 US Patent Application Publication No. 2009/0278950

  However, when the cutting member as in Patent Document 1 is a separate body from the drill, it is difficult to attach the cutting member to the tip of the drill in the joint cavity after drilling the pores. On the other hand, a drilling instrument in which a drill bit is integrated as in Patent Documents 2 and 3 can drill a large hole by rotating the drill bit after drilling the hole. Since the locking tube is provided to fix the corners, the diameter of the pores (rocking tube) has to be increased in order to ensure the strength of the drilling device.

  The present invention has been made in view of such problems of the prior art, and at the time of ligament reconstruction surgery, a large-diameter large hole is easily formed on the outlet side of the through hole opened in the bone as compared to the inlet side. It is an object of the present invention to provide a surgical perforation instrument that can achieve both of ensuring the strength of the instrument and reducing the pore diameter on the inlet side.

In order to solve the above problems, the present invention has a relatively small diameter pore (61) disposed on the perforation inlet side and a relatively large diameter large hole (62) continuous with the pore on the perforation outlet side. Surgical drilling instrument (1) for drilling through holes (60) to be made in bones (71, 72), a cylindrical shaft (10) having a distal end (10a) and a proximal end (10b) When the shaft axis and the shaft-like cutting members rotating shaft with a (K) is pivotally supported on the distal end of the shaft which is substantially perpendicular to the _{(a 10) (20,120,220),} said shaft And a base member (3) coupled to the base end of the shaft, and the cutting member has a first rotation angle whose axis (A ₂₀ , A ₁₂₀ , A ₂₂₀ ) substantially coincides with the axis of the shaft. Sometimes a fine hole drilling blade (51) located at the end of the shaft in the distal direction And a blade (52) for drilling a large hole located at an end portion in the proximal direction of the shaft when the axis is at a second rotation angle intersecting the axis of the shaft, and the base The member is configured to include a rod-like portion (30) that is inserted into the shaft and restricts the rotation of the cutting member.

  With this configuration, the rotation of the cutting member can be regulated by the rod-shaped portion, and the shaft that forms the outer periphery of the surgical perforation instrument supports the cutting member. Therefore, the cutting member is supported with respect to the outer diameter of the surgical perforation instrument. Strength can be increased. Moreover, although the shaft has a cylindrical shape for inserting the rod-like portion, the strength of the shaft itself is only slightly reduced.

  Further, according to one aspect of the present invention, the cutting member is formed with irregularities on a surface facing the hollow portion (18) of the shaft, and the rod-shaped portion has a tip (30) with a concave portion of the cutting member ( The rotation of the cutting member can be restricted by entering the lock hole 24).

  By comprising in this way, rotation of a cutting member can be controlled by changing the insertion amount to the shaft of a rod-shaped part, and rotation and cutting | disconnection of a cutting member can be performed easily.

  According to another aspect of the present invention, a screw (11) is formed at the base end of the shaft, and the base member is a chuck portion (32) chucked by an electric rotary tool, and the screw of the shaft. A screw (37) that is screwed onto the shaft, and further includes a connecting portion (34) that connects the rod-shaped portion and the chuck portion, and the shaft and the connecting portion are screwed together. The axial relative position with respect to the rod-like portion can be kept constant.

  With this configuration, the axial position of the shaft and the rod-shaped portion can be adjusted and kept constant simply by screwing the shaft and the connecting portion, and the rotation of the cutting member can be easily restricted and released. Can be.

  Further, according to one aspect of the present invention, the large hole drilling blade is a common blade (127) that forms the pore drilling blade, and the common blade is configured such that the cutting member is the first rotating member. The cutting member is inclined at a taper angle (θ) in a direction that tapers the cutting member with respect to the axis of the cutting member when the moving member is at a moving angle, and the cutting member is 90 ° with respect to the first rotation angle. It is possible to rotate to an angle obtained by adding the taper angle to the angle, and the common blade is configured to be restricted from being rotated by a rotation angle extending on a plane perpendicular to the axis of the shaft. it can.

  With this configuration, the cutting member can be configured simply by sharing the blade for drilling a large hole with the blade for punching a small hole, and the bottom of the large hole (thin The step with respect to the hole) can be a flat surface, and the graft ligament can be brought into close contact with the bottom of the large hole.

