FR2744010A1 - Osseous implant manufacturing procedure, for e.g. osteosynthetic screws or tibial fixation plates etc - Google Patents
Osseous implant manufacturing procedure, for e.g. osteosynthetic screws or tibial fixation plates etc Download PDFInfo
- Publication number
- FR2744010A1 FR2744010A1 FR9515841A FR9515841A FR2744010A1 FR 2744010 A1 FR2744010 A1 FR 2744010A1 FR 9515841 A FR9515841 A FR 9515841A FR 9515841 A FR9515841 A FR 9515841A FR 2744010 A1 FR2744010 A1 FR 2744010A1
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- France
- Prior art keywords
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- implant
- tube
- constitute
- holes
- Prior art date
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Classifications
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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
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
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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
- A61B17/56—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
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- A—HUMAN NECESSITIES
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- 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
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- 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
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
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- 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
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
- A61F2/446—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
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- 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
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
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- 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
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- 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
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- 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
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- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
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- 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
- A61F2/28—Bones
- A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
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- A61F2/02—Prostheses implantable into the body
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- 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
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3662—Femoral shafts
- A61F2002/3678—Geometrical features
- A61F2002/368—Geometrical features with lateral apertures, bores, holes or openings, e.g. for reducing the mass, for receiving fixation screws or for communicating with the inside of a hollow shaft
-
- 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
- A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
- A61F2002/4256—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints
- A61F2002/4258—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints for trapezo-metacarpal joints of thumbs
-
- 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
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2002/449—Joints for the spine, e.g. vertebrae, spinal discs comprising multiple spinal implants located in different intervertebral spaces or in different vertebrae
-
- 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
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0058—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements soldered or brazed or welded
-
- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
-
- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0019—Angular shapes rectangular
-
- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0069—Three-dimensional shapes cylindrical
-
- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00017—Iron- or Fe-based alloys, e.g. stainless steel
Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Cardiology (AREA)
- Transplantation (AREA)
- Vascular Medicine (AREA)
- Neurology (AREA)
- Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Prostheses (AREA)
Abstract
Description
La présente invention concerne un procédé de fabrication d'implants osseux comprenant une cavité interne et des ouvertures latérales mettant cette cavité en communication avec l'extérieur. L'ancrage de ces implants à l'os est réalisé par croissance osseuse dans ladite cavité, à travers lesdites ouvertures, de tels implants étant en particulier destinés à être implantés dans de l'os spongieux. The present invention relates to a method for manufacturing bone implants comprising an internal cavity and lateral openings putting this cavity in communication with the outside. The anchoring of these implants to the bone is carried out by bone growth in said cavity, through said openings, such implants being in particular intended to be implanted in cancellous bone.
Selon leurs dimensions, les implants obtenus par ce procédé peuvent notamment être des cages inter-vertébrales, des vis d'ostéosynthèse ou de fixation d'éléments prothétiques, notamment des vis de fixation de plateaux tibiaux de prothèses de genou ou des prothèses cotyloidiennes, des vis dites "d'interférence" permettant la fixation à un os des extrémités d'un ligament prothétique, ou des tiges d'ancrage pour éléments de prothèse d'articulation. Depending on their dimensions, the implants obtained by this method can in particular be inter-vertebral cages, osteosynthesis or fixation screws for prosthetic elements, in particular screws for fixing tibial plates of knee prostheses or acetabular prostheses, so-called "interference" screws for fixing the ends of a prosthetic ligament to a bone, or anchor rods for articulation prosthesis elements.
De tels implants sont actuellement réalisés par usinage, ce qui implique des moyens matériels conséquents et de nombreuses opérations successives. Such implants are currently produced by machining, which implies substantial material means and numerous successive operations.
Ces implants ont donc pour inconvénients d'être particulièrement longs, délicats et onéreux à fabriquer. These implants therefore have the disadvantages of being particularly long, delicate and expensive to manufacture.
De plus, la fabrication des implants existants présente des limites quant à la forme ou les dimensions qu'il est possible de donner à ces implants ou quant à ltépaisseur ou à la nature du matériau employé. In addition, the manufacture of existing implants presents limits as to the shape or dimensions that it is possible to give to these implants or as to the thickness or the nature of the material used.
La présente invention vise à remédier à ces inconvénients. The present invention aims to remedy these drawbacks.
