FR2655840A1 - Surgical kit for ligament surgery, and constituent elements - Google Patents
Surgical kit for ligament surgery, and constituent elements Download PDFInfo
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- FR2655840A1 FR2655840A1 FR8916764A FR8916764A FR2655840A1 FR 2655840 A1 FR2655840 A1 FR 2655840A1 FR 8916764 A FR8916764 A FR 8916764A FR 8916764 A FR8916764 A FR 8916764A FR 2655840 A1 FR2655840 A1 FR 2655840A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06004—Means for attaching suture to needle
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06066—Needles, e.g. needle tip configurations
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B50/30—Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments
- A61B50/33—Trays
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
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Abstract
Description
SET CHIRURGICAL DE LICAMENTOPLASTIE ET ELEKENTS CONSTITUTIFS
L'invention concerne un set chirurgical destiné au traitement des instabilités carpiennes ou tarsiennes (poignet, main, cheville ou pied) par ligamentoplastie réparatrice. (Par "set chirurgical", on entend de façon habituelle un ensembLe d'outils ou d'accessoires fonctionnels, permettant au chirurgien de procéder à une intervention chirurgicale ou l'assistant dans cette intervention). L'invention s'étend aux éléments nouveaux constitutifs de ce set chirurgical.LICAMENTOPLASTY SURGICAL SET AND CONSTITUENT ELEKENTS
The invention relates to a surgical set intended for the treatment of carpal or tarsal instabilities (wrist, hand, ankle or foot) by restorative ligamentoplasty. (By "surgical set", we usually mean a set of tools or functional accessories, allowing the surgeon to perform a surgical intervention or the assistant in this intervention). The invention extends to the new constituent elements of this surgical set.
Les instabilités carpiennes ou tarsiennes sont fréquentes chez les sportifs et se rencontrent également chez les personnes atteintes d'arthrite rhumatismale ou traumatique. Elles conduisent à une perte de motilité, s'accompagnant d'un dysfonctionnement et de douleurs. Ces instabilités sont relativement faciles à diagnostiquer toutefois aucun traitement efficace n'existe actuellement. Carpal or tarsal instabilities are common in athletes and are also found in people with rheumatic or traumatic arthritis. They lead to loss of motility, accompanied by dysfunction and pain. These instabilities are relatively easy to diagnose however no effective treatment currently exists.
Elles ont parfois été traitées par substitution des ligaments déficients par les tendons voisins sans que ce traitement donne des résultats satisfaisants pour de multiples raisons.They have sometimes been treated by replacing the defective ligaments with neighboring tendons without this treatment giving satisfactory results for multiple reasons.
A l'heure actuelle, en l'absence de technique de traitement et, a fortiori, d'instruments chirurgicaux de mise en oeuvre, les praticiens se trouvent désarmés devant cette affection. At present, in the absence of treatment technique and, a fortiori, of surgical instruments of implementation, the practitioners find themselves helpless before this affection.
L'inventeur a mis au point une technique de traitement fondée sur l'utilisation d'une aiguille spéciale de ligamentoplastie, d'un ligament artificiel et de vis d'ancrage osseux. Au lieu d'utiliser les tendons naturels avoisinants, cette technique réparatrice consiste à mettre en place et à ancrer un ligament artificiel en particulier en fibres synthétiques, de façon que ce ligament soit apte à remplir la fonction du ligament originel, c'est-à-dire à guider et retenir les os carpiens ou tarsiens pour Leur restituer leurs motilités naturelles et permettre une certaine réhabilitation. The inventor developed a treatment technique based on the use of a special ligamentoplasty needle, an artificial ligament and bone anchor screws. Instead of using the neighboring natural tendons, this repairing technique consists in placing and anchoring an artificial ligament in particular of synthetic fibers, so that this ligament is able to fulfill the function of the original ligament, that is to say - tell to guide and retain the carpal or tarsal bones to restore their natural motility and allow a certain rehabilitation.
