CN110418613A - 用于将片状材料固定到目标组织的系统和方法 - Google Patents

用于将片状材料固定到目标组织的系统和方法 Download PDF

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CN110418613A
CN110418613A CN201880018357.9A CN201880018357A CN110418613A CN 110418613 A CN110418613 A CN 110418613A CN 201880018357 A CN201880018357 A CN 201880018357A CN 110418613 A CN110418613 A CN 110418613A
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T·R·库克利克
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Cannuflow Inc
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    • 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
    • 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
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • 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
    • A61B2017/0409—Instruments for applying suture anchors
    • 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
    • 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
    • A61B2017/0417—T-fasteners
    • 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
    • A61B2017/0427—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 anchoring barbs or pins extending outwardly from the anchor body
    • 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
    • A61B2017/0427—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 anchoring barbs or pins extending outwardly from the anchor body
    • A61B2017/0437—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 anchoring barbs or pins extending outwardly from the anchor body the barbs being resilient or spring-like
    • 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
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks

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Abstract

本文的装置、系统和方法使得能将外科构建体锚定到身体组织。这些系统可用于关节镜检查中的生物植入物固定以及其它片材和支架修复手术。该系统可被用于其中使用合成或生物补片的任何软组织修复手术，例如关节修复或疝修复。

Description

用于将片状材料固定到目标组织的系统和方法
本申请要求于2017年3月16日提交的美国临时申请62/472,131的优先权。
技术领域
以下描述的本发明涉及关节的关节镜修复领域。
背景技术
