CN102551826B - Sew up anchor and threading apparatus - Google Patents

Abstract

The invention provides a kind of stitching anchor assemblies, it stitching anchor including having main body, described main body has the path making stitching thread extend there through.It also includes that stitching thread threading apparatus, described stitching thread threading apparatus are received in described main body by described path.Described stitching thread threading apparatus is elongated tubular, described elongated tubular has the first end and the close mechanism of expansion, described first end is positioned at described body exterior and is suitable within it receive stitching thread, described close mechanism is for closing the first end of the expansion surrounding described stitching thread, so that stitching thread can be kept by elongated tubular and pull stitching thread to pass through described path, to be loaded in described main body by stitching thread.

Description

Sew up anchor and threading apparatus

Related application

U.S. Provisional Patent Application No. of patent application claims submission on August 30th, 2010 The benefit of priority of 61/378,190, entire contents is incorporated by reference herein.

Background technology

Present patent application relates to sewing up anchor, more specifically, relates to unknotted groove part and closes anchor.

Sew up anchor to be commonly used to the soft tissue of such as tendon or ligament etc is attached to bone.Such as, In rotary sleeve is repaired, stitching thread is passed disengaging or the undamaged portion of rotary sleeve tendon.Anchor will be sewed up It is implanted in adjacent bone.By stitching thread being attached to stitching anchor, pull tendon so that it is with bone Head contact, to promote the attachment of tendon and bone.

This kind of operation utilizes arthroscope to perform often through narrow sleeve pipe.This kind of operation is likely difficult to adopt Row threading is anchored into the least stitching.

Summary of the invention

A kind of anchor assemblies of sewing up according to the present invention includes having the stitching anchor of main body, and described main body has Make the path that stitching thread extends there through.Stitching thread threading apparatus is received in described main body by described path In.Described stitching thread threading apparatus includes that elongated tubular, described elongated tubular have and is positioned at described body exterior Open first end, described first end is suitable within it receive and keep described stitching thread, with allow by Described pipe pulls described stitching thread to pass described path, thus described stitching thread is loaded described main body In.

In one aspect of the invention, described elongated tubular includes that braiding structure and described first end include The knitted parts that opening is bigger.Can thus arrange the described knitted parts in described first end so that Axial tensile force on described first end makes described knitted parts shrink, and surrounds described stitching thread with Guan Bi Described first end.

In another aspect of the present invention, one or more axial slots extend to described the of described pipe In one end, thus allow described first end radial dilatation to receive described stitching thread.Described first end Inside can be with thorn-like projection, to limit outside stitching thread moves to described first end.

In another aspect of the present invention, surround the fixture of described first end compress described first end and Described stitching thread is held within.Described fixture may include that spring metal fixture, sews up wire rod Material the collar or trend towards the elastic force of the described end of its inward collapse.Dilator can be received In described first end, it is used for keeping its radial opening to resist elastic force, to allow described stitching thread to be placed in In it, and wherein allow the first side pressure described in when removing described dilator flat and keep it interior Described stitching thread.Preferably, described dilator has the lateral opening allowing described stitching thread to pass through.

According to the invention provides a kind of method being loaded into by stitching thread and sewing up in anchor, described stitching anchor There is the anchor main body including that path received by stitching thread.Said method comprising the steps of: will be described logical Receiving in road has the described stitching anchor of stitching thread threading apparatus to be implanted in patient bone, and described stitching thread is worn Line device is included in the outside of described anchor main body and has the elongated tubular of open first end；Described stitching thread is worn Cross a part for soft tissue and described stitching thread is trapped in described the first of described stitching thread threading apparatus In end；And pull described stitching thread threading apparatus to pass through described path, so that described stitching thread is passed through institute State path to be loaded in described stitching anchor.Preferably, external the carrying out of patient, described stitching thread is captured Step in described first end of described stitching thread threading apparatus.

Accompanying drawing explanation

Fig. 1 is the front view sewing up anchor according to the present invention；

Fig. 2 is the sectional view sewing up anchor in the Fig. 1 implanting bone；

Fig. 3 is through the position sewing up anchor side port shown in Fig. 1 and the inefficacy side of angle about stitching thread The curve chart of formula；

Fig. 4 is through the position of stitching anchor side port shown in Fig. 1 and fixing by force of angle about stitching thread The curve chart of degree；

Fig. 5 be for several fixing intensity being screwed into selection and bone mass of sewing up anchor shown in Fig. 1 it Between the curve chart of relation；

Fig. 6 A to Fig. 6 C is to sew up anchor and the side sectional view of its driver shown in Fig. 1；

Fig. 7 is the sectional view intercepted along the 7--7 line in Fig. 6 A；

Fig. 8 is the perspective view substituting actuator head according to the present invention；