Le set chirurgical conforme à l'invention pour opérer une telle intervention de rigamentoprastie réparatrice, carpienne ou tarsienne, se caractérise en ce qu'iL comprend
une aiguille ayant un corps de forme allongée, pourvu à l'une de ses extrémités de moyens d'attache d'un ligament artificiel adaptés pour permettre de fixer une extrémité dudit ligament artificiel à l'extrémité du corps de façon que le ligament s'échappe en bout du corps dans le prolongement de celui-ci,
une longueur de ligament artificiel,
au moins deux vis d'ancrage osseux adaptées pour être fixées dans un os carpien ou tarsien.The surgical set in accordance with the invention for operating such a repairing carpal or tarsal rigamentoprasty intervention is characterized in that it comprises
a needle having an elongated body, provided at one of its ends with means for attaching an artificial ligament adapted to enable an end of said artificial ligament to be fixed at the end of the body so that the ligament s' escapes at the end of the body in the extension of it,
a length of artificial ligament,
at least two bone anchor screws adapted to be fixed in a carpal or tarsal bone.
Les moyens d'attache du ligament artificieL sont en particulier adaptés pour permettre de fixer le ligament artificiel sur le corps d'aiguille avec une résistance à la traction au moins égale à 0,2 Da.N. The means for attaching the artificial ligament are in particular adapted to allow the artificial ligament to be fixed on the needle body with a tensile strength at least equal to 0.2 Da.N.
(DecaNewton).(DecaNewton).
Selon un mode de réalisation préféré, les moyens d'attache de l'aiguille comprennent
- un canal borgne ménagé à l'extrémité du corps d'aiguille pour déboucher en bout de celui-ci, ledit canal étant adapté pour pouvoir contenir l'extrémité du ligament artificiel,
- des moyens de pincement de l'extrémité du ligament artificiel logée dans ledit canal.According to a preferred embodiment, the means for attaching the needle comprise
a blind channel formed at the end of the needle body to open out at the end thereof, said channel being adapted to be able to contain the end of the artificial ligament,
- means for pinching the end of the artificial ligament housed in said channel.
De pLus, de façon à alléger le travail de préparation lors de L'intervention, l'aiguille et le ligament artificiel sont avantageusement livrés liés l'un à l'autre, le ligament étant préalablement fixé par son extrémité aux moyens d'attache du corps d'aiguille avec une résistance à un effort de traction au moins égale à 0,2 Da.N.. In addition, in order to lighten the preparation work during the intervention, the needle and the artificial ligament are advantageously delivered linked to each other, the ligament being previously fixed by its end to the means of attachment of the needle body with a resistance to a tensile force at least equal to 0.2 Da.N ..
L'invention s'étend, en tant que telle, à l'aiguille de ligamentoplastie précédemment définie. Cette aiguille est en particulier réalisée en métal notamment en acier inoxydable, ses moyens d'attache comprenant le canal borgne déjà évoqué et des moyens de pincement préférentiellement réalisés grâce à des fentes longitudinales pratiquées à l'extrémité du corps, fentes qui forment des lèvres d'extrémité aptes à assurer un pincement du ligament artificiel. The invention extends, as such, to the ligamentoplasty needle previously defined. This needle is in particular made of metal, in particular stainless steel, its attachment means comprising the blind channel already mentioned and pinching means preferentially produced by means of longitudinal slots made at the end of the body, slots which form lips d end capable of ensuring a pinch of the artificial ligament.
L'invention s'étend également à une aiguille de ligamentoplastie telle que ci-dessus définie, pré-équipée d'une longueur de ligament artificiel, ladite longueur du ligament étant fixée par son extrémité aux moyens d'attache du corps de ladite aiguille. The invention also extends to a ligamentoplasty needle as defined above, pre-equipped with an artificial ligament length, said length of the ligament being fixed at its end to the means for attaching the body of said needle.
Le ligament qui équipe l'aiguille est avantageusement en fibres synthétiques, d'élasticité correspondant à un allongement élastique compris entre 5 S et 18 X, et de résistance à la rupture supérieure à 5 Da.N.. The ligament which equips the needle is advantageously made of synthetic fibers, of elasticity corresponding to an elastic elongation between 5 S and 18 X, and of breaking strength greater than 5 Da.N ..