  Thus, according to the present invention, it is possible to easily form a large-diameter thick hole on the outlet side of the through-hole opened in the bone as compared with the inlet side, and to ensure the strength of the instrument and the pore diameter on the inlet side. It is possible to provide a surgical drilling instrument that can achieve both reduction in size.

The perspective view of the surgical perforation instrument based on this invention 1 is an exploded perspective view of the surgical perforation instrument shown in FIG. Side view of the drill member shown in FIG. IV-IV sectional view in FIG. Side view of the base member shown in FIG. VV sectional view in FIG. The principal part side view which shows the use condition of the surgical perforation instrument shown in FIG. VIII-VIII sectional view in FIG. 1 is a perspective view of the drill bit shown in FIG. Front view of the drill bit shown in FIG. Side view of the drill bit shown in FIG. Schematic diagram showing a state in which a through hole (pore) is drilled in the femur Schematic diagram showing the state where the drill bit is tilted in the joint space Schematic diagram showing the state of drilling a thick hole in the femur Schematic diagram showing the state where the drill bit is returned to the original position in the joint space Schematic showing the state of passing the ligament attachment string through the through hole Schematic diagram showing the state of attaching a graft ligament to the knee joint Schematic diagram showing the state where the graft ligament is attached to the knee joint The perspective view of the drill bit which concerns on a 1st modification Front view of the drill bit shown in FIG. Side view of the drill bit shown in FIG. Schematic diagram showing a state in which a large hole has been drilled by the drill bit shown in FIG. Front view of a drill bit according to a second modification Side view of the drill bit shown in FIG. Schematic diagram showing a state in which a large hole has been drilled by the drill bit shown in FIG.

  Hereinafter, embodiments of a surgical perforation instrument (hereinafter simply referred to as a perforation instrument 1) and a surgical method using the same according to the present invention will be described in detail with reference to the drawings.

  The perforating instrument 1 is used when a through hole 60 (see FIG. 14) is drilled in a bone in a ligament reconstruction operation or the like, and has a cutting blade at the tip as shown in FIGS. The shaft-shaped drill member 2 and a base member 3 that extends coaxially with the drill member 2 on the proximal end side of the drill member 2 and is used for gripping by the electric rotary tool.

The drill member 2 includes a cylindrical shaft 10 having a distal end 10a and a proximal end 10b, and an axial drill bit 20 pivotally supported on the distal end 10a of the shaft 10. Here, the shaft shape means that it is made of a long material, in other words, a shape having a longer length that is larger than that in the width direction. Hereinafter, for the drill bit 20, a straight line parallel to the longitudinal direction connecting the center of the cross section is referred to as an axis A ₂₀ .

The base member 3 has a diameter smaller than the inner diameter of the shaft 10 and extends along the axis A ₃ of the base member 3. The base member 3 extends coaxially with the rod-shaped part 30 on the proximal end side of the rod-shaped part 30. A columnar chuck portion 32 that is chucked by the electric rotary tool, and has a diameter larger than that of the shaft 10, and is formed in a columnar shape coaxial with the rod-shaped portion 30 and the chuck portion 32. And a connecting portion 34 for connecting the two.

As shown in FIGS. 3 and 4, a male screw 11 is formed on the base end 10 b side of the shaft 10, and a notch 12 extending in the axial direction is formed in a manner that opens to the end surface and reaches both opposing side surfaces. ing. On the other hand, a slit 13 is formed at the tip 10 a of the shaft 10. Support holes 15 perpendicular to the axis A ₁₀ of the shaft 10 are formed in the pair of walls 14 positioned on both sides of the slit 13, and pins that are inserted into the support holes 15 and supported by the pair of walls 14. 16 pivotally supports the drill bit 20. That is, the drill bit 20 is pivotally supported on the tip 10 a of the shaft 10 with a rotation axis K orthogonal to the axis A ₁₀ of the shaft 10. A through hole 17 having a rectangular cross section is formed at an intermediate position near the base end 10 b of the shaft 10 in a direction substantially perpendicular to the axis A ₁₀ of the shaft 10.

  As shown in FIGS. 5 and 6, a tip portion 30 a having a smaller diameter than other portions is formed at the tip of the rod-like portion 30. The distal end portion 30a is inserted into the lock hole 24 and restricts the rotation of the drill bit 20 as will be described later.

