Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
  • A61B17/171—Guides or aligning means for drills, mills, pins or wires for external fixation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
  • A61B17/64—Devices extending alongside the bones to be positioned
  • A61B17/645—Devices extending alongside the bones to be positioned comprising a framework
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
  • A61B17/64—Devices extending alongside the bones to be positioned
  • A61B17/6458—Devices extending alongside the bones to be positioned with pin-clamps fixed at ends of connecting element
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
  • A61B17/66—Alignment, compression or distraction mechanisms

Definitions

• the invention relates to a monolateral fixative, in particular for orthopedic intervention.
• a fixer can find applications in the very varied fields of the reconstruction of broken objects.
• reference will be made to the specific field of application of orthopedics.
• a certain number of types of monolateral fixators are known, which generally present a certain number of drawbacks, the most important of which are: heaviness, while it is obviously advisable to lighten the patient as much as possible,
• the fracture is reduced and fixed on either side of the jaw fracture, by means of pins for example, said jaws being temporarily coupled by a jig. It is then necessary to remove the template and install the fixative.
• This system does not solve the problem of the reduction itself, nor the way in which the bone fragments are maintained during the installation of the template or during the removal of the templates and the installation of the fixator.
• fixator for reduced fractures since, on the one hand, the reduction is delicate, and, on the other hand, it is random to temporarily contain the fracture.
• fixators are most often used, not for fresh fractures, but for lengthening, pseudo-arthritis or the like.
• fixers are not designed to be combined with other elements, which can also be inconvenient in some cases.
• the fixation of certain bones may require the use of rings encircling the limb to be repaired, as is the case, for example, with the fixers described in patent application FR N. 8602818 filed on February 28, 1986 .
• the invention has set itself the aim of remedying these drawbacks in a simple, efficient and rational manner.
• the problem which the invention proposes to solve is to be able to work on unreduced fractures and to adapt the whole of the fixator as a function of the fractures, whatever the geometric shapes, while being capable of dealing with all cases. of figures, in particular by equipping a part of the fixer with relay elements of design determined according to the interventions to be carried out.
• the fixator comprises jaws capable of cooperating with fixing means cooperating with the elements to be fixed, at least one main body and intermediate elements shaped to fulfill a specific function, said jaws, said one or more body and said elements having arrangements to allow direct or via attached articulation members, their coupling at will to constitute a modular assembly at the level of its structure with capacity for angular orientation in different planes and / or linear adjustment.
• the articulation members are constituted by complementary parts with the capacity of angular movement over at least 180 ° and of disassembly with respect to each other to separate the body and / or the jaw and / or the elements at will.
• the complementary parts of the articulation members are of the male and female type connected by a removable common axis.
• the body receives free sliding at least one piston mounted free in rotation and one end of which is integral with one of the parts of the articulation members.
• fixer according to the invention taking into account the totally modular and removable nature of its constituent elements, makes it possible to cope with all the FR90 / 00251 m. 4 _.
• An important problem which makes it possible to solve the characteristics of the invention, is to be able to adapt the fixator having regard to the constraints which appear post-operatively, but do not necessarily appear intra-operatively. It is difficult to predict the forces that will apply at the level of the fixator when the patient is lying down. It follows that after having correctly positioned the fixator, there may appear a certain offset under the effect of the loads caused in particular by the weight of the patient.
• the fixator it is possible to equip the fixator with added elements capable of permanently adjusting said fixator.
• the added elements are fixed to a part of the body and / or of the jaws with a fixed angular position or with angular orientation capacity by means of the organs of 'coupling.
• the elements consist of turnbuckles of variable length.
• the elements consist of a bar or rod on which moves in successive increments, a cursor constituted by a sleeve sliding on the bar or rod and provided with locking means in position, a threaded ring cooperating with a threaded part of the sleeve, and being mounted free in rotation on a second sleeve also sliding on the bar or rod on which it can be locked in position by means, the movement of the assembly being made by locking in position of one of the sleeves, screwing or unscrewing between ring and threaded part, blocking the other sleeve, unlocking the first, and and so on.
• the turnbuckles comprise two parts mounted on a housing and for at least one, by means of a slider sliding transversely with respect to said parts along a worm screw rotating in a common housing, controlled in rotation by the exterior by rotation of the ends of the screws, thus ensuring a translational offset between said parts.
• Each slider has several fixing points for the turnbuckle parts.
• the housing is separated into two parts articulated on a common axis substantially parallel to the parts of the turnbuckle.
