FR2717070A1 - Ligament fixing screw - Google Patents
Ligament fixing screw Download PDFInfo
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- FR2717070A1 FR2717070A1 FR9402930A FR9402930A FR2717070A1 FR 2717070 A1 FR2717070 A1 FR 2717070A1 FR 9402930 A FR9402930 A FR 9402930A FR 9402930 A FR9402930 A FR 9402930A FR 2717070 A1 FR2717070 A1 FR 2717070A1
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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
- A61F2/0805—Implements for inserting tendons or ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—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
- A61B17/8645—Headless screws, e.g. ligament interference screws
-
- 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
- A61F2/0811—Fixation devices for tendons or ligaments
-
- 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
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0847—Mode of fixation of anchor to tendon or ligament
- A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
-
- 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
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0876—Position of anchor in respect to the bone
- A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Vascular Medicine (AREA)
- Transplantation (AREA)
- Cardiology (AREA)
- Rheumatology (AREA)
- Rehabilitation Therapy (AREA)
- Surgery (AREA)
- Neurology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
Abstract
Description
PERFECTIONNEMENT AUX VIS DE FIXATION LIGAMENTAIRE ET
DISPOSITIF POUR LEUR MISE EN PLACE
Lcioipraoo
La présente invention concerne un perfectionnement des vis cylindro-coniques pour la fixation intra-osseuse d'un ligament, prothétique ou non, émergeant de son tunnel d'insertion osseuse, ainsi qu'un dispositif permettant la mise en place précise de telles vis et leur serrage progressif dans ledit tunnel d'insertion.IMPROVEMENT IN LIGAMENTARY FIXING SCREWS AND
DEVICE FOR THEIR PLACEMENT
Lcioipraoo
The present invention relates to an improvement in cylindrical-conical screws for the intraosseous fixation of a ligament, prosthetic or not, emerging from its bone insertion tunnel, as well as a device allowing the precise placement of such screws and their progressive tightening in said insertion tunnel.
On connaît déjà des vis de fixation ligamentaire de type cylindro-coniques, normalement destinées à remplacer les agrafes ligamentaires traditionnelles assurant la fixation d'un ligament artificiel, par exemple pour le remplacement d'un ligament articulaire naturel distendu ou rompu. Ces vis de fixation ligamentaire ont un avantage majeur sur les agrafes en ce qu'elles préservent lors de leur fixation la direction des fibres longitudinales techniques constituant le ligament prothétique ; à l'inverse, on sait bien que les anciennes techniques par agrafage consistaient à replier l'extrémité du ligament émergeant du tunnel d'insertion tibial sur la face antérieure du tibia, avec comme conséquence néfaste, de créer un relief sous la peau, relief pour le moins disgracieux mais souvent traumatisant pour le patient. Ligament fixation screws of the cylindro-conical type are already known, normally intended to replace traditional ligament staples ensuring the fixation of an artificial ligament, for example for the replacement of a distended or broken natural articular ligament. These ligament fixing screws have a major advantage over staples in that they preserve during their fixing the direction of the longitudinal technical fibers constituting the prosthetic ligament; conversely, it is well known that the old stapling techniques consisted in folding the end of the ligament emerging from the tibial insertion tunnel onto the anterior face of the tibia, with the harmful consequence of creating a relief under the skin, relief to say the least unsightly but often traumatic for the patient.
Pour remédier à tous ces inconvénients, il a déjà été décrit un dispositif pour la fixation intra-osseuse d'un ligament artificiel, notamment dans le brevet français FR-2.688.689 déposé le 18 mars 1992 ; le dispositif proposé est constitué d'une vis à tige filetée sur toute sa longueur que l'on vient visser dans le tunnel osseux d'où émerge le ligament prothétique afin de le contresserrer dans la paroi interne dudit tunnel osseux, le dispositif étant caractérisé en ce que ladite tige filetée de la vis est de forme cylindro-conique, la partie cylindrique s'étendant sous la tête de la vis sur une longueur au moins égale à la moitié de la longueur de ladite tige. To remedy all these drawbacks, a device has already been described for the intraosseous fixation of an artificial ligament, in particular in French patent FR-2,688,689 filed on March 18, 1992; the proposed device consists of a screw with a threaded rod over its entire length which is screwed into the bone tunnel from which the prosthetic ligament emerges in order to counterpress it in the internal wall of said bone tunnel, the device being characterized in that said threaded rod of the screw is of cylindro-conical shape, the cylindrical part extending under the head of the screw over a length at least equal to half the length of said rod.
