CN104394777B - 组织移植物锚定 - Google Patents

组织移植物锚定 Download PDF

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CN104394777B
CN104394777B CN201380007899.3A CN201380007899A CN104394777B CN 104394777 B CN104394777 B CN 104394777B CN 201380007899 A CN201380007899 A CN 201380007899A CN 104394777 B CN104394777 B CN 104394777B
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suture
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coil
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graft
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CN104394777A (zh
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M·J·佩里洛
A·R·小贝鲁布
M·C·弗拉加莫
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Smith and Nephew Inc
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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
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
    • A61B17/04—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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
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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
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
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    • A61F2002/0852—Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
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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
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

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Abstract

一种固定装置(40)，包括限定至少两个开口的构件(26)和缝线(24)，通过将所述缝线穿过所述构件中的至少两个开口以形成供缝线的端部穿过的两个缝线线圈，来将所述缝线系到所述构件上。这两个缝线线圈相互连接。一种固定组织移植物的方法，包括提供固定构件，将缝线附接到组织移植物上，并通过牵拉缝线来调节缝线在固定构件和组织移植物之间的长度。

Description

组织移植物锚定
技术领域
本发明涉及组织移植物锚定。
背景技术
已断裂且不可修复的前交叉韧带(ACL)通常在关节镜下由组织移植物来替换。组织移植物可以从在每个端部具有所谓“骨块”的髌腱的一部分以及半膜肌和股薄肌中获取。替代地，组织移植物可以由合成材料或合成材料与天然材料的组合物形成。
替换用组织移植物通过将组织移植物的一端固定在形成于股骨内的通道中的承窝中，并使移植物的另一端穿过形成于胫骨中的通道来进行植入。通常，使用缝线来将组织移植物的每一端固定到紧固件(例如界面螺钉或柱)上，其然后固定到骨上。
还已知使用例如固定按钮等移植物固定构件将组织移植物固定在股骨皮质上，如在美国专利No.5,306,301(‘301’专利)中描述的那样，其由此通过引用以其整体并入。当使用固定按钮时，股骨通道通常包括用于接纳移植物的相对较大直径的部分、以及位于股骨皮质附近的较小直径的贯穿通道，该贯穿通道用于接纳从组织移植物伸展到固定按钮的一段缝线。通过测量股骨通道的总长度和股骨通道的较大直径部分的长度，外科医生确定用来将固定按钮附接到组织移植物的缝线材料的适当长度。
发明内容
为了增加用于交叉修复的股骨固定中的移植物/通道界面，而缩短移植物固定构件和腱结构之间的距离。使该距离最小的能力通常由固定构件的翻转约束限制，其导致股骨通道中较少的腱，或者导致移植物固定构件的大小受到损害以适应腱和移植物固定构件的翻转。
根据一个方面，一种固定组织移植物的方法，包括提供固定构件，通过使缝线穿过固定构件中的至少两个开口以形成供缝线的端部穿过的两个缝线线圈，来将缝线系到固定构件上，将缝线附接到组织移植物上，并通过牵拉缝线来调节缝线在固定构件和组织移植物之间的长度。
该方面的实施方式可以包括一个或多个下述特征：
两个缝线线圈相互连接。附接缝线包括越过缝线形成组织移植物的软组织的线圈。附接缝线包括将缝线穿过组织移植物的骨块，然后将缝线系到固定构件上。该方法包括使固定构件、缝线和附接的组织移植物穿过骨通道，然后调节缝线在固定构件和组织移植物之间的长度。
根据另一个方面，一种固定装置包括限定至少两个开口的构件和缝线，通过使所述缝线穿过构件中的至少两个开口以形成供缝线的端部穿过的两个缝线线圈，来将缝线系到所述构件上。
该方面的实施方式可以包括一个或多个下述特征：
两个缝线线圈相互连接。所述构件在限定长度的在构件的第一端和第二端之间延伸的第一尺寸上是细长的，并且所述构件具有横向于第一尺寸的比所述长度小的第二尺寸。所述构件限定四个、六个或七个孔。