Fig. 9 is according to drive head shown in the Fig. 8 received in another embodiment sewing up anchor of the present invention The perspective line chart in portion；

Figure 10 is the driver in Fig. 9 and the close-up perspective view sewing up anchor；

Figure 11 is the driver in Fig. 9 and the perspective view sewing up anchor；

Figure 12 is the front view of another embodiment sewing up anchor according to the present invention；

Figure 13 is the sectional view intercepted along the 13--13 line in Figure 11；

Figure 14 is the end-view of another embodiment of the suture clutch according to the present invention；

Figure 15 is the end-view of another embodiment of the suture clutch according to the present invention；

Figure 16 A is the anterior elevational view of another embodiment of the suture clutch according to the present invention；

Figure 16 B is the end-view of the far-end of suture clutch in Figure 16 A；

Figure 17 A and Figure 17 B is the section view of another embodiment of the suture clutch according to the present invention Figure；

Figure 18 A is that the stitching thread of another embodiment realizing the suture clutch according to the present invention drives The perspective view of device shank；

Figure 18 B is the end-view of the near-end of stitching thread driver shank in Figure 18 A；

Figure 19 is the side view of the stitching thread threading apparatus according to the present invention；

Figure 20 is the side view of the replacement usage of stitching thread threading apparatus in Figure 19；

Figure 21 is the side view of another embodiment of the stitching thread threading apparatus according to the present invention；

Figure 22 A to Figure 22 D illustrates another embodiment of the stitching thread threading apparatus according to the present invention.

Figure 23 A is the top view of another embodiment of the stitching thread threading apparatus according to the present invention, and it illustrates The braided tube of biopsy cavity marker devices；With

Figure 23 B is the end-view of stitching thread threading apparatus in Figure 23 A.

Detailed description of the invention

Fig. 1 illustrates that the unknotted groove part according to the present invention closes anchor 10.It includes having far-end 14 with near The main body 12 of end 16.Near-end 16 has hexagonal instrument and receives groove 18.Those skilled in the art Member should be appreciated that can be to use alternative tool engagement mode.It is provided with slightly inward at far-end 14 Taper 19, in order to anchor 10 is inserted bone hole (not shown in figure 1) and in anchor penetrates bone hole Before, taper 19 is for initial fixing stitching thread (not shown in figure 1).

Main body 12 has distal thread part 20 and proximal threaded portion 22.Single head external screw thread 24 around Main body 12 spiral, forms distal thread part 20.This screw thread 24 extends close to far-end 14, terminates In from its about 0.1 inch to 0.3 inch at, in order to insert bone hole (not shown in figure 1).But, Another one or multiple thread head 26 start around proximally 16, distinguish proximal threaded portion 22 to be formed Multiple thread.Each single thread head 24 and 26 has with the screw thread 24 in distal thread part 20 Identical pitch, owing to there is another one or multiple thread head 26, increases so providing effective pitch Big proximal threaded portion 22.But, the pitch of each thread head in proximal threaded portion 22 keeps Identical with the pitch of screw thread 24, to eliminate when anchor 10 screws in bone hole by being compressed axially that screw thread brings Effect.Preferably, proximal threaded portion 22 exists four thread heads, i.e. screw thread 24 and additionally Three thread heads 26.Preferably, the external diameter of proximal threaded portion 22 is slightly larger than distal thread part The external diameter of 20.Screw thread does not have sharp-pointed outward flange, it is preferable that screw thread 24 and 26 have rounding or The profile of passivation, so that the stress being pressed towards on the stitching thread of screw thread is minimum.Although shown anchor main body 12 have screw thread 24 and 26, but, for small diameter, can by annular flange flange or Other grasping reinforcement being more suitable for push-in type anchor compared with screw-type anchor substitutes screw thread.Even with Screw thread 24 and 26, the anchor main body 12 of small diameter can be adapted to push rather than screw in.

Side port 28 passes main body 12 towards the longitudinal axis 30 of distally extending main body 12 with oblique angle, and And it is positioned at proximal threaded portion 22.It provides passage for stitching thread (not shown in figure 1), should Passage axially intubates 32 and the outside 35 of main body 12 in the inside through main body 12.Below will Explain this function.

Main body 12 is formed by suitable biocompatible materials, and preferably provides with aseptic condition And making it in being encapsulated in antibacterial packaging part (not shown) is that sterile surgical is stand-by.Many The intensity of the Biodegradable material non-Biodegradable material not as good as such as PEEK or rustless steel etc And it is more frangible than it.The moving member not having complexity of main body 12 or the simple designs of mutual moving part so that This Biodegradable material can be easier to use, and keeps the structural intergrity of anchor 10 simultaneously.