Une telle solution, si elle remédie incontestablement aux problèmes que posait l'ancienne technique d'agrafage rappelée ci-dessus, présente encore l'inconvénient majeur d'un risque d'accrochage du ligament, surtout s'il est artificiel, par les premiers filets de l'extrémité distale de la vis qui tend alors à repousser le ligament dans le tunnel osseux, conduisant soit à une très fâcheuse détention, lorsque la vis est introduite depuis l'extérieur vers l'articulation, soit à une hypertension tout aussi néfaste lorsque la vis est introduite depuis l'articulation vers l'extérieur. Such a solution, if it undoubtedly remedies the problems posed by the old stapling technique mentioned above, still has the major drawback of a risk of ligament attachment, especially if it is artificial, by the first threads from the distal end of the screw which then tends to push the ligament back into the bone tunnel, leading either to a very annoying retention, when the screw is introduced from the outside towards the joint, or to an equally harmful hypertension when the screw is inserted from the joint to the outside.
Pour cela, et selon la présente invention, il est proposé un perfectionnement aux vis de fixation de ce type, ajoutant à la conicité de ladite vis, la disparition progressive des filets au niveau de l'extrémité distale conique. De cette façon, on comprend bien que la profondeur des filets de la vis croit régulièrement depuis l'extrémité distale pour atteindre une profondeur maximum au niveau de la zone d'intersection avec la partie cylindrique de la vis ; naturellement, cette profondeur maximale sera ensuite conservée jusqu'à l'extrémité proximale de la même vis. On observera à cet égard, qu'une telle solution n'occasionne aucun inconvénient supplémentaire dans la tenue du ligament, puisque seule la partie cylindrique contraint réellement le ligament sur les parois du tunnel d'insertion osseuse, la partie conique ou tronconique à filets progressifs ne servant finalement qu'à l'introduction guidée de la vis dans l'espace intercalaire entre le ligament et les parois osseuses du tunnel d'insertion venant progressivement coincer le ligament contre les parois latérales dudit tunnel, ce qui évite bien entendu le déplacement longitudinal dudit ligament dans le tunnel et permet, en conséquence, de conserver à ce ligament la tension la plus proche possible de celle qui a été déterminée par le praticien lors de sa mise en place. On rappellera, si nécessaire, qu'il est essentiel de ne pas modifier la tension choisie par une hyper ou une hypotension engendrée par le montage de la vis, ce qui serait catastrophique pour la durée du vie du ligament ou la mobilité de l'articulation ainsi appareillée. For this, and according to the present invention, an improvement is proposed to fixing screws of this type, adding to the taper of said screw, the progressive disappearance of the threads at the level of the conical distal end. In this way, it is well understood that the depth of the threads of the screw increases regularly from the distal end to reach a maximum depth at the level of the zone of intersection with the cylindrical part of the screw; naturally, this maximum depth will then be maintained up to the proximal end of the same screw. It will be observed in this regard, that such a solution does not cause any additional disadvantage in the holding of the ligament, since only the cylindrical part actually constrains the ligament on the walls of the bone insertion tunnel, the conical or frustoconical part with progressive threads ultimately serving only for the guided introduction of the screw into the intermediate space between the ligament and the bone walls of the insertion tunnel progressively wedging the ligament against the side walls of said tunnel, which of course avoids longitudinal displacement of said ligament in the tunnel and consequently allows this tension to be kept as close as possible to that which was determined by the practitioner when it was put in place. It will be recalled, if necessary, that it is essential not to modify the tension chosen by a hyper or hypotension generated by the mounting of the screw, which would be catastrophic for the life of the ligament or the mobility of the joint. thus paired.
A cet égard, il donc proposé, conformément à l'invention, une vis de fixation d'un ligament émergeant de son tunnel osseux d'insertion, comprenant une tige filetée sur toute sa longueur de forme générale cylindroconique, la partie cylindrique s'étendant depuis la tête de la vis sur une longueur suffisante pour contres serrer le ligament sur la paroi interne dudit tunnel d'insertion, ladite vis de fixation étant caractérisée en ce que la profondeur des filets, normalement constante sur toute la partie cylindrique de la tige filetée décroît régulièrement dans sa partie conique ou tronconique depuis la zone d'intersection avec la partie cylindrique jusqu'à l'extrémité distale de ladite vis. In this regard, he therefore proposed, in accordance with the invention, a screw for fixing a ligament emerging from its bone insertion tunnel, comprising a threaded rod over its entire length of generally cylindroconical shape, the cylindrical part extending from the head of the screw over a length sufficient to tighten the ligament on the internal wall of said insertion tunnel, said fixing screw being characterized in that the depth of the threads, normally constant over the entire cylindrical part of the threaded rod decreases regularly in its conical or frustoconical part from the area of intersection with the cylindrical part to the distal end of said screw.
Accessoirement, la vis de fixation ligamentaire conforme à l'invention est munie de filets dont le fond est avantageusement arrondi et dont les sommets sont également et avantageusement arrondis dans la partie cylindrique et érodés dans la partie conique ou tronconique pour éviter toute zone saillante pouvant provoquer le refoulement du ligament à l'intérieur de son tunnel d'insertion ce qui entraîne on l'a vu, une très fâcheuse variation de tension de celui-ci. Incidentally, the ligament fixing screw according to the invention is provided with threads the bottom of which is advantageously rounded and the vertices of which are also and advantageously rounded in the cylindrical part and eroded in the conical or frustoconical part to avoid any protruding area which may cause the repression of the ligament inside its insertion tunnel which leads, as we have seen, to a very unfortunate variation in tension of the latter.