一个或更多个实施方式的细节在附图和下面的描述中阐明。本发明的其他特征、目的以及优点将从说明书、附图以及权利要求中清楚。
附图说明
图1A和图1B是由移植物固定构件固定在膝盖内的组织移植物的示意图。
图2是图1中膝关节的另一个视图。
图3-图6是固定装置的实施方式的立体图。
图7A和图7B是固定装置的另一个实施方式的立体图。
具体实施方式
参考图1A和图1B，膝关节具有在前交叉韧带(ACL)修复和重建手术中植入的组织移植物10(例如髌腱移植物(图1A)或半膜肌和股薄肌移植物(图1B))。在植入组织移植物10之前，优选地进行髁间窝成形手术来扩充股骨的髁间窝12。然后在股骨内从髁间窝12以预定距离钻出用来接纳组织移植物10的一端的股骨通道14，并且进一步从股骨通道14穿过股骨到股骨皮质18的区域钻出具有缩小直径的贯穿通道16。从胫骨的前端区域到股骨通道14的开口附近的区域钻出用来接纳组织移植物10的另一端的胫骨通道20。
在髌腱移植物的情况下，组织移植物10的一端包括骨块22，其形状和大小确定为与股骨通道14紧密配合以确保最佳愈合。一段缝线24的一端附接到骨块22上，另一端通过固定装置27的移植物固定构件26固定在股骨皮质区域18。缝线24以这样的方式附接到移植物固定构件26上：在如图1A和图1B所示将移植物10和固定构件26定位之前和之后，允许调节缝线24在移植物固定构件26和组织移植物10之间的长度。组织移植物10的另一端包括第二段缝线28，其例如通过固定螺钉30附接到胫骨上。当拧紧螺钉30时，附接到或定位于固定螺钉30的头部下方的垫圈32有助于将缝线保持就位。
移植物固定构件26使用附接到构件上的牵拉线(未示出)定位。牵拉线从髁间窝12到皮质18穿过通道14和16，并用来牵拉移植物固定构件26穿过通道14和16，其中移植物固定构件的长轴线与通道对齐。从通道16出来后，牵拉线用来翻转移植物固定构件26，使得构件26平靠于皮质上。
参考图2，股骨通道14的长度(L)由外科医生根据骨块22的长度和组织移植物10在股骨内的期望插入距离来选择。缝线24的跨度表示为SS，是大约贯穿通道16的长度，以使期望插入长度(L)和缝线的跨度(SS)之和是从股骨通道14的开口到股骨皮质18处的开口测量的总长度(TL)。在植入组织移植物之前测量这些尺寸的每一个，从而在植入手术期间，外科医生在关节镜观察下能够确保将组织移植物10正确地定位在股骨通道14内。
调节缝线24的长度的能力允许使缝线跨度(SS)的长度最小化，只由贯穿通道16的期望长度限制。存在在将移植物固定构件26贯穿通道14、16期间所需要的缝线24的最小长度，以允许构件26与通道对齐地定位。一旦移植物固定构件26位于抵靠股骨皮质18的位置上，就能够通过继续牵拉缝线，将缝线24的长度缩短，使得组织移植物10位于股骨通道14内的量最大。
缝线24是机织或编织缝线，例如#5超编织(Ultrabraid)缝线，以线圈线结的构造附接于移植物固定构件26上以形成固定装置40。参考图3，移植物固定构件26在限定长度L的在构件26的第一端42和第二端44之间延伸的第一尺寸上是细长的，在横向于第一尺寸的第二尺寸上具有比长度L小的宽度W，以及在横向于第一尺寸和第二尺寸的第三尺寸上具有比长度L小的高度H。移植物固定构件具有骨接触侧面46和相对侧面48。在侧面46、48之间延伸有四个孔50、52、54和56。孔50和56接纳未示出的贯穿缝线。
缝线24是穿过孔52和54的单根长度的缝线，以形成两个相互连接的线圈60、62，缝线24的端部64、66分别穿过线圈60、62，形成线结76和具有三个缝线线圈72、72和74的线圈68。为了形成线圈线结构造，例如，缝线24的端部66向下穿过孔54并向上穿过孔52，形成线圈70；自身折叠，围绕从孔54向上延伸的一段缝线，返回向下穿过孔52，形成线圈60；向上穿过孔54，形成线圈72；穿过线圈60，自身折叠，然后返回向下穿过孔54，形成与线圈60相互连接的线圈62；向上穿过孔52，形成线圈74；并且然后穿过线圈62。
通过继续牵拉缝线24的端部64、66，能够调节线圈68的长度，例如从与孔52和54之间的距离相等的最小值到大约30mm，使得在组织移植物10附接到缝线24上的情况下，能够在0mm到大约15mm之间调节移植物固定构件26和组织移植物10之间的距离。
当固定装置40与半膜肌和股薄肌移植物(图1B)一起使用时，缝线24可以预先系在移植物固定构件26上提供给外科医生，并且手术室工作人员通过使组织移植物穿过缝线线圈68而将组织移植物附接到固定装置40上。当使用髌腱移植物(图1A)时，手术室工作人员在形成线圈线结构造时，通过将缝线穿过移植物的骨块来形成线圈线结构造。
当移植物/固定构件结构位于股骨隧道中时，能够调节移植物固定构件26和组织移植物10之间的距离。替代地，由外科医生在放置移植物之前确定该距离。
一旦移植物固定构件26和组织移植物10使用期望长度的缝线24定位在膝盖中，由组织移植物置于缝线上的张力就起作用来固定线圈线结构造。
固定构件26的长度、宽度和高度例如是12mm×4mm×1.5mm。
其他实施方式在所附权利要求的范围内。
例如参考图4，可以捻合缝线线圈70、72和73。参考图5，可以抵靠移植物固定构件26的骨接触侧面46收紧缝线线圈70和74，使得在使用时组织移植物仅附接于线圈72。图6中的移植物固定构件26a包括六个孔，其中缝线24穿过四个中心孔以形成线圈70、72和74以及线结76。图7A和图7B中的移植物固定构件26b包括七个孔，其中缝线24穿过五个中心孔80、82、84、86和88。缝线结构的形成是缝线端部66向下穿过孔88，向上穿过孔86，越过从孔88向上延伸的缝线，向下穿过孔84，形成线圈并返回向上穿过孔84，向下穿过孔82，向上穿过孔80，然后穿过在孔84和82之间形成的线圈。
通过设置开放端或封闭端以及改变厚度、长度或宽度，能够变更移植物固定构件以有助于构件的翻转。为了有助于将移植物固定构件定位在通道的端部，该构件可以具有香蕉形状或诸如矩形、三角形或其他几何形状等变形。为了有助于拉出的强度，可以调节移植物固定构件在构件中的孔之间的厚度。移植物固定构件在孔之间的该部分可以通过增大或减小其厚度来改变，从而开辟空间并缩短移植物固定构件和组织移植物之间的距离。
移植物固定构件可以只包括单一开口，其中通过将缝线穿过构件中的单一开口以形成供缝线的端部穿过的两个缝线线圈，来将缝线系到移植物固定构件上。
其他实施方式也在所附权利要求的范围内。