A cette fin, le procédé qu'elle concerne consiste
- à constituer, par des opérations de découpe, conformation et éventuellement perçage, une pièce formant une partie principale de l'implant, de telle sorte que cette pièce délimite une cavité interne et comprend des trous ou découpes de forme, dimensions, densité et répartition adaptées à l'implant à fabriquer, et
- à fixer sur la pièce obtenue des éléments complémentaires permettant de constituer l'implant, notamment des bouchons ou parois de fermeture de la cavité, dans le cas où l'implant à obtenir est une cage inter-vertébrale, une tête de vissage et une pointe d'extrémité, dans le cas où l'implant à obtenir est une vis, une pièce pouvant recevoir un moyen d'articulation, dans le cas où l'implant à obtenir est un élément de prothèse d'articulation, des renforts longitudinaux ou autres.To this end, the process to which it relates consists
- to constitute, by cutting, shaping and possibly drilling operations, a part forming a main part of the implant, so that this part delimits an internal cavity and includes holes or cutouts of shape, dimensions, density and distribution adapted to the implant to be manufactured, and
- to fix on the part obtained complementary elements making it possible to constitute the implant, in particular plugs or walls for closing the cavity, in the case where the implant to be obtained is an inter-vertebral cage, a screwing head and a end point, in the case where the implant to be obtained is a screw, a part which can receive a hinge means, in the case where the implant to be obtained is a hinge prosthesis element, longitudinal reinforcements or other.
Ainsi, le procédé selon l'invention permet la fabrication d'implants osseux sans aucun usinage complexe, mais seulement par des opérations simples et rapides de découpe, conformation et éventuellement perçage d'une pièce formant une partie principale de l'implant, puis d'assemblage à cette pièce d'éléments complémentaires permettant de constituer l'implant. Thus, the method according to the invention allows the manufacture of bone implants without any complex machining, but only by simple and rapid operations of cutting, shaping and possibly drilling a part forming a main part of the implant, then d assembly of this piece of complementary elements to constitute the implant.
Ce procédé présente une grande souplesse de mise en oeuvre. This process has great flexibility of implementation.
En effet, la pièce formant une partie principale de l'implant peut être aménagée dans un matériau dont la forme, l'épaisseur ou la nature peuvent être choisies sans restriction en fonction de l'implant à fabriquer. Cette pièce peut notamment être aménagée à partir d'un tronçon de tube, lorsque l'implant à obtenir est une pièce de révolution, ou par conformation et éventuel assemblage d'un ou plusieurs flans découpés dans une pièce plane de matériau, notamment une tôle d'acier inoxydable. Indeed, the part forming a main part of the implant can be arranged in a material whose shape, thickness or nature can be chosen without restriction depending on the implant to be manufactured. This part can in particular be fitted out from a tube section, when the implant to be obtained is a part of revolution, or by conformation and possible assembly of one or more blanks cut from a flat piece of material, in particular a sheet stainless steel.
Ce tube ou cette pièce plane peuvent avoir une structure ajourée, en grillage ou en treillis, de sorte qu'il ne soit pas nécessaire d'y percer des trous. This tube or this flat part can have an openwork structure, in mesh or lattice, so that it is not necessary to drill holes therein.
En cas de pièce à structure non ajourée, la forme, les dimensions, la densité et la répartition de ces trous peuvent également être choisies sans restriction, en fonction de l'implant à fabriquer. In the case of a part with a non-perforated structure, the shape, dimensions, density and distribution of these holes can also be chosen without restriction, depending on the implant to be manufactured.
L'aménagement des trous peut être réalisé avant toute mise en forme du ou des flans, notamment par perçage ou à l'emporte-pièce. The arrangement of the holes can be carried out before any shaping of the blank (s), in particular by drilling or with a punch.
Lorsque ladite pièce formant une partie principale de l'implant est aménagée à partir d'une pièce plane de matériau, le procédé selon l'invention consiste
- à réaliser dans un ordre quelconque les opérations suivantes : découpe dans une pièce plane de matériau, telle qu'une tôle, d'au moins un flan de dimensions adaptées aux dimensions et à la forme de l'implant à obtenir ; aménagement, le cas échéant, de trous ou découpes au travers de ce ou ces flans
- à réaliser dans un ordre quelconque les opérations suivantes : conformation, et, le cas échéant, assemblage de ce ou ces flans les uns aux autres pour constituer une pièce délimitant une cavité interne assemblage des bords adjacents de la paroi de cette pièce, pour conférer une continuité à cette paroi, et
- à fixer sur la pièce obtenue des éléments complémentaires permettant de constituer l'implant.When said part forming a main part of the implant is fitted from a flat piece of material, the method according to the invention consists
- To carry out in any order the following operations: cutting from a flat piece of material, such as a sheet, of at least one blank of dimensions adapted to the dimensions and to the shape of the implant to be obtained; arrangement, if necessary, of holes or cutouts through this or these blanks
- to carry out in any order the following operations: shaping, and, if necessary, assembling this or these blanks to each other to constitute a part delimiting an internal cavity assembling the adjacent edges of the wall of this part, to confer continuity to this wall, and
- to attach additional elements to the part obtained to constitute the implant.