生物构建体和其它片状外科植入物迅速地广泛用于关节病变的修复。生物构建体是一族生物衍生植入物，其用于促进组织生长或者用于修补和修复组织缺损和撕裂。这些修复包括关节炎软骨的修复、肌腱与骨的连结以及肩部中的退变肩袖的桥接。现今，生物构建体在整形外科医疗设备中占据日益重要的位置。生物构建体的一个关键问题在于，附接系统不能跟上这些植入物的发展。缝合钉是生物片材附接的一种最常见形式，但担心简单的缝合钉会向后退出并在关节中松散浮动。
发明内容
以下描述的装置、系统和方法使得能将外科构建体锚定到身体组织。这些系统可用于关节镜检查中的生物植入物固定以及其它片材和支架修复手术。该系统可被用于其中使用合成或生物补片的任何软组织修复手术，例如关节修复或疝修复。
描述了各种植入物锚定件，包括T形杆锚定件、翼形锚定件和箭猪结构锚定件。一种T形杆锚定件使用带齿的条带，该条带与锁定索环中的棘爪接合，以将片状植入物抵靠肩袖固定。另一T形杆锚定件具有连接到锁钮的附接缝合线。另一锚定件的特征在于类似于弯针的尖端，当缝合线或条带向后拉动钝端时，该尖端刺入肩袖并锁定到组织中。这些实施例可靠地将生物片材抵靠任何合适的组织(例如肩袖)保持就位，而不需要外科打结，并且相比于简单的缝合钉，这些实施例更可靠地向下压紧片状植入物。T形杆可以穿过肩袖或肌腱。
箭猪结构的实施例是在接合表面积大的侧面上具有微型模制倒钩的锚定件。这类似于箭猪刺保持固定在组织中并抵抗拔出的方式。这些微结构倒钩布置在中心锚定钉上。锚定件的头部包括具有额外倒钩的压紧杆，以压紧生物植入片材。
附图说明
图1a、1b和1c示出了具有锁定索环的T形杆植入物和植入物驱动器。
图2a和2b示出了锁杆锚定件和具有锁钮的缝合线。
图3a、3b、3c、3d和3e示出T形杆针递送装置和T形杆植入物。
图4a、4b、4c和4d示出了翼形锚定件和驱动器。
图5a、5b和5c示出了箭猪结构锚和驱动器。
具体实施方式
图1a、1b和1c示出了大致T形的T形杆锚定件1，其可用于利用锁定索环4将片状植入物(例如生物构建体2)固定到任何合适的组织3。T形杆锚定件包括植入杆5，其在任何合适的点(例如中点5M)处附接到条带6，从而形成T形构型。植入杆具有尖端7以及钝端或驱动端9。附接点被选择成保持条带6的长度6L比从附接点到钝端9的距离5L更长。条带6在远端6D具有锁眼6H，以用于插设引导缝合线，例如缝合线10。该条带的近端6P在尖端和钝端之间的任何合适位置(例如中点5M)处附接到植入杆5。条带6具有沿着一个或多个侧面(例如侧面12)的齿11，并且该齿与锁定索环4如棘齿那样地接合。齿与锁定索环中的任何合适元件接合，所述锁定索环中的任何合适元件例如为棘爪或锁定索环的内表面。
在使用时，植入片材在合适的治疗部位处与组织并置。例如，图1a示出了与肩袖组织3并置的生物构建体2。使用者朝着植入杆5的钝端9拉住引导缝合线10，这又使条带6如图1a的折叠位置13所示地弯曲或折叠成平行于植入杆。随后，使用者握住T形杆锚定件1，使植入杆的尖端指向植入片材。所示的植入物驱动器14具有与杆状植入物的钝端9接合的远侧端头14D。植入物驱动器14用于推动植入杆的钝端，从而驱动植入杆的尖端穿过植入片材2和肩袖组织3。一旦植入杆5到达期望位置，使用者撤回驱动器，这使得植入杆返回到T形构型，其中条带6垂直于植入杆5，并且条带的远端6D能够通过组织和植入片材接近。使用者对引导缝合线10保持控制提供了防止整个T形杆锚定件1穿过植入片材和组织而不能用锁定索环固定的保险。如果需要，当条带停在片材2和/或组织3之下时，使用者将拉动缝合线10以将条带拉回，使其脱离在T形杆插入穿过生物构建体和组织期间产生的穿孔。随后，锁定索环4被推到条带的远端6D上，并且锁定索环被沿着条带推向条带的近端以与齿11接合，从而将片状植入物抵靠肩袖组织固定。一旦安装就位，植入杆5相对于条带6的垂直定向产生大致T形的T形杆锚定件1。
图2a和2b示出了锁杆锚定件20，其包括锁杆21、缝合线22和锁钮23。锁杆21具有尖锐的穿透端21A和钝的驱动端21B。杆具有在任何合适的位置(例如中点21M)的一个或两个孔24，以便以成环的方式接合缝合线22。缝合线22如图所示地穿过一个孔24并返回穿过另一个孔24，使得其可以朝着锁钮提拉所述杆，从而将植入片材2如图2b所示地与组织3并置。
在使用时，植入片材2在任何合适的治疗部位处与组织3并置。例如，图2b示出了与肩袖组织3并置的生物片材2。使用者使缝合线22沿着锁杆21平直地延伸，缝合线延伸穿过钝驱动端21B中的凹部或通道25。使用者握住锁杆21，使尖端21A指向固定位置26地穿过植入片材2，并驱动锁杆锚定件穿过植入片材和组织，直到驱动端21B穿过组织3。当锁杆21全部穿过组织3时，使锁杆旋转直到其垂直于缝合线22。随后，使用者拉紧缝合线，并将缝合线插入穿过锁钮，以将杆和锁钮拉在一起，从而将片材固定到肩袖。一旦安装就位，锁杆21相对于缝合线22的垂直定向产生大致T形的锁杆锚定件20。