L'aiguille et son ligament sont de préférence conditionnés dans un tube stérilisé, la longueur de ligament artificiel étant repliée dans le tube le long du corps de l'aiguille. The needle and its ligament are preferably packaged in a sterilized tube, the length of artificial ligament being folded back into the tube along the body of the needle.
D'autres caractéristiques, buts et avantages de l'invention ressortiront de la description qui suit en référence aux dessins annexés, lesquels présentent à titre non limitatif un mode de réalisation de l'invention et une variante ; sur ces dessins
- la figure 1 est une vue schématique en perspective, à échelle très dilatée, d'une aiguille de ligamentoplastie conforme à l'invention, équipée de son ligament artificiel,
- la figure 2 en est une coupe longitudinale par un plan AA', le ligament étant schématisé en traits discontinus après insertion dans le canal de l'aiguille,
- la figure 3 est une coupe transversale par un plan BB', de l'aiguille telle que représentée à la figure 2,
- la figure 4 est une coupe transversale analogue, après pincement du ligament par rapprochement des lèvres d'extrémité de l'aiguille,
- la figure 5 est une vue schématique des éléments d'un set chirurgical de Ligamentoplastie conforme à l'invention,
- la figure 6 présente en variante un autre type de vis d'ancrage,
- la figure 7 est une vue schématique d'une aiguille équipée de son ligament, conditionnée dans un tube,
- la figure 8 est une coupe transversale schématique de ladite aiguille conditionnée,
- la figure 9 représente en perspective schématique le set chirurgical conforme à l'invention, conditionné dans un boîtier,
- la figure 10 représente un poignet après intervention chirurgicale (ce poignet était affecté d'instabilité médio-carpienne).Other characteristics, objects and advantages of the invention will emerge from the description which follows with reference to the appended drawings, which show, without limitation, an embodiment of the invention and a variant; on these drawings
FIG. 1 is a schematic perspective view, on a very dilated scale, of a ligamentoplasty needle according to the invention, equipped with its artificial ligament,
- Figure 2 is a longitudinal section through a plane AA ', the ligament being shown schematically in broken lines after insertion into the needle channel,
FIG. 3 is a cross section through a plane BB ′ of the needle as shown in FIG. 2,
FIG. 4 is a similar cross section, after pinching the ligament by bringing the end lips of the needle together,
FIG. 5 is a schematic view of the elements of a Ligamentoplasty surgical set according to the invention,
FIG. 6 presents a variant of another type of anchoring screw,
FIG. 7 is a schematic view of a needle fitted with its ligament, packaged in a tube,
FIG. 8 is a schematic cross section of said conditioned needle,
FIG. 9 represents in schematic perspective the surgical set according to the invention, packaged in a box,
- Figure 10 shows a wrist after surgery (this wrist was affected by mid-carpal instability).
Le set chirurgical représenté à titre d'exemple aux figures est destiné à permettre la mise en oeuvre d'une nouvelle technique de traitement des instabilités carpiennes ou tarsiennes. Par exemple, dans le cas du poignet, on sait que ces instabilités sont essentiellement de trois types : instabilité rotatoire du scaphoide (luxation rotatoire du scaphol-de), instabilité médio-carpienne (luxation dynamique entre semi-lunaire et grand os), instabilité de la colonne cubitale (dissociation entre pyramidal et semi-lunaire). The surgical set shown by way of example in the figures is intended to allow the implementation of a new technique for treating carpal or tarsal instabilities. For example, in the case of the wrist, we know that these instabilities are essentially of three types: rotary instability of the scaphoid (rotary luxation of scaphol-de), mid-carpal instability (dynamic luxation between semi-lunar and large bone), instability of the ulnar column (dissociation between pyramidal and semi-lunar).