La mise en forme du flan peut être réalisée par des moyens mécanisés, et l'assemblage des bords adjacents de la pièce obtenue ainsi que la fixation des éventuelles pièces complémentaires peuvent être réalisés par soudage. The shaping of the blank can be carried out by mechanized means, and the assembly of the adjacent edges of the part obtained as well as the fixing of any additional parts can be carried out by welding.
Le procédé selon l'invention est notamment destiné à la fabrication d'implants osseux comprenant des saillies circulaires ou un filet de prise d'appui dans l'os. The method according to the invention is in particular intended for the manufacture of bone implants comprising circular projections or a support support thread in the bone.
Lorsque ladite pièce formant la partie principale de l'implant est constituée à partir d'un tronçon de tube, le procédé consiste, après les opérations de découpe de ce tronçon de tube et d'éventuel aménagement des trous
- à déformer ce tronçon de tube de manière à aménager lesdites saillies circulaires ou ledit filet, et
- à réaliser l'opération précitée d'assemblage des éléments complémentaires permettant de constituer l'implant. When said part forming the main part of the implant is formed from a section of tube, the method consists, after the operations of cutting this section of tube and possible fitting of the holes
- to deform this section of tube so as to arrange said circular projections or said thread, and
- to carry out the aforementioned operation of assembly of the complementary elements making it possible to constitute the implant.
Lorsque ladite pièce formant la partie principale de l'implant est constituée à partir d'un flan, le procédé consiste, après les opérations de découpe de ce flan et d'éventuel aménagement des trous
- à rouler le flan de manière à former une pièce tubulaire formant l'ébauche de la pièce à obtenir ;
- à réaliser dans un ordre quelconque les opérations suivantes : déformation de cette ébauche de manière à aménager lesdites saillies circulaires ou ledit filet ; assemblage des bords adjacents de l'ébauche ou de la pièce obtenue après déformation, et
- à réaliser l'opération précitée d'assemblage des éléments complémentaires permettant de constituer l'implant. When said part forming the main part of the implant is formed from a blank, the method consists, after the operations of cutting this blank and of any arrangement of the holes
- rolling the blank so as to form a tubular part forming the blank of the part to be obtained;
- To carry out in any order the following operations: deformation of this blank so as to arrange said circular projections or said thread; assembly of the adjacent edges of the blank or of the part obtained after deformation, and
- to carry out the aforementioned operation of assembly of the complementary elements making it possible to constitute the implant.
La déformation du tronçon de tube ou de l'ébauche tubulaire est notamment réalisée en engageant ce tube ou cette ébauche sur une matrice comprenant le relief à aménager dans la pièce à obtenir, et en serrant radialement ce tube ou cette ébauche autour de la matrice au moyen de mors comprenant un relief complémentaire à celui de la matrice, ou par "fluo-tournage", c'est-à-dire en faisant circuler un galet, avec pressage radial, autour de ce tube ou de cette ébauche, au niveau des parties en creux de la matrice. The deformation of the tube section or of the tubular blank is in particular carried out by engaging this tube or this blank on a matrix comprising the relief to be arranged in the part to be obtained, and by tightening this tube or this blank radially around the matrix at jaw means comprising a relief complementary to that of the die, or by "fluo-turning", that is to say by circulating a roller, with radial pressing, around this tube or this blank, at the level of the hollow parts of the matrix.
Ces saillies et filet permettent, outre la prise d'appui de l'implant dans l'os, de rigidifier radialement la paroi latérale de l'implant. Des implants de faibles diamètres, réalisés dans du matériau de faible épaisseur, pouvant difficilement être réalisés par usinage, peuvent ainsi être fabriqués facilement grâce au procédé selon l'invention. These projections and net allow, in addition to the support of the implant in the bone, to radially stiffen the side wall of the implant. Implants of small diameters, made of thin material, which can hardly be produced by machining, can thus be easily manufactured using the method according to the invention.
