U.S. patent application number 17/504795 was filed with the patent office on 2022-02-03 for arthroscopic surgery method for ankle ligament reconstruction.
This patent application is currently assigned to OLYMPUS CORPORATION. The applicant listed for this patent is OLYMPUS CORPORATION. Invention is credited to Chie ONUMA, Sohei UEDA.
Application Number | 20220031338 17/504795 |
Document ID | / |
Family ID | 59064753 |
Filed Date | 2022-02-03 |
United States Patent
Application |
20220031338 |
Kind Code |
A1 |
UEDA; Sohei ; et
al. |
February 3, 2022 |
ARTHROSCOPIC SURGERY METHOD FOR ANKLE LIGAMENT RECONSTRUCTION
Abstract
An arthroscopic surgery method for ankle ligament reconstruction
of this embodiment is removed using an ultrasonic treatment tool,
blowing away a synovial membrane, and secures the view for a
remnant ligament. Then, bone holes are produced to a fibula, a
talus and a calcaneus using the ultrasonic treatment tool.
Inventors: |
UEDA; Sohei; (Tokyo, JP)
; ONUMA; Chie; (Tama-shi, JP) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
OLYMPUS CORPORATION |
Tokyo |
|
JP |
|
|
Assignee: |
OLYMPUS CORPORATION
Tokyo
JP
|
Family ID: |
59064753 |
Appl. No.: |
17/504795 |
Filed: |
October 19, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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16257680 |
Jan 25, 2019 |
11172942 |
|
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17504795 |
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15084975 |
Mar 30, 2016 |
10213223 |
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16257680 |
|
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62269455 |
Dec 18, 2015 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/320069
20170801; A61B 17/1682 20130101; A61B 17/1604 20130101; A61B
2017/320073 20170801; A61B 2017/564 20130101; A61B 17/320068
20130101 |
International
Class: |
A61B 17/16 20060101
A61B017/16; A61B 17/32 20060101 A61B017/32 |
Claims
1. An arthroscopic surgery method with an ultrasonic treatment
tool, the ultrasonic treatment tool comprising: a probe defining a
longitudinal axis and configured to transmit ultrasonic vibration;
a treating portion at a distal part, the treating portion
comprising a projection at its distal end, the projection having a
quadrilateral shape when viewed from the distal part toward a
proximal part of the treating portion, the treating portion
including: a first portion; a plurality of second portions, a
distal-most surface of the plurality of second portions each
including a sharp edge configured to cut bone and being closer to
the proximal part than a distal-most surface of the first portion;
and a third portion closer to the proximal part than the first
portion and the plurality of second portions; and a perfusion
mechanism configured to provide a perfusate around a bone to be
treated, the method comprising: cutting the bone by moving the
ultrasonic treatment tool while pressing the first portion, the
plurality of second portions, and the third portion against the
bone; after cutting the bone, removing any bone particles produced
by cutting the bone using the perfusate of the perfusion mechanism;
and fixing a tendon to a bone hole formed by the first portion, the
plurality of second portions, and the third portion.
2. The method according to claim 1, wherein: surfaces on which the
plurality of second portions are located are symmetrical with
respect to a surface on which the first portion is located when
viewed from the distal part toward the proximal part.
3. The method according to claim 1, wherein the probe has a shape
of a rod extending in the longitudinal axis and having a diameter
of 2 mm to 4 mm.
4. The method according to claim 1, wherein: fixing the tendon
comprises inserting an anchor supporting the tendon into the bone
hole and inserting a fixing thread through the anchor.
5. The method according to claim 4, further comprising: pulling the
fixing thread via the anchor and fixing the tendon with a screw
using a predetermined tension.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This is a Continuation of application Ser. No. 16/257,680
filed Jan. 25, 2019, which is a Continuation of application Ser.
No. 15/084,975 filed on Mar. 30, 2016, now U.S. Pat. No.
10,213,223, which is based upon and claims the benefit of prior
U.S. Provisional Application No. 62/269,455 filed Dec. 18, 2015,
the entire contents of which are incorporated herein by
reference.
