EP1942818A2 - Dispositif antiretour debrayable pour distracteur costal - Google Patents

Dispositif antiretour debrayable pour distracteur costal

Info

Publication number
EP1942818A2
EP1942818A2 EP06808232A EP06808232A EP1942818A2 EP 1942818 A2 EP1942818 A2 EP 1942818A2 EP 06808232 A EP06808232 A EP 06808232A EP 06808232 A EP06808232 A EP 06808232A EP 1942818 A2 EP1942818 A2 EP 1942818A2
Authority
EP
European Patent Office
Prior art keywords
rods
pawl
toothed wheel
distraction
tooth
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP06808232A
Other languages
German (de)
English (en)
French (fr)
Inventor
Johann Robin
Brice Sennequier
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siguler Guff Distressed Oppurtunities Fund III LP
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of EP1942818A2 publication Critical patent/EP1942818A2/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/707—Devices acting on, or attached to, a transverse process or rib; Tools therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B17/66—Alignment, compression or distraction mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7014—Longitudinal elements, e.g. rods with means for adjusting the distance between two screws or hooks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7011—Longitudinal element being non-straight, e.g. curved, angled or branched
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A61B17/8076—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for the ribs or the sternum
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B2017/681—Alignment, compression, or distraction mechanisms

Definitions

  • the invention relates to an improvement of the tensioning device that is placed between the ribs or vertebrae of a child whose growth is not completed, and which has deformities or malformations including the trunk and spine . i ⁇
  • the surgeons of this type of intervention use a distraction device. It will correct both congenital malformations and those that appear during growth, without prohibiting or blocking them.
  • the present invention improves, by its new means
  • This invention thus presents new means improving the patented invention published under No. FR 2794357 which makes it possible to manage the evolution of the deformation of the trunk of a child
  • This invention of the prior art comprises: two rods mounted on a central adjustment means provided with a small hole
  • the present invention goes even further in non-invasive surgery at the time of setting the device that follows the growth. Indeed, the present invention will allow to be able to correct the deformation more quickly, thanks to an even smaller opening to pass a key of a few millimeters in diameter to access the adjustment of the central part, which requires only a small very minimally invasive procedure performed under local anesthesia; it relegates in the technological background the inventions of the prior art.
  • Patent CA 2451977 discloses a device comprising staggered holes in which there is positioned a spring blade which provides a locking device in one direction. There is no possible disengagement for this device, which is very disadvantageous during its implementation or its maintenance, because this distraction device comprises two sliding plates which deviate from one another and which are blocked by a cam located at the end of a spring blade coming to lodge in a hole, thus preventing the recoil of the plates. None is planned to disengage such a device and operate in the opposite direction to facilitate its implementation. In all the following documents of the prior art:
  • Figure 1 plate 1/5 Campbell device (very prior art)
  • Figure 2 Plate 1/5 first Costal distractor device (in a recent prior art)
  • Figure 3 plate 2/5 isometric view of the new device Figures 4,5, 6 and 7 plate 3/5 show several views of the new device object of the invention.
  • Figure 4 Sectional view of the central inner portion of the adjustment device with non-return pawls and disengaged the toothed wheel which can rotate in both directions.
  • Figure 5 view of the central inner part of the new device with the presence of a small diameter intervention tool at the time of implantation of the device. .
  • Figure 6 sectional view of the central inner part of the new adjustment device with ratchets allowing only one direction of rotation.
  • Figure 7 sectional view of the central inner portion of the new adjustment device with pawls blocking the rotation of the toothed wheel in one direction and allowing its rotation in the other direction.
  • Figure 8 device with presentation of mini-tools Figures 9 and 10 views of the internal means to the device in locked and unlocked position
  • the present device 4 improving the distraction device of the first invention Fortin FR2794357 is a disengageable anti-return device which comprises known means and new means, object of the present improvement.
  • the known means corresponding to the prior art Fortin invention included an adjusting device 300 having a central means 31 itself composed of a mini-casing 310 inside which rotates a gear wheel 311 centered on 310 and having means 31 for rotating.
