DE102010016803A1 - Medical fixing device comprises fixing element which is provided with distal end section, where inserting position is converted in fixed position by approaching distal end section relative to proximal end section - Google Patents

Abstract

The medical fixing device comprises a fixing element (38,40) which is provided with a distal end section (48) and a proximal end section (50). An inserting position is converted in a fixed position by approaching the distal end section relative to the proximal end section. The fixing element comprises a hinge (52,54,68) for converting the inserting position in the fixed position.

Description

The invention relates to a medical fixing device, comprising at least one fixing element with a distal end portion and a proximal end portion, which can be transferred by approaching the distal end portion and the proximal end portion relative to each other from an insertion position to a fixing position in which the fixing device has a larger cross-sectional area than in the insertion position.

Such a fixing device is for example in the WO 99/60931 A1 described. It can be used for connecting two tissue located inside the body, wherein the fixation device is introduced endoscopically into the body in a minimally invasive manner by a relatively small access, for example. For this purpose, the at least one fixing element occupies the insertion position, in which it is typically elongated or substantially elongated and has only a small cross-sectional area. In the interior of the body, the fixing element can be transferred into the fixing position, so that the cross-sectional area of the fixing device is larger transversely to the original longitudinal extension of the fixing element than in the insertion position. The exerting of an axially acting force on the distal and on the proximal end portion can thus lead to transferring the at least one fixing element from the insertion position into the fixing position and thereby to a radial widening, optionally with simultaneous axial shortening of the fixing device. This allows the anchoring of the fixation device on a body tissue, for example by engaging behind it or by penetrating into the same. The anchoring to a further body tissue is made possible by means of a further fixing element of the fixing device that can be formed in a corresponding manner to the first-mentioned fixing element.

"Proximal" and "distal" is to be understood in the present case referring to the surgeon who uses the fixator. This introduces the fixing device with its distal end ahead in the interior of the body.

The object of the present invention is to provide a generic fixing device in which a transfer of the at least one fixing element from the insertion position into the fixing position is possible in a simpler manner.

This object is achieved according to the invention in a fixing device of the type mentioned in the introduction that the at least one fixing element comprises at least one joint effective in transferring from the insertion position into the fixing position.

At the point of the at least one fixing element on which the at least one joint is arranged, a defined manipulation of the at least one fixing element can take place. For example, it is possible to bring about a targeted deformation of the at least one fixing element at the location of the at least one joint by approximating the proximal and the distal end section relative to each other. This makes it possible to transfer the fixing element in a simpler manner from the insertion position into the fixing position. This also improves the handling of the fixing device, which can also be anchored by the surgeon in a more reliable manner to a body tissue.

The wording "that the at least one fixing element comprises at least one joint" in the present case includes the case that the at least one fixing element only partially covers the at least one joint, ie for example only one of two or more relatively movable components of the joint.

It is expedient if the at least one fixing element comprises a distal fixing element having the distal end section and a proximal fixing element having the proximal end section, which are connected to one another via a joint. This allows a reliable transfer of the at least one fixing element from the insertion position into the fixing position, wherein the distal and the proximal fixing member are moved relative to each other, so that the fixing element can deform in a defined manner at the location of the joint. The distal and the proximal fixing member, so to speak, form two limbs of the at least one fixing element hinged to each other.

It is advantageous if the joint is arranged on a proximal end of the distal fixing member and / or if the joint is arranged on a distal end of the proximal fixing member. As a result, in the fixing position in the radial direction, relative to an axis of the fixing device, there is no protrusion of the distal and / or proximal fixing element beyond the joint. A risk of injury to body tissue by such a supernatant can be reduced thereby.

Preferably, the distal fixing member and / or the proximal fixing member are web-shaped or strip-shaped, wherein they have a preferably axial longitudinal extent in the insertion position. This allows a compact design of the fixing, so that it can be introduced via a relatively small access in the body. In addition, one can reliable deformation of the at least one fixing element can be achieved.

It is favorable if the at least one joint is arranged centrally between the proximal end section and the distal end section on the at least one fixing element. As a result, the at least one fixing element can deform symmetrically with respect to the joint. This allows a more reliable transfer of the at least one fixing element from the insertion position into the fixing position.

Advantageously, a joint is arranged at the distal end section, via which the at least one fixing element is connected to a distal holding element encompassed by the fixing device. This allows an even easier transfer of the at least one fixing element from the insertion position into the fixing position. For example, a movement of the at least one fixing element in the radial direction to increase the cross-sectional area of the fixing device can take place at the joint. The at least one fixing element may comprise the joint completely, but it is also possible for the joint to be only partially covered by the fixing element and to be divided between the latter and the distal holding element.

In a corresponding manner, it is advantageous if a joint is arranged at the proximal end portion, via which the at least one fixing element is connected to a proximal holding element encompassed by the fixing device, which is designed to be movable relative to the distal holding element. In this case as well, a more reliable transfer of the at least one fixing element from the insertion position into the fixing position is possible, for example in the radial direction with enlargement of the cross-sectional area of the fixing device. The movable relative to the distal support member proximal retaining element allows a relative movement of the distal and the proximal end portion for transferring the at least one fixing element in the fixing position. Also in this embodiment, the at least one fixing element may comprise the joint completely, or the joint may be divided between the proximal holding element and the at least one fixing element.

The fixing device preferably has a carrier element which interacts with the distal holding element and the proximal holding element. By means of the carrier element, a more stable construction and a more reliable function of the fixing device can be achieved. The carrier element can serve to hold the holding elements and thus of the at least one fixing element, and the carrier element can engage the surgeon in order to introduce the fixing device.

In a structurally simple embodiment of the fixing device, it is advantageous if the carrier element comprises or forms at least one holding element. The carrier element may be connected to the at least one holding element, for example in one piece.

It is advantageous if the carrier element defines an axis of the fixing device, parallel to which the at least one fixing element in the insertion position is advantageously aligned parallel. Thereby, a defined approach of the distal and the proximal end portion relative to each other can be achieved.

In a simple structural embodiment, a holding element is fixed to the carrier element, so that also connected to this holding element at least one fixing element is fixed to the carrier element.

The holding element may in particular be fixed to a distal end of the carrier element. This makes it possible to give the fixing a compact design.

Conveniently, at least one holding element is designed to be movable relative to the carrier element in order to ensure a relative mobility of the proximal and the distal holding element to one another.

For example, it can be provided that the distal holding element is fixed to the carrier element and the proximal holding element is designed to be movable relative to the carrier element.

It can also be provided that both the proximal and the distal holding element are designed to be movable relative to the carrier element.

