CN103491883A - 组织修复 - Google Patents
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- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
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- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
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- A61B2017/00646—Type of implements
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- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0409—Instruments for applying suture anchors
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0414—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having a suture-receiving opening, e.g. lateral opening
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- A—HUMAN NECESSITIES
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- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0459—Multiple holes in the anchor through which the suture extends and locking the suture when tension is applied
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- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
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Abstract
一种设备(100)包括:柔性固定构件(10),所述柔性固定构件包括主体(12),所述主体具有纵向范围和宽度,所述主体限定穿过所述主体的多个开口(14),所述多个开口的每一个基本横向地穿过所述主体的宽度形成;和缝线(20),所述缝线具有两个终端(20a,20b),所述缝线交织穿过所述固定构件的主体中的多个开口的每一个,使得所述固定构件的多个部分可滑动地联接到所述缝线并且能够构造成在手术部位内形成簇。
Description
相关申请的交叉引用
本申请是PCT国际专利申请,要求美国专利申请序号13/016389的优先权,其全部公开内容通过引用并入本文中。
技术领域
本公开涉及用于修复组织的设备和方法,并且更具体地涉及用于将软组织联接到骨头的设备和方法。
背景技术
使用缝线和缝线锚定器的关节镜手术已经被用于组织修复,以例如将软组织固定到骨头。诸如金属或其它可吸收或不可吸收聚合物材料的缝线锚定器趋向于取代一定体积的骨头以提供足够的固定强度。较大的必要修复可能需要多个锚定器以适当地将撕裂的软组织再次附接到骨头。许多这些锚定器的尺寸可限制固定点的数量和位置并且影响一些组织修复的解剖本质。小锚定器通常无法提供足够的保持强度以在一些组织修复手术或某些骨区域中有效。
发明内容
在一个一般性方面中,一种设备包括:柔性固定构件,所述柔性固定构件包括主体,所述主体具有纵向范围和宽度,所述主体限定穿过所述主体的多个开口,所述多个开口的每一个基本横向地穿过所述主体的宽度形成;和缝线,所述缝线包括两个终端,所述缝线交织穿过所述固定构件的主体中的多个开口的每一个,使得所述固定构件的多个部分可滑动地联接到所述缝线并且能够构造成在手术部位内形成簇。