D'autres caractéristiques et avantages ressortiront mieux de la description qui va être donnée d'une vis de fixation ligamentaire perfectionnée suivant l'invention, et décrite à titre d'exemple préféré, quoique non limitatif, et en référence au dessin annexé dans lequel
- La figure 1 est une vue générale et schématique de la vis de fixation ligamentaire selon l'invention comportant à droite de l'axe de la vis une demi-vue de celle-ci montrant le profil réel de ses filets, et à droite, une demi-vue en coupe de la vis conforme à l'invention, (complétée par deux schémas arachés représentant à plus grande échelle, les détails des filets dans les deux zones composant le filetage de la vis).Other characteristics and advantages will emerge more clearly from the description which will be given of an improved ligament fixation screw according to the invention, and described by way of preferred example, although not limiting, and with reference to the appended drawing in which
FIG. 1 is a general and schematic view of the ligament fixing screw according to the invention comprising on the right of the axis of the screw a half-view of the latter showing the real profile of its threads, and on the right, a half-view in section of the screw according to the invention, (supplemented by two cutaway diagrams representing on a larger scale, the details of the threads in the two zones making up the threading of the screw).
- La figure 2 est une demi-vue en coupe de la vis de fixation ligamentaire selon une seconde variante de la vis comportant un noyau cylindrique. - Figure 2 is a half-sectional view of the ligament fixing screw according to a second variant of the screw comprising a cylindrical core.
- La figure 3 est une vue schématique en perspective d'une articulation fémoro-tibiale montrant plus particulièrement la mise en place de la vis ligamentaire conforme à l'invention à chacune des extrémités tibiale et fémorale d'un ligament prothétique destiné à la plastie du croisé antérieur du genou. - Figure 3 is a schematic perspective view of a femoro-tibial joint showing more particularly the establishment of the ligament screw according to the invention at each of the tibial and femoral ends of a prosthetic ligament intended for the plasty of the anterior knee cross.
- La figure 4 est une représentation schématique en coupe partielle du dispositif de positionnement et de serrage des vis ligamentaires selon l'invention, en position initiale d'approche de la vis vers le tunnel osseux. - Figure 4 is a schematic representation in partial section of the positioning and tightening device of the ligament screws according to the invention, in the initial position of approach of the screw towards the bone tunnel.
- La figure 5 est une vue identique à la figure 4 du dispositif en position finale de serrage de la vis dans le tunnel osseux. - Figure 5 is a view identical to Figure 4 of the device in the final position for tightening the screw in the bone tunnel.
Conformément à la figure 1, la vis de fixation d'un ligament, ou vis ligamentaire 1, comporte une tige de forme cylindro-conique formée au centre d'un noyau plein 2 comportant une partie cylindrique 3 qui s'étend à partir de la tête 4 de la vis 1 sur la partie supérieure de la tige et une partie conique ou au moins tronconique 5 prolongeant la vis du coté distal. La longueur de la partie cylindrique 3 est telle qu'elle soit suffisante pour assurer le blocage efficace et permanent du ligament à la sortie de ses tunnels osseux ; préférentiellement cette partie cylindrique 3 aura une longueur égale au moins à la moitié de la longueur totale de la tige de la vis 1. In accordance with FIG. 1, the ligament fixing screw, or ligament screw 1, comprises a rod of cylindro-conical shape formed in the center of a solid core 2 comprising a cylindrical part 3 which extends from the head 4 of the screw 1 on the upper part of the rod and a conical or at least frustoconical part 5 extending the screw on the distal side. The length of the cylindrical part 3 is such that it is sufficient to ensure effective and permanent blocking of the ligament at the exit of its bone tunnels; preferably this cylindrical part 3 will have a length equal to at least half of the total length of the rod of the screw 1.
Par ailleurs, les parties cylindrique 3 et tronconique 5 de la tige sont filetées, ce qui permet d'introduire la vis ligamentaire 1 progressivement dans l'os. Furthermore, the cylindrical 3 and frustoconical parts 5 of the rod are threaded, which allows the ligamentary screw 1 to be introduced gradually into the bone.
On observera par ailleurs, en se référant aux détails agrandis de la partie supérieure cylindrique 3 de la vis représentée en figure 1 que celle-ci est pourvue d'un filetage non triangulaire ; en effet, étant observé que les ligaments artificiels sont habituellement réalisés à partir d'une bande textile roulée sur elle-même, une telle disposition des filets dans la partie supérieure cylindrique 3 de la vis 1 permet de ne pas cisailler lesdits ligaments lors du montage de la vis 1 à l'intérieur du tunnel osseux. It will also be observed, with reference to the enlarged details of the cylindrical upper part 3 of the screw shown in FIG. 1, that the latter is provided with a non-triangular thread; in fact, it being observed that the artificial ligaments are usually produced from a textile strip rolled on itself, such an arrangement of the threads in the cylindrical upper part 3 of the screw 1 makes it possible not to shear said ligaments during assembly of screw 1 inside the bone tunnel.