Les trous peuvent être aménagés en dehors des portions du tube ou de l'ébauche destinées à être déformées pour constituer les saillies circulaires ou les spires du filet. Ces trous peuvent également être aménagés sur lesdites portions destinées à être déformées, de manière à s'étendre au moins partiellement sur l'arête extérieure des saillies ou du filet. La déformation du tube ou de l'ébauche permet de faire saillir les arêtes délimitées par les trous. L'implant obtenu présente ainsi des saillies circulaires ou un filet agressifs venant aviver la paroi osseuse dans laquelle l'implant est inséré, ce qui permet de favoriser la croissance osseuse. The holes can be arranged outside the portions of the tube or the blank intended to be deformed to constitute the circular projections or the turns of the net. These holes can also be arranged on said portions intended to be deformed, so as to extend at least partially on the outer edge of the projections or of the thread. The deformation of the tube or the blank makes it possible to project the edges delimited by the holes. The implant obtained thus has circular protrusions or an aggressive thread coming to sharpen the bone wall in which the implant is inserted, which makes it possible to promote bone growth.
Pour sa bonne compréhension, l'invention est à nouveau décrite ci-dessous en référence au dessin schématique annexé représentant, à titre d'exemples non limitatifs, plusieurs étapes de mise en oeuvre du procédé qu'elle concerne, et plusieurs implants osseux obtenus par ce procédé. For a good understanding, the invention is again described below with reference to the appended diagrammatic drawing representing, by way of nonlimiting examples, several stages of implementation of the process which it relates to, and several bone implants obtained by this process.
La figure 1 est une vue en perspective d'un flan perforé, à partir duquel une partie principale d'un implant osseux est constituée
la figure 2 est une vue en perspective d'une pièce tubulaire obtenue par une opération de roulage du flan de la figure 1
la figure 3 est une vue en perspective de la pièce tubulaire et d'un dispositif permettant son formage, avant une opération de formage
la figure 4 est une vue en perspective de la pièce tubulaire après formage, avant assemblage à un élément complémentaire permettant de constituer l'implant
la figure 5 est une vue à échelle agrandie d'une portion de la paroi de cet implant
la figure 6 est une vue de profil d'une cage inter-vertébrale obtenue par le procédé selon l'invention
la figure 7 est une vue en coupe longitudinale de cette cage, après implantation entre deux vertèbres et mise en place d'un dispositif complémentaire d'arthrodèse
la figure 8 est une vue de profil de deux cages inter-vertébrales reliées l'une à l'autre
la figure 9 est une vue en coupe longitudinale d'une pièce obtenue par le procédé selon l'invention, avant assemblage à deux éléments complémentaires permettant de constituer une vis osseuse
la figure 10 est une vue en coupe longitudinale d'une vis osseuse obtenue par le procédé selon l'invention
la figure 11 est une vue en coupe longitudinale d'une "vis d'interférence" obtenue par le procédé selon l'invention, et
les figures 12 et 13 sont des vues en perspective de deux éléments de prothèse d'articulation, également obtenus par ce procédé.Figure 1 is a perspective view of a perforated blank, from which a main part of a bone implant is made
Figure 2 is a perspective view of a tubular part obtained by a rolling operation of the blank of Figure 1
Figure 3 is a perspective view of the tubular part and a device for its forming, before a forming operation
Figure 4 is a perspective view of the tubular part after forming, before assembly with an additional element for constituting the implant
Figure 5 is an enlarged view of a portion of the wall of this implant
Figure 6 is a side view of an inter-vertebral cage obtained by the method according to the invention
Figure 7 is a longitudinal sectional view of this cage, after implantation between two vertebrae and establishment of a complementary arthrodesis device
Figure 8 is a side view of two inter-vertebral cages connected to each other
FIG. 9 is a view in longitudinal section of a part obtained by the method according to the invention, before assembly with two complementary elements making it possible to constitute a bone screw
Figure 10 is a longitudinal sectional view of a bone screw obtained by the method according to the invention
FIG. 11 is a view in longitudinal section of an "interference screw" obtained by the method according to the invention, and
Figures 12 and 13 are perspective views of two articulation prosthesis elements, also obtained by this method.