The Novel suture anchor of the present invention can by metal material, non-biodegradable polymers, can be biological The complex of degradation polymer or biodegradable polymers or copolymer and bioceramic is made.As Term as used herein " biodegradable " is defined as meaning to degrade in the body then wanting It is preferentially absorbed into internal or from internal discharge material.As used herein term " biological pottery Porcelain " it is defined as meaning the ceramic material compatible with bodily tissue and glass material.Preferably, biological Pottery is biodegradable.

Can be used for manufacturing the metal material of anchor of the present invention include rustless steel, titanium, Nitinol or other Biocompatibility metal material.

Can be used for manufacturing the non-Biodegradable material of anchor of the present invention include polyethylene, polypropylene, PEEK or the non-absorbent polymer of other biocompatibility.

The biodegradable polymers that can be used for manufacturing the anchor used in the present invention includes selected from aliphatic series poly- Ester, poe, condensing model, Merlon, polyurethane, polyamide and polyalkylene oxide can be biological Degradation polymer.Preferably, biodegradable polymers be comprised of aliphatic polyester polymers and copolymer and Blend.Generally, ring-opening polymerization synthesizes aliphatic polyester.Suitably monomer includes (but not It being limited to) lactic acid, lactide (include L-lactide, D-lactide, Study of Meso-Lactide and D, L Mixture), glycolic, Acetic acid, hydroxy-, bimol. cyclic ester, 6-caprolactone, to dioxanone (Isosorbide-5-Nitrae-dioxane- 2-ketone), trimethylene carbonate (1,3-dioxane-2-ketone), δ-valerolactone and their group Close.

The bioceramic of the compound anchor that can be used for the present invention include containing single-, double-, three-, α-three-, β- Three-and four-calcium phosphate, hydroxyapatite, calcium sulfate, calcium oxide, calcium carbonate, the pottery of phosphoric acid calcium and magnesium Porcelain.Particularly preferably use bata-tricalcium phosphate.In addition to bioceramic, it is also possible to by biology glass Glass is used for composite screws.Bio-vitric can include phosphate glass and bio-vitric.

Suitably biocompatibility synthetic polymer can include selected from aliphatic polyester, polyamino acid, be total to Poly-(ether-ester), polyalkylenes oxalates, polyamide, tyrosine derived polycarbonates, poly-(imino group carbon Acid esters), poe, polyoxaesters, polyesteramide, the polyoxaesters of amino-contained, poly-(anhydride), Polyphosphazene, polyurethane, polyether-polyurethane, polyester-polyurethane, poly-fumaric acid propylene glycol ester, poly-hydroxyl Alkanoate and the polymer of their blend.

For purposes of the present invention, aliphatic polyester include, but is not limited to following monomer homopolymer and Copolymer and blend polymer thereof: (it includes that lactic acid, D-, L-and meso third is handed over to lactide Ester)；Acetic acid, hydroxy-, bimol. cyclic ester (includes glycolic)；6-caprolactone；To dioxanone (Isosorbide-5-Nitrae-dioxy six Ring-2-ketone)；Trimethylene carbonate (1,3-dioxane-2-ketone)；The alkane of trimethylene carbonate Radical derivative；δ-valerolactone；Beta-butyrolactone；Gamma-butyrolacton；ε-decalactone；Butyric ester；Hydroxyl Valerate；Isosorbide-5-Nitrae-Dioxepane-2-ketone (include its dimer 1,5,8,12-tetra-oxacyclotetradecane- 7,14-diketone)；1,5-Dioxepane-2-ketone, 6,6-dimethyl-Isosorbide-5-Nitrae-dioxane-2-ketone；2,5-bis- Keto-morpholine, pivalolactone, α, α-diethyl propiolactone, ethylene carbonate, oxalic acid vinyl acetate, 3-first Base-Isosorbide-5-Nitrae-dioxane-2,5-diketone, 3,3-diethyl-Isosorbide-5-Nitrae-dioxane-2,5-diketone, 6,6-dimethyl- Dioxepane-2-ketone；6,8-dioxa double-octane-7-ketone.Other exemplary polymer or poly- Compound blend includes (as limiting examples) PPDO, poly butyric ester-hydroxyl Base valerate, poly-adjacent carbonic ester, poly-amino-carbon acid esters and PTMC.Used by the present invention Aliphatic polyester can be have the homopolymer of straight chain, side chain or hub-and-spoke configuration or copolymer (random, Block, fragment, tapered block, grafting, three blocks etc.).For purposes of the present invention, poly-(imines Base carbonic ester) it is understood to include Kemnitzer and Kohn at " Handbook of Biodegradable Polymers " (" biodegradable polymer handbook "), Domb et al. edits, Hardwood Academic Press, the 251-272 page, those polymer described in 1997.For the present invention Purpose, copolymerization (ether-ester) is understood to include Cohn and Younes at " Journal of Biomaterials Research " (" biomaterial research magazine "), volume 22,993- Page 1009, in 1988 and Cohn at " Polymer Preprints ", (" polymer is preprinted This ") (ACS Division of Polymer Chemistry (American Chemical Society: polymer chemistry is special Industry committee)), the 30th (1) volume, page 498, those copolymerization (ether-ester) described in 1989 (such as, PEO/PLA).For purposes of the present invention, polyalkylenes oxalates includes United States Patent (USP) No.4,208,511、No.4,141,087、No.4,130,639、No.4,140,678、No. Those described in 4,105,034 and No.4,205,399.Such as polyphosphazene, by L-lactide, D, L- Lactide, lactic acid, Acetic acid, hydroxy-, bimol. cyclic ester, glycolic, Lanthanum Isopropoxide, trimethylene carbonate and ε-oneself Copolymer based on mix monomer, trimer and the higher order polymer that lactone is made, by Allcock At " The Encyclopedia of Polymer Science " (" polymer science encyclopedia "), Volume 13, the 31-41 page, Wiley Intersciences, John Wiley & Sons, in 1988 And Vandorpe et al. (" can be biological at " Handbook of Biodegradable Polymers " Degradation polymer handbook "), Domb et al. edits, Hardwood Academic Press, the 161-182 page, those described in 1997.Condensing model includes derived from having HOOC- C6H4-O-(CH2) m-O-C6H4-COOH (wherein m is the integer in the range of 2 to 8) form Those of binary acid, and described binary acid and the aliphatic α-omega dibasic acid with most 12 carbon Copolymer.Polyoxaesters, polyoxaamides and comprise the polyoxaesters of amine and/or acylamino-following One or more in United States Patent (USP) are described: United States Patent (USP) No.5,464,929, No. 5,595,751、No.5,597,579、No.5,607,687、No.5,618,552、No.5,620,698、 No.5,645,850, No.5,648,088, No.5,698,213, No.5,700,583 and No. 5,859,150.Poe such as Heller is at " Handbook of Biodegradable Polymers " (" biodegradable polymers handbook "), Domb et al. edits, Hardwood Academic Press, the 99-118 page, those described in 1997.

