CN104619286A - 韧带重建固定系统 - Google Patents
韧带重建固定系统 Download PDFInfo
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Abstract
本公开涉及一种将韧带固定于骨骼中的组件。该组件包括悬挂构件(210)和植入物(100),植入物(100)具有用于固定地接纳悬挂构件和在植入物内至少部分地悬挂该悬挂构件和接纳的骨骼移植物的机构,该植入物允许骨骼向内生长。还公开了将韧带固定于骨骼中的方法。
Description
技术领域
本公开涉及组织的外科手术修复并且更具体而言涉及用于韧带重建的装置和方法。
背景技术
纤维性组织,诸如韧带和腱,可能与骨骼脱离。缝合锚钉(suture anchor)通常用于将软组织和硬组织附连到骨骼。通常,缝合锚钉被植入于骨骼质量中的钻孔内。一根或多根缝线和附连的针被连接到缝合锚钉。缝线穿过组织并且随后系结以将组织牢固固定到骨骼上。
许多韧带重建固定装置诸如内置纽扣(endobutton)或悬挂销已经被确定为在外科手术重建期间用以固定韧带的可能方案。结合这些装置使用的外科手术中的某些手术是低效的并且这些装置中的某些并不允许移植组织(graft tissue)或支架与骨骼最佳地接触。
发明内容
在一方面,本公开涉及一种用于将韧带固定于骨骼中的组件。该组件包括悬挂构件和植入物,悬挂构件具有用于接纳骨骼移植物的第一端;植入物具有用于对悬挂构件的第二端固定地进行接纳和在植入物内至少部分地悬挂该悬挂构件的机构,植入物允许骨骼向内生长。这种组件允许组织移植物在骨骼隧道内悬挂并且最终以完整的360度而接触骨骼隧道壁,这促进了更快地愈合。在另一实施例中,植入物是带窗孔的植入物,并且悬挂构件的第二端包括缝线环钩,缝线环钩具有至少两个钩部;并且用于固定地接纳悬挂构件的第二端的机构包括了在带窗孔的植入物中的孔口。在另一实施例中,带窗孔的植入物为Healicoil缝合锚钉。
在又一实施例中,该组件还包括引导销,其具有用于悬挂构件的附连位点并且其中引导销穿过植入物。在另一实施例中,植入物是生物可吸收的材料。
在另一实施例中,植入物的大小与导向孔和移植物大小成比例使得植入物固定和移植物与窝接触最大化。在其它实施例中,植入物可以是螺钉植入物或带肋插头植入物,并且悬挂构件的第二端包括至少两个J形锁构件并且用于固定地接纳悬挂构件的第二端的机构可以是在植入物中的J形锁保持凹槽或者悬挂构件的第二端包括至少两个卡扣配合舌片并且用于固定地接纳悬挂构件的第二端的机构包括了在植入物中的卡扣配合凹槽。
在本发明中公开的一种用于韧带重建方法包括:将植入物插入于孔口内;将移植物附连到悬挂构件的第一端;将悬挂构件的第二端牢固固定到引导销;将引导销定位成使悬挂构件与孔口对准;以及使悬挂构件与植入物接合,从而至少部分地将移植物悬挂于孔口内。在一实施例中,这种技术创建了一种韧带至骨骼/前交叉韧带(ACL)股骨固定系统,其将移植物、组织或支架牢固固定到制备的骨窝(例如,骨骼隧道)内同时允许移植物或支架与所形成的骨窝成360度接触。在另一实施例中,钻出导向孔以接纳植入物,并且在另一实施例中钻出导向孔并且以单次操作来执行插入植入物。
在另一实施例中,通过将植入物的大小设定为与移植物的大小和导向孔的大小成比例来最大化植入物固定和移植物与窝接触。在另一实施例中,使悬挂构件与植入物接合包括将安置于悬挂构件的第二端上的至少两个钩部钩到带窗孔的植入物中的孔口。在另一实施例中,使悬挂构件与植入物接合包括将至少两个悬挂构件J形锁构件锁定到植入物中相对应的J形锁保持凹槽内。
一种用于韧带重建的套件,包括:悬挂构件,其具有用于牢固固定骨骼移植物的第一端;以及,植入物,其具有用于对悬挂构件的第二端固定地进行接纳和将悬挂构件和所接纳的骨骼移植物悬挂于植入物内的机构,植入物允许骨骼向内生长;以及,插入装置,其被配置成辅助将植入物植入到体内。