实施方式可包括以下特征中的一个或多个。例如,所述柔性固定构件包括缝线、带、辫子或网之一。所述柔性固定构件是非管状的。所述柔性固定构件和所述缝线包括尺码为2的缝线。所述设备还包括输送装置,所述输送装置包括插管,所述插管构造成在其内接收所述柔性固定构件。所述输送装置还包括伸长构件,所述伸长构件构造成在所述插管内从收缩位置滑动到前进位置,并且构造成当所述伸长构件处于所述前进位置时将所述柔性固定构件从所述插管排出。所述固定构件的所述部分构造成相对于所述缝线滑动以在手术部位内形成包括一组褶皱的簇。所述缝线交织穿过所述固定构件中的多个开口以形成缝线的两个基本平行的尾部区段。所述固定构件包括至少一个弯曲部分,其沿所述弯曲部分连续地包括第一开口、第二和第三开口以及第四开口,所述第一开口接收所述两个平行尾部区段中的一个的一部分,所述第二和第三开口接收所述两个平行尾部区段中的另一个的一些部分,并且所述第四开口接收所述两个平行尾部区段中的所述一个的另一部分。所述固定构件和所述缝线由能够吸收到患者体内的材料形成。所述固定构件包括生物生长材料。另外,所述设备还包括第二缝线,所述第二缝线具有两个终端,所述第二缝线交织穿过所述固定构件的主体中的多个开口的每一个,使得所述固定构件的一些部分可滑动地联接到所述缝线。
在另一个一般性方面中,一种组件包括:非管状的组织锚定器,所述组织锚定器由缝线、网、辫子或带之一形成,所述组织锚定器包括主体,所述主体具有纵向范围和宽度,所述主体限定沿所述主体的纵向范围且穿过所述主体的宽度的多个开口;缝线,所述缝线交织穿过所述组织锚定器的主体中的多个开口的每一个,使得所述组织锚定器的一些部分能够相对于所述缝线滑动并且能够构造成在手术部位内形成簇;和输送装置,所述输送装置包括插管,所述插管构造成在其内接收所述柔性固定构件。
实施方式可包括以下特征中的一个或多个。例如,所述输送装置还包括伸长构件,所述伸长构件构造成在所述插管内从收缩位置滑动到前进位置,并且构造成当所述伸长构件处于所述前进位置时将所述柔性固定构件从所述插管排出。所述组织锚定器和所述缝线包括尺码为2的缝线。所述组织锚定器的所述部分构造成相对于所述缝线滑动以在手术部位内形成包括一组褶皱的簇。所述缝线交织穿过所述组织锚定器中的多个开口的每一个以形成缝线的两个基本平行的尾部区段。所述组织锚定器和所述缝线由能够吸收到患者体内的材料形成。所述组织锚定器包括生物生长材料。
在另一个一般性方面中,一种设备包括:组织锚定器,所述组织锚定器包括多个相连的结;和缝线,所述缝线包括两个终端,所述缝线穿过所述多个相连的结中的一个或多个,使得所述组织锚定器可滑动地联接到所述缝线。
实施方式可包括以下特征中的一个或多个。例如,所述多个相连的结顺序地包括第一平结、两个自由交替的后半扣结、第二平结、两个自由交替的后半扣结以及第三平结。所述缝线穿过第一、第二和第三平结的每一个。所述设备还包括第二缝线,所述第二缝线具有两个终端,所述第二缝线穿过所述多个相连的结中的一个或多个,使得所述组织锚定器可滑动地联接到所述第二缝线。所述组织锚定器和所述缝线由能够吸收到患者体内的材料形成。所述组织锚定器包括生物生长材料。所述设备还包括输送装置,所述输送装置包括插管,所述插管构造成在其内接收所述组织锚定器。所述输送装置还包括伸长构件,所述伸长构件构造成在所述插管内从收缩位置滑动到前进位置,并且构造成当所述伸长构件处于所述前进位置时将所述组织锚定器从所述插管排出。
在另一个一般性方面中,一种伤口闭合组件包括:组织锚定器,所述组织锚定器包括多个相连的结;和缝线,所述缝线包括两个终端,所述缝线穿过所述多个相连的结中的一个或多个,使得所述组织锚定器可滑动地联接到所述缝线;和输送装置,所述输送装置包括插管,所述插管构造成在其内接收所述组织锚定器。
实施方式可包括以下特征中的一个或多个。例如,所述输送装置还包括伸长构件,所述伸长构件构造成在所述插管内从收缩位置滑动到前进位置,并且构造成当所述伸长构件处于所述前进位置时将所述组织锚定器从所述插管排出。
在另一个一般性方面中,一种闭合组织伤口的方法包括:将伤口闭合装置输送到手术部位,所述伤口闭合装置包括柔性固定构件和缝线,所述柔性固定构件具有主体,所述主体具有纵向范围和宽度,所述主体限定穿过所述主体的多个开口,所述多个开口的每一个基本横向地穿过所述主体的宽度形成,所述缝线具有两个终端,所述缝线交织穿过所述固定构件的主体中的多个开口的每一个,使得所述固定构件的多个部分可滑动地联接到所述缝线并且能够构造成在手术部位内形成簇;在所述手术部位处从所述伤口闭合装置去除所述柔性固定构件;以及拉动所述缝线的终端以在所述手术部位处形成所述固定构件的多个部分的簇。