A cet effet, et conformément à la variante d'exécution préférentielle qui est décrite ici, les sommets 6 des filets de la vis 1 ont un profil arrondi, le profil du fond 7 de ces mêmes filets étant, lui-même, arrondi ; cette forme arrondie des filets n'est, bien entendu, pas obligatoire et il est tout à fait possible de choisir un filetage carré ou trapézoïdal qui, sans être aussi dangereux que les filetages triangulaires ont néanmoins l'inconvénient majeur de présenter des arrêtes contondantes néfastes pour les ligaments. To this end, and in accordance with the preferred variant embodiment which is described here, the tops 6 of the threads of the screw 1 have a rounded profile, the bottom profile 7 of these same threads being, itself, rounded; this rounded shape of the threads is, of course, not compulsory and it is quite possible to choose a square or trapezoidal thread which, without being as dangerous as the triangular threads, nevertheless has the major drawback of having harmful blunt edges for ligaments.
Suivant la caractéristique essentielle de l'invention, la partie conique ou tronconique 5 de la vis 1 est munie sur toute sa longueur d'un filetage particulier caractérisé en ce que la profondeur des filets décroît régulièrement depuis la zone d'intersection avec la partie supérieure cylindrique 3 de la vis 1 jusqu'a son extrémité distale 1 ; conformément à la vue agrandie de la partie inférieure tronconique 5 de la vis 1 représentée en figure 1, la décroissance régulière de la profondeur des filets est obtenue par érosion de plus en plus importante du sommet 6 des filets, le fond 7 des mêmes filets présentant avantageusement la même forme arrondie que les filets de la zone supérieure cylindrique 3. According to the essential characteristic of the invention, the conical or frustoconical part 5 of the screw 1 is provided over its entire length with a particular thread characterized in that the depth of the threads decreases regularly from the zone of intersection with the upper part cylindrical 3 from screw 1 to its distal end 1; in accordance with the enlarged view of the frusto-conical lower part 5 of the screw 1 shown in FIG. 1, the regular decrease in the depth of the threads is obtained by increasing erosion of the top 6 of the threads, the bottom 7 of the same threads having advantageously the same rounded shape as the threads of the upper cylindrical zone 3.
L'érosion des sommets 6' de la partie tronconique 5 qui est d'autant plus importante que l'on se rapproche de l'extrémité distale 8 de la vis 1, est avantageusement obtenue par usinage ou décolletage des filets selon une ligne de coupe coïncidant avec la génératrice 6" de l'enveloppe conique de la partie 5 de la vis 1 ; il est évident que l'angle au sommet formé entre la génératrice 6" et l'axe longitudinal de la vis 1 détermine la progressivité de l'érosion des filets de la zone tronconique 5. C'est ainsi que selon une variante particulière et caractéristique de l'invention, l'angle de la génératrice 6" est pris de telle manière que le sommet du dernier filet de la zone tronconique 5 aboutissant à l'extrémité distale 8 de la vis 1 vienne tangenter le fond 7 du dernier filet créant ainsi à cet endroit là, une totale fusion entre le filet et le noyau 2 de la vis 1. The erosion of the vertices 6 'of the frustoconical part 5 which is all the more important as one approaches the distal end 8 of the screw 1, is advantageously obtained by machining or turning the threads along a cutting line coinciding with the generator 6 "of the conical casing of part 5 of the screw 1; it is obvious that the apex angle formed between the generator 6" and the longitudinal axis of the screw 1 determines the progressiveness of the Erosion of the threads of the frustoconical zone 5. Thus, according to a particular and characteristic variant of the invention, the angle of the generator 6 "is taken in such a way that the top of the last thread of the frustoconical zone 5 terminates at the distal end 8 of the screw 1 comes to tangent the bottom 7 of the last thread thus creating at this place there, a total fusion between the thread and the core 2 of the screw 1.
Selon une autre variante de l'invention telle que représentée sur la figure 2, il est prévu d'usiner ou de mouler l'ensemble, de telle manière que le noyau 2 de la vis 1 ait une forme globalement cylindrique depuis la tête 4 de la vis jusqu'à son extrémité distale 8 ; dans cette variante particulière, la forme cylindro-conique est obtenue par un premier filetage cylindrique sur toute la hauteur de la vis 1, la partie tronconique 5 étant alors le résultat d'une érosion progressive partant de son maximum dans la zone médiane de la vis 1 pour venir affleurer le noyau 2 à son extrémité 8. According to another variant of the invention as shown in FIG. 2, it is planned to machine or mold the assembly, in such a way that the core 2 of the screw 1 has a generally cylindrical shape from the head 4 of the screw to its distal end 8; in this particular variant, the cylindrical-conical shape is obtained by a first cylindrical thread over the entire height of the screw 1, the frustoconical part 5 then being the result of a progressive erosion starting from its maximum in the median zone of the screw 1 to come flush with the core 2 at its end 8.