La figure 4 représente un implant osseux 1 constitué par assemblage d'une pièce tubulaire 2, formant la partie principale de l'implant, et d'une tête 3. La pièce 2 comprend des ouvertures radiales 4 mettant la cavité interne qu'elle délimite en communication avec l'extérieur, l'ancrage de l'implant 1 à l'os étant réalisé par croissance osseuse dans cette cavité, à travers les ouvertures 4. FIG. 4 represents a bone implant 1 formed by assembling a tubular part 2, forming the main part of the implant, and a head 3. The part 2 comprises radial openings 4 placing the internal cavity which it delimits in communication with the outside, the anchoring of the implant 1 to the bone being produced by bone growth in this cavity, through the openings 4.
La figure 1 représente un flan 5 à partir duquel la pièce 2 a été réalisée. Figure 1 shows a blank 5 from which the part 2 was made.
Ce flan 5 a été découpé dans une tôle par exemple en acier inoxydable. I1 comprend une série de trous 6 aménagés dans une zone 5a de sa surface, mais est dépourvu de tels trous dans une zone 5b de cette même surface. This blank 5 has been cut from a sheet, for example of stainless steel. I1 comprises a series of holes 6 arranged in an area 5a of its surface, but is devoid of such holes in an area 5b of this same surface.
Comme cela se déduit des figures 2 à 4, la longueur et la largeur de ce flan 5 correspondent respectivement à la circonférence et à la longueur de la pièce 2. As can be deduced from FIGS. 2 to 4, the length and the width of this blank 5 correspond respectively to the circumference and to the length of the part 2.
Pour l'obtention de cette dernière
- le flan 5 est roulé, jusqu'à obtention d'une pièce sensiblement tubulaire 10 formant l'ébauche de la pièce 2, comme le montre la figure 2
- la pièce tubulaire 10 est engagée, ainsi que le montre la figure 3, sur une matrice 11 d'enveloppe cylindrique, ayant un diamètre correspondant sensiblement à celui de la pièce 10, ou légèrement supérieur ; cette matrice 11 comprend une portion lla dans laquelle est aménagée une série de gorges 12, et une portion llb dépourvue de telles gorges 12, la pièce 10 étant positionnée sur la matrice 11 de telle sorte que sa portion 10a correspondant à la portion 5a du flan 5 s'étende sur la portion lla de la matrice 11, tandis que sa portion lOb correspondant à la portion 5b du flan 5 s'étend sur la portion îlb
- la matrice 11 et la pièce 10 sont ensuite engagées entre trois mors 15 déplaçables radialement, aptes à venir serrer la pièce 10 autour de la matrice 11 ; chacun de ces mors 15 présente une surface d'extrémité arrondie, s'étendant sur un arc de cercle de 120 degrés, de manière à ce qu'en position de serrage les mors 15 enveloppent entièrement la pièce 10 ; des portions 15a de ces surfaces comprennent des saillies 16 en arc de cercle, de forme complémentaire à celle des gorges 12, et sont destinées à venir s'appliquer en position de serrage sur la portion 10a de la pièce 10 de telle sorte que ces saillies 16 viennent s'engager dans ces gorges 12 ; des portions 15b de ces surfaces d'extrémité ont une forme en segment de paroi cylindrique et sont destinées à venir s'appliquer en position de serrage sur la surface lOb de la pièce 10, et
- les bords adjacents 10c de la pièce 10 sont ensuite assemblés l'un à l'autre par soudage.To obtain the latter
- the blank 5 is rolled, until a substantially tubular part 10 forming the blank of the part 2 is obtained, as shown in FIG. 2
- The tubular part 10 is engaged, as shown in FIG. 3, on a matrix 11 of cylindrical envelope, having a diameter corresponding substantially to that of the part 10, or slightly greater; this matrix 11 comprises a portion 11a in which a series of grooves 12 is arranged, and a portion 11b devoid of such grooves 12, the part 10 being positioned on the matrix 11 so that its portion 10a corresponding to the portion 5a of the blank 5 extends over the portion 11a of the matrix 11, while its portion 10b corresponding to the portion 5b of the blank 5 extends over the portion 11b
- The matrix 11 and the part 10 are then engaged between three jaws 15 which can be moved radially, capable of coming to clamp the part 10 around the matrix 11; each of these jaws 15 has a rounded end surface, extending over a circular arc of 120 degrees, so that in the clamping position the jaws 15 completely envelop the part 10; portions 15a of these surfaces include projections 16 in an arc, of a shape complementary to that of the grooves 12, and are intended to come to apply in clamping position on the portion 10a of the part 10 so that these projections 16 come to engage in these grooves 12; portions 15b of these end surfaces have a cylindrical wall segment shape and are intended to be applied in the clamping position on the surface 10b of the part 10, and
- The adjacent edges 10c of the part 10 are then assembled to each other by welding.