实施方式可包括以下特征中的一个或多个。例如,所述方法还包括在所述组织中钻出孔。所述去除步骤包括将所述柔性固定构件从所述装置排出到所述孔中。所述孔完全穿过所述组织,所述输送步骤包括输送所述装置穿过所述孔并且所述去除步骤包括将所述柔性固定构件放置在所述孔的相对侧上。所述方法还包括当所述缝线的终端被拉动以在所述手术部位处形成所述固定构件的多个部分的簇时,将所述伤口闭合装置保持在所述手术部位处的适当位置。
在另一个一般性方面中,一种闭合组织伤口的方法包括:将伤口闭合装置输送到手术部位,所述伤口闭合装置包括组织锚定器和缝线,所述组织锚定器具有多个相连的结,所述缝线具有两个终端,所述缝线穿过所述多个相连的结中的一个或多个,使得所述组织锚定器可滑动地联接到所述缝线;在所述手术部位处从所述伤口闭合装置去除所述组织锚定器;以及拉动所述缝线的终端以在所述手术部位处形成所述多个相连的结的簇。
实施方式可包括以下特征中的一个或多个。例如,所述方法还包括在所述组织中钻出孔。所述去除步骤包括将所述组织锚定器从所述装置排出到所述孔中。所述孔完全穿过所述组织,所述输送步骤包括输送所述装置穿过所述孔并且所述去除步骤包括将所述组织锚定器放置在所述孔的相对侧上。所述方法还包括当所述缝线的终端被拉动以在所述手术部位处形成所述多个相连的结的簇时,将所述伤口闭合装置保持在所述手术部位处的适当位置。
附图和以下描述阐明了本公开的一个或多个实施方式的细节。其它特征和优点将从所述描述和附图并且从权利要求变得明显。
附图说明
图1A示出了组织修复设备的一种实施方式。
图1B示出了组织修复设备的另一种实施方式。
图2示出了图1A的组织修复设备,其包括交织穿过该结构的额外的缝线。
图3示出了将缝线交织穿过图1A的固定构件的替代实施方式。
图4示出了组织修复设备的另一种实施方式。
图5示出了图4的组织修复设备,其包括交织穿过该结构的额外的缝线。
图6A-6G示出了输送装置的实施方式,该输送装置用于将图1A-5的组织修复设备输送和放置在手术部位。
具体实施方式
参照图1A,组织修复设备100包括固定构件或锚定器10以及交织穿过固定构件10的柔性构件或缝线20。固定构件10由可延展或柔性的辫状主体12构成,主体12具有在第一端部12a和第二端部12b之间延伸的纵向范围以及宽度W。主体12限定多个开口14,所述多个开口14横向地(crosswise)穿过主体12的宽度W形成或者基本沿主体12的宽度W形成。缝线20包括两个终端20a和20b。终端20a、20b中的一个穿过主体12中的每个开口14,形成固定构件10的多个弯曲部分30以及缝线20的两个基本平行的区段22、24。如图1A所示,弯曲部分30沿着固定构件10的长度从区段22、24中的一个通到区段22、24中的另一个,以形成基本S形的弯曲部分30。弯曲部分30可相对于缝线20滑动以形成包括若干褶皱的簇或束30,如图1C所示。如下面将要更详细描述的,簇30与终端20a、20b一起可用于在手术部位中固定组织。
在图1A所示的实施方式中,固定构件10和缝线20由尺码为2的非管辫状缝线制成。然而,取决于外科手术或应用,固定构件10也可以是带、网、管或其它类型的可延展或柔性结构,并且缝线20可以由不同尺码的缝线制成。例如,在另一示例性实施方式中,固定构件10和/或缝线20由扁平管状缝线制成。另外,虽然图1A的固定构件10包括至少四个弯曲部分30,但其它构造也是可能的,例如图1B所示的实施方式,其中,固定构件10具有较小的长度尺寸并且从而在缝线20从中交织穿过时包括三个弯曲部分30。在又一个实施方式中,固定构件10可包括两个弯曲部分30并且基本形成为S形构造。使固定构件10的长度和宽度尺寸变化,和/或使缝线20的尺码和/或穿过固定构件10的开口(缝线20穿过该开口)的数量变化,可影响手术部位内的由固定构件10形成的簇30的尺寸。这些变化的构造可给使用者提供灵活性以满足多种不同外科手术的需要。
参照图2,图1A的组织修复设备100还可包括另外的柔性构件或缝线40,柔性构件或缝线40具有两个终端40a、40b。两个终端40a、40b中的一个可交织在固定构件20周围或者交织穿过固定构件20,形成带来四个自由端20a、20b、40a、40b的结构。在某些实施方式中,带有四个自由端的设备相对于两个自由端可具有优势。例如,在一些应用(例如肌腱套修复)中,常常需要将组织在两个位置捆到骨头上,以便将组织固定到骨头。在这些应用中,在骨头中仅有一个固定构件的情况下提供四个自由端能够减少所需要的固定构件的数量,这可减少手术时间和成本。减少固定构件的数量还可降低应力集中的风险,由于多个钻孔导致修复部位在手术之后骨折的风险。