BACKGROUND OF THE INVENTION
1. Field of the Invention
[0002] The present invention relates to an arthroscopic surgery
method for ankle ligament reconstruction in which an ultrasonic
treatment tool is used.
2. Description of the Related Art
[0003] Generally in an arthroscopic surgical operation, two or
three portals of small holes are made around a joint (in a skin
surface), and an arthroscope comprising a hard mirror and a medical
treatment tool are inserted through these portals. Further, in a
state where perfusate such as saline is filled into the joint, the
surgical operation is carried out while confirming an image
reflected in a monitor.
[0004] As conventional medical treatment tools, there are known a
tool such as a drill that is rotated to make a bone hole and a
shaver system that is pressed against a bone to shave off the bone.
Additionally, an ablator or the like is also used which utilizes a
radiofrequency (RF) system to stop ablation bleeding.
[0005] In the arthroscopic surgical operation in which such a
conventional medical treatment tool is used, there are problems to
be concerned about in several treatments. For example, when the
drill or the like is used in making the bone hole, the hole is made
only in a travelling direction of a drill blade, and hence in a
case where the bone hole is made in the joint, an introducing
direction is restricted by a position of a treatment target region.
Furthermore, when a tip portion of the drill is vibrated and moved
at the start of the making of the bone hole, an unnecessarily
shaved region is generated, and hence it is necessary to
sufficiently carefully use the drill. Additionally, a treatment
tool using a rotary blade is moved while mechanically rotating the
blade to shave the bone, whereby unevenness remains in a treated
surface and it is not easy to smoothen the surface. Additionally,
when a cartilage or the bone is shaved off by using a treatment
tool that is manually operated, an amount of the cartilage or the
like to be shaved off varies with a force to be given to the
treatment tool, and hence the force has to be delicately adjusted,
which requires time and labor. Furthermore, a treatment tool using
a radiofrequency might cause thermal damages to a tissue of a
treatment target.
BRIEF SUMMARY OF THE INVENTION
[0006] According to an embodiment of the present invention, there
is provided an arthroscopic surgery method for ankle ligament
reconstruction comprising: a removing step of cutting and removing
removal target regions comprising at least a synovial membrane, a
synovium-related adipose tissue and a persistence ligament by a
side surface of a treating portion of an ultrasonic treatment tool
that generates ultrasonic vibration; a bone hole forming step of
hitting, against each of a fibula, a talus and a calcaneus, a tip
of the treating portion of the ultrasonic treatment tool used in
the removing step, whereby bone holes to fix tendons are formed in
the fibula, the talus and the calcaneus, respectively.
[0007] Advantages of the invention will be set forth in the
description which follows, and in part will be obvious from the
description, or may be learned by practice of the invention. The
advantages of the invention may be realized and obtained by means
of the instrumentalities and combinations particularly pointed out
hereinafter.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0008] The accompanying drawings, which are incorporated in and
constitute a part of the specification, illustrate embodiments of
the invention, and together with the general description given
above and the detailed description of the embodiments given below,
serve to explain the principles of the invention.
