CN100525721C

CN100525721C - Clamper for thighbone surgery

Info

Publication number: CN100525721C
Application number: CNB028261402A
Authority: CN
Inventors: 尤金·谢里; 迈克尔·伊根
Original assignee: International Patent Owners Cayman Ltd
Current assignee: International Patent Owners Cayman Ltd
Priority date: 2001-11-02
Filing date: 2002-11-01
Publication date: 2009-08-12
Anticipated expiration: 2022-11-01
Also published as: GB2397769A; EP1455660A1; WO2003037192A1; HRP20040493A2; EA200501303A1; KR20050042228A; MXPA04004244A; NO20042278L; NZ562336A; EP1455660A4; JP2010029718A; GB2397769B; AU2002336798B2; DE10297396T5; RO128189A2; CA2465539A1; BR0214094A; JP2012081293A; RO122117B1; GB0411391D0

Abstract

The surgeon grasps the jig (140) by its handle (141) and manipulates the head (210) of the jig through the patient wound and onto the femoral neck (4), as best illustrated in figure 67. The head (210) of the jig (140) includes jig location means in the form of an elongate rod which acts as a spacer (142). The spacer (142) has an end (211) which abuts the trochanteric fossa so as to position the slot (143) of the jig (140) at the required position, which, in the preferred embodiment, is between 5mm and 25mm, and most preferably 15mm, from the trochantic fossa. Additional jig location means are provided by a surface (212) adapted to receive a bone formation. This surface (212) is provided by contours (146) on the base of the head (210) which are adapted to mate with contours of the femur. The slot (143) is oriented generally perpendicularly to the elongate dimension of the rod (142). The slot (143) functions as a surgical tool guide means which is positioned by the jig (140) at the correct position for osteotomisation of the neck (4). Advantageously, osteotomisation takes place whilst the femoral head (3) is still disposed within the acetabulum.

Description

Be used for the accessory clamp on the femur

Technical field

The present invention relates to be applied to the surgery device that hip is changed operation, be used for the accessory clamp of such surgical operation.

Background technology

Existing hip is changed operation and is related generally at first form a big initial incision, so that expose outside hip joint.Then, the surgeon makes hipbone dislocate generally with massage patient's lower limb.This operation need apply huge power usually and realize the dislocation operation.Excessively massage and apply huge power and can cause concurrent infringement, might cause postoperative pain and/or prolong rehabilitation duration patient.Then, the head of femur is blocked at the cervical region place.On hip, cut with scissors out a depression, receive reparation acetabular cup (a prosthetic acetabular cup) (such as a LINK T.O.P acetabular cup), and a reparation is inserted in the described femur backbone with stem shape thing (such as a LINK C.F.P hip stem).In general, the surgeon can will be cut off and the alignment of fraising instrument by estimating, and this might cause little deviation.Therefore, in case restoration is mounted, can exist the deviation that range estimation is not come out in reparation with acetabular cup and between repairing with femoral head so.This can bring some problems, such as the improper and/or incorrect soft tissue traction of the length of lower limb generation deflection, lower limb.Therefore, from long-range viewpoint, the reparation that deviation takes place can be worn and torn more apace with assembly, causes aseptic the getting loose of generation of these assemblies, and might need to carry out once more as soon as possible surgical operation.

Run through description and must not be counted as a kind of confession by any way to any discussion of prior art, promptly this prior art is very known or constituted the part of general knowledge well known in the art.

Summary of the invention

The objective of the invention is to overcome or improve at least one shortcoming of the prior art, a kind of useful succedaneum perhaps is provided.

According to the present invention, a kind of accessory clamp on the femur of femoral head or proximal femur head when being applied to carry out hip changing operation on limiting the hip of acetabular bone is provided, these anchor clamps comprise: the anchor clamps positioner, be fit to described femur on big at least trochanter skeletal structure be complementary, so that these anchor clamps are positioned to be in a kind of predetermined relationship with described femur, described anchor clamps positioner comprises a pad, this pad is suitable for abutting on described big trochanter skeletal structure or the femur neck bone structure, so that described Surigical tool guiding device is positioned to have predetermined spacing with described big trochanter or femoral neck skeletal structure; With the Surigical tool guiding device, be provided with respect to described anchor clamps positioner, so that make when these anchor clamps and described skeletal structure are complementary, this Surigical tool guiding device is suitable for a Surigical tool is guided to precalculated position on the described femur, and described Surigical tool guiding device is formed by one or more grooving; When described femoral head was set at described acetabular bone inside, described anchor clamps positioner was fit to be complementary with described femur.

Preferably, this pad can comprise a bar that is arranged on the anchor clamps head, be fit to the end match with femur structure so that form one, and the grooving that thus one or more is formed this Surigical tool guiding device is positioned to described femur structure and is in a kind of predetermined relationship.

Above-mentioned grooving is suitable for receiving and guides blade that femoral head is blocked or other to cut off instrument.

This anchor clamps positioner also may comprise the surface such as inverted V-arrangement surface, and this surface is arranged on the main body of these anchor clamps or the main body of contiguous these anchor clamps and be fit to and the skeletal structure such as femoral head matches.In one form, this V-arrangement surface is made of a pair of angled arm, and this arm is spaced apart by a horizontal expansion supporting member and described main body.

These anchor clamps may also comprise having the surface that is arranged on the profile on the described main body, on the femur structure of described outline natural sweep of big trochanter in such as femur and be fit to and this femur structure is complementary.

This anchor clamps positioner preferably is made of the relative projection that is fit to described femur matches.Described projection can and be suitable for for arc stinging and is engaged on the described femur, preferably between described big trochanter and described femoral head.

The accompanying drawing summary

Only, below with reference to accompanying drawings the preferred embodiments of the present invention are described as example, wherein:

Fig. 1 is a perspective view of anchor clamps according to an embodiment of the invention;

Fig. 2 is the plane graph of anchor clamps shown in Fig. 1;

Fig. 3 is the side view of anchor clamps shown in Fig. 1;

Fig. 4 is the front end view of anchor clamps shown in Fig. 1;

Fig. 5 has depicted big trochanter, femoral neck and the femoral head that has labelling, shows the line of cut position of three cross-section femoral neck and the mode that these respective outer side edges on anchor clamps and the femur are got up;

Fig. 6 is the perspective view of a pad;

Fig. 7 is the plane graph of pad shown in Fig. 6;

Fig. 8 is the perspective view of a Wood-scoop;

Fig. 9 to 16 shows some related steps in a method for optimizing carrying out hip replacing operation, and wherein Figure 15 and 16 is sketch maps;

Figure 17 has depicted a femur;

Figure 18 is the plane graph of another pad;

Figure 19 is the side view of pad shown in Figure 18;

Figure 20 is the front view of another pad;

Figure 21 is the vertical view of pad shown in Figure 20;

Figure 22 is the left side view of pad shown in Figure 20;

Figure 23 is the front view of another pad;