参照图3,示出了将缝线20编织穿过图1A的固定构件10的替代实施方式。终端20a、20b中的一个穿过主体12中的每个开口14,形成固定构件10的多个弯曲部分30以及缝线20的两个基本平行区段22、24。与通过图1A所示的编织图案形成的弯曲部分30不同,图3的弯曲部分30不沿着固定构件10的长度从一个尾部区段22、24通到另一个尾部区段22、24以形成基本S形弯曲部分30。相反,在图3所示的实施方式中,弯曲部分30沿着缝线10的交织穿过固定构件10的那部分的长度形成基本S形弯曲部分30。该编织图案可允许在骨头中钻出较小直径的孔用于接收固定构件10,这可帮助减小应力集中和骨折。另外,该编织图案可允许访问对于现有组织锚定器组件而言太小或太受约束的手术部位。
参照图4,在另一实施方式中,一种用于组织修复的设备200包括固定构件或锚定器210以及交织穿过该固定构件210的柔性构件或缝线20。固定构件210可以形成为一串相连的结215。在图4所示的具体实施方式中,所述一串结215包括平结220、两个自由交替的后半扣结222、224、平结226、两个自由交替的后半扣结228、230以及平结232。缝线20可穿过每个平结220、226和232,或者由相连的结215形成的一个或多个开口中的任何组合,这允许固定构件210相对于缝线20滑动,从而固定构件210可在手术部位中形成簇或束并且与缝线20协作以将组织固定在手术部位内,如下面将要更详细描述的。固定构件210和缝线20由尺码为2的辫状缝线制成,然而也可例如针对钻头尺寸和强度要求而采用或调整其它缝线尺码。
参照图5,图4的组织修复设备200还可包括另外的柔性构件或缝线40,柔性构件或缝线40具有两个终端40a、40b。两个终端40a、40b中的一个可交织在固定构件210周围或者交织穿过固定构件210,并且更具体地穿过由所述一串结215形成的一个或多个开口,形成带来四个自由端20a、20b、40a、40b的结构。所上文讨论的,在多种实施方式中,带有四个自由端的设备相对于两个自由端可具有优势。
图6A-6E示出了工具或输送装置300,其用于将关于图1A、1B和2-3所描述的固定构件10、210中的任一个输送到手术部位以便例如修复软组织314。参照图6A,输送装置300包括插入管道或插管302。如图6A中的箭头所示,固定构件10、210中的一个被装入管道或插管302,使得缝线20的自由端20a、20b延伸穿过插入管道302的近端302a,使得医生可以操纵自由端20a、20b。如图6B所示,钻头导引件304被放置在手术部位400内,钻头(未示出)被放置在钻头导引件304内并且用于钻出足够深度的孔306,穿过皮层310并进入松质骨组织312。替代地,在经骨修复应用的情况中,钻头可用于完全钻透松质骨组织312。一旦在手术部位400中形成了孔306,包含已装载的固定构件10、210的插入管道302被插入穿过钻头导引件304并进入手术部位400处的期望位置,例如,插入管道302被顶入皮层310中。
参照图6C,然后,插入管道302可移动或进一步顶入孔306中而固定构件10、210保持在插入管道302中的适当位置。一旦管道302处于孔306中的期望位置,则然后使用者可以将插入管道302抽回,将固定构件10、210留在骨头中的孔306内(图6D),或者替代地在经骨应用中留在骨头的相对侧上。
参照图6E,在固定构件10、210位于孔306内并且插入管道302的远端302b位于手术部位400处(例如位于皮层310处或皮层310之下)的情况下,然后,使用者可以拉动缝线20的自由端20a、20b中的一个或两个。拉动自由端20a、20b(和/或在采用诸如图2所示缝线20、40的两个缝线的那些实施方式中的自由端40a、40b)中的一个或两个能够导致固定构件10、210靠住插入管道302的远端302b。随着使用者继续拉动自由端20a、20b中的一个或两个,固定构件10、210相对于缝线20滑动,并且更具体地,固定构件10的弯曲部分30或者固定构件210的所述一串结215相对于缝线20滑动以来到一起以在孔306内(例如在皮层310处或皮层310之下)形成束或簇30。在固定构件10、210处于期望位置的情况下,然后,使用者可以从手术部位400去除插入管道302和钻头导引件304并且将自由端20a、20b(和/或自由端40a、40b)系上,以将组织314固定到骨头312。
