WO2018056924A2

WO2018056924A2 - A surgical guide

Info

Publication number: WO2018056924A2
Application number: PCT/TR2017/000075
Authority: WO
Inventors: Gazi HURI; Mahmut Nedim DORAL
Original assignee: Huri Gazi; Doral Mahmut Nedim
Priority date: 2016-06-30
Filing date: 2017-06-30
Publication date: 2018-03-29
Also published as: WO2018056924A3

Abstract

The present invention relates to a surgical guide which provides ease of application particularly during reverse shoulder prosthesis surgery for surgeons and enables them to perform operation with minimum complication.

Description

A SURGICAL GUIDE Technical Field

Background of the Invention

Reverse shoulder prosthesis is one of the prosthesis designs frequently used in shoulder osteoarthritis originating from rotator cuff muscle damage. The said design provides a better postoperative shoulder motion range than standard total shoulder prosthesis biomechanically and a better support for rotator cuff muscles. Reverse shoulder prosthesis was developed by Grammont in 1980's and its improved applications are still used in clinics today. Various problems are encountered in application of reverse shoulder prosthesis in the state of the art despite improved designs and decreasing complication rates of used applications.

Requirement of positioning glenoid screws in different ways against different defects due to the fact that defects in glenoid part of each patient are personal is the leading problem encountered today. At the present time, surgeons try to create intraoperative solutions by making effort to perform screwing in accordance with anatomic structure in clinical practice. This situation makes things difficult for surgeons and complicates optimum glenoid component positioning. Besides these difficulties, it also leads to increase of complication rates. Because of this reason, applications enabling to position glenoid component of prosthesis correctly are used today. The said applications enable to position component correctly however they do not allow transfer of screw to be used for fixing.

l Wear on glenoid surface and change of joint shape due to requirement for performing patient-specific screwing, difficulty in proper positioning of glenoid component of prosthesis intraoperatively and shoulder biomechanics changing as a result of damage in rotator cuff muscles and asymmetric pressure made by humeral head on the glenoid part of scapula bring along additional problems. In addition, bone defect arising on glenoid part in cases with glenohumeral joint osteoarthritis obstructs completely putting glenoid component of prosthesis into its place intraoperatively. It causes glenoid component to loosen in time and its time to shorten in time by causing humeral part of glenosphere prosthesis placed on glenoid component -which could not be positioned correctly- to make notching to inferior of glenoid part of scapula. Anormal contact and notching of prosthesis to bone reduces postoperative shoulder motion range of patient and causes surgery time to extend by leading to intraoperative difficulty. Whereas in postoperative period, various problems occur depending on changing structure of osteoarthritis base of glenoid part of scapula bone. Among these, notching and failure of prosthesis during movement of shoulder affects success of surgical treatment in a negative way significantly.

Guide applications enabling to place glenoid component correctly are used today. However, the guides used enable to place glenoid component correctly whereas they cannot allow transfer of screws to be used for fixing. In guide applications used, the component is fixed to the bone by means of four screws out of its stem in the middle. However, due to the fact that glenoid bone is small and bone stock is scarce, it is quite difficult to send other screws to the component during surgery.

Summary of the Invention

An objective of the present invention is to realize a surgical guide for enabling transfer of screws, which will be used for fixing component to bone after placing glenoid component to patient, to cavities located on component. Another objective of the present invention is to realize a surgical guide wherein transactions of positioning glenoid component to patient and fixing the positioned component to the patient are carried out by means of a single apparatus. Another objective of the present invention is to realize a surgical guide which helps to position prosthesis in bone and enables to screw prosthesis to bone in the most correct way.

Another objective of the present invention is to realize a surgical guide which has a patient-specific surgical guide design enabling to perform operation with minimum complication together with ease of application during reverse shoulder prosthesis surgery.

Another objective of the present invention is to realize a surgical guide whereby success of reverse shoulder prosthesis treatment is increased by prosthesis implantation specific to each patient.