Comme cela est visible à la figure 4, la pièce 2 présente, suite à l'opération de serrage de la pièce 10 autour de la matrice 11, une série de saillies circulaires 20 au niveau de sa partie 2a correspondant à la partie 10a, et une partie tubulaire 2b, correspondant à la partie lOb de la pièce 10. As can be seen in FIG. 4, the part 2 has, following the clamping operation of the part 10 around the matrix 11, a series of circular projections 20 at its part 2a corresponding to the part 10a, and a tubular part 2b, corresponding to the part 10b of the part 10.
La tête 3 est engagée et est fixée par soudage dans la cavité délimitée par cette partie 2b. Elle comprend par exemple un évidement axial 21 à six pans creux permettant le montage de l'implant 1 sur un outil d'impaction et l'éventuelle manoeuvre en rotation de cet implant lors de sa mise en place dans l'os. The head 3 is engaged and is fixed by welding in the cavity delimited by this part 2b. It includes for example an axial recess 21 with a hexagon socket allowing the implant 1 to be mounted on an impact tool and the possible rotation of this implant when it is placed in the bone.
L'extrémité de l'implant 1 opposée à la tête 3 peut, quant à elle, être fermée par soudage d'une paroi transversale en forme de pastille circulaire. The end of the implant 1 opposite the head 3 can, for its part, be closed by welding a transverse wall in the form of a circular patch.
Il apparaît à la figure 4 que les ouvertures 4 s'étendent au moins partiellement sur l'arête extérieure des saillies 20, les trous 6 correspondants ayant été aménagés de manière à se trouver notamment au niveau des portions de la pièce 10 destinées à être déformées pour constituer les saillies 20. It appears in Figure 4 that the openings 4 extend at least partially on the outer edge of the projections 20, the corresponding holes 6 having been arranged so as to be located in particular at the portions of the part 10 intended to be deformed to form the projections 20.
Comme le montre la figure 5, la déformation de la pièce 10 pour constituer ces saillies 20 permet de faire saillir les arêtes 22 délimitées par les ouvertures 4 s'étendant sur l'arête extérieure des saillies 20. As shown in FIG. 5, the deformation of the part 10 to form these projections 20 makes it possible to project the edges 22 delimited by the openings 4 extending on the external edge of the projections 20.
La pièce 2 présente ainsi une paroi extérieure relativement agressive au niveau de ces saillies 20, venant aviver la paroi osseuse dans laquelle l'implant 1 est inséré, ce qui permet de favoriser la croissance osseuse. The part 2 thus has a relatively aggressive outer wall at the level of these projections 20, coming to sharpen the bone wall in which the implant 1 is inserted, which makes it possible to promote bone growth.
Les figures 6 et 7 montrent un implant 30 constituant une cage intersomatique, de structure similaire à celle de l'implant 1. FIGS. 6 and 7 show an implant 30 constituting an intersomatic cage, of structure similar to that of implant 1.
Cet implant 30 est destiné à recevoir un greffon ou des copeaux d'os spongieux et à être inséré dans un alésage aménagé entre deux vertèbres 31,32 situées de part et d'autre d'un disque intervertébral 33 détérioré. La croissance osseuse au travers des ouvertures latérales 4 permet la fusion du greffon et de l'os spongieux des vertèbres 31,32, et réalise l'immobilisation de ces deux vertèbres. This implant 30 is intended to receive a graft or chips of cancellous bone and to be inserted into a bore arranged between two vertebrae 31, 32 located on either side of a damaged intervertebral disc 33. Bone growth through the lateral openings 4 allows the fusion of the graft and the cancellous bone of the vertebrae 31, 32, and immobilizes these two vertebrae.
Cet implant 30 est réalisé de manière précitée, sinon que, dans ce cas, la matrice comprend non pas des gorges successives 12 mais un filet, et que les surfaces de serrage des mors comprennent des portions de filet, complémentaires du filet de la matrice. This implant 30 is produced in the aforementioned manner, except that, in this case, the matrix comprises not successive grooves 12 but a thread, and that the jaw clamping surfaces comprise portions of thread, complementary to the thread of the matrix.