Figure 24 is the partial enlarged view of a pad, shows it and is engaged in a mode on the acetabular cup;

Figure 25,26 and 27 is respectively side view, plane graph and the end view of another one according to anchor clamps embodiment of the present invention;

Figure 28 is the plane graph of a drilling tool;

Figure 29 is the plane graph of a Wood-scoop;

Figure 30 is the plane graph of an extractor;

Figure 31 and 32 is respectively the plane graph and the side view of a card punch;

Figure 33 and 34 is respectively the plane graph of left side and right side glass stand;

Figure 35 is the plane graph of a door handle device;

Figure 36 is the plane graph of a calibration handle;

Figure 37 and 38 is respectively the side view and the plane graph of one first pad;

Figure 39 and 40 is respectively the side view and the plane graph of one second pad;

Figure 41 and 42 is respectively the side view and the plane graph of one the 3rd pad;

Figure 43 and 44 is respectively the side view and the plane graph of a sizing stop;

Figure 45 is the sectional elevation of a perforating device;

Figure 46 and 47 is respectively the plane graph and the end view of fastener driver;

Figure 48 and 49 is respectively the plane graph and the end view of the driving head of fastener driver shown in Figure 46 and 47;

Figure 50 and 51 is plane graphs of shim member, is respectively applied on left side and the right side hip;

Figure 52 and 53 is respectively the plane graph and the end view of the extra pad of a medium-width;

Figure 54 and 55 is respectively the plane graph and the end view of the extra pad of big width;

Figure 56 is the side view of a pin extractor;

Figure 57 and 58 is respectively the plane graph and the end view of a pin;

Figure 59 to 62 is plane graphs of screw;

Figure 63,64 and 65 is respectively side view, plane graph and the end view of another one according to anchor clamps embodiment of the present invention;

Figure 66 is one and is about to begin to carry out the perspective view that hip is changed the patient of operation, shows a pelvis support and the initial incision position with respect to the jut of big trochanter;

Figure 67 is a perspective view, shows the anchor clamps according to second embodiment of the invention, and it was used on the femur before the break-in operation of femoral neck;

Figure 68 is a perspective view, shows an end of extractor shown in Figure 30, and this extractor is used on the femoral head that an intercepting gets off;

Figure 69 is a perspective view, shows the part of an acetabular cup truing tool, and this acetabular cup truing tool is used on patient's the acetabular bone; And

Figure 70 is a perspective view, shows the part of a pad truing tool, and this pad truing tool is used on patient's the acetabular bone.

Preferred embodiment

With reference to Fig. 1, accessory clamp 1 is fit to be applied to as on the clear femur that illustrates 2 among Figure 17, and femur 2 comprises 3, one femoral neck 4 of a femoral head and big trochanter 5, and wherein femoral neck 4 usually but be not must be to cut off the position.If the surgeon changes at hip and selects to use LINK T.O.P. acetabular cup and C.F.P. cane in the operation, femoral head 3 must be blocked (in other words being switched " off ") so, carry out along the line of a cross-section femoral neck by cutting off operation, the base portion of its position and big trochanter 5 is approximately at a distance of 1.5 centimetres.Certainly, other repairs articles for use, such as MARGRON THR and SP 2 equipment, might cut off other position on femur 2, such as across big trochanter 5.For these application, need anchor clamps 1 to have suitable geometry.

Anchor clamps 1 comprise anchor clamps positioner 6, and it is fit to be complementary with

skeletal structure

3,4 and 5, so that anchor clamps 1 are positioned to be in a kind of predetermined relationship with skeleton 2.Anchor clamps 1 also comprise Surigical tool guiding device 7, it is provided with respect to anchor clamps positioner 6, so that make when anchor clamps 1 and

skeletal structure

3,4 and 5 are complementary, this Surigical tool guiding device is suitable for a Surigical tool, such as a reciprocating blade, guide to the precalculated position on the described skeletal structure.

Anchor clamps 1 comprise a main body 8.An aspect of anchor clamps positioner 6 is first projection 9 that is oppositely arranged on the main body 8 and the form of second projection 10.Projection 9 and 10 all is fit to be complementary with femoral neck 4.Each projection 9 and 10 all is elongate so that make when anchor clamps 1 and femoral neck 4 are complementary, elongated projection 9 and 10 and elongated femoral neck 4 be in same orientation basically.This point is clear illustrating in Fig. 5, and its

center line

11 and 12 shows the matching part of projection 9 and 10 on femoral neck respectively.Projection 9 and 10 can be stung with femoral neck 4 and is combined together.Each projection 9 and 10 all bends along direction of elongate with a flexural center.

The another one aspect of anchor clamps positioner 6 is surfaces 13 that are suitable for receiving such as the such skeletal structure of femoral head 3.In a preferred embodiment, surface 13 limits an inverted V-arrangement, as clear illustrating among Fig. 4.Inverted V-arrangement surface 13 is formed by an inverted v-component 14, and this v-component 14 is arranged on the main body 8 via a horizontal expansion member 16.Inverted v-component 14 is from projection 9 and 10 horizontally sets.Femoral head 3 is provided with the part of being inverted v-component 14 and is illustrated by line 15 in Fig. 5.

Another aspect of anchor clamps positioner 6 is that a sidewall 17 of main body 8 is processed to be complementary with skeletal structure.Especially, sidewall 17 is bending, so that abut on the natural sweep of big trochanter 5.Sidewall 17 is clearly depicted by line 18 in Fig. 5 along the line that it abuts on the natural bending section of big trochanter 5 basically.

Thus, be complementary via the skeletal structure on following manner and the femur 2 at the anchor clamps preferred embodiment 1 shown in Fig. 1 to 5:

Projection 9 and 10 matches with femoral neck;

Described v-component matches with the part of femoral head, and

Curved sidewall 17 abuts on the natural sweep of big trochanter.

These positioners have guaranteed that jointly anchor clamps 1 can accurately be placed on the femur 2, and are maintained on the correct position, help the break-in operation of femoral neck 4 is calibrated.Selectively,, inverted v-component 14 is resisted against on the femoral head other direction (theother way around) around anchor clamps 1 can be positioned at by being resisted against on the femoral neck 4 and with projection 9 and 10.These anchor clamps 1 can pass described main body 8 or projection 9 and 10 such as the such securing member of pin and enter in the femoral head 3 and further be fixed in its position by ordering about one or more.Certainly, owing to femoral head 3 will be blocked, so less consideration is owing to the damage of described securing member to femoral head 3.As the back in more detail as described in, anchor clamps 1 connect at the pin on the femoral head 3 to be removed femoral head after can being used to subsequently help cutting off operation.