Preferably, the movable support member is formed relative to the support member in particular axially displaceable, because this ensures their reliable operation with a simple structural design of the fixing.

In order to secure the at least one fixing element in the fixing position, it is advantageous if the fixing device comprises a locking device for fixing the holding element relative to the carrier element.

Preferably, the locking device is designed as a latching device, because this allows their simple structural design and ease of operation by the surgeon.

It is advantageous if at least one holding element is designed as a sleeve surrounding the carrier element, since this likewise makes possible a simple design configuration of the fixing device. The sleeve may be displaceable along the carrier element and thereby guided by this.

It is advantageous if the carrier element is designed as a hollow body, in particular as an axially extending hollow cylinder. By the cavity enclosed by the hollow body, for example, an actuating element or the like for transferring the at least one fixing element can be guided from the insertion position into the fixing position.

Preferably, the fixing device has a pulling element which is guided from the proximal to distal through the hollow body and exits from it at a distal outlet opening and engages on at least one proximal holding element of the fixing device. The tension element is an actuating element with the aid of which the at least one fixing element can be transferred from the introduction position into the fixing position. For this purpose, the surgeon can act on a proximal end of the tension element, which is deflected at the distal outlet opening and thereby can be effective for the application of force to the proximal holding element in the distal direction.

Preferably, the at least one fixing element is rigid, apart from the at least one joint encompassed by it. About the rigidly formed at least one fixing axial tensile forces can be transmitted reliably and thereby the fixing device securely anchored to a body tissue.

In a structurally simple embodiment of the fixing device, it is favorable if at least one joint is formed as a material weakening region of the at least one fixing element. As a result, it is also possible to achieve a compact design of the fixing device, which is advantageous for a minimally invasive use of the fixing device in the interior of the body.

Preferably, the joint is formed as a result of a material recess on at least one fixing element, so that the joint can be performed as material weakening range in a simple manner manufacturing technology.

It is advantageous if the joint is formed as a portion of higher mechanical deformability than the rest of the at least one fixing element. This also makes it possible in a structurally simple way to form a joint as a material weakening area.

It may in particular be provided that each joint is formed as a material weakening region of the at least one fixing element.

A simple constructive embodiment of the fixing device can also be achieved in that at least one joint is formed at least partially in one piece and in particular completely in one piece with the at least one fixing element. Particularly preferably, all joints are formed integrally with the at least one fixing element.

Preferably, at least one joint is designed as a hinge joint, in particular as integrally formed with the at least one fixing element film hinge. In a structurally simple way, thereby a reliable function of the fixing can be ensured. The joint axis defined by the hinge joint is favorably aligned transversely and in particular perpendicular to an axis of the fixing device. As a result, the fixing device can be radially expanded defined under axial shortening.

It is particularly advantageous if all the joints of the at least one fixing element are designed as hinge joints and, in particular, as living hinges, ie for example a joint for connecting the fixing element to a distal holding element, a joint for connecting the fixing element to a proximal holding element and a joint between a distal one and a proximal fixing member of the fixing element, which to a certain extent form legs of the hinge joint.

In another embodiment, it can be provided that at least one joint is designed as a ball joint. As a result, the at least one fixing element can be given additional degrees of freedom for transferring from the insertion position into the fixing position, thereby making the fixing device even more flexible.

It is favorable if the at least one fixing element covers an angle of less than approximately 20 ° in the circumferential direction of an axis defined by the fixing device, preferably approximately 5 ° to approximately 10 °. As a result, the at least one fixing element is so narrow that only little space is required for the introduction of the fixing device into the interior of the body, for example via a hollow needle and / or endoscopically. Furthermore, with such a narrowly formed fixing element, an axial force acting on the distal and the proximal end sections can result in such a large radial force on the at least one fixing element that the at least one fixing element can penetrate radially into the body tissue for anchoring. Due to the limited education of at least one Fixing this can also be provided in the manufacture in a simpler way with a joint and in particular a film hinge this.

Advantageously, the fixing device comprises two or more fixing elements arranged in the circumferential direction of an axis defined by it. As a result, the fixing device can be more reliably anchored to a body tissue using more than one fixation element.

An even more reliable anchoring and also a uniform anchoring of the fixing device on the body tissue is possible if each two fixing elements are diametrically opposed to each other with respect to the axis.

Also, a uniform anchoring of the fixing device on the body tissue is facilitated by the fact that the two or more fixing elements are uniformly spaced in the circumferential direction of the axis, d. H. two fixing elements each include the same angle between each other. In two specific embodiments of the fixing device according to the invention, it proves to be favorable in practice if the fixing device comprises two fixing elements for anchoring to a body tissue or eight fixing elements for anchoring to a body tissue.

Preferably, the fixing device comprises at least one distal fixing element and at least one proximal fixing element, which are spaced apart in the axial direction with respect to an axis defined by the fixing device. This allows two body tissues to be connected together. By means of the at least one distal fixing element, the fixing device can be anchored to a first body tissue and to the second body tissue by means of the at least one proximal fixing element. In this case, the body tissues can each be grasped behind, or the fixing elements can penetrate into the body tissue. If the fixing elements assume their respective fixing position, the body tissues are at least partially arranged between the at least one proximal and the at least one distal fixing element.

The above-described features of the at least one fixing element of the fixing device according to the invention and advantageous embodiments thereof are valid both for the at least one distal and for the at least one proximal fixing element. The at least one proximal and the at least one distal fixing element can therefore each have all or part of the abovementioned features of the at least one fixing element.

It is favorable if the proximal end section of the at least one distal fixing element is coupled to the distal end section of the at least one proximal fixing element. For example, both are fixed to a common holding element. Through the coupling, a force can be transmitted in the axial direction, which is effective in the connection of the body tissues together.

Preferably, the proximal end portion of the at least one distal fixing element and the distal end portion of the at least one proximal fixing element are fixed to a common, in particular radially to the support member axially movable holding element. This allows a structurally simple coupling of the at least one distal with the at least one proximal fixing element and a facilitated transfer of the distal and the proximal fixing in the fixing position. For the at least one distal fixing element, the holding element is a proximal holding element, and for the at least one proximal fixing element, the holding element is a distal fixing element.

A fixing device of the latter type preferably additionally comprises a distal holding element fixed to the carrier element, which is connected to the distal end section of the at least one distal fixing element, and also a proximal holding element, which is designed to be movable relative to the carrier element and to the proximal end section of the at least one proximal fixing element is connected. When the latter holding element is subjected to a force in the distal direction, it and the holding element coupling the proximal fixing element with the distal fixing element are moved in the direction of the distal end section of the distal fixing element. This makes it possible in a user-friendly manner to transfer both the proximal and the distal fixing element from the insertion position into the fixing position. The radial widening of the fixing device is greater, the further the coupling and the proximal holding element are moved in the direction of the distal holding element.