附图说明
附图合并于说明书中并构成说明书的部分,附图示出本公开的实施例且与书面描述一起用于解释本公开内容的原理、特征和特点。在附图中:
图1示出了本公开的植入物和钻具引导件的透视图。
图2示出了用于将韧带固定于骨骼中的本公开的组件的分解图。
图3示出了在股骨窝的骨骼隧道中插入并悬挂之后的图2的组件。
图4A至图4C示出了本公开的植入物和悬挂构件的替代实施例。
具体实施方式
下文优选实施例的描述在本质上只是示例性的且绝不旨在限制本公开、其应用或用途。如本文中所公开的用于将韧带固定于骨骼中的组件包括植入物和匹配的悬挂构件,悬挂构件在韧带重建手术期间附连到植入物上。这种组件从植入物向远端悬挂一种连接到悬挂构件上的骨骼移植物,植入物可以经由引导销附连到钻具上并且在导向孔放置期间插入。
现参考图1,用于将韧带固定于骨骼中的示例性组件10包括植入物100,植入物100例如插入于股骨窝中的骨骼隧道中。植入物100包括远端61、近端62、线圈部分63(也被称作螺纹)和孔口64-66。在一实施例中,在插入之前,植入物被组装到钻具导丝110(也被称作引导销110)上。钻具导丝110可包括连接到悬挂构件210的附连位点120,钻孔端112和远端114。悬挂构件210包括第一端214和第二端,第二端在此处被示出为钩部212a和212b(通常被称作钩部212)。在一实施例中,悬挂构件210被牵拉穿过植入物,钩部212a和212b与植入物100的锁定机构接合。在一实施例中,锁定机构包括孔口64-66和与钩部212形成接口连接的线圈部63。在此实施例中,钩部212通过孔口64-66接触线圈部63并且绕线圈部63钩住。在其它实施例中,悬挂构件210利用J形锁连接或卡扣配合而连接到植入物100。在一实施例中,悬挂构件210使用附连到钩部212的缝线122而连接到附连位点120。在其它实施例中,使用将悬挂构件210推入就位的装置来插入悬挂构件210,而不使用钻具引导件110,然后将悬挂构件210锁定到植入物100内。
存在用以插入植入物100的多种方法。在一实施例中,使用钻具导丝110钻出导向孔,之后由管状钻具形成骨骼隧道。在这些实施例中,以单次操作来执行钻出骨骼隧道和插入植入物。在一实施例中,植入物类似于Smith & Nephew
HEALICOIL™缝合锚钉,其与常规实芯植入物的不同之处在于排除了内径材料。这允许骨骼在锚钉螺纹轮廓内交错/相间错杂,提供优良的固定安全性。在一实施例中,Healicoil ™型植入物被预加载到钻具上。具体而言,根据用于固定植入物的一种技术,钻具和植入物在先前放置的引导销110上被预加载和插入。植入物100和钻具一体地工作以形成导向孔并且也将植入物插入就位。一旦使植入物100就位,使用引导销110将悬挂构件210(例如,缝线夹)牢固固定于植入物内并且使附连到缝线夹210上的骨骼植入物悬挂于导向孔中邻近于植入物的远端61或者在其它实施例中部分地在植入物内侧。用于插入植入物100的其它方法包括使用专用插入器械。植入物100也可以插入于常规地钻出的骨骼隧道中。
在另一实施例中,植入物100可与组织是生物相容的并且由生物可吸收的材料制成(即,能在生物环境诸如人体中随着时间降解为在正常新陈代谢过程期间移除的化合物)。在另一实施例中,植入物100可以大小设定为与导向孔和骨骼移植物大小成比例使得植入物固定和移植物到窝的接触最大化。植入物100的大小可能不同以适应骨骼隧道,例如从4.5 mm至13.0 mm。本文所描述的组件10和技术可以用于骨骼移植物或软组织移植物。