To embodiment shown in Figure 5, Surigical tool guiding device 7 is set between inverted v-component 14 and projection 9 and 10 at Fig. 1.This helps to prevent anchor clamps 1 owing to the effect of power rotates or displacement, and wherein said power is passed to anchor clamps 1 from Surigical tool.Surigical tool guiding device 7 is one or more grooving 20 forms that are arranged at main body 8 inside.Preferred embodiment has three groovings 20.Each grooving all is set at the different lateral position on the main body 8, so that allow grooving 20 that Surigical tool is guided to a more than precalculated position on the described skeletal structure.Described precalculated position is selected as can be corresponding to the reparation articles for use of different size.For example, certain type reparation articles for use need femoral neck 4 being blocked at a distance of 1.5 centimetres position with the base portion of big trochanter 5, and are configured to Surigical tool is guided to this position one of in the described thus grooving 20.Each grooving 20 all carries out horizontal expansion across main body 8, and all is suitable for receiving and guiding a Surigical tool, such as one such as the such reciprocating blade of jib saw.In case in Fig. 5, utilize line 21 to show the positioning states that anchor clamps 1 have matched grooving 20 on the femur 2.Other preferred embodiment (not shown) is suitable for guiding other instrument, is a hollow cylindrical member that is suitable for the drill bit channeling conduct of rotating such as a kind of tool guides device.

Although do not illustrate in Fig. 1 to 4, described preferred embodiment comprises a handle that is arranged on the main body 8.The length of this handle is enough to extend to outside the patient body when anchor clamps 1 coupling is on described skeletal structure.Allow the surgeon to handle the muscular tissue of anchor clamps 1 like this, be complementary with femur 2 through patient.

Preferred surgical method is particularly useful for carrying out hip and changes operation under the situation of osteoarthritis, rheumatic arthritis and osteonecrosis.But it does not been proposed under the following occasion usually and uses:

Being used in femoral head or cervical region has taken place on one's body the distored patient of human anatomy; Perhaps

If patient is very fat, make to be difficult to touch anatomy boundary portion.

Be that patient carries out hip on one's body and changes in the method for optimizing process of operation, preferably adopt the outside, a kind of back surgical operation mode, although other surgical operation mode also is competent at.In the reality,,, must adopt other surgical operation mode so such as owing to previous serious injury of sciatic nerve if the outside, back surgical operation mode is avoided.

Described method for optimizing originates in step a)-manifest patient's big trochanter 5 and femoral neck 4.This just requires on patient's thigh to form a length is 3 to 7 centimetres initial incision, preferably 5 centimetres.An end of otch approximately originates in 1 to 3 centimeters at big trochanter 5 rears, and from bending backward here.The rear of femoral neck 4 reveals by the triceps tendon of peeling off patient, and it can be carried out labelling so that unite by a seam later on.Also can carry out vesiculectomy and manifest femoral neck 4 fully.What pay particular attention to is that femoral head 3 was not dislocated in this stage.Patient's lower limb keeps approximately being with vertical direction the position of 45 degree, preferably utilizes a leg support.For the surgeon, preferably utilize a head lamp.

Step b) relates to the anchor clamps 1 with Surigical tool guiding device 7 is applied on the femur 2, so that make Surigical tool guiding device 7 near femoral neck 4, as shown in Figure 9.Preferably, anchor clamps 1 as previously mentioned.Anchor clamps 1 are matched suitably can cause Surigical tool guiding device 7 to be configured to base portion with big trochanter 5 on the femur 2 at a distance of predetermined distance.Especially, described preset distance is between 10 to 20 millimeters, and in a preferred embodiment, and at least one grooving 20 is configured to base portion with big trochanter 5 at a distance of 15 millimeters.

Optionally, the surgeon can form a notch 22 to help subsequently the excision of femoral head from acetabular bone in femoral head 3 sides of cutting off position 26 on femoral neck 4.Preferably, this notch 22 formed before cutting off operation.This notch can be by making that a jigger saw impacts femoral neck 4 momently or head 3 forms.

Step c) relates to utilizes described Surigical tool guiding device to cut off the instrument channeling conduct to one, so that block described femoral neck.In general, the blade of jib saw is by grooving 20 feedings, so that dispose and lean against on the femoral neck 4 cutting off the position, although also can adopt other to cut off device.Jib saw is opened subsequently, make that cutting off blade moves back and forth, and this jib saw moves progressively perpendicular to femoral neck 4 under the guiding of grooving 20, is blocked until femoral head 3 and a part of femoral neck 4.

Step d) requires the femoral head of blocking is removed from patient's hip joint.Can adopt multiple different technologies to realize this point.For example, can use a Wood-scoop 23 as shown in Figure 8 that the femoral head 3 of blocking is prized from hip joint.Notch 22 can provide one to be convenient to the position that utilizes 23 pairs of femoral head 3 of Wood-scoop to prize, as shown in Figure 10.The part 24 of Wood-scoop 23 has cutter sweep, such as sharp edges, helps to block femoral head 3 is retained in tendon 25 in the hip 26.Sharp edges 24 is set between two

juts

27 and 28, and they help the surgeon to handle Wood-scoop 23, thereby makes sharp edges 24 point to tendon 25.In other words, the surgeon is placed to Wood-scoop 23 and makes

jut

27 and 28 lay respectively at the both sides of tendon 25, then makes Wood-scoop 23 move towards tendon 25 along its longitudinal axis, utilizes sharp edges 24 that tendon 25 is cut off.

If described anchor clamps as described above by dowel fixes on femoral head 3, can adopt a kind of alternative method that femoral head 3 is removed of being used for so.In this case, can apply the effect of power to anchor clamps 1, this power is passed to femoral head 3 by described pin.In some cases, only utilize described power to be enough to femoral head 3 is removed from hip joint.In other cases, described power can help other removal device, such as aforesaid Wood-scoop 23.

Those skilled in the art will be appreciated that, blocking femoral neck 4 before the femoral head of will block 3 is removed is of value to and avoids needing in the prior art at first to make the hip joint dislocation, avoid thus or alleviated the damage that this operation may cause, and simplified surgical procedure.After the femoral head 3 of will block is removed, can finish hip according to prior art and change operation.But, provided multiple further improvement below to the known surgical procedures program.

Be used for a reparation related to the existing method in the cane implanted femur backbone and order about a skeleton compressor and enter in the femur pipeline.Substituting method for optimizing comprises the steps:

E) criterion 29 is placed in patient's femur backbone 31 the femur pipeline 30; (with reference to Figure 11)

F) utilize 29 pairs one flexible reamer 32 channeling conducts of criterion, so that in femur pipeline 30, drill through out a perforation; And

G) reparation is inserted in the described perforation with cane 33, so that make the first end 34 of cane 33 stretch from an end nipple of femur backbone 31.Selectively, can utilize a removable trial-production cane to replace final cane 33.Then, in case the opposed hip joint of using instead has carried out inspection and obtained gratifying result, replace described removable trial-production assembly the assembly of reality is implanted.