Dans le premier cas, selon la nouvelle technique sus-visée, l'instabilité du scaphoïde de est réduite (1) en ancrant une première vis sur le pôle distal du scaphoïde à la hauteur de l'interligne articulaire, (2) en ancrant une deuxième vis dans la tête du scaphoïde, (3) en ancrant une troisième vis sur le semi-lunaire à 4 ou 5 mm de la ligne articulaire du radius dans la voie antéropostérieure, (4) et en réunissant ces vis par un ligament artificiel qui est mis en place au moyen de l'aiguille spéciale du set, de façon à former un triangle dtimmobilisation. In the first case, according to the new technique referred to above, the instability of the scaphoid is reduced (1) by anchoring a first screw on the distal pole of the scaphoid at the height of the joint space, (2) by anchoring a second screw in the head of the scaphoid, (3) by anchoring a third screw on the semi-lunar at 4 or 5 mm from the articular line of the radius in the anteroposterior way, (4) and by joining these screws by an artificial ligament which is set in place using the special needle of the set, so as to form a immobilization triangle.
Dans le deuxième cas (instabilité médiocarpienne), l'abord se fait par la voie antérieure et palmaire. On pratique une perforation dans la tête du grand os et du semi-lunaire, dans le sens vertical, c'est-à-dire du dorsal au palmaire. Le ligament artificiel est amené à traverser ces perforations en y faisant passer l'aiguille spéciale du set (perforations pratiquées au moyen d'une mèche de 3 mm, permettant le passage de ladite aiguille). On ancre une première vis dans le grand os au niveau du col pour attacher une extrémité du ligament et on ancre une seconde vis dans la face dorsale du semi-lunaire pour fixer l'autre extrémité du ligament. In the second case (mediocarpal instability), the approach is made by the anterior and palmar route. A perforation is made in the head of the large bone and the semi-lunar, in the vertical direction, that is to say from the dorsal to the palmar. The artificial ligament is brought through these perforations by passing there the special needle of the set (perforations made by means of a 3 mm drill bit, allowing the passage of said needle). A first screw is anchored in the large bone at the neck to attach one end of the ligament and a second screw is anchored in the dorsal side of the semi-lunar to fix the other end of the ligament.
Dans le troisième cas (instabilité de la colonne cubitale), on ancre une première vis sur la tête proximale du semi-lunaire et une seconde vis sur la face distale de la tête latérale du pyramidal. Ces vis sont réunies par le ligament artificiel qui est mis en place au moyen de l'aiguille spéciale du set, de façon à empêcher tout mouvement anarchique des deux os. In the third case (instability of the ulnar column), a first screw is anchored on the proximal head of the semi-lunar and a second screw on the distal face of the lateral head of the pyramidal. These screws are joined by the artificial ligament which is placed by means of the special needle of the set, so as to prevent any uncontrolled movement of the two bones.
Dans tous les cas, il convient de prendre la précaution de recouvrir le ligament artificiel par un repli du tissu capsulaire et synovial pour faciliter sa réhabilitation. In all cases, care should be taken to cover the artificial ligament with a fold of the capsular and synovial tissue to facilitate its rehabilitation.
Les figures 1, 2, 3 et 4 représentent l'aiguille spéciale de ligamentoplastie conforme à l'invention. Figures 1, 2, 3 and 4 show the special ligamentoplasty needle according to the invention.
Cette aiguille en acier inoxydable possède un corps cylindrique 1 dont le diamètre externe est en particulier compris entre 0,8 et 1,5 mm, et la longueur entre 60 mm et 130 mm. Par exemple on peut choisir un diamètre d'environ 1,2 mm et une longueur d'environ 100 mm. This stainless steel needle has a cylindrical body 1 whose external diameter is in particular between 0.8 and 1.5 mm, and the length between 60 mm and 130 mm. For example, you can choose a diameter of around 1.2 mm and a length of around 100 mm.
A une de ses extrémités la, le corps présente une forme arrondie notamment semi-sphérique afin de limiter le traumatisme des tissus lors de son passage. At one of its ends 1a, the body has a rounded shape, in particular semi-spherical, in order to limit the trauma of the tissues during its passage.