Ainsi constituée, la vis 1 conforme à l'invention, qu'elle ressorte de la première variante figure 1 ou de la deuxième variante figure 2 ou de toute autre combinaison de ces deux variantes, permet au praticien opérant une ligamentoplastie, d'aborder la sortie d'un tunnel d'insertion osseuse d'où émerge un ligament prothétique préalablement mis en place, sans risque de repousser ledit ligament à l'intérieur dudit tunnel par l'effet d'un filetage agressif qui, de ce fait, viendrait entraîner le ligament dans le même sens que son déplacement longitudinal ; dans la mesure où l'extrémité distale 8 de la vis 1 est quasiment lisse et constitue le sommet de la partie tronconique 5 dont les filets sont d'autant plus émoussés qu'ils convergent vers ledit sommet, il est possible d'introduire ladite partie 5 à l'intérieur du tunnel osseux sans friction importante avec l'extrémité ligamentaire et l'engagement de la vis 1 à l'intérieur du tunnel peut alors être effectué en douceur. Le ligament n'étant que très progressivement contraint sur les parois du tunnel osseux, on évite ainsi de le refouler dans ledit tunnel dans un premier temps, de le retendre ensuite par effet de réaction entre la vis et le ligament. Thus constituted, the screw 1 according to the invention, whether it emerges from the first variant in FIG. 1 or from the second variant in FIG. 2 or from any other combination of these two variants, allows the practitioner operating a ligament, to approach the exit from a bone insertion tunnel from which emerges a prosthetic ligament previously placed, without risk of pushing said ligament inside said tunnel by the effect of an aggressive threading which, as a result, would cause the ligament in the same direction as its longitudinal displacement; insofar as the distal end 8 of the screw 1 is almost smooth and constitutes the apex of the frustoconical part 5, the threads of which are all the more blunt as they converge towards said apex, it is possible to introduce said part 5 inside the bone tunnel without significant friction with the ligament end and the engagement of the screw 1 inside the tunnel can then be carried out smoothly. The ligament being only very gradually constrained on the walls of the bone tunnel, it is thus avoided to push it back into said tunnel at first, then to tighten it again by reaction effect between the screw and the ligament.
L'engrènement progressif de la vis 1 à l'intérieur du tunnel, assure la fixation du ligament sans en modifier la tension déterminée préalablement par le praticien.The progressive meshing of the screw 1 inside the tunnel, ensures the fixation of the ligament without modifying the tension determined beforehand by the practitioner.
On comprend mieux maintenant l'intérêt majeur du filetage très particulier de la partie conique ou tronconique 5 de la vis 1 conforme à l'invention permettant ce montage en deux étapes : guidage de la vis 1 grâce à la partie tronconique 5 suivi d'un blocage sans refoulement ni attraction grâce à la partie cylindrique 3. We now understand better the major advantage of the very particular threading of the conical or frustoconical part 5 of the screw 1 according to the invention allowing this assembly in two stages: guiding of the screw 1 thanks to the frustoconical part 5 followed by a blocking without backflow or attraction thanks to the cylindrical part 3.
La figure 3 représente un exemple de fixation d'un ligament 9 dans une articulation fémoro-tibiale 10, une première extrémité du ligament 9 déjà fixée à l'intérieur du tunnel d'insertion fémorale et la seconde extrémité dudit ligament 9 émergeant du tunnel d'insertion tibiale, en attente de fixation définitive au moyen de la vis 1 du type de l'invention. Du côté tibial, le ligament 9 est préalablement fixé à un fil de traction 11 d'abord destiné à le faire passer au travers des deux tunnels d'insertion, fémoral et tibial. FIG. 3 represents an example of attachment of a ligament 9 in a femoro-tibial joint 10, a first end of the ligament 9 already fixed inside the femoral insertion tunnel and the second end of said ligament 9 emerging from the tunnel d 'tibial insertion, awaiting final fixation by means of the screw 1 of the type of the invention. On the tibial side, the ligament 9 is previously fixed to a traction wire 11 first intended to pass it through the two insertion tunnels, femoral and tibial.
Selon une technique exemplaire de pose du ligament 9, on enfile par des moyens adéquats, une broche 12 au travers des deux tunnels fémoral et tibial. According to an exemplary technique for fitting the ligament 9, a pin 12 is threaded by appropriate means through the two femoral and tibial tunnels.