Alternatively, it can be provided that the distal holding element and the coupling holding element are designed to be movable relative to the carrier element and that the proximal holding element is fixed to the carrier element.

Again alternatively, it can be provided that the distal holding element and the proximal holding element are movable relative to the carrier element and that the coupling holding element is fixed to the carrier element.

A reliable connection between two body tissues can be achieved if the fixation device comprises the same number of proximal fixation elements and of distal fixation elements.

It is favorable if in the axial direction a respective distal fixing element and a proximal fixing element are aligned with each other. In the respective fixing positions, the distal and proximal fixing elements can press two body tissues against each other for improved connection.

It may be provided that at least one distal fixing element and at least one proximal fixing element are identical, and in particular all distal and all proximal fixing elements and especially all fixing elements of the fixing device are formed identically. This simplifies the production of the fixing device.

It is favorable if the fixing device is made of a resorbable material. After application, the fixation device can be picked up by the body and does not need to be removed from it by means of a new operation.

• 1. Medizinische Fixiereinrichtung, umfassend mindestens ein Fixierelement (38, 40) mit einem distalen Endabschnitt (48) und einem proximalen Endabschnitt (50), das durch Annähern des distalen Endabschnittes (48) und des proximalen Endabschnittes (50) relativ zueinander von einer Einbringstellung in eine Fixierstellung überführbar ist, in welcher die Fixiereinrichtung (10; 100; 110) eine größere Querschnittsfläche aufweist als in der Einbringstellung, dadurch gekennzeichnet, dass das mindestens eine Fixierelement (38, 40) mindestens ein beim Überführen von der Einbringstellung in die Fixierstellung wirksames Gelenk (52, 54, 68) umfasst.
• 2. Fixiereinrichtung nach Satz 1, dadurch gekennzeichnet, dass das mindestens eine Fixierelement (38, 40) ein den distalen Endabschnitt (48) aufweisendes distales Fixierglied (76) und ein den proximalen Endabschnitt (50) aufweisendes proximales Fixierglied (78) umfasst, die miteinander über ein Gelenk (68) verbunden sind.
• 3. Fixiereinrichtung nach Satz 2, dadurch gekennzeichnet, dass das Gelenk (68) an einem proximalen Ende des distalen Fixiergliedes (76) angeordnet ist und/oder dass das Gelenk (68) an einem distalen Ende des proximalen Fixiergliedes (78) angeordnet ist.
• 4. Fixiereinrichtung nach Satz 2 oder 3, dadurch gekennzeichnet, dass das distale Fixierglied (76) und/oder das proximale Fixierglied (78) steg- oder streifenförmig ausgebildet sind.
• 5. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das mindestens eine Gelenk (68) mittig zwischen dem proximalen Endabschnitt (50) und dem distalen Endabschnitt (48) am mindestens einen Fixierelement (38, 40) angeordnet ist.
• 6. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass am distalen Endabschnitt (48) ein Gelenk (52) angeordnet ist, über das das mindestens eine Fixierelement (38, 40) mit einem von der Fixiereinrichtung (10; 100; 110) umfassten distalen Halteelement (42, 44) verbunden ist.
• 7. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass am proximalen Endabschnitt (50) ein Gelenk (54) angeordnet ist, über das das mindestens eine Fixierelement (38, 40) mit einem von der Fixiereinrichtung (10; 100; 110) umfassten proximalen Halteelement (44, 46) verbunden ist, welches relativ zum distalen Halteelement (42, 44) beweglich ausgebildet ist.
• 8. Fixiereinrichtung nach Satz 7, dadurch gekennzeichnet, dass die Fixiereinrichtung (10; 100; 110) ein Trägerelement (12; 112) aufweist, das mit dem distalen Halteelement (42, 44) und dem proximalen Halteelement (44, 46) zusammenwirkt.
• 9. Fixiereinrichtung nach Satz 8, dadurch gekennzeichnet, dass das Trägerelement (12; 112) mindestens ein Halteelement umfasst oder ausbildet.
• 10. Fixiereinrichtung nach Satz 8 oder 9, dadurch gekennzeichnet, dass das Trägerelement (12; 112) eine Achse (14) der Fixiereinrichtung (10; 100; 110) definiert.
• 11. Fixiereinrichtung nach einem der Sätze 8 bis 10, dadurch gekennzeichnet, dass ein Halteelement (42) am Trägerelement (12; 112) festgelegt ist.
• 12. Fixiereinrichtung nach Satz 11, dadurch gekennzeichnet, dass das Halteelement (42) an einem distalen Ende (16) des Trägerelementes (12; 112) festgelegt ist.
• 13. Fixiereinrichtung nach einem der Sätze 8 bis 12, dadurch gekennzeichnet, dass mindestens ein Halteelement (44, 46) relativ zum Trägerelement (12; 112) beweglich ausgebildet ist.
• 14. Fixiereinrichtung nach Satz 13, dadurch gekennzeichnet, dass das bewegliche Halteelement (44, 46) relativ zum Trägerelement (12; 112) insbesondere axial verschieblich ausgebildet ist.