Returning again to Fig. 2, shown stitching anchor 10 is positioned at bone hole 34, makes one section of stitching thread 36 wear Cross anchor main body 12 and also through tendon (e.g., the tendon in rotary sleeve) 38.The set of stitching thread 36 The first side 44 that ring 40 carries over anchor main body 12 subsequently through tendon 38 and its free end 42 extends, Especially it is trapped between anchor main body 12 and the bone 46 forming bone hole 32 by screw thread 24 and 26.So After, free end 42 is through far-end 14, and entrance axially intubates 32 and then passes through side port 28 from intubating 32 Pass return.From the beginning of this, they are through the anchor main body 12 being trapped in main body 12 and bone 46 The second side 48.It is possible that other threading is arranged.Such as, tendon 38 is passed with making the collar 40 Difference, the second anchor or a line anchor (not shown) can be placed on below tendon 38, make stitching thread 36 pass through tendon 38 through these anchors (one or more), arrive anchor main body 12 or multiple anchor main body 12。

Returning again to Fig. 3 and Fig. 4, the position of side port 28 affects what anchor main body 12 was fixed on bone 46 The intensity that intensity and stitching thread 36 are fixing on bone 46 and main body 12.The farther side of side port 28 Position provides higher fixing intensity, but failure mode is the most often that anchor main body 12 is by from bone Hole 34 is extracted.It is preferred for relate to stitching thread 36 sliding rather than extract the failure mode of anchor main body 12, Not make alien material get loose in the junction of patient when failure event occurs.It addition, extract mistake Effect may cause bone 46 impaired.Side port 28 is through angle shadow relative to the longitudinal axis 30 during main body 12 Ring fixing intensity, and bigger inclination angle strengthens fixing intensity.

It addition, the size of side port 28 and the functional and fixing of design can be affected through main direction Intensity.The cross-sectional area of side port 28 is provided with sufficiently large size, so that required size and quantity Stitching thread may pass through side port 28.Side port 28 little should not pass through side to during loading, configuring or use The degree that stitching thread is impaired is made during hole 28.Similarly, if making the stitching thread of unbecoming quantity through chi Very little inadequate side port 28, can make anchor main body 12 damaged themselves.On the contrary, side port 28 should not arrive greatly Making it that benefit of fixing intensity to become the degree of minimum, described fixing intensity comes from stitching thread 36 and passes through The bending process of system.The oversize meeting of side port causes the structural strength of anchor main body to occur worthless bad Change.Side port size can be optimized to be easy to use and avoid system damage, simultaneously additional fixing strong Benefit is provided in the range of degree.