[0009] FIG. 1 is a diagram showing a constitution example of a
surgical system comprising an ultrasonic treatment tool to carry
out an arthroscopic surgery method for ankle ligament
reconstruction of one embodiment;
[0010] FIG. 2 is a view conceptually showing a step of removing a
synovial membrane/a soft tissue or the like by an arthroscope and
the ultrasonic treatment tool inserted into a joint;
[0011] FIG. 3A is a view showing a constitution example where a tip
of a treating portion of a probe is round;
[0012] FIG. 3B is a view showing a example where the tip of the
treating portion of the probe is elliptic;
[0013] FIG. 3C is a view showing an example where the tip of the
treating portion of the probe has a long hole shape;
[0014] FIG. 3D is a view showing an example where the tip of the
treating portion of the probe is rectangular;
[0015] FIG. 4 is a view showing an example of a curette to be
disposed in the probe:
[0016] FIG. 5A is a view showing an example of a twill line
treating portion of the probe;
[0017] FIG. 5B is a view showing an example of a straight knurl
treating portion of the probe;
[0018] FIG. 6 is a flowchart to explain the arthroscopic surgery
method for ankle ligament reconstruction;
[0019] FIG. 7 is a view showing a surgical operation step of
sucking and removing a tissue piece or a ligament piece;
[0020] FIG. 8 is a view showing a surgical operation step of
forming a guide bone hole in a fibula with Kirschner wire;
[0021] FIG. 9 is a view showing a surgical operation step of
forming a fibula bone hole in the fibula;
[0022] FIG. 10 is a view showing a surgical operation step of
forming a guide hole in a talus;
[0023] FIG. 11 is a view showing a surgical operation step of
forming a talus bone hole in the talus;
[0024] FIG. 12 is a view showing a surgical operation step of
forming a guide hole in a calcaneus with the Kirschner wire;
[0025] FIG. 13 is a view showing a surgical operation step of
forming a calcaneus bone hole in the calcaneus;
[0026] FIG. 14 is a view showing a surgical operation step of
attaching, to a fixing jig, an anchor into which a fixing thread is
inserted, to place the anchor into the talus bone hole;
[0027] FIG. 15 is a view showing a surgical operation step of
fixing the anchor into the talus bone hole;
[0028] FIG. 16 is a view showing a surgical operation step of
pulling an end button into the fibula bone hole;
[0029] FIG. 17 is a view showing a surgical operation step of
pulling up an end button 64 to pull a tendon into the fibula bone
hole;
[0030] FIG. 18 is a view showing a surgical operation step of
fixing a folded region of the tendon into the fibula bone hole to
fix the region with a traction thread;
[0031] FIG. 19 is view showing a surgical operation step of fixing
the tendon to the fibula bone hole with a screw;
[0032] FIG. 20 is a view showing a surgical operation step of
pulling the tendon into the talus bone hole; and
[0033] FIG. 21 is a view showing a surgical operation step of
fixing the tendon into the talus bone hole with a screw.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0034] Hereinafter, with reference to the drawings, there will be
described an arthroscopic surgery method for ankle ligament
reconstruction in which there is used an ultrasonic treatment tool
according to an embodiment of the present invention. The present
embodiment is the arthroscopic surgery method for ankle ligament
reconstruction in which the ultrasonic treatment tool is used for
treatments to remove a synovial membrane/a soft tissue and to
secure a viewing field, and for the formation of a bone hole in a
fibula, the formation of a bone hole in a talus, and the formation
of a bone hole in a calcaneus.
[0035] FIG. 1 shows a constitution example of a surgical system
comprising the ultrasonic treatment tool to carry out the
arthroscopic surgery method for ankle ligament reconstruction of
the present embodiment. FIG. 2 is a view conceptually snowing a
situation of a surgical operation by an arthroscope and the
ultrasonic treatment tool inserted into a joint. Hereinafter, in
the present embodiment, an ankle ligament will be described as one
example of a treatment target region 100 but the region is not
limited to this ligament, and it is possible to easily carry out a
surgical operation in another ligament similarly by use of the
ultrasonic treatment tool.
[0036] A surgical system 1 of the present embodiment is constituted
of an ultrasonic treatment tool 2 and an endoscope system 3
including an arthroscope 21. As shown in FIG. 2, portals 31 and 32
are prepared on a front inner side and a front outer side, the
arthroscope 21 is inserted from one of the portals, and a probe 12
of the ultrasonic treatment tool 2, a surgical instrument or the
like is inserted from the other portal.
[0037] The ultrasonic treatment tool 2 comprises an ultrasonic wave
generating section 11 that generates ultrasonic vibration by an
ultrasonic vibration element (e.g., a piezoelectric element), the
probe 12 that transmits the ultrasonic vibration to perform a
cutting treatment of the treatment target region, and an operating
section 13 that drives and controls the ultrasonic wave generating
section 11 to perform an on/off operation of the generation of the
ultrasonic vibration.
[0038] Hereinafter, a treating portion of the probe 12 of the
ultrasonic treatment tool 2 will be described.
[0039] The probe 12 for use in the present embodiment is a thin and
long rod-like member linearly extending in a longitudinal axis
direction and having a diameter of about 2 mm to 4 mm, and has a
distal portion and a proximal portion. The proximal portion is
coupled with the ultrasonic wave generating section 11, and in the
distal portion, an after-mentioned treating portion is
disposed.