Cette broche 12 qui émerge hors de la peau grâce à l'incision cutanée pratiquée dans les chairs, pourra être utilisée pour engager et guider une vis ligamentaire 1 conforme à l'invention jusqu'à l'entrée des tunnels tibial et/ou fémoral. A cet effet, il est prévu de percer longitudinalement la vis ligamentaire 1 de part en part et suivant son axe vertical, de sorte qu'elle puisse être librement coulissée le long de la broche de guidage 12 en faisant alors progresser la vis 1 le long de ladite broche 12 jusqu'à ce que son extrémité distale 8 vienne au contact de l'entrée du tunnel tibial, par exemple ; le praticien est assuré d'engager la tige de la vis 1 contre le ligament 9 sans risque de dévier la direction des tunnels d' insertion. This pin 12 which emerges from the skin through the skin incision made in the flesh, can be used to engage and guide a ligamentous screw 1 according to the invention up to the entrance to the tibial and / or femoral tunnels. To this end, provision is made to drill the ligament screw 1 longitudinally right through and along its vertical axis, so that it can be freely slid along the guide pin 12, then advancing the screw 1 along of said pin 12 until its distal end 8 comes into contact with the entrance to the tibial tunnel, for example; the practitioner is ensured to engage the rod of the screw 1 against the ligament 9 without risk of deviating the direction of the insertion tunnels.
Selon une caractéristique essentielle de l'invention, il est, par ailleurs, prévu que la vis 1 présente une tête cylindrique 4 à six pans creux pouvant coopérer avec une clef 13 telle que représentée sur les figures 4 et 5, comportant elle-même un percement axial lui permettant de coulisser le long de la broche de guidage 12. De cette manière, en engagent la clef 13 dans la tête 4 de la vis 1, le praticien peut sans difficulté enfoncer cette dernière jusqu'à la zone de fixation du ligament 9 puis la visser exactement dans le tunnel d' insertion concerné. According to an essential characteristic of the invention, it is further provided that the screw 1 has a cylindrical head 4 with a hexagon socket which can cooperate with a key 13 as shown in FIGS. 4 and 5, itself comprising a axial drilling allowing it to slide along the guide pin 12. In this way, by engaging the key 13 in the head 4 of the screw 1, the practitioner can without difficulty drive the latter up to the ligament fixation zone 9 then screw it exactly into the insertion tunnel concerned.
A cet effet, et selon une caractéristique complémentaire de l'invention, il est prévu d'associer à la vis 1 un matériel ancillaire plus particulièrement destiné à son entraînement et à sa mise en place de manière précise dans le tunnel osseux, lorsque l'opération est effectuée "à ciel ouvert" c'est-à-dire par le moyen d'une simple incision pour parvenir à l'articulation concernée. To this end, and according to a complementary characteristic of the invention, it is planned to associate with the screw 1 an ancillary material more particularly intended for its drive and its positioning in a precise manner in the bone tunnel, when the operation is carried out "open" that is to say by means of a simple incision to reach the joint concerned.
On comprend bien en effet, que dans ces conditions d'intervention particulièrement avantageuses pour le patient, le praticien soit tenu de bien d'assurer de la fixation correcte du ligament 9 dans son tunnel osseux 100, c'est-à-dire que la vis 1 soit correctement introduite dans le tunnel de la manière que l'on a précisée ci-avant, mais également qu'elle soit introduite selon une profondeur adéquate dans le tunnel 100 ; la vis 1 doit être totalement enfouie dans ledit tunnel 100 afin de contres serrer le ligament 9 sur toute la portée de la zone cylindrique 3 de la vis 1 comme on l'a vu cidessus ; réciproquement, il est impératif que la vis 1 ne soit pas trop enfouie dans le tunnel osseux 100 c'est-à- dire que la tête 4 de la vis doit venir juste affleurer l'entrée du tunnel d'insertion 100 ; or, dans une opération à ciel ouvert, le praticien n'a aucune possibilité de contrôler visuellement la progression de l'enfouissement de la vis 1 dans le tunnel 100. C'est pourquoi, il a été mis au point une variante particulière de la clé 13 permettant naturellement d'assurer le serrage de la vis 4 dans le tunnel osseux 100 mais encore d'en contrôler le niveau d'enfouissement dans ledit tunnel 100. It is well understood indeed, that in these intervention conditions which are particularly advantageous for the patient, the practitioner is required to ensure that the ligament 9 is correctly fixed in its bone tunnel 100, that is to say that the screw 1 is correctly introduced into the tunnel in the manner specified above, but also that it is introduced at an adequate depth into the tunnel 100; the screw 1 must be completely buried in said tunnel 100 in order to counter-tighten the ligament 9 over the entire range of the cylindrical zone 3 of the screw 1 as seen above; conversely, it is imperative that the screw 1 is not too buried in the bone tunnel 100, that is to say that the head 4 of the screw must just come flush with the entry of the insertion tunnel 100; however, in an open-air operation, the practitioner has no possibility of visually controlling the progress of the burial of the screw 1 in the tunnel 100. This is why, a particular variant of the key 13 naturally making it possible to tighten the screw 4 in the bone tunnel 100 but also to control the level of burial in said tunnel 100.