在将固定构件10、210插入并部署在手术部位400内的整个过程中将插入管道302保持在适当位置,可给使用者提供固定构件10、210已经靠住插入管道302的触觉反馈。这相对于如下的手术会是有利的,该手术相反依赖于皮层310来提供针对固定构件10、210在手术部位400内的部署的硬止动部。在那些系统中,一旦固定构件接触皮层310,使用者就会感觉到固定构件安置或部署,皮层310对于不同患者具有不同的密度。因此,皮层310在一些患者中可能感觉类似硬止动部,而在一些患者中可能感觉类似软止动部。因此,当依赖于皮层来提供针对固定构件部署的止动部时,在试图部署或安置固定构件的时候,存在很大的风险将固定构件拉出。作为对比,在本实施方式中,通过插入管道302给使用者提供了固定构件10、210已经部署在手术部位400内并且已经形成所需的束或簇的触觉反馈。这帮助降低了在部署和安置固定构件10、210时将固定构件10、210拉出的风险。
已经描述了本发明的多种实施方式。然而,将会理解的是,可以在不偏离本发明的精神和范围的情况下执行各种实施方式。例如固定构件和柔性构件可包括生长因子,例如血管生成因子。固定构件和柔性构件还可载有生物活性材料、兴奋剂或任何促进组织愈合的物质。另外,形成在固定构件主体中的开口被描述为基本横向地穿过主体形成,但它们也可根据具体应用而沿其它取向形成。而且,可在使柔性构件穿过开口之前在固定构件的主体中形成开口,或者可通过使柔性构件穿过固定构件的主体来形成开口,例如通过使载有柔性构件的针穿过固定构件的主体而在固定构件中形成期望数量的开口。
另外,虽然已经针对固定构件被固定在骨头中钻出的孔内的应用描述了该过程,但固定构件也可用于经骨应用,在经骨应用中,孔的深度不是制约因素。在这些应用中,固定构件可完全穿过孔并且固定在骨头的背侧上。在替代的实施方式(图6F)中,在将固定构件插入孔306的整个过程中,插入管道302可被保持在皮层310的顶上。在这种实施方式中,输送装置300包括滑动构件320,滑动构件320布置在插入管道302中并且联接到固定构件10、210。使用者可使滑动构件320在插入管道302中向前移动以从插入管道302部署固定构件10、210并将其部署到孔306中。在又一替代的实施方式(图6G)中,输送装置300可包括穿过钻头导引件304放置的管道330。管道330被顶入皮层310中并且然后接收从中穿过的插入管道302。另外,虽然输送装置300(包括插入管道302)已经被示出具有平直的构造,但取决于具体的手术位置和将要进行的手术,输送装置300(包括插入管道302)也可具有弯曲形状或其它合适的构造。
而且,除了关于图4的固定构件210所描述的具体结串之外,应当理解的是,还可以根据具体应用使用各种结串和尺码以及缝线尺码。因此,其它实施方式也在所附权利要求的范围内。
Claims (20)
1.一种设备,包括:
柔性固定构件,所述柔性固定构件包括主体,所述主体具有纵向范围和宽度,所述主体限定穿过所述主体的多个开口,所述多个开口的每一个基本横向地穿过所述主体的宽度形成;和
缝线,所述缝线包括两个终端,所述缝线交织穿过所述固定构件的主体中的多个开口的每一个,使得所述固定构件的多个部分可滑动地联接到所述缝线并且能够构造成在手术部位内形成簇。
2.如权利要求1所述的设备,其中,所述柔性固定构件包括缝线、带、辫子或网之一。
3.如权利要求1所述的设备,其中,所述柔性固定构件是非管状的。
4.如权利要求1所述的设备,其中,所述柔性固定构件和所述缝线包括尺码为2的缝线。
5.如权利要求1所述的设备,还包括输送装置,所述输送装置包括插管,所述插管构造成在其内接收所述柔性固定构件。
6.如权利要求5所述的设备,其中,所述输送装置还包括伸长构件,所述伸长构件构造成在所述插管内从收缩位置滑动到前进位置,并且构造成当所述伸长构件处于所述前进位置时将所述柔性固定构件从所述插管排出。
7.如权利要求1所述的设备,其中,所述固定构件的所述部分构造成相对于所述缝线滑动以在手术部位内形成包括一组褶皱的簇。
8.如权利要求1所述的设备,其中,所述缝线交织穿过所述固定构件中的多个开口以形成缝线的两个基本平行的尾部区段。
9.如权利要求8所述的设备,其中,所述固定构件包括至少一个弯曲部分,其沿所述弯曲部分连续地包括第一开口、第二和第三开口以及第四开口,所述第一开口接收所述两个平行尾部区段中的一个的一部分,所述第二和第三开口接收所述两个平行尾部区段中的另一个的一些部分,并且所述第四开口接收所述两个平行尾部区段中的所述一个的另一部分。
10.如权利要求1所述的设备,其中,所述固定构件和所述缝线由能够吸收到患者体内的材料形成。