Après déformation de la pièce tubulaire 10, l'implant 30 comprend un filet 35 permettant son vissage entre les plateaux vertébraux préalablement réséqués des vertèbres 31 et 32. After deformation of the tubular part 10, the implant 30 comprises a thread 35 allowing it to be screwed between the vertebral plates previously resected from the vertebrae 31 and 32.
Dans l'exemple représenté, les ouvertures 4 sont disposées en dehors du filet 35. Ces ouvertures pourraient bien entendu être situées sur les spires du filet 35, pour conférer à ce filet, de la manière précitée, une surface relativement abrasive permettant d'aviver l'os spongieux des plateaux vertébraux. In the example shown, the openings 4 are arranged outside the net 35. These openings could of course be located on the turns of the net 35, to give this net, in the aforementioned manner, a relatively abrasive surface allowing to sharpen the cancellous bone of the vertebral plates.
En outre, la figure 7 montre que la portion tubulaire 30b est, dans cet exemple, taraudée et comprend des encoches latérales 36 pour son montage sur un instrument de vissage. Une fois l'implant 30 mis en place, cette portion 30b peut recevoir un bouchon fileté du même type que la tête 3 précitée. In addition, FIG. 7 shows that the tubular portion 30b is, in this example, tapped and comprises lateral notches 36 for its mounting on a screwing instrument. Once the implant 30 is in place, this portion 30b can receive a threaded plug of the same type as the above-mentioned head 3.
Le dispositif d'arthrodèse 40 représenté à la figure 7 est du même type que celui décrit dans le document FR-A-2 681 776, dont le contenu est incorporé à la présente description par référence, et ne sera donc pas particulièrement décrit. The arthrodesis device 40 represented in FIG. 7 is of the same type as that described in document FR-A-2 681 776, the content of which is incorporated into the present description by reference, and will therefore not be particularly described.
La figure 8 montre que deux implants 30, lorsqu'ils sont mis en place par voie d'abord antérieure, peuvent être reliés l'un à l'autre au moyen d'une tige 45 et de deux ensembles 46 de serrage de cette tige 45. FIG. 8 shows that two implants 30, when they are put in place by the anterior approach, can be connected to each other by means of a rod 45 and two sets 46 for tightening this rod 45.
Chacun de ces ensembles 46 étant pourvu d'un plot fileté 47, vissé dans l'alésage fileté de la portion 30b correspondante de l'implant 30. Les ensembles 46 sont du même type que ceux décrits dans le document
FR-A-2 681 776. Each of these assemblies 46 being provided with a threaded stud 47, screwed into the threaded bore of the corresponding portion 30b of the implant 30. The assemblies 46 are of the same type as those described in the document
FR-A-2 681 776.
Les portion 30b peuvent, d'une manière générale, servir au montage de tout type d'organes complémentaires de fixation des implants 30, si nécessaire. The portion 30b can, in general, be used for mounting any type of complementary means for fixing the implants 30, if necessary.
Les figures 9 et 10 montrent des vis osseuses 50,51 réalisées de la même manière que l'implant 30. Dans ce cas, la pièce tubulaire 52 reçoit par soudage une tête de vissage 53 à une extrémité et une pointe 54 à son autre extrémité. Figures 9 and 10 show bone screws 50, 51 made in the same way as the implant 30. In this case, the tubular part 52 receives by welding a screw head 53 at one end and a tip 54 at its other end .
La figure 9 montre une vis 50 à âme de diamètre relativement important et à filet 55 de hauteur limitée, plus particulièrement destinée à être insérée dans de l'os spongieux, pour la réalisation d'ostéosynthèses ou la fixation d'éléments prothétiques tels que des plateaux tibiaux de prothèse de genou ou des éléments cotyloïdiens de prothèse de hanche, tandis que la figure 10 montre une vis 51 à âme de diamètre moins important que celui de la vis 50 et à filet 55 de plus grande hauteur, plus particulièrement destinée à être insérée dans la corticale osseuse. FIG. 9 shows a screw 50 with a relatively large diameter core and a thread 55 of limited height, more particularly intended to be inserted into cancellous bone, for carrying out osteosyntheses or fixing prosthetic elements such as tibial plates of knee prosthesis or acetabular elements of hip prosthesis, while FIG. 10 shows a screw 51 with a core of smaller diameter than that of screw 50 and with a thread 55 of greater height, more particularly intended to be inserted into the cortical bone.