[0040] In the probe 12 shown in FIG. 3A, a treating portion 14 to
form a bone hole in a bone is disposed. In a center of a distal
surface of the treating portion 14, a pointed projection 14a longer
than any other portion is disposed to be positioned with a
precedingly formed guide hole, and around the pointed projection, a
plurality of projections 14b are disposed. Additionally,
rectangular projecting portions 14c are disposed on a side surface
of the treating portion 14 and formed into a checkered pattern
along about a half of this peripheral surface. It is to be noted
that the plurality of projections 14b are disposed to improve a
cutting efficiency, and are not essentially required, and the bone
hole may be formed by a shape of a tip of the treating portion in
which any projections are not disposed.
[0041] In the present embodiment, the probe 12 transmits the
ultrasonic vibration to the treating portion 14 and the treating
portion 14 performs the cutting treatment to form the bone holes in
a talus 42, a fibula 43 and a calcaneus 45. Needless to say, the
pointed projection 14a is utilized in a case where the guide hole
is beforehand formed, and therefore is not an essentially required
portion, and the treating portion may be constituted only of the
projections 14b.
[0042] The ultrasonic treatment tool 2 enables the cutting
treatment to bones such as a cartilage and a subchondral bone (a
cortical bone and a cancellous bone) and all regions of a
biological tissue. That is, the cartilage can be melted and cut off
by frictional heat generated between the treating portion 14 and
the cartilage, when the projecting portions 14c comprising edges
formed on the side surface of the probe 12 are hit against the
cartilage. Additionally, the bone can be cut by hammering the bone
with the projections 14b of the treating portion 14 disposed at the
tip of the probe 12 by use of the ultrasonic vibration and very
finely grinding and cutting the bone. Therefore, when the treating
portion of the probe tip is formed into a shape corresponding to a
cutting target, not only a type of cutting target region but also
an amount of the region to be cut and a shape of the region can
suitably be selected. It is to be noted that an amount of the bone
to be cut by the projecting portions 14c disposed on the side
surface of the probe 12 is smaller than an amount of the bone to be
cut by the projections 14b, but the projecting portions 14c can
also hammer and cut the bone.
[0043] Additionally, a conventional drill used in forming the bone
hole is rotated to make the hole, and hence the hole is basically
round, and even when the drill is horizontally swung, a diameter of
the hole only increases in an undetermined manner, and the hole
cannot be formed into a desirable shape. On the other hand, the
probe of the ultrasonic treatment tool 2 does not rotate but
minutely moves forward and backward, and hence when the probe tip
abuts on the surface of the bone to vertically hammer the surface
during the cutting, the shape of the bone hole is not limited to
the round shape, and the bone hole can be formed into a shape in
accordance with an outer shape of the treating portion (or a
sectional shape of the probe). The bone hole of an optional shape
can be formed by moving a region on which the treating portion 14
abuts. In a case where the shape of the bone hole to be formed is
determined, for example, when a treating portion 15 including one
pointed projection 15a and a plurality of projections 15b is formed
at a tip of an elliptic probe 12 as shown in FIG. 3B, an elliptic
bone hole can be formed. In this example, in a side surface of the
probe 12, two rows of grooves 15c are arranged in a longitudinal
axis direction to constitute a cutting edge. Similarly, also by a
long hole (track-shaped) treating portion 16 shown in FIG. 3C or a
rectangular treating portion 17 shown in FIG. 3D, a bone hole of a
shape in accordance with a shape of the treating portion is
formed.
[0044] In the ultrasonic tool, the cutting is performed by the
minute vibration, and hence more precise processing is enabled.
First, a small bone hole (a first bone hole) is precedingly formed,
and additionally, the bone is cut to form the hole into a desirable
larger shape, which makes it possible to form a bone hole (a second
bone hole) of an optional shape.
[0045] Furthermore, the bone hole is not limited to a linear shape,
but it is also possible to form a bone hole having a curved region.