图3a、3b、3c、3d和3e示出了T形杆植入锚定件30、驱动器31以及固定到组织3的T形杆锚定件。T形杆32具有缝合线，例如缝合线33，其固定在T形杆纵向中心以形成T形杆植入物。诸如索环34的滑动锁定索环沿着缝合线33向下滑动，以将植入片材固定到诸如组织3的任何合适组织。T形杆驱动器31具有尖锐远端35以及中空空间36，该中空空间36用于保持T形杆植入物正好接近T形杆驱动器的尖锐远端。T形杆驱动器具有能够操作地连接到手柄的滑杆37，以用于将T形杆植入物推出或驱动到外科手术空间中。
在使用时，生物片材2在任何合适的治疗部位处与组织3并置。例如，图3e示出了与肌腱3并置的生物片材2。使用者将T形杆植入物如图3b和3c所示地装入T形杆驱动器31。使用者滑动地接合递送装置滑块37以驱动T形杆植入物穿过生物片材和肌腱。使用者撤回T形杆驱动器，将T形杆32留在肌腱下面，并使缝合线33附接并且延伸穿过肌腱和片材。使用者拉动缝合线33穿过锁定索环34，以将T形杆和锁定索环拉到一起，从而将片材固定到肌腱。一旦安装就位，T形杆植入物32相对于缝合线33的垂直定向产生大致T形的T形杆锚定件30。
图4a、4b、4c和4d示出了大致T形的翼形锚定件40以及附件和驱动器。翼形锚定件40具有带锁定棘齿(例如齿42)的中心柱(柱41)。两个翼部(翼部43)弹性地向外弹出并且在中心柱41的远端(柱根部44)从中心柱41延伸。翼43相对于中心柱41的定向产生大致T形的翼形锚定件40。中心柱41具有位于其近端41P处的锁眼孔(孔45)，该锁眼孔用于接合缝合线46。锚定件驱动器47在其远端处具有中空部分47H，该中空部分47H的尺寸和大小被设计成如图4c所示地在柱根部44处接合翼形锚定件40并包围柱41。翼形锚定件40还包括用于穿透植入片材和组织的闭孔端头40T。
在使用时，生物片材2在任何合适的治疗部位处与组织3并置。例如，图4d示出了与肩袖3并置的植入片材2。使用者将缝合线46插入穿过孔45并保持缝合线不接近侧面。使用者握住翼形锚定件40，使尖头的闭孔端头40T在植入物片上。驱动器中空部分插在翼形锚定件的中心柱上。使用者推动驱动器，以驱动翼形锚定件穿过植入片材和组织3到固定部位。一旦翼形锚定件已完全穿过组织3，翼部远离驱动器和柱弹出。使用者移除驱动器，同时仍抓住缝合线。缝合线被进给穿过锁定索环48，并且锁定索环被在中心柱上向远侧推动，以使锁定索环抵靠植入物片夹住，并且保持植入物片与组织接触。
图5a、5b和5c示出了通常为T形的箭猪结构锚定件50和驱动器51。柔性“箭猪结构”或微结构倒钩(例如倒钩52)与固定棘齿54一起布置在中心锚定钉53上。锚定件50的头部包括压紧杆55，该压紧杆55在其相反两端处具有侧桩55A和55B。中心锚定钉53与压紧杆55的组合产生通常为T形的箭猪结构锚定件50。中心锚定钉53还包括在近端的用于引导缝合线的缝合线通道或锁孔56。驱动器51用于将箭猪结构锚定件推动穿过任何合适的植入物片而就位，以使组织与柔性的箭猪接合，并且使棘齿与组织接合并抵抗拔出。驱动器的远端，即远端51D，包括锚定件配合端57，其尺寸和形状被设计成与压紧杆55摩擦地接合。
虽然已经参照开发装置和方法的环境描述了装置和方法的优选实施例，但是它们仅仅是本发明原理的说明。各种实施例的元件可被并入到其它种类的每个中以获得那些元件与所述其它种类的组合的益处，且各种有益特征可单独或彼此组合地用于实施例中。在不背离本发明的精神和所附权利要求的范围的情况下，可以设计出其它实施例和配置。

Claims (6)

1.一种植入物锚定件，包括：
大致T形的本体，所述本体具有垂直地固定到杆的中心柱；
与所述中心柱接合的锁定索环。
2.如权利要求1所述的植入物锚定件，其特征在于，所述中心柱还包括多个棘齿。
3.如权利要求1所述的植入物锚定件，其特征在于，所述中心柱是缝合线。
4.如权利要求1所述的植入物锚定件，其特征在于，所述中心柱是条带。
5.如权利要求4所述的植入物固定件，其特征在于，所述条带还包括多个棘齿。
6.一种植入物锚定系统，包括：
大致T形的本体，所述本体具有垂直地固定到杆的中心柱；
与所述中心柱接合的锁定索环；以及
锚定件驱动器。
CN201880018357.9A 2017-03-16 2018-03-16 用于将片状材料固定到目标组织的系统和方法 Pending CN110418613A (zh)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US201762472131P 2017-03-16 2017-03-16
US62/472,131 2017-03-16
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