图2示出了用于将韧带固定于骨骼中的组件10的一实施例。该组件10包括悬挂构件210,悬挂构件210具有第一端214和第二端(此处被图示为钩部212)。韧带202附连到骨骼移植物204(也被称作骨骼到骨骼(BTB)移植物204)上。悬挂构件210的第一端214接纳BTB移植物204。应了解韧带202可以例如是髌腱或其它软组织并且能围绕比如图2所示表面积更大或更小的骨块的表面积。
在一实施例中,BTB移植物204使用缝线或类似材料附连到悬挂构件210的第一端214。在其它实施例中,悬挂构件210由穿过骨块的缝线、进入骨块的螺钉、胶带而附连到BTB移植物上,或者直接穿过BTB移植物204并且牢固固定。如果移植物是软组织移植物,那么移植物204可以围绕悬挂构件210折叠或成环。如果如图2所示移植物为骨骼移植物,那么悬挂构件210可以被缝合到移植物上或者直接穿过移植物204。
在植入物100(此处为带窗孔的植入物)被固定于股骨窝302(图3)的骨骼隧道304(图3)中之后,悬挂构件的第二端被牢固固定到引导销110上。引导销110被定位成使悬挂构件与导向孔对准并且使用引导销110,使悬挂构件210与植入物100接合,从而至少部分地将移植物204从植入物110悬挂于骨骼隧道内。在某些实施例中,移植物204可以至少部分地悬挂于植入物100内。
在一实施例中,悬挂构件210为缝线环钩弹簧,其具有用于接纳BTB移植物204的第一端214并且植入物100为带窗孔的植入物,例如Healicoil™缝合锚钉,具有用于固定地接纳悬挂构件第二端的机构。在此实施例中。通过缝线环钩弹簧210的钩部212a和212b与带窗孔的植入物100中的孔口相接合而提供锁定机构,以便使缝线环钩弹簧210和接纳的骨骼移植物204分别在植入物和骨骼隧道304内悬挂。在此实施例中,缝线环钩弹簧210被牵拉到植入物100的远端62并且跨过孔口64-66和66和线圈63“渐进”直到在一旦已到达了所希望的位置和张力的情况下所述钩部锁定就位。
利用这种布置,用于将韧带固定于骨骼中的组件10允许在带窗孔的植入物100、缝线环钩弹簧210和接纳的骨骼移植物204内骨骼向内生长。在此实施例中,悬挂构件210,此处为缝线环钩弹簧,向组件10提供阻尼特征并且当钩部212a和212b与带窗孔的植入物100中的孔口相接合时在钩部212a和212b上提供弹簧张力。应了解悬挂构件210可包括额外钩部212并且可以使用其它机构来用于附连到植入物100,包括(但不限于)J形锁连接件(在下文中结合图4A至图4c讨论)、卡扣配合舌片、螺纹、翼形件和棘爪。在一实施例中,悬挂构件210为金属且在另一实施例中悬挂构件210由聚醚醚酮(PEEK)制成,其类似于塑料并且具有类似于骨骼的弹性模量。
现参考图3,组件10被示出处于股骨窝302的骨骼隧道304内。BTB移植物204附连到悬挂构件210并且从插入于骨骼内的植入物100悬挂。在此实施例中,移植物附连到悬挂构件210上,悬挂构件210至少部分地悬挂于植入物100内。此处,植入物100附连到钻具上并且在导向孔放置期间插入。在此实施例中,植入物100为带窗孔的植入物(也被称作笼式螺钉紧固件),其允许骨骼向内生长并且在设计上类似于Healicoil™锚钉,添加了用于固定地接纳内部锁定特征的机构,此处为钩到植入物100中的孔口上的钩部212a和212b。
在一实施例中,线圈部63(例如,螺纹)接合着骨骼隧道304(即,植入物100的内径近似等于骨骼隧道304的直径)。骨骼移植物204也可以具有近似等于骨骼隧道304直径的直径,允许实现韧带202的厚度和骨骼移植物插入于骨骼隧道304中的空隙。现参考图4A和图4B,被示出为未组装的J形锁部件的替代组件10'包括植入物100',植入物100'具有J形锁保持凹槽410和锁定凹部412。组件10'还包括悬挂构件210',悬挂构件210'具有钩部,此处J形锁构件为212a'和212b'。图4C示出了组件10' 的组装的部件植入物100'和悬挂构件210',而没有附连的骨骼移植物。利用组件10'悬挂韧带202和骨骼移植物包括将悬挂构件210'插入于J形锁保持凹槽410内;旋转该悬挂构件210'并且将J形锁构件 212a'和212b'锁定到凹部412内。