The existing method that is used for cutting with scissors out a cavity in acetabular bone relates to utilizes range estimation that the fraising instrument is calibrated.On the contrary, be used for acetabular bone reamed and receive a reparation and comprise the steps: with the preferred steps of acetabular cup

H) first end 34 is placed within patient's the acetabular bone;

I) pad 35 (being also referred to as the pushing-off the wagons club) is inserted between femur backbone 31 the described end and acetabular bone;

J) utilize a pad 35 on patient's acetabular bone, to determine some datum marks 36 (with reference to Figure 12); And

K) utilize described datum mark 36 to come to provide guiding for the fraising operation of acetabular bone.

Especially, in Fig. 6 and 7, illustrated be used in step I) in the example of pad 35.In case their purpose is femur roughly is placed on their positions that will present of this EO.Labelling 40 on the pad 35 is at step j) in determine datum mark guiding be provided.Preferably, datum mark 36 utilizes a heating element heater to be fired on acetabular bone, and described heating element heater is similar to the heated tip that adds of flatiron on function.Pad 35 comprises a handle 37 and a grooving 38, and this grooving 38 is used to be placed into the first end of repairing with cane 33 34.

At step j) in the center of the datum mark 36 that makes up provide be used at step k) to the ream starting point of operation of acetabular bone.These provide a kind of more accurate and stable alternative that is used for existing fraising technology, utilize range estimation to calibrate in described existing fraising technology.

Having illustrated in Figure 20 to 24 can be in step I) and j) in other pad example 100 of adopting.These pads 100 comprise a neighboring 123, and the radius of curvature of this neighboring 123 corresponds essentially to the radius of curvature of repairing with acetabular cup 104.In a preferred embodiment, the radius of curvature of neighboring 123 is complementary with the minimum profile curvature radius of repairing with acetabular cup 104.At step j) in, when at step k) in the fraising operation before when firing datum mark 36 on acetabular bone, the surgeon utilizes edge 123 as guiding piece.

Existing hip is changed operation method and is related to the surgeon at the required size of repairing with assembly, such as repairing with the length of stem/head and the size of acetabular cup, carries out valid estimation (an educated estimate).Then, utilization has the trial-production assembly of estimation size temporarily with the hip joint assembly.If final trial-production joint is unsatisfactory, such as since tissue tension improper, this joint is removed, and uses the trial-production assembly of other size.Method for optimizing provides a kind of alternative method by utilizing pad 35 once more for described prior art.As in Figure 18 clear illustrate, one or more pad 35 and 45 has a spherical surface 48 that is positioned at the middle part, this spherical surface 48 exactly likes femoral head, so that as a femoral head on probation.In certain embodiments, spherical surface 48 is hemispheres, and it is corresponding to a part of repairing with head.Pad 35 and 45 with spherical surface 48 is set on the first end 34 of cane 33, the most approaching described acetabular cup of this first end 34, thus make spherical surface 48 facing to described acetabular cup.The thickness 39 of each pad 35 is selected with the size utilized of assembly according to repairing.For example, a kind of existing reparation has three kinds of available sizes, 40 millimeters, 43 with assembly.5 millimeters and 47 millimeters.In this case, the thickness 39 of at least two pads 35 is 3.5 millimeters, so that corresponding to the size increment between the available reparation usefulness assembly.These two pads have smooth parallel surfaces 46 and 47.The reparation that utilizes different size can realize by the pad 41 that utilizes different numbers or thickness with the effect of assembly.For example, the edge of pad 35 shown in Figure 14 is used in and repairs with on the first end 34 of cane 33.This point exactly likes the interval effect that realizes with assembly by the reparation of using 47 millimeters.If utilized two pads 35, this point will exactly like the interval effect that is associated with assembly with 43.5 millimeters reparation so, or the like.As in Figure 14 clear illustrate, another one pad 45 is wedge shape.This wedge shape has been determined and has been repaired the head trim (perhaps " orientation ") of using the femur cane with acetabular cup and reparation.If adopted a kind of front or preceding outside surgical operation mode, need the wedge shape of a reverse so.Described wedge shape tilts to about 3.5 millimeters minimum widith from 14 millimeters Breadth Maximum.

Other pad embodiment 100 has been shown in Figure 20 to 24, and it is suitable for controlling the head trim of repairing with acetabular cup 103.Pad 100 comprises that a definition has the handle 101 of first end 102.Calibrating installation 103 be set at first end 102 places or near.This calibrating installation 103 is fit to be complementary with acetabular cup 104 with a reparation, so that make that in use, cup 103 is oriented to be in a kind of predetermined relationship with respect to patient's acetabular bone.

Calibrating installation 103 has limited one and has been suitable for abutting in the plane 105 of repairing with on the corresponding flat 106 of acetabular cup 104.Calibrating installation 103 comprises the adapting device that is one or more projection 119 forms, and they are suitable for being coupled to repairs with on the concave surface 120 of acetabular cup 104.Plane 105 is limited by a semicircular surface 107 and forms, and is configured to respect to the 112 one-tenth acute angles 111 in the plane that is limited by handle 101.Thus, calibrating installation 103 is a form that is positioned at the wedge-like member 110 at first end 102 places.Preferably, angle 111 is in 5 degree to the scope of 25 degree.More preferably, angle 111 is positioned at the scope of 10 degree to 20 degree, and angle 111 is approximately 15 degree in a preferred embodiment.This angle 111 is selected, so that corresponding to the natural angle of slope degree of hip joint.

In a preferred embodiment, described calibrating installation is selected to the outside, the operating back of the hip surgical operation mode that is suitable for respect to the geometry of handle.Certainly, other surgical operation mode can need the geometry that changes slightly, and such as comparing with Figure 20, the different handle geometries among Figure 23 are suitable for other surgical operation mode.Overall goal be guarantee when pad 100 be used in a reparation with femur cane 33 expose on the end 34 time, calibrating installation 100 is repaired with acetabular cup 104 with such head trim location, promptly basically with repair with the required head trim of acetabular cup 104 when the surgery surgeon's knot bundle identical.

Calibrating installation 103 comprises a grooving 108, and this grooving 108 is suitable for receiving the evagination end 34 of a reparation with femur cane 33.In case the end 34 of cane 33 is placed in grooving 108 inside, pad 100 will be engaged on the cane 33 in such a way so, promptly be similar to Figure 14 Intermediate gasket 45 and be engaged in mode on the cane end 34.