Another objective of the present invention is to realize a surgical guide which extends life of prosthesis by enabling correct positioning of glenoid component of reverse shoulder prosthesis preoperatively; prevents complications such as vein, nerve injury and loosening of prosthesis; enables to reduce hospitalization periods and costs of patients.

Another objective of the present invention is to realize a surgical guide which prevents difficulty of correct positioning of intraoperative glenoid component of patients with no sufficient bone stock in glenoid part of scapula due to glenohumeral osteoarthritis and shortens surgery time

Another objective of the present invention is to realize a surgical guide which is used in personalized glenoid component positioning by using three-dimensional scapula model made of polymer material based upon radiographic imaging of patient. Detailed Description of the Invention

"A surgical guide" realized to fulfill the objectives of the present invention is shown in the figures attached, in which:

Figure 1 is a perspective view of the inventive surgical guide.

Figure 2 is a sectioned view of the inventive surgical guide.

Figure 3 is another sectioned view of the inventive surgical guide.

Figure 4 is a further sectioned view of the inventive surgical guide.

Figure 5 is a view of the connection apparatus used in the inventive surgical guide.

The components illustrated in the figures are individually numbered, where the numbers refer to the following:

1. Surgical guide

2. Body

3. Recess

4. Fixing cavity

5. Screw guide

6. Screw channel

7. Component cavity

8. Wing

9. Connection apparatus

10. Cavity

11. Tab

The inventive surgical guide (1) essentially comprises:

- at least one body (2) having at least one protrusion on which there is a cavity to be used for positioning and through which a drilling member will pass and a recess (3) wherein the glenoid component -which is used for fixing after positioning transaction and preferably has a plurality of cavities wherein screws can fit- will be placed;

at least one fixing cavity (4) which is located on the body (2) and wherein a router -that is used for routing the body (2) more comfortably and is preferably a handle- is fixed;

a plurality of screw guides (5) having at least one screw channel (6) which is on the body (2), rises upwards from the body (2) surface where glenoid component is not connected and wherein drilling members or connection members to transmit the glenoid component to the cavities located on thereof pass on its internal parts;

a plurality of component cavities (7) which are located on the body (2) surface where glenoid component is connected, meets the cavities body (2) used for positioning and fixing in the glenoid component, enables fixing members -preferably screw- and drilling member to reach the connection and fixing cavities in the glenoid component by passing through the screw channel (6).

The inventive surgical guide (1) also comprises at least one wing (8) which is located among the screw guides (5) on the body (2) and enables interconnection of screw guides (5). In one preferred embodiment, the wings (8) are located on the parts wherein the ends where the screws of the screw guides (5) enter unite.

In one preferred embodiment of the invention, the glenoid component fits to the lower surface of the body (2) and on the upper surface thereof, there are screw guides (5) number of which change depending on the number of connection member cavity located in the glenoid component. In one preferred embodiment, there is a fixing cavity (4) which is located on the body (2) surface whereon screw guides are located in order to move the body (2) more comfortably, and on which a handle is fixed. In the said invention, the fixing cavity (4) and the screw guides (5) are located on the same surface of the body (2).

3 In one preferred embodiment of the inventive surgical guide (1), the recess (3) is located on the lower surface of the body (2) and it has a width and thickness whereby any glenoid component can fit. There are component cavities (7) where the screw channel (6) finishes on the junction of the recess (3) and the body (2).

In the inventive surgical guide (1), the number of screw guides (5) varies by the cavity of connection member located on the glenoid component and there are four screw guides (5) on the body (2) in one preferred embodiment. The said screw guides (5) have a combined structure with the body (2) from their one end and there is screw channel (6) inlet extending along the screw guide (5) on their other ends. Two of the screw guides (5) proceed until the body (2) separately while the other two start in the middle of the said two separate screw guides (5) separately and then combine and finish on the body (2) as a single structure. In one preferred embodiment, the screw guides (5) are in an oblique position on the body (2) such that they will be between 10-15 degrees according to an axis cutting the body (2) vertically in a position where the body (2) extends parallel to the surface.