A son autre extrémité lb, le corps 1 est doté d'un canal borgne 2 qui s'étend sur une longueur de 10 mm environ et débouche en bout du corps. Deux fentes longitudinales 3a et 3b sont pratiquées à l'extrémité du corps sur la longueur du canal (ou une partie substantielle de celle-ci), de façon à réaliser deux lèvres d'extrémité 4a et 4b de forme semi-circulaire, aptes à se rapprocher par Le jeu de l'élasticité de la matière. Le canal 2 et les fentes 3a et 3b sont réalisés au moyen d'un laser, l'alésage du canal 2 étant dimensionné de façon que l'épaisseur de matière de chaque lèvre d'extrémité soit de l'ordre de 0,15 mm afin d'être apte à subir une déformation lors du pincement du ligament, tout en ayant la résistance souhaitable. At its other end 1b, the body 1 is provided with a blind channel 2 which extends over a length of approximately 10 mm and opens out at the end of the body. Two longitudinal slots 3a and 3b are formed at the end of the body along the length of the channel (or a substantial part thereof), so as to produce two end lips 4a and 4b of semi-circular shape, suitable for get closer by The play of the elasticity of the material. The channel 2 and the slots 3a and 3b are produced by means of a laser, the bore of the channel 2 being dimensioned so that the material thickness of each end lip is of the order of 0.15 mm in order to be able to undergo a deformation during the pinching of the ligament, while having the desirable resistance.
Ces moyens de pincement servent à fixer en bout du corps de l'aiguille une longueur prédéterminée d'un ligament artificiel schématisé en 5 aux figures. Ce ligament est constitué de fibres synthétiques biocompatibles en polyester (en particulier "Dacron"), telles que son élasticité corresponde à un allongement élastique compris entre 10 S et 16 , et sa résistance à la rupture supérieure à 5 Da.N.. These pinching means serve to fix at the end of the body of the needle a predetermined length of an artificial ligament shown diagrammatically in 5 in the figures. This ligament is made of biocompatible polyester synthetic fibers (in particular "Dacron"), such that its elasticity corresponds to an elastic elongation between 10 S and 16, and its breaking strength greater than 5 Da.N ..
Le diamètre externe du ligament artificiel correspond à l'alésage du canal, avec un jeu -j- compris entre 0,03 mm et 0,1 mm. Par exemple dans le cas d'un canal d'alésage égal à 0,9 mm, le diamètre du ligament est de 0,8 mm, le jeu -jétant de 0,05 mm.The external diameter of the artificial ligament corresponds to the bore of the canal, with a clearance -j- between 0.03 mm and 0.1 mm. For example in the case of a bore channel equal to 0.9 mm, the diameter of the ligament is 0.8 mm, the play-throwing of 0.05 mm.
La longueur de ligament artificiel attaché à l'aiguille est comprise entre 100 mm et 300 mm, notamment de l'ordre de 200 mm. Une extrémité du ligament est introduite dans le canal 2 de l'aiguille jusqu'au fond de celui-ci, et les deux lèvres d'extrémité 4a et 4b sont rapprochées pour pincer et sertir ladite extrémité de ligament. Ces dispositions permettent de fixer le ligament à l'aiguille avec une résistance à la traction qui peut être de l'ordre de 0,8 Da.N.. Ainsi, le ligament s'échappe en bout du corps 1 dans le prolongement de celui-ci en l'absence de toute saillie ou protubérance. The length of artificial ligament attached to the needle is between 100 mm and 300 mm, in particular of the order of 200 mm. One end of the ligament is introduced into the channel 2 of the needle to the bottom of the latter, and the two end lips 4a and 4b are brought together to pinch and crimp said ligament end. These provisions make it possible to fix the ligament to the needle with a tensile strength which can be of the order of 0.8 Da.N .. Thus, the ligament escapes at the end of the body 1 in the extension of that -this in the absence of any projection or protuberance.
Lors de l'intervention, une fois le ligament mis en place, il sera sectionné au voisinage de l'aiguille qui sera jetée. During the procedure, once the ligament is in place, it will be cut in the vicinity of the needle which will be thrown away.