• Another problem which the invention proposes to solve lies in the jaws as such, avoiding inducing a line of weakness on the bone resulting from their method of fixation.
• the jaws have a series of aligned positions allowing the passage of screws or pins.
• the disadvantage of such a system is that, in certain cases, the drilling of aligned holes and even with a coplanar axis, in particular in a long bone, can initiate cracking between the different holes which can lead to another fracture. It is therefore essential to be able to have jaws that do not have aligned holes.
• Another problem which the invention proposes to solve and which is not resolved according to the state of the art, is to give the fixer a so-called property, active dynamics.
• it is possible to incorporate at least one elastic element allowing not a pure droop but a droop with a stress which can be dosed and used at the chosen time.
• Another problem which the invention proposes to solve is to correctly place the jaws on an unreduced fracture, namely a jaw above the fracture and a jaw below.
• the problem is to have a perfect alignment of the pins perpendicularly and horizontally on each of the parts above and below the fracture.
• a viewfinder has been designed for the installation of fixing means for fixer.
• a viewfinder in a block transparent to X-rays, are drilled right through at least one guide hole identified by a reticular device opaque to X-rays and passing through the axis of the holes.
• the reticular device includes platelets and series of coplanar wires.
• Figure 1 shows a first embodiment of the modular .fixer according to the invention applied to a femur.
• FIG. 2 is a plan view and in partial section of a fixator as shown in FIG. 1.
• FIGS. 4a to 4e represent the stages of mounting a fixator as shown in FIGS. 1, 2 and 3.
• Figure 5 is a perspective view of the main reticular part of the viewfinder according to the invention.
• Figures 6 and 7 are respectively a sectional view and an elevational view of an epiphyseal assembly produced on a tibia.
• Figures 8a to 8e show five variants of epiphyseal mounting on a tibia.
• Figures 9a to 9e show the different phases of mounting a fixator in an osteotomy case.
• Figures 10a to 10c are alternative arrangements for elongation.
• Figure 11 shows in section a cursor for bars.
• Figure 12 is a sectional view of a body fitted with a spring.
• Figure 13 is a sectional view of a basin equipped with a fixer according to the invention.
• Figure 14 is a sectional view of an embodiment of the jaw according to the invention.
• FIG. 15 shows in axial section a turnbuckle device with lateral offset according to the invention.
• FIG. 1 there is shown a first embodiment of single-sided fixing device according to the present invention. It comprises a body (1) in which slides and rotates a piston (2) whose external end has the female part (3) of a joint whose male part (4) is connected to a jaw (5). At the other end of the body (1), a plug (6) carries the female part of a joint (7), the male part (8) of which is - o -
• the jaws (5) and (9) enclose a number of pins, rods or screws 10 fixed in the bone under the conditions which will be described below.
• the body (l) has a piston (2) and a plug (6), in variants which will be described below, the body may not be fitted with one piston but two; each being capable of both sliding to adjust the length of the assembly and of rotating 360 °.
• the articulations (3), (4) and (7), (8) allow a movement of at least 180 ° around any axis perpendicular to the axis of the assembly, it is clear that, by relative to the body, the jaws (5) and (9) can take all the orientations in a solid angle covering at least one hemisphere.
• the body (1) has the shape of an elongated tube, preferably with flat faces so as to allow, on each of the faces, for example 4 faces, to drill holes (11) which will be seen to be useful in what follows.
• the body (1) is axially bored to allow the establishment of a piston (2), the other end being closed by a plug not shown in the figure, or two pistons (2) and (2 ').
• the piston (2 ') is shown here in section and it is noted that this piston is itself axially pierced at (12). The usefulness of this axial drilling will appear later in the description.
• the end of the pistons (2) and (2 ') is connected to the female parts (3) and (7) seen one in plan, the other turned 90 ° relative to the first.
• the male parts (4) and (8) are articulated by means of axes (13) and (14) mounted by any conventional system but possibly of so that they can be removed easily. It may be, in particular, an axis whose end is threaded so that it can be screwed into one of the wings of the female part and whose head has, for example, a hexagonal hole to allow it fixation.
• the male parts (4) and (8) thus articulated in the female parts (3) and (7) are screwed into the jaws (5) and (9) either directly, as is the case of the jaw (9) , by means of a thread and a locking nut (15), either by means of a threaded length adjusting part, as is the case for the jaw (5), with a locking nut (16 ) and a length adjusting nut (17).
• Each jaw (5) (9) is essentially composed of two jaws (5 ') and (5 ") (not visible in Figure 2), (9') and (9"), visible since the jaw is turned 90 ° relative to its axis by comparison with the jaw (5).