• 15. Fixiereinrichtung nach Satz 13 oder 14, dadurch gekennzeichnet, dass die Fixiereinrichtung (10; 110) eine Feststelleinrichtung (22) umfasst zum Fixieren des Halteelementes (44, 46) relativ zum Trägerelement (12; 112).
• 16. Fixiereinrichtung nach Satz 15, dadurch gekennzeichnet, dass die Feststelleinrichtung (22) als Rasteinrichtung (22) ausgebildet ist.
• 17. Fixiereinrichtung nach einem der Sätze 8 bis 16, dadurch gekennzeichnet, dass mindestens ein Halteelement (42, 44, 46) als das Trägerelement (12; 112) umgebende Hülse (24, 26, 28) ausgebildet ist.
• 18. Fixiereinrichtung nach einem der Sätze 8 bis 17, dadurch gekennzeichnet, dass das Trägerelement (112) als Hohlkörper (114) ausgebildet ist, insbesondere als axial erstreckter Hohlzylinder (114).
• 19. Fixiereinrichtung nach Satz 18, dadurch gekennzeichnet, dass die Fixiereinrichtung (110) ein von proximal nach distal durch den Hohlkörper (114) hindurch geführtes, an einer distalen Austrittsöffnung (122) aus diesem austretendes und an mindestens einem proximalen Halteelement (44, 46) der Fixiereinrichtung (110) angreifendes Zugelement (118) aufweist.
• 20. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das mindestens eine Fixierelement (38, 40) starr ausgebildet ist, abgesehen von dem mindestens einen von ihm umfassten Gelenk (52, 54, 68).
• 21. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass mindestens ein Gelenk (52, 54, 68) als Materialschwächungsbereich (60, 62, 72) des mindestens einen Fixierelementes (38, 40) gebildet ist.
• 22. Fixiereinrichtung nach Satz 21, dadurch gekennzeichnet, dass das Gelenk (52, 54, 68) als Folge einer Materialausnehmung (64, 66, 74) am mindestens einen Fixierelement (38, 40) gebildet ist.
• 23. Fixiereinrichtung nach Satz 21 oder 22, dadurch gekennzeichnet, dass das Gelenk (52, 54, 68) als Abschnitt höherer mechanischer Verformbarkeit als der Rest des mindestens einen Fixierelementes (38, 40) gebildet ist.
• 24. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass mindestens ein Gelenk (52, 54, 68) zumindest teilweise einstückig mit dem mindestens einen Fixierelement (38, 40) gebildet ist.
• 25. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass mindestens ein Gelenk (52, 54, 68) als Scharniergelenk (56, 58, 70) ausgebildet ist, insbesondere als Filmscharnier (56, 58, 70).
• 26. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass mindestens ein Gelenk als Kugelgelenk ausgebildet ist.
• 27. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das mindestens eine Fixierelement (38, 40) in Umfangsrichtung einer von der Fixiereinrichtung (10; 100; 110) definierten Achse (14) einen Winkel von kleiner als ungefähr 20° überdeckt, bevorzugt ungefähr 5° bis ungefähr 10°.
• 28. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Fixiereinrichtung (10; 100; 110) zwei oder mehr in Umfangsrichtung einer von ihr definierten Achse (14) angeordnete Fixierelemente (38, 40) umfasst.
• 29. Fixiereinrichtung nach Satz 28, dadurch gekennzeichnet, dass je zwei Fixierelemente (38, 40) einander bezüglich der Achse (14) diametral gegenüberliegen.
• 30. Fixiereinrichtung nach Satz 28 oder 29, dadurch gekennzeichnet, dass die zwei oder mehr Fixierelemente (38, 40) in Umfangsrichtung der Achse (14) gleichmäßig voneinander beabstandet sind.
• 31. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Fixiereinrichtung (10; 100; 110) mindestens ein distales Fixierelement (38) und mindestens ein proximales Fixierelement (40) umfasst, die in axialer Richtung bezüglich einer von der Fixiereinrichtung (10; 100; 110) definierten Achse (14) voneinander beabstandet sind.
• 32. Fixiereinrichtung nach Satz 31, dadurch gekennzeichnet, dass der proximale Endabschnitt (50) des mindestens einen distalen Fixierelementes (38) mit dem distalen Endabschnitt (48) des mindestens einen proximalen Fixierelementes (40) gekoppelt ist.
• 33. Fixiereinrichtung nach Satz 32, dadurch gekennzeichnet, dass der proximale Endabschnitt (50) des mindestens einen distalen Fixierelementes (38) und der distale Endabschnitt (48) des mindestens einen proximalen Fixierelementes (40) an einem gemeinsamen, axial beweglichen Halteelement (44) festgelegt sind.
• 34. Fixiereinrichtung nach einem der Sätze 31 bis 33, dadurch gekennzeichnet, dass die Fixiereinrichtung (10; 100; 110) dieselbe Anzahl von proximalen Fixierelementen (40) und von distalen Fixierelementen (38) umfasst.
• 35. Fixiereinrichtung nach einem der Sätze 31 bis 34, dadurch gekennzeichnet, dass in axialer Richtung je ein distales Fixierelement (38) und ein proximales Fixierelement (40) miteinander fluchten.
• 36. Fixiereinrichtung nach einem der Sätze 31 bis 35, dadurch gekennzeichnet, dass mindestens ein distales Fixierelement (38) und mindestens ein proximales Fixierelement (40) identisch ausgebildet sind.
• 37. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass alle Fixierelemente (38, 40) der Fixiereinrichtung (10; 100; 110) identisch ausgebildet sind.
• 38. Fixiereinrichtung nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Fixiereinrichtung (10; 100; 110) aus einem resorbierbaren Material gefertigt ist.