In preferred embodiment, the screw guides (5) allow transfer of drilling member necessary for positioning the glenoid component on the bone; opening of the screw holes; and sending the screws from inside the guide (5) by means of the screw channels (6) owned by them. In addition, due to the fact that the glenoid component is positioned without being moved away from the bone and the screw guides (5) remain angled on the body (2) by means of the screw guides (5) owned by thereof, the surgical guide (1) ensures that angled screw holes are opened on the bone and glenoid component is fixed to the bone by sending the screws.

In preferred embodiments of the invention, the end parts of the screw channels (6) located at the screw guide (5) ends which do not combine with the body (2) are in screw threaded form.

The inventive surgical guide (1) also comprises at least one connection apparatus (9) wherein the drilling member -which will enable to open the hole to be used for fixing the glenoid component to the bone upon being fitting into the wings (8) locate among the screw guides (5)- enters. The said connection apparatus (9) comprises a plurality of tabs (11) which provide a stable structure while on the body (2) by contacting a cavity (10) where the drilling apparatus can enter/exit and the wings (8).

In one preferred embodiment of the invention, each screw guide (5) comprises an entry cavity which creates the start of the screw channel (6) and wherein the connection member -which is preferably screw- can enter. One of the entry cavities is larger than the other cavities and octahedral. The octahedral one of the cavities enables the drilling member to directly reach the connection hole cavity located in the middle of the glenoid component and used for the purpose of positioning, from the connection apparatus (9). In transfer made from other screw channels (6) and the same cavity without using the connection apparatus (9), the connection member- which is screw- reaches the cavities of the glenoid component used for the purpose of fixing.

In the preferred embodiment, the component cavity (7) is in the same number with the connection hole cavity used for the purpose of fixing and positioning in the glenoid component. There are screw guides (5) on the body (2) as much as the connection hole cavity located in the glenoid component. The drilling member fits into the connection hole cavity preferably located in the middle of the glenoid component directly and used for positioning due to the fact that the screw guide (5) -which has an octahedral cavity- corresponds to the cavity (10) located on the connection apparatus (9). Thus, the drilling member positions the glenoid component on the bone.

In the inventive surgical guide (1), the wings (8) are located among the screw guide (5) and they start from the end of the screw guide (5) and continues until the body (2). Thus, a stronger structure is obtained by providing connection of the screw guides (5) among themselves and with the body (2). The inventive surgical guide (1) is designed in computer environment based upon the radiographic image of the patient scapula. In one preferred embodiment, 3D models are created via software programs by having 3D computerized tomography (BT) of the scapula. The surgical guide to enable correct positioning of the glenoid component on the said models is also designed by using individual computer software programs for each patient. In one preferred embodiment, model of scapula and surgical guide is created by means of three-dimensional printers and surgical modelling is made on thereof. Biomaterials such as poly (lactic acids-PLA) biocompatibilities and tissue interactions of which are displayed will be used in production of cut guide.

Drilling member is sent for making hole for the purpose of positioning on the bone from the cavity (10) by using the connection apparatus (9) in order to position the glenoid component on the bone after the designing the inventive surgical guide (1); positioning cavity is made on the bone in order to place the glenoid component from the protrusion to the bone while the drilling member is on the bone after making the hole. After the positioning cavity is made, the glenoid component is placed to the bone together with the surgical guide. Then, the fixing transaction of the glenoid component is completed after the positioning by removing the connection apparatus (9) on the screw guides (5) and sending screws to the holes from each screw guids (5).

The inventive surgical guide (1) used in reverse shoulder prosthesis is produced in one piece. Only the connection apparatus (9) can be used separately on the surgical guide (1). Due to the fact that the surgical guide (1) is in one piece, production phase gets easy and convenience and reliability are enhanced in practice.

It is possible to develop a wide range of embodiments of the inventive surgical guide (1), the invention cannot be limited to examples disclosed herein and it is essentially according to claims.