Repair with acetabular cup with respect to repairing the natural geometry that must as far as possible accurately reflect hip joint with the angle of inclination of cane 33.Along with pad 100 rotates around rotation axis 118, the direction at 15 degree angles of inclination can change.In order to provide guiding to judge whether calibrating installation 103 is oriented to be in described predetermined relationship with respect to patient's acetabular bone to the surgeon, orientation indicating device 109 the second end 113 places or near be set on the pad 100.Orientation indicating device 109 comprises a plummet 114, and this plummet 114 be can be rotatably set on the pad 100, so that be folded down vertically basically under the influence of gravity.Plummet 114 rotatably is attached on the round member 115 on the pad 100 by a pin 116.A datum mark 117 is set on the described pad 100, is oriented to acetabular bone with respect to patient when being in described predetermined relationship with convenient calibrating installation 103, and the plummet 114 that is folded down aligns with datum mark 117.In other words, when hypothesis pad 100 was in required position of rotation with respect to rotation axis 118, the plummet 114 that is folded down alignd with datum mark 117, as shown in Figure 20 and 23.Therefore, if patient lies on one's side, grooving 108 will be complementary with the end 34 of repairing with key so, and pad 100 will be rotated around axis 118, align with datum mark 117 until plummet 114, then reparation will have required head trim with respect to cane 33 with acetabular cup 103.That is to say that when correct use, described pad can guarantee that the thicker end portion 121 on the tapered member 110 is configured to towards the place ahead of patient, and the thinnest end 122 is configured to the rear towards patient.Thus, the gradient of 15 degree is pointed to patient's the outside, the place ahead, has reflected the natural geometry of hip joint.

Especially, being used to determine the method for optimizing of repairing with the required size of assembly comprises the steps:

L) head on probation 41 is placed on the first end 34;

M) acetabular cup on probation 42 is placed in the acetabular bone after the fraising (with reference to Figure 13);

N) described head 41 on probation is placed in the acetabular cup on probation 42;

O) between the described end of one or more pad 35 being inserted femur backbones 31 and the head 41 on probation, until in realization required assembling (with reference to Figure 13,14,15 and 16) between head 41 on probation and the acetabular cup of trying out 41; And

P) make the number of pad 35 or size be associated with the required size of repairing with assembly.

The surgeon is at step o) in utilize to check key element determines between head 41 on probation and the acetabular cup of trying out 41 whether realized required assembling, and described inspection key element is such as being the calibration condition of tissue tension, assembly, length of lower limb or the like.In case at step n) in determined the required size of repairing with assembly, to utilize final reparation to substitute reparation on probation with assembly 41 and 42 (Figure 15), although this fashion of described acetabular cup is not embedded into (not impacted) so with assembly 43 and 44 (Figure 16).The another one purposes of pad 35 is to determine the accurate orientation of the final sum of acetabular cup 44 on cane 33, and then acetabular cup 44 is embedded securely, for good and all is set to put in place.Liner is placed in the acetabular cup 33, is that reparation is restored with head 43 subsequently.In case confirmed the range of movement in new joint, cortex will be sewn and triceps tendon will be retightened so.

Referring to Figure 25 to 65, the apparatus that illustrates has formed a kind of embodiment of kit that is used to carry out described preferred surgical procedure jointly.This instruments box comprises that second embodiment of the anchor clamps 140 (Figure 25-27) on the femur 2 that is applied in acetabular bone cuts off the position with the best of determining femoral neck 4.Described preferred surgical procedure starts from the patient location state that becomes to lie on one's side, and as clear illustrating among Figure 66, the side of performing the operation is positioned at the top.Preferably, adopt a pelvis frame 230 to keep patient to be in required state.Equally preferably, before the surgical operation and among reduce patient's limb temperature.

The operation that appears of operative site originates in an otch along line 231 about 5 centimeter length, and this otch approximately is formed on projection (shown in Figure 66 center line 232) rear 2 centimeters on the big trochanter 5.Then tensor muscle is chosen mouthful (a tensor fasia) and cut off, and the surgeon carries out blunt dissection, until the cervical region 4 that manifests femur 2.The automatic guard ring of batch (-type) utilization (self-retainers) below epidermis.The trailing flank of femoral neck 4 reveals by the lateral rotator of peeling off triceps tendon and weak point, and described lateral rotator is carried out labelling, so that after a while that it is solid again attached.Vesiculectomy manifests trochanteric fossa (that is to say the base portion of big trochanter 5), and manifests femoral neck 4, can touch the base pitch hyperosteogeny subsequently and remove.Different with existing hip replacing operation method, head 3 is not removed at this moment.The surgeon can select to utilize head lamp to improve visibility.Preferably, any in surgical procedures employed flush fluid all through supercooling, so that alleviate bleeding.

Lower limb is placed on the lower limb frame, and keeps approximately being 45 degree with respect to vertical direction.The handle 141 of surgeon by anchor clamps 140 grips these anchor clamps 140, and the head 210 of handling these anchor clamps passes patient's wound on one's body, arrives femoral neck 4, as clear illustrating among Figure 67.The head 210 of anchor clamps 140 comprises the anchor clamps positioner that is the elongate rod form, and it is as a pad 142.An end 211 of pad 142 abuts on the trochanteric fossa, so that the grooving on the anchor clamps 140 143 is positioned desired location, in a preferred embodiment, described position and trochanteric fossa are preferably 15 millimeters at a distance of 5 to 25 millimeters.

As shown in Figure 67, first kind of pattern of anchor clamps 140 is suitable for use on patient's the left side hip joint, and another pattern of anchor clamps 140 is suitable for use on patient's the right hips.Essential distinction between these two kinds of patterns only is that pad 142 is set on the opposite flank of head 210.

Other anchor clamps positioner is formed by a surface 212 that is suitable for receiving a skeletal structure.This surface 212 is formed by the profile 146 on head 210 base portions, and it is fit to the profile phase coupling with femur.

In case described anchor clamps are by appropriate location, as shown in Figure 57 and 58, order about such as the such fixture 143 of pin and pass hole 144 on the head 210 of anchor clamps 140, and enter within the femoral head 3.

Grooving 143 is oriented to the direction of elongate of bar 142 and becomes an acute angle, and this angle depends on the specific reparation assembly required angle of otch in order to be adapted at using in the surgical operation.Grooving 143 is as a Surigical tool guiding device, and it is positioned at the correct position place that is used to block cervical region 4 by anchor clamps 140.As previously mentioned, break-in operation is carried out when femoral head 3 still is positioned at acetabular bone inside.If think to be necessary, the surgeon can also carry out auxiliary nearly body centre side sphenoid and cut operation.

After blocking cervical region 4, femoral head 3 is folding forward, utilize in a large amount of available modes one or more that femoral head 3 is removed subsequently.As shown in Figure 28, can utilize drilling tool 147 within femoral head 3, to drill through out a hole 233.Then, by rotating handles 150 the self-tapping type screw member on the extractor 149 148 is screwed in the hole 223.In case be fixed within the femoral head 3, the surgeon will apply an outside power on handle 150, and correspondingly, this power can be applied on the femoral head 3, so that femoral head 3 is removed.Another alternative mode is provided by Wood-scoop 151, and it can combine with extractor 149 or use separately.Distal portion 152 gradually attenuation be one can wedged femoral head 3 belows the edge, help head 3 is prized from acetabular bone.The end 152 of attenuation can also be used to cut off head 3 is remained on tendon in the acetabular bone gradually.Other alternative removing method comprises head 3 is cut into pieces or dicing.