• These two parts are capable of coming together thanks to head screws having a polygonal hole (18), so as to allow the blocking between the jaws in grooves (19) provided for this purpose on either side of the interface between the parts (9 ') and (9 "), of rods, screws or pins such as (10) (figure 1).
• the grooves (19) provide holes for generally substantially circular shape which are aligned in the same plane, and could, without departing from the scope of the invention, affect other shapes, and in particular, for example, diamond sections to ensure better tightening.
• the jaws (5) and (9) may have a series of holes such as 20, preferably threaded, on one or other of the parts (5 '), (5 ") , (9 '), (9 "), as well as axial holes such as the one where the male parts (4) and (8) are mounted and an opposite hole ' at the other end of the macho ires, not shown in Figure 2.
• These different holes (20) allow the attachment of several jaws on top of each other, including - 10 -
• FIG. 3 we will find, with the same reference numbers, a certain number of elements of FIGS. 1 and 2.
• the body (1) is bored longitudinally so as to be able to receive, as has been mentioned above, a piston (2) and a plug (21) or two shorter pistons.
• the translational locking of the pistons (2) can be carried out by means of a screw (22) for example, engaged in the thickness of the body (1) in a position of quasi-tangency with the generatrices of the piston (s), said screw with a flat.
• This allows, in particular, to adjust the length of the assembly, that is to say that corresponding to a more or less protrusion of the piston outward.
• One can also provide a wedge (23) on the piston, to allow either to wedge it longitudinally thanks to a screw tightened in a threaded hole (24) and coming to press on the external wall of the piston (2), or to wedge another element of the kit on said piston.
• the holes (18) allow the threading of screws which tighten in the threaded part in the jaw (5 ") of the jaw (5).
• the holes (19) for the passage of the pins, rods or screw (10).
• a number of elements which can be screwed into the different holes (11) of the body (1) or the holes (20) of the jaws (5) or (9) ( Figures i and 2).
• These various elements can be constituted by threaded rods (26) equipped with a tightening nut, with seals such as (27) making it possible to rotate around the axis and having a jaw system (28) making it possible to grip a smooth bar, or a bar or threaded rod if the jaws (28) are themselves threaded.
• the part (29) with two equally threaded ends is a simple articulation allowing a rotation of 90 ° around the axis and which can be used to support several accessories, as will be described below.
• FIG. 4 we have shown the successive phases of setting up a modular fixing assembly in accordance with the preceding figures on a fractured tibia (30), the associated fibula (31) of which is also fractured.
• FIGS. 4a to e represent the phases of this setting up of the fixing assembly, the constituent elements of which are removable and easily interchangeable.
• the first phase consists of the respective positioning of the jaws (5) and (9) on the upper and lower parts of the tibia (30). To do this, a viewfinder as shown in FIG. 5 is used.
• This viewfinder essentially comprises a block (32) transparent to X-rays in which are drilled one or more guide holes (33) perpendicular to the upper and lower parallel faces of the block, or, in certain particular cases, of a given inclination.
• This transparent block (32) is held on its periphery by any suitable support device, preferably a frame provided with a handle to facilitate handling. The frame is not necessarily transparent to X-rays.
• Each of the holes (33) is defined axially with respect to a reticular system constituted, for example, by strips (34) (35) crossing on the axis of the one of the holes (33), and which they are not radiolucent.
• the viewfinder when the viewfinder is placed under fluoroscopy, it is possible to easily define whether the axis (33) is placed upright or if it is inclined. If it is placed upright, the image of each of the strips (34) and (35) must be reduced to a line whereas if the hole (33) is inclined relative to the fluoroscopy, the strips (34) and ( 35) appear all the wider as they are oblique to the sight, for example, in the form of parallelograms if these slats are rectangular.
• this sight will allow either to pass a needle and to orient it during its penetration in the bone, or to ensure a drilling, or to pass a hollow drill around the needle once the sight removed, either to pass a screw.
• the viewfinder may include a number of holes side by side (33) whose spacing and position corresponds to the spacing and position of the holes (19) of the jaws (5) and (9) (see FIG. 14) .
• rods (36) such as (26) shown in Figure 3, on which are fixed joints (37) having two elements, one of which is screwed at the desired distance on each of the rods (36) and the other in the form of a jaw allows the mounting and locking in position, by any suitable means, of a bar (38) of any conventional type.