Advantageously, become to make its angles and positions promote through the set direction of anchor main body by side port 28 Stitching thread 36 passes through system.Between loading and validity period, stitching thread 36 forms obtuse angle is optimal, Because obtuse angle can make the contact friction minimum of corner, reduce holding power and abrasion therewith and increase The robustness of whole system.The direction of side port 28 can be optimally disposed relative to the compound of the longitudinal axis Incline direction and deviation post.This composite inclined direction and deviation post so that the outlet of side port 28 Distally to the tangent line of the helix close to thread head rough on the direction of nearside.

It has been shown that this direction and position are to have positive influences to fixing intensity.When anchor screws in bone hole Time, in theory, the composite inclined direction of side port 28 and deviation post promote that stitching thread 36 is in receding side Form mild folding during mouth 28, thus cause stitching thread 36 easily to fall between proximal thread head In root.In such a case, such as, the side port 28 radial and normal to longitudinal axis orientation will may require that Stitching thread 36 forms lofty folding when exiting side port 28.Lofty folding thus inserts bone hole at anchor In by lofty transition occurs during side port 28, thus owing to causing bone weak along the shearing of bone hole wall Change, finally make fixation degree reduce.By not forming lofty bending, Ke Yiti in stitching thread 36 For there is the anchor of reduced size and stitching thread 36 not increased the biggest extra-stress.

Other form reaching gentle transition can be included in " the fracture limit of use near side port 28 Edge ", chamfering or inclined-plane.But, in the design using grapnel wall thickness, big Interim The cross section that can cause side port 28 increases inadvisablely.

Return again to Fig. 5, it can be seen that the quantity of the thread head 26 in proximal threaded portion 22 affects bone Stitching thread 36 between 46 and anchor main body 12 fixing.Increasing of thread head can strengthen this stitching Fixing of line 36.Uppermost curve represents have four thread heads (screw thread 24 and other three Thread head 26) time optimal fixing.

It is desirable that make the fixing of anchor main body 12 and the fixing optimization of stitching thread 36, to provide Still provide the slip of stitching thread 36 as dominating in anchor main body 12 while of maximum anchor main body 12 fixing The dominant failure mode extracted.

Now, Fig. 6 A, Fig. 6 B and Fig. 6 C are returned again to, it is shown that stitching anchor main body 12 is installed into anchor and drives On dynamic device 50.Driver includes slender casing 52, and this sleeve pipe 52 has in its portions of proximal 56 and drives Move shank 54 and in its distal part 59, there is driver top 58.Driver top 58 engages Tool receptacle 18 in anchor main body 12.Preferably, driver top 58 is engaged in the instrument of anchor main body The mode of groove 18 makes anchor main body 12 be only capable of at one to be rotationally oriented to be placed in driver 50, with Just surgeon can determine this direction by the position of rotation of shank 54.(see Fig. 7, drive Spline 60 on device top 58 matches with the receiving keyway 62 in anchor main body 12.)

Stitching thread threading-in device 64, as CHIA PERCAPASSER (is available from DePuy Mitek public Department (Raynham, MA)), there is distally stitching thread and grab the elongated braiding nitinol wire of ring or external member 68 Material 66 is engaged in driver 50 and anchor main body 12.The central authorities of its proximally slit 72 threading 52 Chamber 70, distally slit 74 passes central chamber 70, through removable ramp 76 and pass through side port 28 enter anchor main body intubates 32, makes the stitching thread collar 68 extend to the far-end 14 of main body 12 and stretch Go out.Wire rod 66 is flexible but is to maintain some rigidity, and ramp 76 provides and enters the smooth of side port 28 Entry angle.Preferably, central chamber 70 has internal ramp, wherein, needs again to insert after it is removed In the case of entering driver 50, wire rod 66 exits at distally slit 74.Tensioning grasping device 78 is put Between shank 54 and sleeve pipe 52.The portions of proximal 80 of wire rod 66 is passed through by grasping device 78 and is sewed up Line traffic control passage 82.At intra-operative, after stitching thread 36 passes tendon 38, by free end 42 Pull-out surgery cannula (not shown), is moved to exterior and by the stitching thread collar 68 Load.

After free end 42 loads stitching thread threading-in device 64, it is pulled up along sleeve pipe 52, stay certainly It is upward through anchor main body by end 42 from its far-end 14 and intubates 32, passed by side port 28, Jing Guopo Road 76, enters cavity 70 by distally slit 72, and passes cavity 70 and pass through proximal slot 72 and by grasping device stitching thread control passage 82, as depicted in figure 6b.As shown in figure 6c, Remove the ramp 76 being no longer necessary to.Preferably, ramp 76 by snap-fitted to sleeve pipe 52, Thus easily remove.Now, the implantation of anchor is ready for ready.