Connecting portion 34 is made of a connecting member 35 which exhibits a stepped cylindrical through hole 36 is formed along its axis A _3. A rod-like member 31 constituting the rod-like portion 30 is inserted into the through hole 36, and the chuck member 33 constituting the chuck portion 32 and the rod-like member 31 are welded at the rear end face of the connecting member 35 in a state where they are coaxially continuous. The three parties are united with each other. Further, the front end side of the through hole 36 has a large diameter, and a screw hole 37 in which a female screw that is screwed into the male screw 11 of the shaft 10 is formed on the inner surface thereof. By inserting the base end 10b of the shaft 10 into the screw hole 37 and screwing the shaft 10 and the connecting portion 34 together, the axial relative position of the shaft 10 and the rod-shaped portion 30 is kept constant.

The coupling portion 34, a through hole 38 perpendicular to the axis A ₃ is formed at a position passing through the axis A _3, the pin 39 is inserted into the through hole 38. Thus, a wall surface perpendicular to the terminal end (rear end) of the screw hole 37 is formed, the screwing depth of the shaft 10 with respect to the connecting portion 34 is set, and the screw hole 37 is tapered along the tap for female screw formation. As a result, the shaft 10 is prevented from being bitten into the screw hole 37 by the torque at the time of drilling.

As shown in FIGS. 7 and 8, the drill bit 20 has a hollow shaft 10 in a state where the axis A ₂₀ of the drill bit 20 coincides with the axis A _{10 of the} shaft 10 (the state shown in FIG. 7A). a position facing the unit (18), two locations of a position facing the hollow portion 18 of the shaft 10 in a state where the axis _{a 20} of the drill bit 20 is perpendicular to the axis _{a 10} of the shaft 10 (state shown in (B) of FIG. 7) the lock hole 24 leading to the pin 16 extends along the axis a ₁₀ of the shaft 10 (through hole 23 to be described later exactly pin 16 is inserted into) are bored in each state. That is, two lock holes 24 with an opening angle of 90 degrees centered on the pin 16 are formed.

The axial length of the shaft 10 and the axial length of the rod-shaped portion 30 are the tip of the rod-shaped portion 30 in a state where the shaft 10 is screwed into the screw hole 37 of the connecting portion 34 and abuts against the pin 39 (FIG. 6). 30 a is set to enter the lock hole 24. That is, when the shaft 10 is inserted over the entire length of the screw hole 37, the rod-shaped portion 30 has its tip portion 30 a inserted into the lock hole 24, so that the axis A ₂₀ of the drill bit ₂₀ is aligned with the axis A ₁₀ of the shaft _10. drill the first rotation angle that matches the (state shown in (a) of FIG. 7) a second rotation angle perpendicular to the axis a ₁₀ of the shaft 10 (the state shown in (B) of FIG. 7) The rotation of the bit 20 is restricted, and when the insertion depth of the shaft 10 into the screw hole 37 is made shallow, the tip 30a is detached from the lock hole 24 and the rotation restriction of the drill bit 20 is released.

  As shown in FIGS. 9 to 11, the drill bit 20 has a substantially cylindrical shape with a notch 26 formed in a substantially cylindrical shape, and a flat shape continuously from the base end of the cutter 21, and the pin 16 is And a base portion 22 having a through hole 23 for insertion.

  As described above, the lock holes 24 are formed at two locations on the surface of the base portion 22. Further, the base portion 22 has an arc shape with one side surface extending to the base end surface 22a so that the drill bit 20 can be rotated in one direction from the first rotation angle. The other side surface is formed at a right angle to the base end surface 22a so as to make the rotation in the other direction from the rotation angle impossible, thereby forming the stopper 25.

The cutter unit 21, one generally quarter was about the axis A ₂₀ of the cylinder there is a notch 26. The distal end surface 21a of the cutter portion 21 has a shape obtained by continuous half cone gradually changing small apex angle the axis A ₂₀ in the clockwise direction around the one edge 41 which is formed as a starting point by the notch 26 It is processed to become. Then, the distal end surface 21a notch 26 and the next blade 51 for edge 41 pores perforations crossing the axis A _20, which is formed at the boundary, the axis A ₂₀ formed by the notch 26 on the outer peripheral surface 21b The parallel edge 42 becomes a blade 52 for drilling a large hole.