• This bar (38) is, for example, constituted by two tubes (39) and (40) into which are screwed two parts with reverse threads of a part (41) having, in the central part, a fixed nut (41) by hexagon example. On either side of this fixed nut (41), two nuts (42) and (43) allow the piece (41) to be blocked respectively with respect to the tubes (40) and (39).
• jaws having, on their different faces, holes (20), it is possible to mount either a single bar (38) as shown in Figure 4, or two and even three bars. It will also be noted that the body (1) can, if desired, be replaced by bars such as (38) with adjustable length, and this with or without joints (3) and (7). The absence of joints obviously requires a coaxial mounting of all the jaws
• FIGS. 6 and 7 respectively represent such an assembly in section and in elevation.
• Figure (6) shows the arrangement of the different jaws, the jaw (9) being axially substantially parallel to that of the tibia (30) while the jaws (46) and (47) are transverse.
• FIG. 8a there are the three upper jaws (46), (9) and (47), the body (l) and the lower jaw (5).
• This is a centered monolateral system.
• We can also consider a three-bar system by fixing, in the holes (22) of the body (1) threaded rods (48) and (49), on which we mount the joints (50) and (51) equivalent to the joints (37) of Figure 4, as well as bars (52) and (53) which are fixed in the holes (20) of the jaws (46) and (47) ( Figure 8b). It is therefore a three-bar system, two of which mounted on the central body allow axis recovery.
• FIG. 8c a system with three bars is shown, two of which (52) and (53), respectively mounted between the jaw (5) and the jaw (46), the jaw (5) and the jaw (47).
• FIG. 8d a system with two bars has been shown on the center equivalent to that of FIG. 8b but without connection between the body (1) and the upper central jaw (9).
• FIG. 8e In Figure 8e is shown a two bar system, jaw to jaw, respectively mounted between the jaws (5) and the jaws (46) and (47), which corresponds to the assembly of Figure 8c but without the body (1 ).
• the assembly of FIG. 8c is the assembly, of course, the most rigid.
• Figure 9 there is shown the application of a device according to Figures 1 and 2, in an osteotomy, performed on the tibia (30) and fibula (31).
• the fixing assembly comprising the body (l) and the jaws (5) and (9) equipped with the joints (3) and (7), is mounted as indicated above with the difference that the upper jaw (9) is mounted transversely, which allows the mounting of a threaded rod (54), or any equivalent element such as a joint (55) extended by a threaded rod (56). Between this rod (56) and a threaded rod (57) fixed to the body (1) (FIG.
• FIG. 10a the use of a device such as that which is the subject of FIGS.
• an extension device (63) having elements (64) and (65) of respective fixings in the holes (22) of the body (l) and of the ring (23).
• This device (63) can be of any conventional type and have a screw along which a adjustable slider which allows the progressive spacing of the parts (65) and (64) and therefore the progressive exit of the piston (6) and, consequently, the elongation of the assembly.
• a rigging screw (60) used as in FIG. 9, but in the opposite direction, to progressively move the body (1) away from the jaw ( 9) thanks to a controlled sliding of the piston (6) in the body (l).
• FIG. 10c another variant represents an equivalent system in which the body (1) is replaced by a rigging screw (66) associated with a rigging screw (60) mounted as in FIG. 4.
• this device which makes it possible to move one element relative to another and can be used for elongation or reduction as in the cases of the preceding figures.
• this device On a bar (67), is mounted this device which essentially comprises, an externally threaded ring or sleeve (68) whose head (69) is polygonal, a nut (70) screwed onto a threaded seat (68) and mounted at free rotation on a sliding element or sleeve (71).
• the element or sleeve (71) can carry, in threaded holes such as (72) and (73), various elements in particular for fixing a jaw or a body, as has been the case in the previous figures relating to lengthening or shortening.
• the nut (70) and the part (71) can be fixed to the bar (67) by means of screw systems (73) and (74). If the nut is deeply screwed onto the threaded seat (68), and if the nut (70) is blocked by means of the screw (73), the nut (74) being released when the screw is unscrewed nut (70), the part (71) moves upwards with respect to FIG. 11. The screw (74) is then fixed, the screw (73) is unscrewed and the nut (70) is screwed back. The part (71) then remains fixed, the part (68) amount. By successive iterations, an upward advancement is thus allowed relative to FIG. 11 of the cursor assembly (68), (70), (71). This allows to move in correspondence any element fixed in one of the holes (72) or (73).
• FIG 12 there is shown a body equipped with a spring. “This in fact makes it possible to obtain what is generally called active dynamization. This means that internal stresses can be applied allowing, in particular, the exit of the piston (6) relative to the body (1).