For example, when the bone has a linear shape, a length (a depth)
of the bone hole is only short, but when there occurs the problem
that a tendon cannot be fixed to this bone hole, the tendon can be
fixed by forming a curved bone hole. The bone hole having the
curved region can be achieved by using a probe having a bend in its
distal portion.
[0046] Also as to the diameter or a width of the bone hole, there
can be formed not only a hole of the same diameter or a hole of the
same width but also a hole of a tapered shape having the diameter
or the width that decreases from its inlet. In this case, the bone
hole can be formed into each of a tapered shape having a stepped
region and a tapered shape in which any stepped regions are not
disposed. Furthermore, a bone hole can be formed into such a shape
that the width or the diameter of the inlet is small and the
diameter or the width increases in a deeper region. This may be
achieved by using, for example, an L-shaped treating portion having
a bent tip. It is to be noted that by a treatment tool in which a
conventional drill is used, the linear bone hole of the same
diameter can be formed, or by replacing its drill blade with a
drill blade having a different diameter, the bone hole can be
formed into a tapered shape having a stepped region and having a
diameter that gradually decreases from an inlet.
[0047] In the present embodiment, a bone hole to be utilized in the
reconstruction can be formed into a shape corresponding to a
sectional shape of the tendon (the ligament) removed from another
region at once. Additionally, the treating portion may be prepared
into a shape equal to the sectional shape of the tendon in
advance.
[0048] It is to be noted that when the probe tip having an edge is
horizontally pressed against the surface of the bone, a treatment
surface of the treatment target region is frictionally hammered
while vibrating, and hence the region can be resected by the
hammering and cutting-off with the edge of the probe tip. It is to
be noted that a treatment target region having an elasticity, e.g.,
the cartilage, fat or the like can be resented by cutting-off with
the edge and melting by frictional heat.
[0049] Another treating portion of the probe 12 for use in the
present embodiment will be described.
[0050] A curette 33 disposed at a tip of a probe 12 shown in FIG. 4
is provided with a round hole, and a cartilage, a bone or the like
can be cut with an edge of the hole while ultrasonically
vibrating.
[0051] Additionally, a twill line treating portion 34 disposed at a
distal of a probe 12 shown in FIG. 5A is provided with a plurality
of rhombic projecting portions, a cartilage is cut off with edges
of the projecting portions while ultrasonically vibrating, and a
bone is hammered and cut with edge tip surfaces of the projecting
portions.
[0052] A straight knurl treating portion 35 disposed at a tip of a
probe 12 shown in FIG. 5B is provided with edges formed by a
plurality of grooves arranged in parallel, a cartilage is melted by
friction on tip surfaces of the ultrasonically vibrating and cut
off with the edges, and further a bone is hammered and cut with the
tip surfaces of the edges.
[0053] In the ultrasonic treatment tool 2, mechanical cutting by
minute sliding is performed by giving the ultrasonic vibration to
the probe having one end supported by the ultrasonic transducer,
and hence an amount of a treatment region to be cut off can be
adjusted in accordance with a degree of a strength at which the
treating portion 14 of its tip is pressed against the treatment
region. That is, when the treating portion lightly comes in contact
with the region, the amount of the region to be cut off decreases,
but when flattening of the surface of the treatment target region
and minute cutting-off are achieved and the treating portion is
strongly brought into contact with the region, the amount of the
region to be cut off increases. Therefore, a cutting degree by an
operator can be adjusted, and efficient cutting, resecting or the
like can be achieved.
[0054] The endoscope system 3 is constituted of the arthroscope 21
comprising a hard mirror that is one type of endoscope, a visible
light source 22 that is a light source of illumination light for
irradiation with the illumination light of visible light, a control
section 23 that controls the whole endoscope system 3, an input
section 24 such as a keyboard or a touch panel, a display section
25 that displays surgical operation information including a
photographed surgical operation situation, and a water-supply
water-discharge section 26 that supplies, discharges or circulates
perfusate such as saline in a periphery including the ankle
ligament of the treatment target region 100.
[0055] In the present embodiment, the water-supply water-discharge
section 26 supplies the saline to the treatment region through the
arthroscopy 21 and discharges the saline from the region through
the arthroscope, but the saline may be supplied and discharged by
the ultrasonic treatment tool 2.