The above description thus includes in particular the embodiments of a medical fixing device defined below in the form of numbered sets:

• 1. Medical fixing device, comprising at least one fixing element ( 38 . 40 ) with a distal end portion ( 48 ) and a proximal end portion ( 50 ) by approaching the distal end portion ( 48 ) and the proximal end portion ( 50 ) can be moved relative to one another from an insertion position into a fixing position, in which the fixing device ( 10 ; 100 ; 110 ) has a larger cross-sectional area than in the insertion position, characterized in that the at least one fixing element ( 38 . 40 ) At least one effective in the transfer of the insertion position in the fixing position joint ( 52 . 54 . 68 ).
• 2. Fixing device according to sentence 1, characterized in that the at least one fixing element ( 38 . 40 ) a distal end portion ( 48 ) having distal fixing member ( 76 ) and a proximal end portion ( 50 ) having proximal fixing member ( 78 ), which are connected to each other via a joint ( 68 ) are connected.
• 3. Fixing device according to sentence 2, characterized in that the joint ( 68 ) at a proximal end of the distal fixation member (US Pat. 76 ) is arranged and / or that the joint ( 68 ) at a distal end of the proximal fixation member (US Pat. 78 ) is arranged.
• 4. Fixing device according to sentence 2 or 3, characterized in that the distal fixing member ( 76 ) and / or the proximal fixation member ( 78 ) are web-shaped or strip-shaped.
• 5. Fixing device according to one of the preceding sentences, characterized in that the at least one joint ( 68 ) centrally between the proximal end portion ( 50 ) and the distal end portion ( 48 ) on at least one fixing element ( 38 . 40 ) is arranged.
• 6. Fixing device according to one of the preceding sentences, characterized in that at the distal end portion ( 48 ) a joint ( 52 ) is arranged, via which the at least one fixing element ( 38 . 40 ) with one of the fixing device ( 10 ; 100 ; 110 ) comprise distal holding element ( 42 . 44 ) connected is.
• 7. Fixing device according to one of the preceding sentences, characterized in that at the proximal end portion ( 50 ) a joint ( 54 ) is arranged, via which the at least one fixing element ( 38 . 40 ) with one of the fixing device ( 10 ; 100 ; 110 ) comprise proximal holding element ( 44 . 46 ), which relative to the distal holding element ( 42 . 44 ) is designed to be movable.
• 8. Fixing device according to sentence 7, characterized in that the fixing device ( 10 ; 100 ; 110 ) a carrier element ( 12 ; 112 ), which with the distal holding element ( 42 . 44 ) and the proximal holding element ( 44 . 46 ) cooperates.
• 9. Fixing device according to sentence 8, characterized in that the carrier element ( 12 ; 112 ) comprises or forms at least one retaining element.
• 10. Fixing device according to sentence 8 or 9, characterized in that the carrier element ( 12 ; 112 ) an axis ( 14 ) of the fixing device ( 10 ; 100 ; 110 ) Are defined.
• 11. Fixing device according to one of the sentences 8 to 10, characterized in that a holding element ( 42 ) on the carrier element ( 12 ; 112 ).
• 12. Fixing device according to sentence 11, characterized in that the holding element ( 42 ) at a distal end ( 16 ) of the carrier element ( 12 ; 112 ).
• 13. Fixing device according to one of the sentences 8 to 12, characterized in that at least one retaining element ( 44 . 46 ) relative to the carrier element ( 12 ; 112 ) is designed to be movable.
• 14. Fixing device according to sentence 13, characterized in that the movable holding element ( 44 . 46 ) relative to the carrier element ( 12 ; 112 ) is formed in particular axially displaceable.
• 15. Fixing device according to sentence 13 or 14, characterized in that the fixing device ( 10 ; 110 ) a locking device ( 22 ) comprises for fixing the retaining element ( 44 . 46 ) relative to the carrier element ( 12 ; 112 ).
• 16. Fixing device according to sentence 15, characterized in that the locking device ( 22 ) as a latching device ( 22 ) is trained.
• 17. Fixing device according to one of the sentences 8 to 16, characterized in that at least one retaining element ( 42 . 44 . 46 ) as the carrier element ( 12 ; 112 ) surrounding sleeve ( 24 . 26 . 28 ) is trained.
• 18. Fixing device according to one of the sentences 8 to 17, characterized in that the carrier element ( 112 ) as a hollow body ( 114 ) is formed, in particular as an axially extending hollow cylinder ( 114 ).
• 19. Fixing device according to sentence 18, characterized in that the fixing device ( 110 ) from proximal to distal through the hollow body ( 114 ) guided at a distal outlet opening ( 122 ) from this exiting and at least one proximal retaining element ( 44 . 46 ) of the fixing device ( 110 ) engaging tension member ( 118 ) having.
• 20. Fixing device according to one of the preceding sentences, characterized in that the at least one fixing element ( 38 . 40 ) is rigid, apart from the at least one joint included by it ( 52 . 54 . 68 ).
• 21. Fixing device according to one of the preceding sentences, characterized in that at least one joint ( 52 . 54 . 68 ) as material weakening area ( 60 . 62 . 72 ) of the at least one fixing element ( 38 . 40 ) is formed.
• 22. Fixing device according to sentence 21, characterized in that the joint ( 52 . 54 . 68 ) as a result of a material recess ( 64 . 66 . 74 ) on at least one fixing element ( 38 . 40 ) is formed.
• 23. Fixing device according to sentence 21 or 22, characterized in that the joint ( 52 . 54 . 68 ) as a portion of higher mechanical deformability than the remainder of the at least one fixing element ( 38 . 40 ) is formed.
• 24. Fixing device according to one of the preceding sentences, characterized in that at least one joint ( 52 . 54 . 68 ) at least partially integral with the at least one fixing element ( 38 . 40 ) is formed.
• 25. Fixing device according to one of the preceding sentences, characterized in that at least one joint ( 52 . 54 . 68 ) as a hinge joint ( 56 . 58 . 70 ) is formed, in particular as a film hinge ( 56 . 58 . 70 ).
• 26. Fixing device according to one of the preceding sentences, characterized in that at least one joint is designed as a ball joint.
• 27. Fixing device according to one of the preceding sentences, characterized in that the at least one fixing element ( 38 . 40 ) in the circumferential direction of one of the fixing device ( 10 ; 100 ; 110 ) defined axis ( 14 ) covers an angle of less than about 20 °, preferably about 5 ° to about 10 °.
• 28. Fixing device according to one of the preceding sentences, characterized in that the fixing device ( 10 ; 100 ; 110 ) two or more in the circumferential direction of an axis defined by it ( 14 ) arranged fixing elements ( 38 . 40 ).
• 29. Fixing device according to sentence 28, characterized in that each two fixing elements ( 38 . 40 ) each other with respect to the axis ( 14 ) are diametrically opposed.
• 30. Fixing device according to sentence 28 or 29, characterized in that the two or more fixing elements ( 38 . 40 ) in the circumferential direction of the axis ( 14 ) are evenly spaced from each other.
• 31. Fixing device according to one of the preceding sentences, characterized in that the fixing device ( 10 ; 100 ; 110 ) at least one distal fixing element ( 38 ) and at least one proximal fixing element ( 40 ), which in the axial direction with respect to one of the fixing device ( 10 ; 100 ; 110 ) defined axis ( 14 ) are spaced from each other.
• 32. Fixing device according to sentence 31, characterized in that the proximal end section ( 50 ) of the at least one distal fixing element ( 38 ) with the distal end portion ( 48 ) of the at least one proximal fixing element ( 40 ) is coupled.
• 33. Fixing device according to sentence 32, characterized in that the proximal end section ( 50 ) of the at least one distal fixing element ( 38 ) and the distal end portion ( 48 ) of the at least one proximal fixing element ( 40 ) on a common, axially movable holding element ( 44 ).
• 34. Fixing device according to one of the sentences 31 to 33, characterized in that the fixing device ( 10 ; 100 ; 110 ) the same number of proximal fixation elements ( 40 ) and distal fixation elements ( 38 ).
• 35. Fixing device according to one of the sentences 31 to 34, characterized in that in the axial direction depending on a distal fixing element ( 38 ) and a proximal fixing element ( 40 ) are aligned with each other.
• 36. Fixing device according to one of the sentences 31 to 35, characterized in that at least one distal fixing element ( 38 ) and at least one proximal fixing element ( 40 ) are formed identically.
• 37. Fixing device according to one of the preceding sentences, characterized in that all fixing elements ( 38 . 40 ) of the fixing device ( 10 ; 100 ; 110 ) are formed identically.
• 38. Fixing device according to one of the preceding sentences, characterized in that the fixing device ( 10 ; 100 ; 110 ) is made of a resorbable material.