The tip angle θp of the hole 51 for pore drilling is 0 degree, and the change in the apex angle of the half cone by the tip surface 21a forms a clearance angle in the blade 51 for hole drilling. Further, a portion of the outer peripheral surface 21b adjacent to the blade 52 for punching a large hole is cut into a flat surface to form a clearance angle (20 degrees here) in the blade 52 for punching a large hole, thereby forming a notch 26. A portion of the surface adjacent to the blade 52 for punching a large hole is inclined to form a rake angle (25 degrees in this case) in a direction in which the cutout portion 26 is larger than a quarter circle in front view. . Incidentally, the blade 52 for large hole drilling is formed on the side opposite to the side where the stopper 25 is formed with respect to the axis A _20, the shaft 10 when the drill bit 20 is in the second rotation angle Turn to the proximal direction.

When the drill bit 20 formed in this way is at the first rotation angle, the blade 51 for pore drilling is located at the end in the distal direction of the shaft 10 and at the second rotation angle. Further, a blade 52 for drilling a large hole is located at the end of the shaft 10 in the proximal direction. When the drill bit 20 is in the first rotation angle, the radially outer end of the blade 51 for pores perforated in the outer peripheral edge 10c substantially the same distance of the shaft 10 relative to the axis A ₁₀ of the shaft 10 in position, when the drill bit 20 is in the second rotation angle, the radially outer end of the blade 52 for large hole drilling than the outer peripheral edge 10c of the shaft 10 relative to the axis a ₁₀ of the shaft 10 Is also far away.

Therefore, when the drill bit 20 is fixed at the first rotation angle with respect to the shaft 10 and the drill member 2 is drilled with the blade 51 for drilling pores while pushing in the distal direction, the drill bit 20 is substantially the same as the shaft 10. When the drill bit 20 is fixed at the second rotation angle with respect to the shaft 10 and the drill member 2 is pulled in the proximal direction while drilling with the blade 52 for drilling a large hole, A hole having a diameter larger than that of the shaft 10 is formed. When the drill bit 20 is in the second rotation angle, because the blade 52 for large hole drilling extends in the direction perpendicular to the axis A ₁₀ of the shaft 10, in FIG. 7 (B ), The bottom 62a of the thick hole 62 (step difference from the fine hole 61) is a flat surface, and the graft ligament 70 (see FIG. 18) can be closely attached to the bottom 62a of the thick hole 62.

  According to the drilling instrument 1 configured as described above, the rotation of the drill bit 20 can be restricted by the rod-shaped portion 30 and the shaft 10 that forms the outline of the drill member 2 supports the drill bit 20. The support strength of the drill bit 20 can be increased with respect to the outer diameter, that is, the outer diameter of the shaft 10. Moreover, although the shaft 10 has a cylindrical shape for inserting the rod-shaped portion 30, the strength of the shaft 10 itself can be reduced only slightly. Therefore, the diameter of the pore 61 can be reduced. In the present embodiment, the diameter of the pore 61 is about 2.4 mm.

  Further, the drill bit 20 is rotated by changing the amount of insertion of the rod-shaped portion 30 into the shaft 10, that is, the amount of insertion of the shaft 10 into the screw hole 37 and causing the tip portion 30 a of the rod-shaped portion 30 to enter the lock hole 24. The rotation of the drill bit 20 and the release thereof can be easily performed. Since the relative position in the axial direction of the shaft 10 and the rod-shaped portion 30 can be adjusted and kept constant only by screwing the shaft 10 and the connecting portion 34, the rotation restriction of the drill bit 20 at the time of surgery is controlled. And its release work is easy.

  Next, the procedure of the ligament reconstruction operation performed using the drilling instrument 1 thus formed will be described.

  First, as shown in FIG. 12, the drilling tool 1 in which the drill bit 20 is fixed to the shaft 10 at the first rotation angle with respect to the femur 71 exposed through incision is watched with an electric rotary tool (not shown). While being rotated around, it is pressed in the axial direction of the shaft 10, and the pore 61 (through hole 60) reaching the joint cavity 73 between the tibia 72 is drilled (pressed) by the pore drilling blade 51.