In order to complete operation, by stitching thread tensioning grasping device 78, stitching thread 36 is tensioned to required Tensioning degree.Then, by driver 50, anchor main body 12 is screwed in the bone hole 34 got out in advance.When When main body 12 is close to also access aperture 34, grasping device 78 pulls out free end 42 to keep on stitching thread 36 Correct tension force, and allow stitching thread 36 from grasping device 78 rather than enter bone hole 34 from tissue, by This is avoided the stitching thread 36 when anchor main body 12 advances through hole 34 to be wrapped in anchor main body 12.Preferably, Clamped by side port 28 from stitching thread 36 and access aperture 34 to anchor main body 12 be fully recessed into hole time, anchor Main body only turns over less than a circle, such as 1/4th circles.Anchor main body 12 (the most therein) and stitching When line 36 can be formed or be used in configuration anchor by some materials, minimizing rubs and strengthens stitching thread 36 and slides Dynamic material or operation strengthen its surface property.When being configured completely, the near-end of anchor main body 12 22 are preferably positioned at below bone 46 in bone hole 34.Exit driver 50 and cutting free end 42, anchor 10 is stayed the position shown in Fig. 2.

Fig. 8 illustrates the alternate embodiment of insertion instrument 100, and Fig. 9 illustrates the anchor 102 according to the present invention Alternate embodiment, both of which is suitable to be used together.The structure of anchor 102 and the structure class of anchor 10 Seemingly, difference is its axial boss axially intubating in 106 (axial boss) 104, and it is with slotting The distally axial slots 108 entered in the distally drive part 110 of instrument 100 matches.It addition, axially Intubate 106 to increase diametrically, wherein receive drive part 110 so that drive part 110 interior Portion intubates 112 and has identical internal diameter with distal part 114, and anchor axially intubates 106 and axial boss 104 internal diameters extending radially into the degree of depth coupling internal prongs 112 in slit 108, thus in inside Intubate 112 and axially intubate the transition providing smooth in 106, eliminating and rotating configuration anchor 102 phase Between stitching thread may meet with hinder time discontinuity.Axial boss 104 provides insertion instrument 100 He Additional joint between anchor 102.In order to strengthen rigidity, internal prongs 112 can be formed with Its distal part (big axial hole) as shown in Figure 8, but its portions of proximal is unlike slit 108 is wide, and preferably its portions of proximal and distal part all has smooth transition.

Returning again to Figure 10 and Figure 11, axial boss 104 is the most right with the side port 116 on anchor Accurate.Stitching thread ramp 118 is directed at side port 116 on insertion instrument 100.Axial boss 104 phase Alignment and slit 108 for side port 116 make side port 116 and slope relative to the alignment in ramp 118 Road 118 is directed at the most in the circumferential.

Ramp 118 is formed by the molded polymeric thing with arc-shaped slit zygonema receiving channel 120, and its footpath is outside Stretch, with the slit 124 that stitching thread and/or suture clutch 122 are directed on insertion instrument 100 Outside and enter side port 116, and be formed without lofty transition, and stitching thread or stitching thread grasping Device 122 forms inclination angle when entering side port 116 relative to self.Ramp 118 is also with a pair C Shape snap-fastener intermediate plate 126, it can buckle and disengage insertion instrument 100, in order in the operation described before Period is readily removable ramp 118.Pulldown 128 provides and is prone to take off with hands the grasping table in ramp 118 Face, and also provide the surface of setting " operation instruction ".

As shown in Figure 11, the T-shaped shank 130 on suture clutch 122 preferably has hands Finger contacting surface 132, to be prone to handle suture clutch 122.Shown suture clutch 134 But being positioned at the distally of shank 136 can be contained therein, suture clutch generally clamps stitching Line, then discharges stitching thread when applying torque to the shank 136 of insertion instrument 100.Subsequently herein The details of preferred grasping mechanism is provided.

Figure 12 illustrates another embodiment sewing up anchor 140 according to the present invention.Itself and stitching before Anchor 10 is similar with 102；But, its at near-end with axial slots 142 rather than side port.Slit 142 terminate with returning part 146 at its far-end 144, this returning part leading to along thread head 147 Road direction nearside is circumferentially extending, so that slit 142 forms the hook-type of entirety.In its proximal openings, examine Consider to being easier to carry out the threading of suture clutch (not shown in Figure 12).

The Discussing Convenience raising of threading makes can directly be worn by stitching thread 148 intra-operative surgeon The main shaft crossing anchor 140 is fed in slit 142 to intubating 150 and is put into slit In the case of in returning part 146, it is convenient to omit grasping device.Anchor will be used as described earlier 140 perform the operation, and surgeon holes and by stitching thread 148 the most in advance through tissue, Preferably, in arthroscopic type is performed the operation, through sleeve pipe, (sleeve pipe, tissue and bone do not show in fig. 12 Go out).When the free end of stitching thread 148 is in exterior, surgeon is passed through intubating 150 and stitching thread is inserted in returning part 146.Anchor 140 will be loaded such as instrument 100 subsequently Or 50 etc insertion instrument on and insert as previously indicated in bone, the fixing seam of returning part 146 The mode of zygonema is similar to above-mentioned side port.Preferably, returning part is as about before about side port institute Describe to penetrate with inclination angle and intubate 150, thus allow stitching thread 148 penetrate slotting by returning part 146 Pipe 150, keeps inclination angle relative to self simultaneously.