A cet égard, il a donc été conçu un ancillaire 13 muni en sa partie proximale d'une poignée 131 d'où émerge une tige de tournevis 132 dont la partie terminale est un tournevis à six pans 133 pouvant coopérer avec la tête 4 de la vis 1. L'ensemble tige tournevis 132 et tournevis 133 est percé axialement de part en part, de telle façon qu'il puisse être enfilé sur la broche 12 servant, comme il a été indiqué ci-dessus, de guidage depuis l'extérieur jusque dans le tunnel d'insertion osseux 100 pour la mise en place, et du ligament, et de sa vis de fixation.In this respect, an ancillary device 13 has therefore been designed provided in its proximal part with a handle 131 from which emerges a screwdriver rod 132 whose terminal part is a hexagonal screwdriver 133 which can cooperate with the head 4 of the screw 1. The screwdriver rod 132 and screwdriver 133 assembly is drilled axially right through, so that it can be threaded onto pin 12 serving, as indicated above, for guiding from the outside as far as the bone insertion tunnel 100 for positioning, and the ligament, and its fixing screw.
La tige 132 de l'ancillaire 13 coopère en outre avec un système de repérage 14 assurant un contrôle visuel du niveau d'enfouissement de la vis 1 pour le praticien, le système de repérage 14 comporte un tube 142 venant coulisser juste sur la tige tournevis de l'ancillaire 13 et il est tel que sa longueur totale coïncide exactement avec la longueur de la tige 132 de telle façon que le tube 142 étant en butée supérieure sur la poignée 131 son extrémité distale 143 soit exactement à l'aplomb du tournevis six pans, c'est-à-dire au niveau de la surface supérieure de la tête 4 de la vis 1 lorsqu'elle est engagée sur le tournevis six pans qui doit l'entraîner. Le système de réglage 14 est en outre muni d'une poignée 141 s'étendant radialement par rapport au tube 142 qu'elle est supposée pouvoir déplacer plus facilement lors de l'opération envisagée. La poignée 141 est avantageusement conçue de telle manière qu'elle puisse accessoirement être utilisée par le praticien comme écarteur des chairs préalablement à son utilisation comme ancillaire de vissage notamment pour le perçage des tunnels osseux ou la mise en place du ligament prothétique. The rod 132 of the ancillary 13 further cooperates with a locating system 14 ensuring a visual control of the level of burial of the screw 1 for the practitioner, the locating system 14 comprises a tube 142 sliding just on the screwdriver rod of the ancillary 13 and it is such that its total length exactly coincides with the length of the rod 132 so that the tube 142 is in upper abutment on the handle 131 its distal end 143 is exactly plumb with the screwdriver six hexagonal, that is to say at the upper surface of the head 4 of the screw 1 when it is engaged on the hexagonal screwdriver which must drive it. The adjustment system 14 is further provided with a handle 141 extending radially relative to the tube 142 which it is supposed to be able to move more easily during the envisaged operation. The handle 141 is advantageously designed in such a way that it can incidentally be used by the practitioner as a flesh spreader prior to its use as a screwing aid, in particular for piercing bone tunnels or placing the prosthetic ligament.
En référence aux figures 4 et 5, l'ancillaire 13 peut être alors utilisé de la manière suivante : le ligament 9 ayant été préalablement inséré dans son tunnel osseux 100 et la broche 12 de guidage étant toujours en place, il convient maintenant de procéder à la fixation dudit ligament 9 grâce à la vis 1 selon l'invention, la vis 1 est alors montée sur le tournevis 133 et le tube 142 est disposé sur la tige 132 de l'ancillaire 13 l'ensemble peut alors être enfilé le long de la broche 12 pouvant comme on la vu au travers de la vis 1 puis au travers du tournevis 133, de la tige 132 et finalement de la poignée 31 permettant à l'ensemble de pouvoir pénétrer jusqu'à l'entrée du tunnel d'insertion d'où émerge le ligament 9 à fixer. Lorsque l'ensemble vis/ancillaire arrive en butée sur la partie osseuse de l'articulation, le système de repérage est alors repoussé vers l'intérieur grâce à sa poignée 141 de telle manière que son extrémité distale 143 vienne au contact de la corticale de l'os entourant l'entrée du tunnel d'insertion 100 a à cet instant, il apparait entre la poignée 131 et l'extrémité proximale du tube 142 un écart 1 représentant la partie de vis 1 émergeante par rapport à l'entrée du tunnel 100 puisque par construction le tube 142 à la même longueur que la partie de tige 132 comprise entre la tête de vis montée sur cette même tige et la poignée 131. Le praticien peut alors commencer le vissage de la vis 1 entraînant sa pénétration progressive dans le tunnel 100, le tube 142 du système de repérage 14 restant bien entendu en appui sur l'entrée dudit tunnel 100 ; au fur et à mesure de l'enfouissement de la vis, la distance 1 diminue jusqu'à ce qu'elle tende vers zéro c'est à dire jusqu'au contact entre le tube 142 et la poignée 131 de l'ancillaire 13 ; à ce moment là le praticien sait que la tête 4 de la vis 1 est exactement au niveau de l'extrémité 143 du système de repérage 14 c'est à dire à fleur de la corticale de l'os d'où émerge le tunnel d'insertion 100 ; il suffit alors de retirer l'ensemble 13 et 14 ainsi que la broche 12 et procéder à une résection de