La figure 5 montre les éléments du set chirurgical décrit à titre d'exemple. On retrouve en 6 l'aiguille de ligamentoplastie équipée de sa longueur de ligament artificiel. Le set comprend en outre des vis d'ancrage osseux qui, en pratique, seront en nombre compris entre quatre et huit. En l'exemple, six vis équipent le set trois d'une longueur de l'ordre de 12 mm (vis telles que 7), et trois d'une longueur de l'ordre de 14 mm (vis telles que 8). Figure 5 shows the elements of the surgical set described by way of example. We find in 6 the ligamentoplasty needle equipped with its length of artificial ligament. The set also includes bone anchor screws which, in practice, will be between four and eight in number. In the example, six screws equip the set three with a length of the order of 12 mm (screws such as 7), and three with a length of the order of 14 mm (screws such as 8).
Chaque vis dont le diamètre est de l'ordre de 2 mm pour être adapté à un ancrage dans les os carpiens ou tarsiens, possède une portion sous-tête 7a ou 8a qui est dépourvue de filets sur une longueur supérieure au diamètre du ligament artificiel. Lors de l'intervention, le ligament est noué à son extrémité autour de cette portion de façon à ne pas être endommagé par les filets. Each screw whose diameter is of the order of 2 mm to be suitable for anchoring in the carpal or tarsal bones, has a sub-head portion 7a or 8a which is devoid of threads over a length greater than the diameter of the artificial ligament. During the operation, the ligament is tied at its end around this portion so as not to be damaged by the threads.
En l'exemple de la figure 5, les vis sont en acier inoxydable à tête conique classique (diamètre de tête égal à 4 mm), et le set est pourvu de rondelles d'appui telles que 9 en acier inoxydable ; ces rondelles sont en nombre correspondant à celui des vis (c'est-à-dire compris entre quatre et huit, et en l'exemple égal à six) et sont adaptées pour être enfilées autour de la tige de vis jusqu'au contact de la tête pour servir d'appui au ligament et éviter son dégagement de la tête de vis. In the example of FIG. 5, the screws are made of stainless steel with a conventional conical head (head diameter equal to 4 mm), and the set is provided with support washers such as 9 made of stainless steel; these washers are in number corresponding to that of the screws (that is to say between four and eight, and in the example equal to six) and are adapted to be threaded around the screw rod until contact the head to serve as a support for the ligament and to prevent its release from the screw head.
Lors de l'intervention, le ligament est mis en place au moyen de l'aiguille 6, les vis nécessaires sont ancrées dans les os à stabiliser (avec leurs rondelles ou éventuellement en l'absence de celle-ci selon la direction des efforts s'exerçant sur le ligament), et le ligament est noué autour des vis. During the intervention, the ligament is placed by means of needle 6, the necessary screws are anchored in the bones to be stabilized (with their washers or possibly in the absence thereof, depending on the direction of the efforts s exerting on the ligament), and the ligament is tied around the screws.
En variante, la figure 6 présente une vis 10 réalisée en matériau biodégradable, en particulier en polyester résorbable du type "Résomer de #.I. Chimie" ou "Dexon de Bioscience LTD". Dans cette variante , la té te 10 a de cette vis a été réalisée à un diamètre plus important que les têtes coniques précédentes pour permettre de supprimer les rondelles. As a variant, FIG. 6 shows a screw 10 made of biodegradable material, in particular of absorbable polyester of the type "Résomer de # .I. Chimie" or "Dexon de Bioscience LTD". In this variant, the head 10 a of this screw has been produced at a larger diameter than the previous conical heads to allow the washers to be eliminated.
Ce type de vis en matériau biodégradable présente l'avantage d'éviter une seconde intervention puisqu'il n'est plus nécessaire de les retirer lorsque le ligament artificiel s'est fixé naturellement (comme c'est le cas pour les vis en acier inoxydable). This type of screw made of biodegradable material has the advantage of avoiding a second intervention since it is no longer necessary to remove them when the artificial ligament is fixed naturally (as is the case for stainless steel screws ).
Le set chirurgical selon l'invention est livré au praticien sous conditionnement stérilisé. The surgical set according to the invention is delivered to the practitioner in sterilized packaging.