• the piston had a central hole in which a shim (75) can be introduced, allowing a spring (76) to be wedged between this shim (75) and the plug (77).
• a spring (76) Depending on the length chosen for the shim (75) and the type of spring that can be calibrated at will, we will therefore obtain, on the piston (6), an expulsion constraint which can be perfectly controlled, whether in size and / or at the desired time. This can be used effectively . .
• FIG. 13 represents a new example of application of the device according to the invention.
• the jaws (5) and (9) here allow the closure of disjunctions or fractures of a pelvis thanks to the modular nature of the devices according to the invention.
• the threaded rods (78) are mounted on these jaws at the end of the jaw (5) and (79) on the side of the jaw (9).
• Two joints (80) and (81) screwed at a desired distance to the respective threaded rods (78) and (79) allow the mounting of a threaded bar (82) in the joint (81) and of a turnbuckle (83 ) in the joint (80).
• the bars (82) and (83) are themselves connected by a joint (84), screwed on the one hand on the end of the bar (82) and on the other hand enclosing the bar (83).
• FIG. 14 there is shown a preferred embodiment of the jaws such as (5) or (9).
• the holes (19) are not placed in the same plane but are offset. Under these conditions, the pins, screws or rods attached to it are not in the same plane and are not likely, by successive perforations, to cause a cracking of the bone which may translate into an aggravation or even a new incident.
• the jaw shown in FIG. 14 has, of course, moreover the same characteristics as the previous jaws and, in particular, the fixing holes (20) allowing mounting with other jaws or with other elements.
• FIG 15 is shown in section a particular type of turnbuckle intended to ensure, when fixed between two parts to provide a lateral offset.
• This turnbuckle with lateral offset consists essentially of a body (85) in which two sliders (86) and (87) can slide transversely along worms (90) and (91) rotated by polygonal heads (92), (93), (94) and (95). These screws (90) and (91) are free to rotate, but its locked in translation by any suitable device.
• bars (88) and (89) are respectively mounted, at least one of which may have an adjustable length and be constituted by a turnbuckle.
• a turnbuckle it is obvious that if an apparatus such as that shown in FIG. 15 is mounted, instead of a simple turnbuckle, it is possible to offset laterally a jaw for example or any other element with respect to another or in particular to turn it angularly or in any other direction by playing on the joints and the rotation of the pistons in the * bodies. Such a side turnbuckle can thus be used for rotation adjustment when reducing a fracture.
• the sliders (86) and (87) may have a series of holes, preferably threaded, which allows, depending on the holes chosen to fix the various rods or bars, to change the range of possible spacings.
• this turnbuckle in Figure 15 into two independent parts, but mounted for rotation on a common axis, for example perpendicular to two threaded rods, which makes it possible to create an additional angular gap between them and allows not only a shift along the screws (90) and (91), but a shift in a plane according to polar coordinates (pivoting angle and distance from translation on the screws). It is also possible to envisage only one cursor, the other being replaced by a simple attachment to the housing of the assembly.
• fixers in accordance with the present invention is, because of their modular nature and the ease of assembly and disassembly, of being able to be associated with most of the existing fixers on the market. This can be useful in the case of complex arrangements.
• fixative allowing to work on unreduced fractures and to build any and infinite geometrical figures allowing to adapt the fixative to the different pathological cases, as well in per-operative as in post-operative.
• the dynamic nature of the fixator taking into account the sliding mounting of the pistons in the body against compression means allowing at a moment in the history of the fracture, to release certain elements of the fixator and to allow the weight of s 'express naturally.
• fixative it is possible intraoperatively to act on fractures initially displaced and to adjust certain post-operative elements of the fixative in the post-operative phase. adapt to actual conditions of use. This possibility __. -

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• Health & Medical Sciences (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Biomedical Technology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Engineering & Computer Science (AREA)
• Heart & Thoracic Surgery (AREA)
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• General Health & Medical Sciences (AREA)
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• 1989
  • 1989-04-11 FR FR8904771A patent/FR2645428A1/fr not_active Withdrawn
• 1990
  • 1990-04-10 EP EP19900907134 patent/EP0423299A1/de not_active Withdrawn
  • 1990-04-10 JP JP50694790A patent/JPH03505295A/ja active Pending
  • 1990-04-10 WO PCT/FR1990/000251 patent/WO1990011727A1/fr not_active Application Discontinuation
  • 1990-04-10 CA CA 2031302 patent/CA2031302A1/fr not_active Abandoned

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