  Next, in a state where the electric rotary tool is stopped, the shaft 10 is rotated counterclockwise (removal direction), the insertion depth of the connecting portion 34 into the screw hole 37 is decreased, and the distal end portion 30a of the rod-shaped portion 30 is locked into the lock hole. Then, as shown in FIG. 13, another surgical instrument 74 is inserted into the joint cavity 73 to rotate the drill bit 20 by 90 degrees, and the shaft 10 is rotated clockwise (screwing direction). Then, the distal end portion 30 a of the rod-shaped portion 30 is caused to enter the lock hole 24.

  After fixing the drill bit 20 at the second rotation angle, as shown in FIG. 14, the drilling tool 1 is pulled again in the axial direction of the shaft 10 while being rotated clockwise with the electric rotary tool, thereby drilling a large hole. A large hole 62 is drilled (pulled) on the joint cavity 73 side (exit side) of the through hole 60 by the blade 52 for use. Thus, a through hole 60 is formed in the femur 71 in which the relatively small diameter pore 61 is disposed on the perforation entrance side and the relatively large diameter large hole 62 continuous with the pore 61 is disposed on the perforation exit side. The

  Thereafter, the rotation of the electric rotating tool is stopped, the drilling tool 1 is gently pushed in until the drill bit 20 protrudes from the large hole 62, the shaft 10 is rotated in the removing direction, and the tip 30a of the rod-shaped part 30 is locked into the lock hole 24. 15, the drill bit 20 is rotated 90 degrees with another surgical instrument 74 in the joint cavity 73 to return to the first rotation angle as shown in FIG. Pull out.

  Similarly, the through hole 60 in which the pore 61 is disposed on the piercing entrance side and the thick hole 62 is disposed on the piercing exit side is also drilled in the tibia 72. Then, after separating the drilling instrument 1 into the drill member 2 and the base member 3, as shown in FIG. 16, for extracting the graft ligament in which a ring is formed at the distal end of the notch 12 on the proximal end side of the drill member 2. The string 75 is locked and inserted into the through hole 60.

  Further, as shown in FIG. 17, the fixing string 70 a extended to one end of the graft ligament 70 is passed through the ring of the string 75 for pulling out the graft ligament, and the string 75 for pulling out the graft ligament is pulled out to transplant the graft ligament 70. Are buried in the thick hole 62. Although illustration is omitted, instead of the procedure shown in FIGS. 16 and 17, the proximal end side of the drill member 2 is inserted into the through hole 60, and the graft ligament 70 is inserted into the through hole 60 formed near the proximal end. The end of the graft ligament 70 may be buried in the large hole 62 by pulling out the drill member 2 through the fixing string 70a and pulling out the fixing string 70a.

  Similarly, after inserting the string 75 for extracting the graft ligament into the through hole 60 using the drill member 2, the fixing string 70 a extended to the other end of the graft ligament 70 is also transplanted to the tibia 72. The string 75 for pulling out the graft ligament is pulled out through the loop of the string 75 for pulling out the ligament, and the end of the graft ligament 70 is buried in the large hole 62 as shown in FIG. Are fixed to the femur 71 and the tibia 72 using the fixing tool 76 or the like.

≪First modification≫
Next, with reference to FIGS. 19-22, the 1st modification of the punching instrument 1 which concerns on this invention is demonstrated. In addition, about the component similar to the said embodiment, the description is abbreviate | omitted using the same code | symbol and description of a usage method is demonstrated focusing on a different point. The same applies to the following modifications.

  As shown in FIGS. 19-21, the drilling instrument 1 which concerns on this modification has the drill bit 120 of a shape different from the above. The drill bit 120 has a flat shape, and includes a base portion 22 in which a through-hole 23 for inserting the pin 16 is formed, and a cutter portion 121 that has a flat shape continuously to the base portion 22.

The cutter unit 121 has a length in a direction orthogonal to the rotation axis K in a front view, and extends in a rotationally symmetric manner from the point on the outer peripheral edge 10c of the shaft 10 indicated by an imaginary line toward the axis A _120. There are two existing straight edges 141a and 141b and an edge 141c that connects the tips of the two edges 141a and 141b with straight lines. In the first rotation angle, the edge 141a, 141b, 141c are blades 51 next to a pore drilling, the axis _{A 120} of the drill bit 120 shaft the axis _{A 120} of the drill bit 120 is aligned with the axis _{A 10} of the shaft 10 The edge 141a located at the end portion in the proximal direction of the shaft 10 becomes the blade 52 for drilling a large hole at the second rotation angle intersecting the _ten axis A10. That is, the edge 141 a of the blade 51 for pore drilling is a common blade that forms the blade 52 for drilling a large hole.