Comme le schématisent les figures 7 et 8, l'aiguille de ligamentoplastie 6 équipée de sa longueur de ligament artificiel est conditionnée de façon stérile dans un tube 11 en polyearbonate, bouché à son extrémité ouverte ; la longueur de ligament artificiel est repliée dans le tube le long du corps de l'aiguille. As shown schematically in Figures 7 and 8, the ligamentoplasty needle 6 equipped with its length of artificial ligament is packaged in a sterile manner in a polyearbonate tube 11, closed at its open end; the length of artificial ligament is folded back into the tube along the body of the needle.
Les vis d'ancrage et le cas échéant les rondelles sont elles-mêmes conditionnées dans des tubes stérilisés. La figure 9 montre un set dans lequel ces divers éléments sont logés dans les compartiments d'un boîtier 12. The anchoring screws and, if necessary, the washers are themselves packaged in sterilized tubes. FIG. 9 shows a set in which these various elements are housed in the compartments of a housing 12.
En l'exemple ce boîtier en matière plastique moulée (notamment polycarbonate) comporte un compartiment 12a dans lequel est logée l'aiguille de ligamentoplastie conditionnée comme représenté aux figures 7 et 8, un compartiment 12b où sont logées trois vis d'ancrage (vis longues) conditionnées dans un tube stérilisé, un compartiment 12c où sont logées trois autres vis d'ancrage (vis courtes) conditionnées dans un tube stérilisé, et deux compartiments 12d et 12e où sont logées les six rondelles conditionnées dans deux tubes stérilisés. Le boîtier est fermé au moyen d'une feuille ("tyveck") collée sur sa bordure, avec un coin de préhension pour le décollage situé du côté du coin triangulaire 12f. Le boîtier peut être inséré dans une petite mallette de transport, l'ensemble étant stérilisé par rayonnement ionisant. In the example, this molded plastic case (in particular polycarbonate) comprises a compartment 12a in which is housed the ligamentoplasty needle conditioned as shown in FIGS. 7 and 8, a compartment 12b in which three anchor screws are housed (long screws ) packaged in a sterilized tube, a compartment 12c where three other anchor screws (short screws) are housed packaged in a sterilized tube, and two compartments 12d and 12e where the six washers packaged in two sterilized tubes are housed. The box is closed by means of a sheet ("tyveck") glued on its border, with a grip corner for take-off located on the side of the triangular corner 12f. The case can be inserted in a small carrying case, the whole being sterilized by ionizing radiation.
La figure 10 montre à titre d'illustration un poignet atteint d'instabilité médio-carpienne après intervention utilisant la technique de ligamentoplastie précitée et le set chirurgical ci-dessus décrit. FIG. 10 shows, by way of illustration, a wrist reached with mid-carpal instability after intervention using the aforementioned ligamentoplasty technique and the surgical set described above.
Le ligament L passe dans une perforation de la tête du grand os GO et du semi-lunaire SL pour se rattacher par ses extrémités à deux vis d'ancrage V1 et V2, l'une vissée dans le grand os (au niveau du col), l'autre vissée sur la face dorsale du semi-lunaire. The ligament L passes through a perforation of the head of the large GO bone and the semi-lunar SL to be attached by its ends to two anchor screws V1 and V2, one screwed into the large bone (at the level of the neck) , the other screwed onto the dorsal side of the semi-lunar.
Claims (23)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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FR8916764A FR2655840B1 (en) | 1989-12-15 | 1989-12-15 | SURGICAL SET OF LIGAMENTOPLASTY AND CONSTITUENT ELEMENTS. |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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FR8916764A FR2655840B1 (en) | 1989-12-15 | 1989-12-15 | SURGICAL SET OF LIGAMENTOPLASTY AND CONSTITUENT ELEMENTS. |
Publications (2)
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FR2655840A1 true FR2655840A1 (en) | 1991-06-21 |
FR2655840B1 FR2655840B1 (en) | 1994-04-01 |
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FR8916764A Expired - Fee Related FR2655840B1 (en) | 1989-12-15 | 1989-12-15 | SURGICAL SET OF LIGAMENTOPLASTY AND CONSTITUENT ELEMENTS. |
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