The following description of preferred embodiments of the invention is used in conjunction with the drawings for a more detailed explanation of the invention. Show it:

1 a schematic perspective view of a first preferred embodiment of a fixing device according to the invention with each one insertion position engaging fixing elements;

2 : a schematic perspective view of the fixing from 1 when introduced into two body tissues to be joined together by means of a hollow needle;

3 : the fixing device when connecting the two body tissues together by transferring the fixing elements into a fixing position, partially cut;

4 : the two body tissues in the state connected by means of the fixing device, wherein the fixing elements occupy a fixing position;

5 : A schematic perspective view of a second preferred embodiment of the fixing device according to the invention and

6 : a representation accordingly 3 with a third preferred embodiment of a fixing device according to the invention.

1 shows a schematic perspective view of a total there with the reference numeral 10 occupied first preferred embodiment of a fixing device according to the invention, hereinafter as a fixing clip 10 designated. The fixing clip 10 is elongated formed along one of a support element 12 defined longitudinal axis 14 , The carrier element 12 has a distal end 16 on and not shown in the drawing, a proximal end, the distal end 16 opposite.

The carrier element 12 is configured as a solid body, and it includes a plurality of radial projections 18 , The radial projections 18 form along the longitudinal axis 14 each equidistant from each other spaced circumferential ribs, which locking elements 20 a locking device 22 the fixing bracket 10 form ( 3 ).

The fixing clip 10 further comprises three concentric with the longitudinal axis 14 aligned and axially spaced rigid sleeves of the same diameter, namely a distal sleeve 24 , a middle sleeve 26 and a proximal sleeve 28 , The distal sleeve 24 is at the distal end 16 firmly with the carrier element 12 whereas the middle sleeve 26 and the proximal sleeve 28 relative to the carrier element 12 and thus to the distal sleeve 24 are formed axially displaceable. They can from the carrier element 12 be passed, they overlap each form-fitting. Due to their respective mobility are thus the middle sleeve 26 and the proximal sleeve 28 formed axially displaceable relative to each other.

Radially in the direction of the longitudinal axis 14 has the proximal sleeve 28 an annular projection 30 on which a locking element 31 the locking device 22 forms and with the radial projections 18 of the carrier element 12 can lock ( 3 and 4 ). Such an annular projection could also be on the middle sleeve 26 be arranged.

The fixing clip 10 serves to connect two body tissues 32 and 34 with each other through a minimally invasive procedure. In the body tissues 32 and 34 These may be, for example, menisci or artificial menisci, the use of the fixation clip 10 however, is not limited to this purpose.

Intended use includes the fixing clip 10 in addition to the features already mentioned four ribs 36 of which two ribs 36 at the proximal end of the distal sleeve 24 and at the distal end of the middle sleeve 26 are held, these ribs 36 be as distal fixation elements 38 the fixing bracket 10 designated. Two more ribs 36 are at the proximal end of the middle sleeve 26 and at the distal end of the proximal sleeve 28 held, they are called proximal fixation elements 40 designated.

Due to their aforementioned property, the sleeves become 24 . 26 and 28 also as holding elements 42 . 44 respectively. 46 the fixing bracket 10 designated. The middle sleeve 26 couples the proximal and distal fixation elements 38 and 40 together.

Proximal and distal are two ribs 36 each other with respect to the longitudinal axis 14 diametrically opposite. In the axial direction each aligned a distal fixing 38 with a proximal fixing element 40 ,

Ribs 36 are all identical, so that their features on, for example, a single rib 36 be described in more detail. The rib 36 is in the in 1 shown elongated position and extends parallel to the longitudinal axis 14 , It is strip-shaped or web-shaped with transversely to the longitudinal extent significantly lower transverse extent.

The rib 36 has a distal end portion 48 and a proximal end portion 50 on, passing over the end sections 48 and 50 on each two of the sleeves 24 . 26 and 28 is fixed. So are the distal fixation elements 38 over the distal end portions 48 on the distal sleeve 24 fixed and by means of the proximal end portions 50 at the middle sleeve 26 , The proximal fixation elements 40 are over the distal end sections 48 at the middle sleeve 26 and over the proximal end portions 50 at the proximal sleeve 28 established.

At each of the end sections 48 and 50 includes the rib 36 a joint 52 respectively. 54 , Which in each case as a hinge 56 respectively. 58 is designed. The hinges 56 and 58 are integral with the rest of the rib 36 formed, so that the hinges 56 and 58 Film hinges are. The film hinges are through material weakening areas 60 respectively. 62 in the form of recesses 64 respectively. 66 at the rib 36 formed so that the end sections 48 respectively. 50 have a range of high ductility.

Thus, the distal fixation elements 38 by means of the end sections 48 and 50 at least partially, articulated with the sleeves 24 respectively. 26 connected, and the proximal fixing elements 40 are, at least partially, articulated over the end sections 48 and 50 with the sleeves 26 respectively. 28 connected. "At least partially" means present, that because the hinges 56 and 58 completely in the end sections 48 and 50 are formed, the end sections 48 and 50 only partially relative to the pods 24 . 26 and 28 let move, while the respective immovable part firmly on the sleeves 24 . 26 and 28 is appropriate.

In another embodiment of a fixing device according to the invention, it may be provided that corresponding hinges between the end sections 48 and 50 as well as the pods 24 . 26 and 28 each are divided.

Centered between the distal end section 48 and the proximal end portion 50 points the rib 36 another joint 68 on, which also in the form of a hinge 70 is designed and as integral with the rib 36 formed film hinge is executed. The hinge 70 is also due to a material weakening area 72 at the rib 36 in the form of a recess 74 Are defined. The recesses 74 such as 64 and 66 are each on one of the longitudinal axis 14 facing inside of the rib 36 educated.

Also on the hinge 70 points the rib 36 an increased deformability. It is altogether, except for the joints 52 . 54 and 68 rigidly formed. The joint 68 separates here a distal web-shaped fixing member 76 and a proximal ridge-shaped fixation member 78 the rib 36 from each other in the axial direction, which are therefore configured otherwise rigid and further axially of identical length.

The fixing clip 10 can, as already mentioned, for the connection of the body tissues 32 and 34 be used. To the fixing bracket 10 In the interior of the body, it can take an elongated configuration in which the ribs 36 axially extending, ie they are parallel to the support element 12 and thus to the longitudinal axis 14 ( 1 ). This defines an insertion position of the ribs 36 and thus the fixing clip 10 in which their diameter is determined by the diameter of the sleeves 24 to 28 is predetermined.