[0056] Next, the arthroscopic surgery method for ankle ligament
reconstruction according to the present embodiment will be
described with reference to FIG. 2 and FIG. 6 to FIG. 23. FIG. 6 is
a flowchart to explain the arthroscopic surgery method for ankle
ligament reconstruction.
[0057] First, as shown in FIG. 2, the arthroscope 21 and the probe
12 of the ultrasonic treatment tool 2 which is constituted to be
thin and long are inserted through the prepared portals 31 and 32
to remove a synovial membrane/a soft tissue and the like 44 of
removal target regions (step S1). In the following drawings, it is
defined that the portals are present, but the portals are omitted.
Subsequently, as shown in FIG. 7, to secure a viewing field for the
reconstruction surgery method, the removal target regions including
the synovial membrane, a synovium-related adipose tissue, a
persistence ligament 46 and the like are resected by using the
ultrasonic treatment tool 2, and tissue pieces or ligament pieces
of the region are sucked and removed (step S2). The present
embodiment has large advantages obtained by utilizing the
ultrasonic treatment tool 2 when removing these removal target
regions (the tissue, the ligament, etc.). That is, the ultrasonic
treatment tool 2 does not make movement other than the minute
vibration, and does not cause damages due to excessive involving
and accidental contact as compared with a conventional rotary
shaver or the like, and hence even the removal target regions that
are very close to a nerve and a blood vessel can safely be
removed.
[0058] Next, as shown in FIG. 8, a Kirschner wire 37 is inserted
from a lower part (the vicinity of an ankle) of the fibula 43 to
form a guide bone hole 48 (step S3).
[0059] Next, as shown in FIG. 9, a fibula bone hole 43b is formed
in the fibula 43 by use of the probe 12 of the ultrasonic treatment
tool 2 comprising the treating portion 14 (step S4). At this time,
by inserting the pointed projection 14a of the treating portion 14
into the guide bone hole 48, the fibula 43 is cut along the guide
bone hole 48 by the ultrasonic vibration. The fibula bone hole 43b
has a shape tapered in three stages as described later with
reference to FIG. 16. A region of the fibula bone hole 43b which is
close to the lower part 43a is formed into an elliptic shape close
to a sectional shape of a double folded tendon 66. Needless to say,
the shape is not limited to the elliptic shape, and may be a round
shape. When this bone hole is prepared, bone pieces and bone powder
cut outside are removed from a body by the saline perfused by the
water-supply water-discharge section 26.
[0060] Next, similarly as shown in FIG. 10 and FIG. 11, a guide
bone bole 49 is formed in the talus 42 (step S5), and then a talus
bone hole 42a is formed along the guide bone hole 49 by use of the
probe 12 comprising the treating portion 14 (step S6). Furthermore,
as shown in FIG. 12 and FIG. 13, a guide bone hole 50 is formed in
the calcaneus 4542 (step S7), and then a calcaneus bone hole 45a is
formed along the guide bone hole 50 by use of the probe 12
comprising the treating portion 14 (step S8).
[0061] Next, as shown in FIG. 14, an anchor 63, into which a fixing
thread 62 to support the tendon 66 to be implanted is inserted, is
attached to a tip of a handle for exclusive use and placed in the
talus bone bole 42a. As shown in FIG. 15, the anchor 63 of the tip
is deeply pushed and attached to pierce through an upper bottom of
the talus bone hole 42a (step S9). The anchor 63 is fixed in the
talus bone hole 42a in a state where the fixing thread 62 is
movably inserted into the anchor.
[0062] Next, as shown in FIG. 16, a tip of the fibula bone hole 43b
cut from the lower part 43a of the fibula 43 in an oblique
direction is extended out through the fibula 43. A fixing thread 70
is fixed by hooking the thread in one hole of an end button 64 made
of a metal and pulling the thread out from the tip of the fibula
bone hole 43b (step S10). The end button 64 is usually a
rectangular metal plate material in which holes are made on both
side, and a ring is fixed to a center of the plate material between
the two holes. At this time, a traction thread 65 to hold the
tendon 66 to be implanted in a pulled state is hooked in the ring
of the center of the end button 64.