Claims (7)

1.一种固定装置，包括：
限定至少一个开口的构件；以及
缝线，所述缝线包括线结和线圈，并且通过使所述缝线穿过所述构件中的所述至少一个开口以形成供所述缝线的端部穿过的两个缝线线圈来将所述缝线系到所述构件上；
其中所述线结和线圈通过如下来形成：使缝线的端部向下穿过第二开口并向上穿过第一开口，形成第一缝线线圈；使缝线在其自身上折叠，围绕缝线的长度从第二开口向上延伸并返回向下穿过第一开口，形成第一互相连接的线圈；使缝线向上穿过第一开口，形成第二缝线线圈；使缝线通过第一互相连接的线圈，并使缝线在其自身上折叠，并且使缝线返回向下穿过第二开口，形成与第一互相连接的线圈互相连接的另一互相连接的线圈，向上穿过第一开口，并且形成第三缝线线圈，并使第三缝线线圈穿过所述另一互相连接的线圈。
2.如权利要求1所述的固定装置，其中所述两个缝线线圈相互连接。
3.如权利要求1或2所述的固定装置，其中所述构件在限定长度的在所述构件的第一端和第二端之间延伸的第一尺寸上是细长的，并且所述构件具有横向于所述第一尺寸的比所述长度小的第二尺寸。
4.如权利要求1或2所述的固定装置，其中所述构件限定两个开口。
5.如权利要求1或2所述的固定装置，其中所述构件限定四个开口。
6.如权利要求1或2所述的固定装置，其中所述构件限定六个开口。
7.如权利要求1或2所述的固定装置，其中所述构件限定七个开口。
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AU2013214999A1 (en) 2014-08-21
ZA201405599B (en) 2015-10-28
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US8926662B2 (en) 2015-01-06
US20130197580A1 (en) 2013-08-01
US9561027B2 (en) 2017-02-07
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