Because the ribs 36 Moreover, in the circumferential direction of the longitudinal axis 14 Covering only a small angle, about 10 °, it is possible to fix the fixing clip 10 for example, in the cavity 80 a hollow needle 82 to introduce into the body ( 2 ). Alternatively or additionally, the fixing clip 10 also be introduced endoscopically into the body. In both cases, only a relatively small incision is needed in each case. This allows a minimally invasive fixation of body tissues 32 and 34 to each other by means of the fixing clip 10 ,

Is the fixing bracket 10 inserted so far into the body that the distal fixation elements 38 at least partially within the body tissue 32 are arranged and the middle sleeve 26 in a possible gap 83 between the body tissues 32 and 34 , can the hollow needle 82 retracted and thereby the fixing clip 10 from the cavity 80 be released (not shown).

To the actual connection of the body tissues 32 and 34 can the fixing bracket 10 be acted upon with two oppositely effective axial forces. For example, it is possible to use the proximal end of the proximal sleeve 28 with a hold-down 84 to apply a force acting in the distal direction. The hold down 84 is in 3 Shown schematically by dash-dotted lines. A required counterforce in the proximal direction, for example, on the support element 12 be applied at its proximal end. The proximal counterforce acts on the distal sleeve 24 and thus the distal fixation elements 38 and about this on the middle sleeve 26 and the distal force acts via the proximal sleeve 28 on the proximal fixation elements 40 and thus also on the middle sleeve 26 one.

Power and drag cause the ribs 36 on the hinges 56 . 58 and 70 deform deformed. Their joint axes 86 . 88 and 90 are each transverse and in particular perpendicular to the longitudinal axis 14 aligned. This has the consequence that itself the end sections 48 and 50 axially approach each other, at the same time the ribs 36 with the hinges 70 in the radial direction from the originally elongated configuration into an angled configuration ( 3 ).

Ribs 36 This can be done either in the body tissues 32 and 34 penetrate, this is shown in the drawing. For this it is advantageous that the ribs 36 , from the joints 52 . 54 and 68 apart, rigid and further formed web-shaped. As a result, the axial force and counterforce are transmitted via the fixing members 76 and 78 deflected as radial forces and become on the hinges 70 selectively effective.

Depending on the axial extent of the body tissue 32 and 34 It is also possible that the distal fixation elements 38 the body tissue 32 engage behind and / or the proximal fixing elements 40 by means of the distal fixation members 76 proximal to the body tissue 34 can come to the plant.

A position of the ribs 36 and thus the fixing clip 10 in which the ribs 36 with respect to the introduction position in a direction transverse to the longitudinal axis 14 oriented direction to an enlarged cross-sectional area on the fixing bracket 10 lead, is called Fixierstellung. In the fixation position, the ribs 36 transferred from the insertion position.

The above-described radial expansion of the fixing clip 10 done by the middle sleeve 26 and the proximal sleeve 28 axially relative to each other, to the distal sleeve 24 and relative to the carrier element 12 be moved. Because the middle sleeve 26 the distal fixation elements 38 and the proximal fixation elements 40 coupled with each other, these are transferred substantially simultaneously from the insertion position into the fixing position. Radial is the widening of the fixing elements 38 and 40 the larger, the smaller the axial distance of the hinges 70 the distal fixation elements 38 and the hinges 70 the proximal fixation elements 40 from each other.

By means of the locking device 22 Ensures that the proximal sleeve 28 not again from the distal sleeve 24 can remove. Once connected the body tissues 32 and 34 is thus preserved.

How far the pods 28 and 26 in detail, in the direction of the distal sleeve 24 for example, depends on the type of body tissue 32 and 34 and on the desired force with which they are to be fixed together. For example, an axial displacement of the sleeves 26 and 26 done so long until the respective end sections 48 and 50 almost touching each other, leaving the ribs 36 each take a maximum angled position ( 4 ).

Due to the largely rigid ribs 36 can reliably axial holding forces of the fixing 38 and 40 on the body tissues 32 and 34 be transmitted. In addition, as ever a distal fixing 38 with a proximal fixation element 40 axially aligned, are the body tissues 32 and 34 reliable between the proximal fixing member 78 the former and the distal fixation member 76 held the latter fixing element.

Is the fixation of body tissues 32 and 34 This can be done in the proximal direction via the proximal sleeve 28 projecting carrier element 12 by means of an in 4 by dashed lines schematically illustrated tool 92 be shortened.

The fixing clip 10 can be made for example of a resorbable material. As a result, it is possible to avoid that after coagulation of the body tissue 32 and 34 with each other another operation to remove the fixing bracket 10 is required.

A second preferred embodiment of a fixing device according to the invention is in 5 shown schematically and there with the reference numeral 100 busy; it is also used as a fixing clip 100 designated. The fixing clip 100 is largely identical to the Fixierklammer 10 , For the same or equivalent features or components of the fixing clips 10 and 100 Therefore, identical reference numerals are used. The with the fixing bracket 10 achieved advantages can with the fixing clip 100 also be achieved.

From the fixing bracket 10 the fixing bracket differs 100 in that each eight distal fixing elements 38 and eight proximal fixation elements 40 available. All fixing elements 38 and 40 are at the fixing bracket 100 also as with the fixing clip 10 identically formed and as above-described rib 36 designed.

In the circumferential direction of the longitudinal axis 14 are the fixing elements 38 and 40 each pair equally spaced apart, and in the axial direction each aligned a distal fixing 38 with a proximal fixation element 40 ,

By means of the fixing clip 100 may even have a more reliable fixation of body tissues 32 and 34 to each other, because of the increased number of ribs 36 an increased axial holding force on the body tissues 32 and 34 can be exercised. By the way, it works the fixing bracket 100 like the fixing clip 10 , so that reference can be made to the above explanations.

A third preferred embodiment of a fixing device according to the invention is in 6 shown schematically and there with the reference numeral 110 busy. It is used as a fixing clip 110 designated. Same and equivalent components and features of Fixierklammer 110 and the fixing bracket 10 are assigned the same reference numerals. The with the fixing bracket 10 achievable advantages can be achieved by means of the fixing clip 110 also be achieved.

Unlike the fixing clip 10 is at the fixing bracket 110 the carrier element 112 as a hollow body and in particular as an axially extending hollow cylinder 114 designed. The hollow cylinder 114 closes a cavity 116 one.

Through the cavity 116 is a tension element 118 guided, for example in the form of a thread 120 , The string 120 enters the carrier element at the proximal end 112 and extends through the cavity 116 , At a distal outlet 122 at the distal end 16 occurs the thread 120 from the carrier element 112 out. About the distal sleeve 24 it is deflected in the proximal direction and runs parallel to the carrier element 112 , On a coupling link 124 which is from the proximal sleeve 28 is included is the thread 120 determined, for example by means of a node 126 , The string 120 may continue to extend in the proximal direction.