The tip angle θp of the blade 51 for pore drilling, specifically, the tip angle θp of the edges 141a and 141b at the time of pore drilling is θ × 2 degrees. That is, the edges 141a and 141b are inclined with a taper angle θ in a direction in which the drill bit 120 is tapered with respect to the axis A ₁₂₀ of the drill bit 120 when the drill bit 120 is at the first rotation angle. Further, when the drill bit 120 is at the second rotation angle, a clearance angle of 20 degrees (see FIG. 20) is formed at the edge 141a forming the blade 52 for drilling a large hole.

Lock holes 24 are formed at two locations on the surface of the base 22 in the same manner as in the above embodiment, and one of them is in a state where the axis A ₁₂₀ of the drill bit 120 coincides with the axis A _{10 of the} shaft 10. Although formed along the axis A ₁₂₀ at a position facing the hollow portion 18 of the shaft 10, the other is that the axis A ₁₂₀ of the drill bit 120 is more than 90 degrees with respect to the axis A _{10 of the} shaft 10. It is formed at a position facing the hollow portion 18 of the shaft 10 with a large inclination by θ. That is, the opening angle of the two locking holes 24 around the pin 16 has a (90 + θ) degrees, the drill bit 120, its axis _{A 120} with respect to the axis _{A 10} of the shaft 10 (90 + θ) degrees inclined The rotation is restricted by the second rotation angle.

As shown in FIG. 22, the drill bit 120 formed in this way has a large-hole drilling blade 52 located at the end in the proximal direction of the shaft 10 at the second rotation angle. extending on a plane perpendicular to the axis a ₁₀ of. Therefore, the bottom 62a of the thick hole 62 (step difference from the fine hole 61) becomes a flat surface, and the graft ligament 70 can be brought into close contact with the bottom 62a of the thick hole 62.

≪Second modification≫
Next, with reference to FIGS. 23-25, the 2nd modification of the punching instrument 1 which concerns on this invention is demonstrated. First, as shown in FIGS. 23 and 24, the drilling instrument 1 according to the present modification has a drill bit 220 having a different shape as in the modification. The point that the drill bit 220 is composed of a base portion 22 and a cutter portion 221 that is flattened continuously to the base portion 22 is similar to the above-described modified example, but the cutter portion 221 of this modified example has a predetermined tip angle θp. It has a substantially rectangular flat plate shape. The cutter unit 221 has edges 241a and 241b located on one side of the isosceles triangle at the tip, an edge 241c connecting the ends of the edges 241a and 241b on the apex side of the isosceles triangle, and a long side. And two edges 242a and 242b located on the outer peripheral edge 10c of the shaft 10 indicated by an imaginary line in front view.

In the first rotation angle, the edge 241a, 241b, next blade 51 for 241c pores piercing, the axis _{A 220} of the drill bit 220 shaft the axis _{A 220} of the drill bit 220 is aligned with the axis _{A 10} of the shaft 10 in the second rotation angle is perpendicular to the axis _{a 10} of 10, the edge 242a located at the end of the proximal direction of the shaft 10, 241a is blade 52 for large hole drilling.

As shown in FIG. 25, the drill bit 220 formed in this way has an edge 242 a among the large-hole drilling blade 52 positioned at the proximal end of the shaft 10 at the second rotation angle. Is located on a plane orthogonal to the axis A ₁₀ of the shaft 10. Therefore, although the area of the bottom 62a of the thick hole 62 (step difference from the fine hole 61) is smaller than the other cross sections depending on the tip angle θp, it becomes a flat surface, so that it is transplanted to the bottom 62a of the thick hole 62. The ligament 70 can be adhered.