Grasping device 134 includes the disc body 152 with distal part 154, this distal part 154 Being attached to slender casing 156, slender casing 156 self terminates at hexagonal driver portion 110.Main body The portions of proximal 158 of 152 is attached to insert tool shank 136, is positioned at sleeve pipe 156 and main body 152 The radial outside of attachment position.The most clearly showing from Figure 13, axial slots 160 leads to main body 152 In, receive and catch stitching thread 148.Preferably, its inner surface 162 is by rubber or other elastic material Material is formed, to strengthen the ability catching stitching thread 148.Put on the torque of shank 136 by grasping Device main body 152 is delivered to sleeve pipe 156.Main body 152 is formed by the material of such as hard rubber, and it has Enough elastic force, to allow slit 160 open under the influence of this torque and unclamp stitching thread 148.Therefore, grasping device 134 generally clamps stitching thread to keep tension force, but when implanting anchor 140 Period, it unclamped when shank 136 reverses, thus allowed stitching thread 148 to slip over grasping device 134.

Figure 14 illustrates the alternate embodiment of the grasping device main body 164 according to the present invention.It includes a pair Slit 166 slightly radially, this will be applied to relevant shank (Figure 14 to slit 166 along torque Not shown in) direction radially-inwardly spiral.

Figure 15 illustrates another enforcement of the grasping device main body 170 including multiple arm 172 radially extended Example, slit 174 received by the stitching thread in each arm with circumference.Sleeve pipe attachment position 176 is positioned at Center and the shank attachment position 178 of main body 170 are positioned on arm, and the footpath being in slit 174 is outside Side.

Figure 16 A and Figure 16 B illustrates another embodiment of grasping mechanism 180, and this grasping mechanism includes just Property appearance shank grip 182 and inner radial elastic plugin 184.The near-end 186 of plug-in unit 184 The far-end 188 being attached to outer shank 182 and plug-in unit 184 is attached to sleeve pipe 190.Stitching thread 192 The gap between outer shank 182 and plug-in unit 184 is entered by the radial slit 196 in shank 182 194.Being sized to of gap 194 can clamp stitching thread 192.Applied by outside shank 182 Torque makes plug-in unit 184 distort, thus opening clearance 194 and allow stitching thread 192 therefrom to slide Cross.

Figure 17 A and Figure 17 B illustrates another reality of the grasping mechanism 200 including a pair radial flange 202 Executing example, this is the most overhanging from sleeve pipe portions of proximal 204 to flange.The elastomeric material of such as rubber etc 206 both sides being attached to flange 202.Outer shank 208 includes two half-unit 210, and each half portion is the most attached In a flange 202 and separate with relative flange 202, to form stitching thread receiving slit 212.Slit 212 can have the opening 214 widened, and within it has stitching thread to keep antelabium 216. As shown in figure 17 a, the pressure between the elastomeric material 206 on flange 202 and outer shank 208 Under effect, stitching thread 218 is clamped in slit 212.As shown in Figure 17 B, by outside handle Portion 208 applies torque, presses the elastomeric material between shank 208 and flange 202, narrow to open Groove 212, discharges stitching thread.

Figure 18 A and Figure 18 B illustrates the further embodiment of grasping mechanism 220.Outside shank 222 includes Cylindrical grip 224 and middle shaft core 226, grip 224 is attached by multiple radial ribs 228 In core 226.A pair rib 230 extends and adjacent one another are slightly off axisly, and grip 224 exists Opening therebetween, thus in shank 222, form radially-extending axial slit 232.Near shank The position of the near-end 234 of 222, keeper component 236 is placed in from a rib 230 towards adjacent In the slit 232 that rib 230 extends.It has the opening 238 widened and keeps antelabium 240, in order to Stitching thread 242 enters slit 232 and antelabium 240 is fixed and prevents it from dropping out.In slit 232 Elastomeric material 244 clamp stitching thread 242.The torque being applied to grip 224 is often opened Slit 232, thus discharge the tension force on stitching thread 242.