Claims

1. A surgical guide (1 ) essentially comprising

characterized by

- at least one fixing cavity (4) which is located on the body (2) and wherein a router -that is used for routing the body (2) more comfortably and is preferably a handle- is fixed;

- a plurality of screw guides (5) having at least one screw channel (6) which is on the body (2), rises upwards from the body (2) surface where glenoid component is not connected and wherein drilling members or connection members to transmit the glenoid component to the cavities located on thereof pass on its internal parts;

- a plurality of component cavities (7) which are located on the body (2) surface where glenoid component is connected, meets the cavities used for positioning and fixing in the glenoid component, enables fixing members - preferably screw- and drilling member to reach the connection and fixing cavities in the glenoid component by passing through the screw channel (6).

2. A surgical guide (1) according to Claim 1, characterized by at least one wing (8) which is located among the screw guides (5) on the body (2) and enables interconnection of screw guides (5).

3. A surgical guide (1) according to Claim 2, characterized by the wing (8) which is located on the parts wherein the ends where the screws of the screw guides (5) enter unite.

4. A surgical guide (1) according to any of the preceding claims, characterized by the body (2) wherein the glenoid component fits to its lower surface and on the upper surface thereof, there are screw guides (5) number of which changes depending on the number of connection member cavity located in the glenoid component.

5. A surgical guide (1) according to any of the preceding claims, characterized by the fixing cavity (4) which is located on the body (2) surface whereon screw guides are located in order to move the body (2) more comfortably, and on which a handle is fixed.

6. A surgical guide (1) according to any of the preceding claims, characterized by the fixing cavity (4) and the screw guides (5) which are located on the same surface of the body (2).

7. A surgical guide (1) according to any of the preceding claims, characterized by the recess (3) which is located on the lower surface of the body (2) and has a width and thickness whereby any glenoid component can fit.

8. A surgical guide (1) according to any of the preceding claims, characterized by the component cavities (7) which is located on the junction of the recess (3) and the body (2) and where the screw channel (6) finishes.

9. A surgical guide (1) according to any of the preceding claims, characterized by the screw guide (5) the number which varies by the cavity of connection member located on the glenoid component and wherein there are four screw guides (5) on the body (2) in one preferred embodiment.

10. A surgical guide (1) according to any of the preceding claims, characterized by the screw guides (5) which have a combined structure with the body (2) from their one end and there is screw channel (6) inlet extending along thereof on their other ends.

11. A surgical guide (1) according to any of the preceding claims, characterized by the screw guides (5) which are in an oblique position on the body (2) such that they will be between 10-15 degrees according to an axis cutting the body (2) vertically in a position where the body (2) extends parallel to the surface.

12. A surgical guide (1) according to any of the preceding claims, characterized by the screw guides (5) wherein the end parts of the screw channels (6) located at the ends thereof which do not combine with the body (2) are in a screw threaded form.

13. A surgical guide (1) according to any of Claim 2 to 12, characterized by at least one connection apparatus (9) wherein the drilling member -which will enable to open the hole to be used for fixing the glenoid component to the bone upon being fitting into the wings (8) locate among the screw guides (5)- enters.

14. A surgical guide (1) according to Claim 13, characterized by the connection apparatus (9) having a plurality of tabs (11) which provide a stable structure while on the body (2) by contacting a cavity (10) where the drilling apparatus can enter/exit and the wings (8).

15. A surgical guide (1) according to any of the preceding claims, characterized by the screw guides (5) which comprises an entry cavity that creates the start of the screw channel (6) and wherein the connection member -which is preferably screw- can enter.

16. A surgical guide (1) according to Claim 15, characterized by the entry cavity one of which is larger than the other cavities and octahedral.

17. A surgical guide (1) according to any of the preceding claims, characterized by the component cavity (7) which is in the same number with the connection hole cavity used for the purpose of fixing and positioning in the glenoid component.

18. A surgical guide (1) according to any of the preceding claims, characterized by the screw guide (5) which are included on the body (2) as much as the connection hole cavity located in the glenoid component.

19. A surgical guide (1) according to any of Claim 2 to 18, characterized by the wings (8) which are located among the screw guide (5) and start from the end of the screw guide (5) and continue until the body (2) 20. A surgical guide (1) according to any of the preceding claims, which is produced in one piece.