In order to carry out next surgical procedure, patient's lower limb is supported perpendicular to operating-table.The femur of nearly body centre side utilizes a trocar awl and a guide preparation according to the prior art of standard.Sharp-pointed Hohmanns (that is to say traction apparatus) is placed in the either side of femoral neck 4.Selectively, can below cervical region 4, use a broad blunt formula Hohmann, so that cervical region 4 is raise.

A skeleton compressor can be installed on the drive surfaces 154 of piercer 153, and utilizes a pin 156 to remain on correct position.This skeleton compressor utilizes piercer 153 to be driven within the longitudinal axis that enters femur by using iron hammer, wooden mallet or other suitable tools to impact close end 157.This operates in and forms a hollow bulb in the femur pipeline, is used for subsequent installation one rhizome bar 34 (referring to following).The drive surfaces 154 of piercer 153 allows the surgeon more easily to drive described skeleton compressor along proper orientation from the 155 mode laterally offsets of elongated longitudinal member, and feasible simultaneously and manipulation piercer 153 passes patient's wound on one's body.This helps to reduce described skeleton compressor will be driven into risk in the femur with such angle, promptly might cause the outward flange of femur to chap.Subsequently, use one to come on the end of cervical region 4, to form a circular flat apart from reamer (acalcar reamer).Femur was ready for use on a reparation was inserted with cane this moment, and is as described below such, and described reparation operates in and will carry out after the acetabular cup insertion with the insertion of cane.

Next the surgeon is positioned patient's limbs on the operating-table with relaxation state, prepares the acetabular bone operation of reaming.Then, a sharp-pointed Hohmann is placed in above the leading edge of acetabular bone.Subsequently, utilize the diameter step-by-step movement that constantly increases to the acetabular bone operation of reaming.

Be inserted in the acetabular bone after the fraising in order to repair with acetabular cup, utilize following three component groups to dress up an acetabular cup truing tool 167: calibration handle 159 shown in Figure 36, handle 213 shown in Figure 35 and left side glass stand 158 shown in Figure 33 or right side glass stand 158 shown in Figure 34.Calibration handle 159 comprises a main body 182, and definition has a distal portion 161 and a close end 223 on this main body 182, and handle 182 is between described end.A gauge that is plummet 172 forms is placed in close end 223 places.Gauge 172 is suitable for indicating reparation whether to be in predetermined orientation with respect at least one first plane in the reference system with acetabular cup.A connector that comprises the female thread collar 163 is set at distal portion 161 places.

As required, left side glass stand or right side glass stand 158 are attached on the calibration handle 159 via attachment assembly 160, and wherein attachment assembly 160 is positioned on the close end 164 of glass stand 158.Especially, attachment assembly 160 comprises a jut 169, and this jut 169 is bonded on the connector on the distal portion 160 that is positioned at calibrating installation 159, guarantees alignment suitably between these two assemblies.In case mutual bonding, the female thread collar 163 will be engaged on the external screw thread 224 on the glass stand 158, and these two assemblies are fixed together.

Handle 213 provides extra leverage for the surgeon handling when base connects glass truing tool 167.For handle 213 is connected on the glass stand 158, be positioned at external screw thread 163 threaded engagement on the handle 213 on the female thread 162 that is positioned at glass stand 158 inside.Thus obtained base connects glass truing tool 167 as shown in Figure 69 (although the part of glass stand 158 is interior and invisible owing to being inserted into patient's wound 234 on one's body).

Next procedure is that a reparation with suitable dimension is attached on the acetabular cup truing tool 167 admittedly with acetabular cup.Size according to repairing with acetabular cup might need pad 174,215 or 216.As shown in Figure 37 to 42, the pad with various width can cooperate with the first end 168 of an axle sleeve 170, and its bottom bracket axle 170 is set on the distal portion 165 of glass stand 158.Especially, interference fits can take place with the corresponding perforation 214 in the first end 168 that is arranged on axle sleeve 170 in a jut 166 that is arranged on the pad 174.

The surgeon chooses a pad 174,215 with suitable width or 216 and is complementary with the size of acetabular cup with the reparation that is inserted in patient's hip.Reparation acetabular cup for minimum need not to use pad 174.Pad 174,215 or 216 is consumable goodss of being made by a kind of plastic material, and it is designed to only for disposable use.Described rig comprises four screws 217,218,219 and 220 with different length, respectively as shown in Figure 59 to 62.Thus, this screw and pad scheme are fit to four kinds of reparation acetabular cup sizes, and they correspond respectively to:

Repair with acetabular cup size 1: screw 217, no pad;

Repair with acetabular cup size 2: screw 218 and pad 174;

Repair with acetabular cup size 3: screw 219 and pad 215; And

Repair with acetabular cup size 4: screw 220 and pad 216.

Preferably, screw 217,218,219 and 220 all has a hexagon socket head portion slot 221.The length of each screw all is enough to radially extend through the perforation 214 in the axle sleeve 170 just, the head 222 of each screw passes length and makes pad 174,215 or 216 to cooperate with first end 168 just near the second end 171 of axle sleeve 170 and the first end 168 that thread head 223 passes axle sleeve 170 just simultaneously.The protruding tip of thread head 223 can get up with acetabular cup 104 threaded engagement with reparation.By this way, described reparation is installed on the acetabular cup truing tool 167 with acetabular cup.Especially, described acetabular cup and glass stand 158 cooperate, so that make the concave surface of this acetabular cup facing to the second end 171 of axle sleeve 170.

Then, the surgeon handles acetabular cup truing tool 167 and enters in the wound 234 as shown in Figure 69, so as to make acetabular cup with the fraising after the acetabular bone adjacency.Must carry out orientation this moment to acetabular cup truing tool 167, is in the suitable anatomical position in the acetabular bone that is used to be inserted into after the fraising with acetabular cup to guarantee this reparation.This point is by realizing with reference to the gauge 172 on the calibration handle 159 in conjunction with a sizing stop 176.

Gauge 172 has a thimble 173 as plummet.This thimble 173 be can be rotatably set on the calibration handle 159, so that be folded down vertically basically under the influence of himself gravitational field.This gauge allows the surgeon correctly acetabular cup to be calibrated at least one first plane, this point is by positioning acetabular cup truing tool 167, and the datum mark of thimble 175 forms aligns and realizes with being fixedly to make rotatable thimble 173 in the plummet 172.

Can be used in a plane that not influenced by plummet 172, accurately acetabular cup be calibrated at sizing stop 176 shown in Figure 43 and 44.This sizing stop 176 comprises a support element 177, and definition has a first end 178 and a second end 179 on it.When watching from the side, support element 177 is L-shaped generally, and its plane graph is " A " shape.One back cushion 180 is set on the first end 178, and is suitable for abutting on the flat surface, especially on the vertical side of operating-table.For example, the surgeon can utilize their knee will prop up back cushion 180 to be pressed against on the side of operating-table.The second end 179 of sizing stop 176 is placed near patient's the hip.