The seam that stitching thread 148 is passed Figure 12 can be manually completed under the auxiliary not having threader That closes anchor 140 intubates 150.But, simple threading apparatus 300 of assembling as shown in figure 19 can enter One step simplifies operation.Threading apparatus 300 includes that the opening with one end 304 and the second bellend 306 is compiled Knitting pipe 302, described one end 304 intubates 150, can be with hands by one or more stitching thread 148 Push described second bellend 306.Threading apparatus 300 is preferably knitted by flexible biocompatible materials Make and form and combine anchor 140 and arrange, make by intubating 150 receiving threading apparatuss 300, and make Threading apparatus 300 and anchor are all aseptic and are encapsulated in aseptic antimicrobial packaging (not shown). When surgeon prepares to load in anchor 140 stitching thread 148, from aseptic packaging, take out anchor 140 The bellend 306 combining and being pushed by stitching thread 148 threading apparatus with threading apparatus 300.Due to The other end 304 is applied with tension force, cause bellend 306 near intubating 150 and through intubating 150, Thus with stitching thread 148 by intubating.It is then possible to complete operation as described above.

Alternatively, as shown in Figure 20, stitching thread 148 can only pierce through braided tube 302.As Really fabric opening is sufficiently large, then can be sewed up with hands or pin (not shown) can be used it Sew up.Then, as in Figure 19, pull pipe 302 by intubating 150.

As shown in Figure 21, threading apparatus 310 can be formed by pipe 312, and pipe 312 needs not to be braiding , but at one end 316 it is provided with axial slits 314, to form the opening receiving stitching thread 148 318.The grasping reinforcement of such as tusk 320 etc can be arranged in opening 318, thus helps In when threading apparatus 310 passes and intubates 150, stitching thread 148 being held within.

In order to ensure the good closure of bellend 306 of the threading apparatus 300 of Figure 19, can be with other Closed manners is come it and is improved, as shown in Figure 22 A to Figure 22 D.For example, it is possible to be braided tube 324 arrange simple spring metal snap elements 322, and this element 322 has as shown in Figure 22 B First aperture position and the second lax make position as shown in fig. 22 c.Inserting stitching thread 148 Afterwards, the element 322 being in aperture position is extruded, thus is bound to make position.Can be at element 322 surroundings use and load the stitching thread collar 324, to provide the extruding force realizing Guan Bi, and also enter one Stitching thread 148 in pipe 324 is pressed by step.The stitching thread collar 324 individually loaded can also be individually Arrange and pass in tatting mode the knitted parts (replacing element 322) of pipe 324.

Alternatively, the knitted parts of pipe 324 can be by tatting to promote Guan Bi (especially material When there is elasticity) and keep bellend 316 to open, stretcher 326 can be inserted, as Shown in Figure 23 A and Figure 23 B.The simplest form of stretcher 326 includes having total length limit opening 330 Pipe 328, thus, after stitching thread 148 is loaded in bellend 316, be taken out pipe 328, make stitching thread 148 pass opening 330, so that pipe 328 can be removed.

Above by reference to some preferred embodiments, the present invention is described.Obviously, other people once read also More than having known illustrating the present invention, they just will recognize that some amendments to the present invention and become More.The present invention is identified and is understood to include all this modifications and changes, as long as they are in appended power In the range of profit claim and equivalent thereof.

Claims (9)

1. sew up an anchor assemblies, comprising:

Sewing up anchor, including main body, described main body has the path making stitching thread extend there through；

Stitching thread threading apparatus, it is received in described main body by described path, described stitching thread threading apparatus includes elongated tubular, described elongated tubular has the open first end being positioned at described body exterior, described first end is suitable within it receive and keep described stitching thread, to allow to pull described stitching thread to pass described path by described pipe, thus described stitching thread is loaded in described main body；

Wherein one or more axial slots extend in described first end of described pipe so that described first end can radial dilatation to receive described stitching thread.

Stitching anchor assemblies the most according to claim 1, wherein said elongated tubular includes that braiding structure and wherein said first end include the knitted parts that opening is bigger.

Stitching anchor assemblies the most according to claim 2, described knitted parts is shunk by the axial tensile force that the described knitted parts in wherein said first end is arranged such that on described first end, surrounds described first end of described stitching thread with Guan Bi.

Stitching anchor assemblies the most according to claim 1, the inside of wherein said first end is with thorn-like projection, to limit outside stitching thread moves to described first end.

Stitching anchor assemblies the most according to claim 1, also includes the fixture surrounding described first end, is used for compressing described first end and being held within by described stitching thread.

Stitching anchor assemblies the most according to claim 5, wherein said fixture includes spring metal fixture.

Stitching anchor assemblies the most according to claim 5, wherein said fixture includes the collar of suture material.

Stitching anchor assemblies the most according to claim 1, wherein said first end is by radially inwardly resiliency urged, and described stitching anchor assemblies also includes the dilator being received in described first end, for keeping described first end radial opening disposed within the described stitching thread of permission, and wherein allow the first side pressure described in when removing described dilator flat and described stitching thread is held within.

Stitching anchor assemblies the most according to claim 8, wherein said dilator has the lateral opening allowing described stitching thread to pass through.