11.如权利要求1所述的设备,其中,所述固定构件包括生物生长材料。
12.如权利要求1所述的设备,还包括第二缝线,所述第二缝线具有两个终端,所述第二缝线交织穿过所述固定构件的主体中的多个开口的每一个,使得所述固定构件的一些部分可滑动地联接到所述缝线。
13.一种组件,包括:
非管状的组织锚定器,所述组织锚定器由缝线、网、辫子或带之一形成,所述组织锚定器包括主体,所述主体具有纵向范围和宽度,所述主体限定沿所述主体的纵向范围且穿过所述主体的宽度的多个开口;
缝线,所述缝线交织穿过所述组织锚定器的主体中的多个开口的每一个,使得所述组织锚定器的一些部分能够相对于所述缝线滑动并且能够构造成在手术部位内形成簇;和
输送装置,所述输送装置包括插管,所述插管构造成在其内接收所述柔性固定构件。
14.如权利要求13所述的组件,其中,所述输送装置还包括伸长构件,所述伸长构件构造成在所述插管内从收缩位置滑动到前进位置,并且构造成当所述伸长构件处于所述前进位置时将所述柔性固定构件从所述插管排出。
15.如权利要求13所述的组件,其中,所述组织锚定器和所述缝线包括尺码为2的缝线。
16.如权利要求13所述的组件,其中,所述组织锚定器的所述部分构造成相对于所述缝线滑动以在手术部位内形成包括一组褶皱的簇。
17.如权利要求13所述的组件,其中,所述缝线交织穿过所述组织锚定器中的多个开口的每一个以形成缝线的两个基本平行的尾部区段。
18.如权利要求13所述的组件,其中,所述组织锚定器和所述缝线由能够吸收到患者体内的材料形成。
19.如权利要求13所述的组件,其中,所述组织锚定器包括生物生长材料。
20.一种设备,包括:
组织锚定器,所述组织锚定器包括多个相连的结;和
缝线,所述缝线包括两个终端,所述缝线穿过所述多个相连的结中的一个或多个,使得所述组织锚定器可滑动地联接到所述缝线。
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RU2600222C2 (ru) | 2016-10-20 |
EP3753499B1 (en) | 2024-03-13 |
CN103491883B (zh) | 2016-11-23 |
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US20120197271A1 (en) | 2012-08-02 |
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US9078651B2 (en) | 2015-07-14 |
JP6338858B2 (ja) | 2018-06-06 |
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EP2667787A1 (en) | 2013-12-04 |
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US20160220243A1 (en) | 2016-08-04 |
US20220313242A1 (en) | 2022-10-06 |
US8795334B2 (en) | 2014-08-05 |
KR20130140835A (ko) | 2013-12-24 |
MX339600B (es) | 2016-05-31 |
US20190261975A1 (en) | 2019-08-29 |
US20230285017A1 (en) | 2023-09-14 |
EP2667787B1 (en) | 2020-11-04 |
MX2013008734A (es) | 2014-03-05 |
US9370352B2 (en) | 2016-06-21 |
BR112013018641A2 (pt) | 2016-10-18 |
US11413031B2 (en) | 2022-08-16 |
RU2013138875A (ru) | 2015-03-10 |
WO2012103536A1 (en) | 2012-08-02 |
US20140296883A1 (en) | 2014-10-02 |
US11857176B2 (en) | 2024-01-02 |
JP6685883B2 (ja) | 2020-04-22 |
JP2017060823A (ja) | 2017-03-30 |
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