在另一实施例中,卡扣配合机构(未图示)用于将悬挂构件牢固固定到植入物内,而不是使用J形锁机构。应了解植入物,无论是Healicoil、螺钉、螺钉植入物、插头植入物还是带肋插头植入物,可以在壁中包括孔口/窗孔并且可以为管状的(即,挖空的以接纳悬挂构件)。
在替代实施例中,由悬挂构件的长度和悬挂构件相对于植入物的放置来调整从移植物到植入物的距离,且在一些实施例中,移植物可以至少部分地悬挂于植入物内或者仅在骨骼隧道中。在其它实施例中,植入物可以沿着其整个长度带有窗孔,或者沿着其长度的部分带有窗孔。悬挂构件可以是缝线环、金属环、弹簧或夹(即,用于将移植物联结到植入物的任何机构)。
在不偏离本公开范围的情况下,也可对如上文参考相对应图示描述的示例性实施例做出各种修改,预期的是,包含于前文描述中且在附图中示出的所有内容应被理解为是说明性的而不是限制性的。因此,本公开的范畴和范围不应受到前述示例性实施例中的任何实施例限制,而是应当仅根据所附权利要求和其等效物限定。
Claims (20)
1.一种用于将韧带固定于骨骼中的组件,包括:
悬挂构件,其具有用于接纳骨骼移植物的第一端;以及
植入物,其具有用于对悬挂构件的第二端固定地加以接纳和在植入物内至少部分地悬挂所述悬挂构件的机构,所述植入物允许骨骼向内生长。
2.根据权利要求1所述的组件,其特征在于,植入物包括带窗孔的植入物。
3.根据权利要求2所述的组件,其特征在于,悬挂构件的第二端包括缝线环钩,缝线环钩具有至少两个钩部;以及
用于对悬挂构件的第二端固定地加以接纳的机构包括在带窗孔的植入物中的孔口。
4.根据权利要求2或3的组件,其特征在于,带窗孔的植入物包括Healicoil缝合锚钉。
5.根据前述权利要求中任一项的组件,其特征在于,其还包括:引导销,其具有用于悬挂构件的附连位点并且其中引导销旋拧穿过植入物。
6.根据前述权利要求中任一项的组件,其特征在于,植入物包括生物可吸收的材料。
7.根据前述权利要求中任一项的组件,其特征在于,植入物的大小与导向孔和移植物大小成比例使得植入物固定和移植物与窝接触最大化。
8.根据前述权利要求中任一项的组件,其特征在于,植入物包括螺钉植入物和带肋插头植入物之一。
9.根据前述权利要求中任一项的组件,其特征在于,悬挂构件的第二端包括至少两个J形锁构件并且用于对悬挂构件的第二端固定地加以接纳的机构包括在植入物中的J形锁保持凹槽。
10.根据前述权利要求中任一项的组件,其特征在于,悬挂构件的第二端包括至少两个卡扣配合舌片并且用于对悬挂构件的第二端固定地加以接纳的机构包括在植入物中的卡扣配合凹槽。
11.一种韧带重建方法,包括:
将植入物插入于孔口内;
将移植物附连到悬挂构件的第一端;
将悬挂构件的第二端牢固固定到引导销;
将引导销定位成使悬挂构件与导向孔对准;以及
使悬挂构件与植入物接合,从而至少部分地将移植物悬挂于植入物内。
12.根据权利要求11的方法,其特征在于还包括:钻出导向孔以接纳植入物。
13.根据权利要求11的方法,其特征在于,钻出导向孔并且将以单次操作来执行插入植入物。
14.根据权利要求11的方法,其特征在于,其还包括:通过将植入物的大小设定为与移植物的大小和导向孔的大小成比例来最大化植入物固定和移植物与窝接触。
15.根据权利要求11的方法,其特征在于,植入物包括带窗孔的植入物。
16.根据权利要求15的方法,其特征在于,使悬挂构件与植入物接合包括将安置于悬挂构件的第二端上的至少两个钩部钩到带窗孔植入物中的孔口上。
17.根据权利要求11的方法,其特征在于,带窗孔的植入物包括Healicoil缝合锚钉。