The fixing clip 110 can be transferred from the insertion position into the fixing position by the thread 120 at the proximal, ie at the proximal side of the support element 112 exiting end, acted upon by a force in the proximal direction and additionally the carrier element 112 is subjected to a counterforce in the distal direction. As a result, the proximal sleeve 28 and thus the middle sleeve 26 towards the distal sleeve 24 be moved axially. This leads to the above-explained radial unfolding of the ribs 36 for fixation of body tissues 32 and 34 together. By pulling on the proximal, over the knot 126 projecting section can be the thread 120 then be removed from the inside of the body.

Incidentally, the fixing bracket works 110 like the fixing clip 10 , so that reference can be made to the above explanations.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• WO 99/60931 A1 [0002]

Claims (25)

Medical fixing device, comprising at least one fixing element ( 38 . 40 ) with a distal end portion ( 48 ) and a proximal end portion ( 50 ) by approaching the distal end portion ( 48 ) and the proximal end portion ( 50 ) can be moved relative to one another from an insertion position into a fixing position, in which the fixing device ( 10 ; 100 ; 110 ) has a larger cross-sectional area than in the insertion position, characterized in that the at least one fixing element ( 38 . 40 ) At least one effective in the transfer of the insertion position in the fixing position joint ( 52 . 54 . 68 ). Fixing device according to claim 1, characterized in that the at least one fixing element ( 38 . 40 ) a distal end portion ( 48 ) having distal fixing member ( 76 ) and a proximal end portion ( 50 ) having proximal fixing member ( 78 ), which are connected to each other via a joint ( 68 ) are connected. Fixing device according to claim 2, characterized in that the joint ( 68 ) at a proximal end of the distal fixation member (US Pat. 76 ) is arranged and / or that the joint ( 68 ) at a distal end of the proximal fixation member (US Pat. 78 ) is arranged. Fixing device according to claim 2 or 3, characterized in that the distal fixing member ( 76 ) and / or the proximal fixation member ( 78 ) are web-shaped or strip-shaped. Fixing device according to one of the preceding claims, characterized in that the at least one joint ( 68 ) centrally between the proximal end portion ( 50 ) and the distal end portion ( 48 ) on at least one fixing element ( 38 . 40 ) is arranged. Fixing device according to one of the preceding claims, characterized in that at the distal end portion ( 48 ) a joint ( 52 ) is arranged, via which the at least one fixing element ( 38 . 40 ) with one of the fixing device ( 10 ; 100 ; 110 ) comprise distal holding element ( 42 . 44 ) connected is. Fixing device according to one of the preceding claims, characterized in that at the proximal end portion ( 50 ) a joint ( 54 ) is arranged, via which the at least one fixing element ( 38 . 40 ) with one of the fixing device ( 10 ; 100 ; 110 ) comprise proximal holding element ( 44 . 46 ), which relative to the distal holding element ( 42 . 44 ) is designed to be movable. Fixing device according to claim 7, characterized in that the fixing device ( 10 ; 100 ; 110 ) a carrier element ( 12 ; 112 ), which with the distal holding element ( 42 . 44 ) and the proximal holding element ( 44 . 46 ) cooperates. Fixing device according to claim 8, characterized in that the carrier element ( 12 ; 112 ) an axis ( 14 ) of the fixing device ( 10 ; 100 ; 110 ) Are defined. Fixing device according to claim 8 or 9, characterized in that a holding element ( 42 ) on the carrier element ( 12 ; 112 ). Fixing device according to one of claims 8 to 10, characterized in that at least one retaining element ( 44 . 46 ) relative to the carrier element ( 12 ; 112 ) is designed to be movable. Fixing device according to one of claims 8 to 11, characterized in that the carrier element ( 112 ) as a hollow body ( 114 ) is formed, in particular as an axially extending hollow cylinder ( 114 ). Fixing device according to one of the preceding claims, characterized in that the at least one fixing element ( 38 . 40 ) is rigid, apart from the at least one joint included by it ( 52 . 54 . 68 ). Fixing device according to one of the preceding claims, characterized in that at least one joint ( 52 . 54 . 68 ) as material weakening area ( 60 . 62 . 72 ) of the at least one fixing element ( 38 . 40 ) is formed. Fixing device according to claim 14, characterized in that the joint ( 52 . 54 . 68 ) as a result of a material recess ( 64 . 66 . 74 ) on at least one fixing element ( 38 . 40 ) is formed. Fixing device according to claim 14 or 15, characterized in that the joint ( 52 . 54 . 68 ) as a portion of higher mechanical deformability than the remainder of the at least one fixing element ( 38 . 40 ) is formed. Fixing device according to one of the preceding claims, characterized in that at least one joint ( 52 . 54 . 68 ) at least partially integral with the at least one fixing element ( 38 . 40 ) is formed. Fixing device according to one of the preceding claims, characterized in that at least one joint ( 52 . 54 . 68 ) as a hinge joint ( 56 . 58 . 70 ) is formed, in particular as a film hinge ( 56 . 58 . 70 ). Fixing device according to one of the preceding claims, characterized in that the at least one fixing element ( 38 . 40 ) in the circumferential direction of one of the fixing device ( 10 ; 100 ; 110 ) defined axis ( 14 ) covers an angle of less than about 20 °, preferably about 5 ° to about 10 °. Fixing device according to one of the preceding claims, characterized in that the fixing device ( 10 ; 100 ; 110 ) two or more in the circumferential direction of an axis defined by it ( 14 ) arranged fixing elements ( 38 . 40 ). Fixing device according to one of the preceding claims, characterized in that the fixing device ( 10 ; 100 ; 110 ) at least one distal fixing element ( 38 ) and at least one proximal fixing element ( 40 ), which in the axial direction with respect to one of the fixing device ( 10 ; 100 ; 110 ) defined axis ( 14 ) are spaced from each other. Fixing device according to claim 21, characterized in that the proximal end portion ( 50 ) of the at least one distal fixing element ( 38 ) with the distal end portion ( 48 ) of the at least one proximal fixing element ( 40 ) is coupled. Fixing device according to claim 22, characterized in that the proximal end portion ( 50 ) of the at least one distal fixing element ( 38 ) and the distal end portion ( 48 ) of the at least one proximal fixing element ( 40 ) on a common, axially movable holding element ( 44 ). Fixing device according to one of claims 21 to 23, characterized in that in the axial direction depending on a distal fixing element ( 38 ) and a proximal fixing element ( 40 ) are aligned with each other. Fixing device according to one of claims 21 to 24, characterized in that at least one distal fixing element ( 38 ) and at least one proximal fixing element ( 40 ) are formed identically.

Images