CN104994809A - 组织移植体锚定 - Google Patents

组织移植体锚定 Download PDF

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CN104994809A
CN104994809A CN201380015986.3A CN201380015986A CN104994809A CN 104994809 A CN104994809 A CN 104994809A CN 201380015986 A CN201380015986 A CN 201380015986A CN 104994809 A CN104994809 A CN 104994809A
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tissue graft
size
transplant
fixed part
braided material
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C.D.哈尔纳
M.C.弗拉加莫
M.J.佩里洛
A.R.小贝鲁布
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Smith and Nephew Inc
University of Pittsburgh
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Smith and Nephew Richards Inc
University of Pittsburgh
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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
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    • A61F2/0811—Fixation devices for tendons or ligaments
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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
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    • 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
    • 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
    • A61B2017/0446—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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0852—Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0864—Fixation of tendon or ligament between anchor elements, e.g. by additional screws in the anchor, anchor crimped around tendon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
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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

固定装置包括部件(26)、附连到该部件上的编织材料(90，112)，以及缝合线(118)，缝合线(118)延伸通过编织材料，并且包括用以将编织材料紧固到组织移植体上的自由区域。紧固组织移植体的方法包括：提供固定部件，固定部件具有附连到其上的编织材料和延伸通过编织材料的缝合线；确定固定部件和组织移植体之间的期望距离；以及使用缝合线，在用以获得期望距离的位置处，将编织材料附连到组织移植体上。