The adapting device that is slotted component 181 forms is set on the second end 179, and is calibrated, so that outstanding towards patient's hip.Uncovered grooving 225 on the slotted component 181 limits a semicircular surface 226, and the inboard radius of curvature of this semicircular surface 226 is complementary with the lateral curvature radius of the main body 182 of calibration handle 159.In other words, grooving 225 is processed to receive and to guide the main body 182 of calibration handle 159.Described geometry is to make calibration handle 159 cooperate with adapting device 181, forces calibration handle 159 to be in predetermined orientation with respect to one second plane (being different from first plane that is associated with plummet 172).This is that the longitudinal axis of main body 182 is consistent with the axis of slotted component 181 because width 227 sufficient to guarantees of slotted component 181 are when main body 182 cooperates with slotted component 181.Especially, in the time of in main body 182 is set at slotted component 181, main body 182 is substantially perpendicular to the side of operating-table.

Preferably, patient's hip keeps being in a kind of predetermined state with respect to operating-table on operating-table, such as utilizing a pelvis frame 230 and/or other to be used for fixing the device of the position of patient on operating-table.When each following condition satisfies:

Patient's hip is in described predetermined state on operating-table;

The first end 178 of sizing stop 176 abuts near on the operating-table side of patient's hip, thereby makes the hip of slotted component 181 facing to patient;

The main body 182 of calibration handle 159 cooperates with slotted component 181; And

Rotatable thimble 173 in the plummet 172 aligns with fixing thimble 175, is in predetermined orientation so that indicate reparation with acetabular cup,

The surgeon can confirm that described reparation is correctly located with acetabular cup so, so that be inserted within patient's hip.

At this moment, the surgeon utilizes hole punched device 183 that acetabular cup is impacted in the acetabular bone after the fraising as shown in Figure 45 like that.Especially, the driving head 184 of hole punched device 183 is put on the second end 171 that leans against axle sleeve 170, and when the surgeon grips hole punched device 183 by handle 186, utilizes an iron hammer or similar tool to impact shock surface 185.This process is fixed on described acetabular cup within the acetabular bone after the fraising.

Preferably, fastener driver 187 is Allen keys, as shown in Figure 46 and 47, the interior hexagonal slot 221 on itself and screw 217,218,219 or 220 is complementary, and described screw 217,218,219 or 220 is used for described acetabular cup is fixed on glass stand 158.Allen key 187 has a circular drives end 188, allows screw 217,218,219 or 220 except that directly being activated from certain angular range the alignment.This helps to allow the surgeon to have level of freedom, solves and drives the difficult problem that described screw is associated by patient's wound 234 on one's body.Allen key 187 also has a handle 189, and this handle 189 helps making drive head 188 to be rotated.In case screw 217,218,219 or 220 has got loose from acetabular cup, glass stand 158 will be extracted in the patient body so.

If desired, described acetabular cup can utilize such as the such fixture of screw and optionally be fixed in the acetabular bone after the fraising, and wherein said screw is driven passes described acetabular cup, and enters within patient's the pelvis.Then, a liner is inserted in the described acetabular cup, and a blunt formula Hohmann can be inserted into the below of described liner, avoids taking place subsequent movement.

This moment, patient's lower limb remained in vertical state, allowed cane 33, such as the C.F.P. cane, was inserted within the femur pipeline.After inserting, the end 34 of cane 33 is stretched from the end nipple of femur.

At this moment, must determine postoperative and have the length of the required reparation of suitable lower limb length, tissue tension and muscle tone with cervical region.The trial-production head of a weak point is placed on the described cane, and hip joint is reduced.As in Figure 70 clear illustrate, this moment is by being attached to left side or right side shim member 190 admittedly on the calibration handle 159 in a kind of mode that before glass stand 158 is attached on the door handle device 159 that is similar to as required, and is assembled into a pad truing tool 189.That is to say that jut 191 bondings are gone in the perforation on the distal portion 161 that is arranged on door handle device 159, and the collar 163 threaded engagement are on the close end 192 of shim member 190.Be similar to the previous assembling process of acetabular cup truing tool 167 equally, handle 162 is screwed in the described shim member at female thread 193 places, and wherein female thread 193 is provided with near the close end 192 of shim member 190.In other words, for assembled gasket truing tool 189, only need utilize acetabular cup truing tool 167 simply and utilize shim member 190 to substitute described glass stand 158.

Shim member 190 comprises a pad 194, and this pad 194 has a suitable grooving 195 that matches with the end 34 of cane 33.As shown in Figure 70 (although as described in head on probation be hidden in acetabular bone inside after the fraising), pad 194 is between the end 34 of described head on probation and femur.When correct location, described head on probation is set at semispherical surface 203 inside.The surgeon can utilize plummet 172 and sizing stop 176 to guarantee that pad 194 and described head on probation are able to orientation in a kind of correct anatomy mode when carrying out following inspection once more.

Utilization is in the pad 194 of correct position, and the surgeon checks whether lower limb length and/or tissue tension and/or muscle tone is enough.If answer negates, the surgeon will extract pad truing tool 189 and additional 196 (as shown in Figure 52 and 53) of a medium-width will be clamped on the pad 194 so.The additional pad 196 of medium-width is clamped on the pad 194 via being arranged on two press-fitting structures 198 on the assembly.If lower limb length and/or tissue tension and/or muscle tone are still not enough, utilize the additional pad 196 of the additional pad 197 replacement medium-width of big width to repeat described process once more so.

In other words, the pad 194,196 or 197 (perhaps utilizing the pad of different numbers) that described checking process utilization has different-thickness repeats, until obtaining suitable anatomy lower limb long and/or tissue tension and/or muscle tone.Subsequently, the surgeon notes the spacer thickness (perhaps pad number) that optimum efficiency is provided, and makes this spacer thickness (perhaps pad number) be associated with neck length with required reparation according to a predetermined contingency table.For example, if the suitable lower limb that obtains under the condition that need not

additional pad

196 or 197 long and/or tissue tension and/or muscle tone will utilize the shortest reparation neck length so.If utilize the additional pad 196 of intermediate gauge to obtain suitable lower limb length or the like, will utilize a medium reparation neck length so.If utilize the accessory pads 197 of big width to obtain suitable lower limb length or the like, will use the longest reparation neck length so.Certainly, also can design other contingency table at other method for optimizing.

For prior art, preferably detecting out provides suitable lower limb length or the like required reparation articles for use size, and it relates to makes hip joint dislocate repeatedly, until determining the suitable dimension of repairing with assembly.

But hip dislocates and checks that to repairing with assembly present reparation by reality is substituted with assembly with the hip recovery.The surgeon confirms that at this moment patient's lower limb has suitable range of movement, and check out for twice obtained that permissible lower limb is long, tissue tension and muscle tone.The surgeon is connected again by the outer rotor with triceps tendon and weak point and sews up each cortex and come to finish operation process with standard mode.In order to help postoperative rehabilitation, suggestion is at low temperature cuff of hip area applications.