18.根据权利要求11的方法,其特征在于,植入物包括螺钉植入物和带肋插头植入物之一。
19.根据权利要求11的方法,其特征在于,使悬挂构件与植入物接合包括将至少两个悬挂构件J形锁构件锁定到植入物中相对应的J形锁保持凹槽内。
20.一种用于韧带重建的套件,包括:
悬挂构件,其具有用于牢固固定骨骼移植物的第一端;
植入物,其具有用于对悬挂构件的第二端固定地加以接纳和将悬挂构件和所接纳的骨骼移植物悬挂于植入物内的机构,植入物允许骨骼向内生长;以及
插入装置,其配置成辅助将植入物植入到体内。
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- 2013-06-26 JP JP2015520421A patent/JP2015521912A/ja not_active Ceased
- 2013-06-26 AU AU2013280421A patent/AU2013280421A1/en not_active Abandoned
- 2013-06-26 RU RU2015101568A patent/RU2015101568A/ru not_active Application Discontinuation
- 2013-06-26 US US14/409,111 patent/US9629706B2/en not_active Expired - Fee Related
- 2013-06-26 EP EP13737908.7A patent/EP2866734A1/en not_active Withdrawn
- 2013-06-26 IN IN11070DEN2014 patent/IN2014DN11070A/en unknown
-
2017
- 2017-02-03 US US15/423,993 patent/US9999495B2/en not_active Expired - Fee Related
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Publication number | Priority date | Publication date | Assignee | Title |
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CN113349909A (zh) * | 2021-05-07 | 2021-09-07 | 四川大学华西医院 | 一种分离式螺钉 |
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US20150320544A1 (en) | 2015-11-12 |
US20170143471A1 (en) | 2017-05-25 |
JP2015521912A (ja) | 2015-08-03 |
IN2014DN11070A (zh) | 2015-09-25 |
KR20170065692A (ko) | 2017-06-14 |
RU2015101568A (ru) | 2016-08-20 |
EP2866734A1 (en) | 2015-05-06 |
US9629706B2 (en) | 2017-04-25 |
US9999495B2 (en) | 2018-06-19 |
BR112014032440A2 (pt) | 2017-06-27 |
AU2013280421A1 (en) | 2015-01-22 |
WO2014004614A1 (en) | 2014-01-03 |
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