  Although the description of the specific embodiment is finished as described above, the present invention is not limited to the above-described embodiment, and can be changed as appropriate without departing from the gist of the present invention. For example, the piercing device 1 of the present invention can be applied not only to the knee, but also to ligament reconstruction surgery in other parts having ligaments, that is, shoulders, elbows, hands, and ankle joints. Moreover, the perforation device 1 of the present invention can also be applied to the case of perforating a bone in an operation other than a ligament reconstruction operation. In the above embodiment, two lock holes 24 are formed for each drill bit 20, 120, 220, but three or more lock holes 24 are formed so that they can be fixed at various rotation angles. Also good. Moreover, in the said embodiment, although the front-end | tip part 30a of the rod-shaped part 30 is made into a small diameter and it penetrates into the lock hole 24, rotation of the drill bit 20 is controlled, The drill bit 20 does not need to have a small diameter, and the drill bit 20 may be provided with irregularities such as a groove instead of the lock hole 24 as long as it is locked to the rod-shaped portion 30.

  On the other hand, not all the components of the perforation instrument 1 and the surgical method using the perforation instrument 1 according to the present invention shown in the above embodiment are necessarily indispensable, and at least as long as they do not depart from the spirit of the present invention. Is possible. For example, in the procedure of ligament reconstruction surgery, after drilling the large hole 62, the drill bit 20 is rotated in the joint cavity 73 by the surgical instrument 74 and returned to the first position. The drill bit 20 may be rotated by pulling the drilling instrument 1 as it is in a state in which the distal end portion 30 a of the portion 30 is escaped from the lock hole 24.

1 Drilling device (surgical drilling device)
2 Drill member 3 Base member 10 Shaft 10a Tip 10b Base 11 Male thread 12 Notch 13 Slit 18 Hollow part 20, 120, 220 Drill bit (cutting member)
24 Lock hole (concave)
30 Rod-shaped part 30a Tip part 32 Chuck part 34 Connecting part 37 Screw hole 41, 141a, 141, 141c, 241a, 241b, 241c Edge (blade for pore drilling)
42, 141a, 241a, 242a Edge (blade for drilling large holes)
51 Blades for drilling holes 52 Blades for drilling large holes 60 Through holes 61 Pores 62 Thick holes 71 Femurs 72 Tibias A ₁₀ Shaft 10 axis A ₂₀ , A ₁₂₀ , A ₂₂₀ Cutter bit axis K Rotating axis θ taper angle

Claims (4)

A surgical drilling device for drilling a bone with a through hole in which a relatively small diameter pore is disposed on the perforation inlet side and a relatively large diameter large hole continuous with the pore is disposed on the perforation outlet side. There,
A cylindrical shaft having a distal end and a proximal end;
An axial cutting member pivotally supported at the tip of the shaft with a rotation axis substantially orthogonal to the axis of the shaft;
A base member coupled to the proximal end of the shaft,
The cutting member has a fine hole drilling blade positioned at an end portion in a distal direction of the shaft when the axis thereof is at a first rotation angle substantially coincident with the axis of the shaft, and the axis thereof is the shaft. A blade for drilling a large hole located at an end portion in the proximal direction of the shaft when the second rotation angle intersects the axis of
The said base member is provided with the rod-shaped part inserted in the said shaft, and controls rotation of the said cutting member, The surgical perforation instrument characterized by the above-mentioned. In the cutting member, irregularities are formed on the surface facing the hollow portion of the shaft,
The surgical perforation instrument according to claim 1, wherein the rod-shaped portion restricts the rotation of the cutting member by having a distal end thereof entering a concave portion of the cutting member. A screw is formed at the proximal end of the shaft,
The base member further includes a chuck portion that is chucked by the electric rotary tool, a screw that is screwed into the screw of the shaft, and a connecting portion that connects the rod-shaped portion and the chuck portion.
The surgical perforation according to claim 1 or 2, wherein the axial relative position between the shaft and the rod-like portion is kept constant by screwing the shaft and the connecting portion. Instruments. The blade for drilling a large hole is a common blade that forms the blade for drilling the pore, and the common blade is in relation to the axis of the cutting member when the cutting member is at the first rotation angle. Inclined with a taper angle in the direction of tapering the cutting member,
The cutting member can be rotated to an angle obtained by adding the taper angle to 90 degrees with respect to the first rotation angle, and the common blade extends on a plane orthogonal to the axis of the shaft. The surgical perforation instrument according to any one of claims 1 to 3, wherein the rotation is restricted by a rotation angle.

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