Reclaim pin 143 if desired, can utilize pin extractor 199, wherein pin 143 had before been driven and had been entered in the femoral head 3, in case and femoral head 3 from patient body, removed, maintenance is embedded within the femoral head 3.Also have, might on femoral head 3, check, need in this case pin 143 is removed.Utilize the clamp that radially separates, through mating component 203, pin 143 can be inserted within the perforation 202.Then, clamp radially is clamped together,, makes pin extractor 199 grasp pin 143 tightly thus so that make mating component 203 on the notch 229 of end 229 adnexaes that are positioned at pin 143, apply a cross force.Then apply a longitudinal force on pin extractor 199, this power is passed to pin 143, helps pin 143 is extracted from the femoral head of cutting off 3.Described longitudinal force can apply by utilizing an iron hammer to impact jut 204.

It will be understood that being used for hip changes the described method for optimizing of operation and compare with existing method many advantages are provided.Especially, hip joint need not dislocation before blocking; The ream degree of accuracy and the concordance of operation of femur and acetabular bone is improved, and is used to make up repair and needs less preproduction and less the error in general with the required size of assembly and orientation.In general, this can provide a kind of like this surgical procedures, and wherein patient's ligament and less the standing of muscle adnexa are bothered, and allows patient's rehabilitation quickly, has less postoperative pain.Other advantage generally is associated with preferred embodiment, comprises that cicatrix is less, lose blood and blood clot is less, the risk of infection reduces, the hospital stays shortens and expense descends.

Although invention has been described with reference to specific example, those skilled persons should be understood that in the art, and the present invention can be implemented with multiple other form.

Claims

1. accessory clamp on the femur of femoral head or proximal femur head when being applied on limiting the hip of acetabular bone, to carry out hip and changing operation, these anchor clamps comprise:

The anchor clamps positioner, be fit to described femur on big at least trochanter skeletal structure be complementary, so that these anchor clamps are positioned to be in a kind of predetermined relationship with described femur, described anchor clamps positioner comprises a pad, this pad is suitable for abutting on described big trochanter skeletal structure or the femur neck bone structure, so that described Surigical tool guiding device is positioned to have predetermined spacing with described big trochanter or femoral neck skeletal structure; With

The Surigical tool guiding device, be provided with respect to described anchor clamps positioner, so that make when these anchor clamps and described skeletal structure are complementary, this Surigical tool guiding device is suitable for a Surigical tool is guided to precalculated position on the described femur, and described Surigical tool guiding device is formed by one or more grooving;

When described femoral head was set at described acetabular bone inside, described anchor clamps positioner was fit to be complementary with described femur.

2. according to the accessory clamp described in the claim 1, it is characterized in that described pad is an elongate rod.

3. according to the accessory clamp described in the claim 1, it is characterized in that described anchor clamps positioner comprises a surface that is suitable for receiving described big trochanter and a femoral neck skeletal structure and a femoral head skeletal structure.

4. according to the accessory clamp described in the claim 3, it is characterized in that described surface comprises the profile that profile phase suitable and described skeletal structure mates.

5. according to the accessory clamp described in the claim 1, it is characterized in that described anchor clamps also comprise a head on the distal portion that is arranged on a handle.

6. according to the accessory clamp described in the claim 5, it is characterized in that described pad is that a velamen is arranged on the elongate rod on the described head.

7. according to the accessory clamp described in the claim 5, it is characterized in that described one or more grooving is set on the described head.

8. according to the accessory clamp described in the claim 6, it is characterized in that described one or more grooving is set on the described head, the direction of elongate of described bar becomes an acute angle to extend with respect to the direction of elongate of described grooving.

9. accessory clamp according to claim 1 is characterized in that, each described grooving all is suitable for receiving and guiding a reciprocating blade.

10. accessory clamp according to claim 1 is characterized in that, a more than grooving is set on the described head, so that allow these groovings that a Surigical tool is guided to a more than precalculated position on the described skeletal structure.

11. the accessory clamp according to described in the claim 10 is characterized in that, each precalculated position on the described femur is selected to can be corresponding to the reparation articles for use of different size.

12., also comprise being used for these anchor clamps are fixed on fixture on the described skeletal structure with required state according to the accessory clamp described in the claim 1.

13. the accessory clamp according to described in the claim 12 is characterized in that, described fixture comprises pin, and these pins can be driven the hole of passing on this anchor clamps head, and enter within the described skeletal structure.

14. the accessory clamp according to described in the claim 2 is characterized in that, described bar comprises an end, and this end is suitable for abutting on the trochanteric fossa that is limited by described femur.

15. the accessory clamp according to described in the claim 14 is characterized in that, described bar is processed to described Surigical tool guiding device can be positioned to have 5 to 25 millimeters spacing with described trochanteric fossa.

16. the accessory clamp according to described in the claim 15 is characterized in that, described spacing is 15 millimeters.

17. the accessory clamp according to described in the claim 1 is characterized in that, described anchor clamps positioner comprises the first relative projection and second projection that is arranged on this jig main body.

18. the accessory clamp according to described in the claim 17 is characterized in that, described projection is fit to be complementary with the cervical region of a femur.

19. according to the accessory clamp described in the claim 18, it is characterized in that, each described projection all has a direction of elongate, this direction of elongate is oriented to when these anchor clamps and described skeletal structure are complementary, and the direction of elongate of described projection is in same direction with the direction of elongate of femoral neck basically.

20. accessory clamp according to claim 17 is characterized in that, described projection can be stung and is engaged on the described skeletal structure.

21. the accessory clamp according to described in the claim 19 is characterized in that, described projection can be stung and is engaged on the described skeletal structure, and described projection utilizes a flexural center to bend along described direction of elongate.

22. the accessory clamp according to described in claim 3 or 4 is characterized in that, described surface limits an inverted V-arrangement.

23. the accessory clamp according to described in the claim 22 is characterized in that, described inverted V-arrangement surface is formed by an inversion v-component that is arranged on the described main body.

24. the accessory clamp according to described in the claim 23 is characterized in that, described anchor clamps positioner comprises the first relative projection and second projection that is arranged on this jig main body, and described inverted v-component is from described projection horizontally set.

25. the accessory clamp according to described in the claim 24 is characterized in that, described Surigical tool guiding device is set between described inverted v-component and the described projection.

26. the accessory clamp according to described in the claim 5 is characterized in that, the length of described handle is enough to extend to outside the patient body when the head of these anchor clamps mates on described femur.

27. the accessory clamp according to described in the claim 1 is characterized in that, described anchor clamps positioner comprises the main body with a sidewall, and this sidewall is processed to and can be complementary with described skeletal structure.

28. the accessory clamp according to described in the claim 27 is characterized in that, described sidewall is crooked.

29. the accessory clamp according to described in the claim 28 is characterized in that, described crooked sidewall is processed to abut on the natural bending section of the big trochanter on the femur.