l'extrémité du ligament 9 débordant hors du tunnel osseux pour terminer l'opération. With reference to FIGS. 4 and 5, the ancillary device 13 can then be used in the following manner: the ligament 9 having been previously inserted in its bone tunnel 100 and the guide pin 12 still being in place, it is now necessary to proceed with fixing said ligament 9 using the screw 1 according to the invention, the screw 1 is then mounted on the screwdriver 133 and the tube 142 is disposed on the rod 132 of the ancillary 13 the assembly can then be threaded along the spindle 12 can, as seen through the screw 1 then through the screwdriver 133, the rod 132 and finally the handle 31 allowing the assembly to be able to penetrate to the entrance of the insertion tunnel from which the ligament 9 to be fixed emerges. When the screw / ancillary assembly comes into abutment on the osseous part of the joint, the locating system is then pushed inwards using its handle 141 so that its distal end 143 comes into contact with the cortex of the bone surrounding the entrance to the insertion tunnel 100 has at this instant, there appears between the handle 131 and the proximal end of the tube 142 a gap 1 representing the part of the screw 1 emerging from the entrance to the tunnel 100 since by construction the tube 142 at the same length as the rod portion 132 between the screw head mounted on this same rod and the handle 131. The practitioner can then start the screwing of the screw 1 causing its progressive penetration into the tunnel 100, the tube 142 of the tracking system 14 of course remaining in abutment on the inlet of said tunnel 100; as the screw is buried, the distance 1 decreases until it tends towards zero, that is to say until it comes into contact between the tube 142 and the handle 131 of the ancillary 13; at this point the practitioner knows that the head 4 of the screw 1 is exactly at the end 143 of the locating system 14, that is to say flush with the cortex of the bone from which the tunnel d 'insertion 100; it then suffices to remove the assembly 13 and 14 as well as the pin 12 and proceed to resection of the end of the ligament 9 projecting out of the bone tunnel to complete the operation.
Accessoirement, il est prévu d'adapter l'extrémité 143 du système de réglage 14 venant autour de l'ancillaire 13 afin d'éviter toute erreur de référence tenant à la topologie de la corticale de l'os au niveau de l'entrée du tunnel d'insertion 100 ; il est donc prévu de donner à l'extrémité distale du tube 142 un biais suffisant permettant de limiter le contact à la seule extrémité supérieure 143 déterminant lorsque le tube 142 et en appui sur la poignée 131 l'aplomb par rapport à la tête 4 de la vis 1, la poignée 141 permettant pour le praticien de connaître l'orientation du pans coupé 143 et être sur que le point d'appui formant la référence d'enfouissement longitudinal de la vis 1 est bien correct ; en outre, le dégagement créé par le pans coupé de l'extrémité distale 143 du tube 142 procure une voie de dégagement pour l'extrémité débordante du ligament 9 pendant sa fixation. Incidentally, it is planned to adapt the end 143 of the adjustment system 14 coming around the ancillary 13 in order to avoid any reference error relating to the topology of the cortex of the bone at the level of the entry of the insertion tunnel 100; provision is therefore made to give the distal end of the tube 142 a sufficient bias making it possible to limit the contact to the only upper end 143 determining when the tube 142 and pressing on the handle 131 plumb with respect to the head 4 of the screw 1, the handle 141 allowing the practitioner to know the orientation of the cut sides 143 and to be sure that the fulcrum forming the longitudinal burial reference of the screw 1 is indeed correct; in addition, the clearance created by the cut section of the distal end 143 of the tube 142 provides a clearance path for the projecting end of the ligament 9 during its fixation.
I1 est bien évident que la tête 4 de la vis ligamentaire 1 doit être préférentiellement telle qu'elle ne laisse subsister aucun débord par rapport à l'encombrement de la partie cylindrique 3 correspondant à la partie de serrage de la vis 1 afin de pouvoir coulisser librement à l'intérieur du tube de repérage 14. I1 is quite obvious that the head 4 of the ligamentous screw 1 must preferably be such that it leaves no overhang with respect to the size of the cylindrical part 3 corresponding to the tightening part of the screw 1 in order to be able to slide freely inside the marking tube 14.
Naturellement, il peut toujours être envisagé d'utiliser une vis conforme à l'invention qui soit munie d'une débordante venant après serrage, en appui sur la corticale de l'os. Naturally, it can always be envisaged to use a screw in accordance with the invention which is provided with an overflowing coming after tightening, bearing on the cortex of the bone.
Claims (10)
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FR9402930A FR2717070B1 (en) | 1994-03-14 | 1994-03-14 | Improvement to the ligament fixation screws and device for their installation. |
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FR9402930A FR2717070B1 (en) | 1994-03-14 | 1994-03-14 | Improvement to the ligament fixation screws and device for their installation. |
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