[0063] As shown in FIG. 17, the fixing thread 70 is pulled upward
to remove the end button 64 from the tip of the fibula bone hole
43b. The end button 64 extended outward is fixed in a configuration
in which the plate member sticks to the outside to close the fibula
bone hole 43b and the ring of the center remains in the fibula bone
hole 43b (step S11).
[0064] As shown in FIG. 18, one end of the traction thread 65 is
coupled to be sewn on a folded region 66a of the double folded
tendon 66, the other end of the traction ad 65 is pulled toward the
operator to pull a part of the folded region of the tendon 66 into
the fibula bone hole 43b through the ring of the end button 64 as
shown in FIG. 18, and the tendon 66 is fixed by fixing the traction
thread 65 in a state where the part of the folded region is pulled
inside (step S12). Furthermore, one end 66b of the double folded
tendon 66 is returned to sew the one end with a fixing thread 67,
and another end 66c is tied with the fixing thread 62.
[0065] The fixing thread 67 is inserted into the calcaneus bone,
hole 45a, and subsequently, as shown in FIG. 19, the other end 66b
of the tendon 66 is also inserted into the calcaneus bone hole,
whereby the tendon is fixed by a fixing anchor 68 (step S13).
[0066] Next, as shown in FIG. 20, the fixing thread 62 is pulled
via the anchor 63 fixed in the talus bone hole 42a and the one end
66c of the tendon 66 is pulled into the talus bone hole 42a.
Afterward, as shown in FIG. 21, a screw 69 is fixed to push the one
end 66c of the tendon 66 into the talus bone hole 42a (step S14).
The tendon 66 is fixed to apply predetermined tension to each of a
region between the fibula bone hole 43b and the talus bone hole 42a
and a region between the fibula bone hole 43b and the calcaneus
bone hole 45a. According to the above-mentioned procedure, by use
of the ultrasonic treatment tool under the arthroscope of the
present embodiment, the ankle ligament can be reconstructed.
[0067] The ultrasonic treatment tool of the present embodiment
mentioned above has the following operations and effects.
[0068] The distal portion of the ultrasonic treatment tool does not
rotate, but minutely vibrates to perform the cutting, so that the
cutting treatment can safely be carried out without involving any
peripheral tissues of the treatment target.
[0069] The shape of the bone hole formed by using the ultrasonic
treatment tool is not limited to a linear round shape as in the
drill, and the bone hole can be formed into each of a linear shape
and a curved shape in a depth direction. Additionally, a laterally
sectional shape of the bone hole is not limited to the round shape,
and the hole can be formed into the desirable shape by moving the
treating portion during the cutting. Additionally, by using the
treating portion beforehand formed in a desirable shape such as the
round shape, an elliptic shape, a long hole shape or a rectangular
shape, the hole can be formed into the desirable shape without
moving the treating portion.
[0070] Additionally, it is also possible to form the bone hole into
the shape corresponding to the sectional shape of the tendon (the
ligament) removed from the other region for use in the
reconstruction at once. Additionally, the treating portion may
beforehand be prepared into a shape equal to the sectional shape of
the tendon.
[0071] By the ultrasonic treatment tool, both the soft tissue and a
hard tissue can be treated, and hence the tissues can be treated by
the same treatment tool though a conventional treatment tool has to
be replaced in accordance with a treatment target region, so that
the ultrasonic treatment tool is efficient, and is capable of
shortening a surgical operation time and decreasing burdens on a
patient.
[0072] The ultrasonic treatment tool performs a treatment of
cutting the treatment target region by the ultrasonic vibration
without heating the treatment target region, and hence thermal
damages can be decreased, postoperative progress can suitably be
obtained and the ultrasonic treatment tool is excellent in less
invasive properties.
[0073] Additional advantages and modifications will readily occur
to those skilled in the art. Therefore, the invention in its
broader aspects is not limited to the specific details and
representative embodiments shown and described herein. Accordingly,
various modifications may be made without departing from the spirit
or scope of the general inventive concept as defined by the
appended claims and their equivalents.
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