Le procédé précité permet l'obtention de ces types de filets différents simplement par l'utilisation de matrices 11 et de mors 15 de formes appropriées. The above method allows these different types of threads to be obtained simply by using dies 11 and jaws 15 of suitable shapes.
La figure 11 représente une "vis d'interférence" 60, c'est-à-dire une vis permettant la fixation des extrémités d'un ligament prothétique, notamment du genou. FIG. 11 represents an "interference screw" 60, that is to say a screw allowing the fixing of the ends of a prosthetic ligament, in particular of the knee.
Cette vis est également constituée par l'assemblage d'une pièce tubulaire 62, similaire à la pièce 2, avec une tête de vissage 63 et une pointe 64.This screw is also formed by assembling a tubular part 62, similar to part 2, with a screw head 63 and a tip 64.
La figure 12 représente une tige fémorale 70 de prothèse de hanche. Dans ce cas, la partie médullaire 71 de cette tige 70 est réalisée par découpe convenable puis pliage d'un, ou, au besoin, deux, flan(s) de tôle, préalablement perforé(s). Cette partie médullaire 71, une fois constituée, reçoit un embout supérieur 72, comprenant un col fémoral 73 à extrémité 74 en forme de cône morse, destinée à supporter une tête sphérique d'articulation. Figure 12 shows a femoral stem 70 of hip prosthesis. In this case, the medullary part 71 of this rod 70 is produced by suitable cutting then folding of one, or, if necessary, two, sheet blank (s), previously perforated (s). This medullary part 71, once formed, receives an upper endpiece 72, comprising a femoral neck 73 at the end 74 in the form of a Morse cone, intended to support a spherical articulation head.
La figure 13 montre une tige médullaire 80 pour prothèse trapézo-métacarpienne, comprenant une partie métaphysaire évasée. Dans ce cas, l'ébauche tubulaire 10 peut être constituée sous forme légèrement conique et peut être déformée à froid ou à chaud de manière à prendre la forme évasée montrée au dessin. Une fois conformée, la pièce 82 ainsi obtenue reçoit un embout d'extrémité comprenant une collerette d'appui 83 et un alésage central 84, cet alésage étant destiné à recevoir un col solidaire d'une tête sphérique. FIG. 13 shows a medullary rod 80 for a trapezo-metacarpal prosthesis, comprising a flared metaphyseal part. In this case, the tubular blank 10 can be formed in a slightly conical shape and can be deformed cold or hot so as to take the flared shape shown in the drawing. Once shaped, the part 82 thus obtained receives an end piece comprising a support flange 83 and a central bore 84, this bore being intended to receive a neck secured to a spherical head.
L'invention fournit ainsi un procédé permettant la fabrication d'implants osseux de forme et de dimensions très variées, sans aucun usinage complexe, mais seulement par des opérations simples et rapides de découpe, de perçage et de conformation d'un flan, d'assemblage des bords adjacents de la pièce obtenue, et d'éventuel assemblage à cette pièce d'éléments complémentaires permettant de constituer l'implant. The invention thus provides a method allowing the manufacture of bone implants of very varied shape and dimensions, without any complex machining, but only by simple and rapid operations of cutting, drilling and shaping a blank, assembly of the adjacent edges of the part obtained, and possible assembly with this part of complementary elements making it possible to constitute the implant.
Ces implants, une fois mis en place, sont parfaitement fixés à l'os par repousse osseuse à l'intérieur de la cavité qu'ils délimitent. Ils restent toutefois faciles à retirer le cas échéant, par ablation ou dévissage de leur tête, et perçage à l'intérieur de leur cavité pour éliminer l'os ayant repoussé dans cette cavité. These implants, once in place, are perfectly fixed to the bone by bone regrowth inside the cavity which they delimit. However, they remain easy to remove if necessary, by ablation or unscrewing of their head, and drilling inside their cavity to remove the bone that has grown back in this cavity.
Claims (10)
Priority Applications (1)
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FR9515841A FR2744010B1 (en) | 1995-12-28 | 1995-12-28 | PROCESS FOR THE MANUFACTURE OF BONE IMPLANTS |
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FR9515841A FR2744010B1 (en) | 1995-12-28 | 1995-12-28 | PROCESS FOR THE MANUFACTURE OF BONE IMPLANTS |
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