Description

组织移植体锚定
技术领域
本发明涉及组织移植体锚定。
背景技术
一般通过关节镜由组织移植体代替已经断裂且不可修复的前十字韧带(ACL)。组织移植体可取自腱/骨头重建组织的一部分，即跟腱；膝盖骨；或在至少一端上具有所谓的“骨块”的四头肌腱，以及取自半腱肌和股薄肌。这些可作为自体或异体而获取。备选地，组织移植体可由合成材料形成，或者由合成材料和天然材料的组合形成。
通过将组织移植体的一端紧固到形成于股节内的路径中的关节窝中，并且使移植体的另一端穿过形成于胫骨中的路径，从而移植组织移植体。一般而言，使用缝合线将组织移植体的各端固定到紧固件(例如干涉螺钉或柱)上，紧固件然后紧固到骨头上。
还知道使用移植体固定部件(例如固定按钮)来在股骨皮层处紧固组织移植体，如美国专利No. 5,306,301(“301专利”)中描述的那样，该专利通过引用而整体地结合在本文中。当使用固定按钮时，股骨路径大体包括用于接收移植体的直径相对更大的部分，以及直径更小的部分，经过在股骨皮层附近的通道，用于接收从组织移植体延伸到固定按钮的一定长度的缝合线。通过测量股骨路径的总长度和股骨路径的直径更大部分的长度，外科医生确定用于将固定按钮附连至组织移植体的缝合线材料的适当长度。
发明内容
根据一方面，一种固定装置包括部件、附连到该部件上的编织材料、以及缝合线，缝合线延伸通过编织材料并且包括用于将编织材料紧固到组织移植体上的自由区域。
这方面的实施例可包括一个或多个以下特征。
部件限定至少一个开口。部件在第一尺寸上伸长，第一尺寸限定在部件的第一端和第二端之间延伸的长度，并且部件具有与第一尺寸横向的第二尺寸，第二尺寸小于该长度。
根据另一方面，一种紧固组织移植体的方法包括：提供固定部件，固定部件具有附连到其上的编织材料和延伸通过编织材料的缝合线；确定固定部件和移植体韧带之间的期望距离；以及使用缝合线，在用以获得期望距离的位置处，将编织材料附连到组织移植体上。
在附图和以下描述中阐述一个或多个实施方式的细节。根据描述和附图并根据权利要求，本公开的其它特征、目标和优点将是显而易见的。
附图说明
图1示出被移植体固定部件紧固在膝盖内的组织移植体。
图2是图1的膝关节的另一个视图。
图4A-4C是固定装置的侧视图、端视图和透视图。
图5A和5B是固定装置的额外的实施例的侧视图和透视图。
图6是固定装置的额外的实施例的透视图。
具体实施方式
参照图1，膝关节具有在前十字韧带(ACL)修复和重建程序中移植的组织移植体10(例如，半腱肌和股薄肌移植体)。在移植组织移植体10之前，然后从凹口12钻削出用于接收组织移植体10的一端的股骨通道14，在股节内达预定距离，直径减小的传送通道16从股骨通道14进一步钻削通过股节到达股骨皮层18的区域。从胫骨的前部区域到股骨通道14的开口附近的区域，钻削出用于接收组织移植体10的另一端的胫骨通道20。
利用固定装置27的移植体固定部件26将组织移植体10在股骨皮层区域18处紧固。通过下面论述的编织结构24将组织移植体10连接到移植体固定部件26上。组织移植体10的另一端包括例如用固定螺钉30来附连到胫骨上的一定长度的缝合线28。当螺钉30上紧时，附连到固定螺钉30的头部上或定位在固定螺钉30的头部下方的垫圈32帮助保持缝合线就位。
使用附连到部件上的拉线(未显示)来定位移植体固定部件26。拉线从凹口12穿过通道14和16到达皮层18，并且在移植体固定部件的长轴与通道对齐的情况下，使用拉线将移植体固定部件26拉过通道14和16。在离开通道16之后，使用拉线轻按移植体固定部件26，使得部件26平放在皮层上。
参照图2，外科医生根据组织移植体10在股节内的期望插入距离来选择股骨通道14的长度(L)。结构24的额外跨度(标为SS)大约为传送通道16的跨度，使得期望插入长度(L)和结构的跨度(SS)的总和是从股骨通道14的开口到股骨皮层18处的开口的测量总长度(TL)。在移植组织移植体之前测量这些尺寸中的各个，使得在移植程序期间，外科医生在关节镜观察下，可确保组织移植体10已经恰当地定位在股骨通道14内。
参照图3，移植体固定部件26在第一尺寸上伸长，第一尺寸限定长度L，长度L在部件26的第一端42和第二端44之间延伸，第二尺寸与第一尺寸横向，第二尺寸具有宽度W，宽度W小于长度L，并且第三尺寸与第一尺寸和第二尺寸横向，第三尺寸具有高度H，高度H小于长度L。移植体固定部件具有骨头接触侧46和对置侧48。在侧部46、48之间延伸的是四个孔50、52、54和56。孔50和56接收经过的缝合线，缝合线未显示。
固定部件26的长度、宽度和高度为例如12 mm×4 mm ×1.5 mm。
参照图4A-4C，固定装置100包括编织或编成结构24(例如中国指套90)，以将组织移植体保持就位，使其与移植体固定部件26相距预定距离。预定距离的范围从0 mm至指套的长度，例如大约30 mm。由外科医生在放置移植体之前确定移植体固定部件26和组织移植体之间的距离，并且通过将中国指套90装载到组织移植体上来设定该距离，以产生期望距离。
通过按钮、通过孔，直接固定指套，或者通过额外的纤维92，从而将指套附连到移植体固定部件26上，额外的纤维92馈送通过按钮通过孔，然后被编织通过指套的长度。如图4A中显示的那样，纤维92可延伸出中国指套90的基部，附连针94，使得在移植结构之前，一旦组织移植体定位在中国指套90中，可使纤维92穿回通过中国指套90和组织移植体。中国指套90例如为大约30mm长，并且其直径为10 mm。纤维92可为编织缝合线或编成缝合线，例如，#5 Ultrabraid™缝合线。
不像中国指套90，可将硬编织材料制作成热狗面包或挤压式“V”形，并且在期望位置处缝合到组织移植体上。硬编织材料也可呈在一端处附连到固定装置上且围绕腱缝在一起的两个长度的材料的形式。参照图5A和5B，固定装置110包括限定槽口114的管状元件112。管状元件112由硬编织材料形成，例如聚乙烯纤维。在使用中，将组织移植体置于管状元件112内，并且在期望位置处将管状元件112缝合到组织移植体上。管状元件112被开放网眼116(未在图5B中显示)包围，并且使在端部具有针(未显示)的缝合线118通过开放网眼116进行编织，并且紧固到移植体固定部件26上。由手术室工作人员使用带针缝合线118来将管状元件112缝合到组织移植体上。在图6中，已经由两个管状区段120a、120b代替管状元件112，管状区段120a、120b在它们之间接收组织移植体。
其它实施方式在所附权利要求的范围内。

Claims (2)

1. 一种固定装置，包括：
限定至少两个开口的部件，所述部件在第一尺寸上伸长，所述第一尺寸限定在所述部件的第一端和第二端之间延伸的长度，所述部件具有与所述第一尺寸横向的第二尺寸，所述第二尺寸小于长度；
附连到所述部件上的编织材料；以及
缝合线，其延伸通过所述编织材料，并且包括用于将所述编织材料紧固到组织移植体上的自由区域。
2. 一种紧固组织移植体的方法，包括：
提供固定部件，所述固定部件具有附连到其上的编织材料以及延伸通过所述编织材料的缝合线；
确定所述固定部件和组织移植体之间的期望距离；以及
使用所述缝合线，在用以获得所述期望距离的位置处，将所述编织材料附连到所述组织移植体上。
CN201380015986.3A 2012-03-23 2013-03-12 组织移植体锚定 Pending CN104994809A (zh)

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PCT/US2013/030340 WO2013142131A1 (en) 2012-03-23 2013-03-12 Tissue graft anchoring

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KR20150037727A (ko) 2015-04-08
JP2015512701A (ja) 2015-04-30
AU2013235641B2 (en) 2017-07-27
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IN2014DN07702A (zh) 2015-05-15

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