  • This means can be a hole for the engagement of a hexagonal key type tool 321, or any other equivalent means, its only need is to fit into the toothed wheel 311.
  • this mini-casing 310 are positioned on each side of the wheel 311 two rods 35 and 36 which can be translationally on demand and in any direction through the central adjustment means 31 receiving the mini-tool 321.
  • the rods 35 and 36 have a toothed portion followed by a preferably smooth portion, which makes it possible to very easily and symmetrically engage the toothed parts, then allowing meshing in the wheel 311.
  • These rods are attached to the bones by hooking means known to those skilled in the art.
  • the new device 4 comprises a new central mini-casing of adjustment 410 including the known means of the prior art: a toothed wheel 311 centered on the casing 410 and having at one end of its axis a means 312 for rotating the toothed wheel 311 which allows the advancement of each rod 35 and 36 in an opposite direction, in distraction or in compression.
  • the rods will move in one direction, that of growth, thanks to the presence of new means that are at least one pawl 37 having a tooth 370 always in contact with the gear wheel 311 when the device is activated (FIGS. 6 and 7), said pawl 37 being:
  • the housing 410 which is preferably a rigid rib, serving as a stop for the pawl and containing the elastomeric block 373. It will preferably be placed two pawls 37 inverted ( Figure 4, 5, 6, 7) located from and other of said toothed wheel 311 for supporting the mechanical loads transmitted to the device via the rods 35 and 36; said pawls 37 each comprising a tooth 370 pivotable about an axis 371, these identical pawls 37 can take three positions: first disengaged position ( Figure 4 and 5): the pawls blocked by a screw or a pin 375 are not in contact of the toothed wheel, the rods 35 and 36 can freely translate in both directions to facilitate the installation of the device 4 by the operator.
  • This position is obtained by rotating in the direction that allows to escape the pawl of the toothed wheel 311, this maneuver is performed simultaneously on the one hand with the mini-tool 321 actuating the gear wheel 311 by the orifice 312 adapted to the end of the tool and secondly with another tool such as a screwdriver actuating the rotation of the pawl 37 by its axis 371 accessible above the housing 410.
  • the establishment of screws or of mini-pins 375 between the piece 374 and the tooth 370 of the pawl allows compressing the elastomer block 373 to prevent the return of the pawl 37 to the toothed wheel 311, the rods 35 and 36 can therefore freely translate in both meaning.
  • This operation can be performed before the device 4 is implanted.
  • the disengaged position is fundamental for the implantation of the distraction device. The operator indeed needs to translate the rods with rounds to optimize its position and its fixation on the bones.
  • the device 4 having been hooked to the bones, the means 375 are completely removed, which has the effect of decompressing the viscoelastic block 373 which will act as a restoring force and by pressing the tooth 370 against the toothed wheel 311
  • the operator rotates the toothed wheel 311 to distract the device 4 in the only possible direction by causing the elastomeric pad 373 to be compressed.
  • the gear wheel 311 drives the rods 35 and 36 that translate in this direction, by separating the means of clashes with the bones.
  • Third position Auto locking of the device As soon as the mini-tool 321 is removed, the viscoelastic blocks 373 (acting as a restoring force) push back by decompressing the tooth 370 against that of the toothed wheel 311.
  • the tensioned rods 35 and 36 exerted by the bones will drive the toothed wheel 311 in the opposite direction to the growth, said toothed wheel 311 will in turn drive the tooth 370 of the pawl until said pawl 37 is abutting on the piece (or rib) 374, preventing loss of distraction.
  • the operator can easily distract the device 4. It is sufficient to make a very small incision of a few mm in order to have access to the orifice 312.
  • the device 4 automatically prevents any return back of the rods 35 and 36.
  • the new device 5 comprises a single pawl or "double ratchet" 376 (FIG. 9) which replaces the two pawls 37; this double pawl 376 does not act on the toothed wheel 311.
  • This pawl 376 has two opposite teeth 376 a and b placed symmetrically; this pawl pivots about an axis 379 which allows its disengagement and clutch against the toothed portions 350 and 360 of the rods 35 and 36.
  • the releasable non-return device 5 also comprises two viscoelastic blocks 378a and b located on each side of the pawl 376 acting as a restoring force exerted on the teeth 376a and b by pressing them onto the teeth of the parts fluted
  • the viscoelastic blocks 378a and b may be compressed by the rotation of the pawl about its axis 379, which allows the rods 35 and 36 to be able to translate in both directions by rotation of the toothed wheel 311 (FIG. 12).
  • the viscoelastic blocks can be held in permanent compression by means of a tool 380 introduced into the impression 381 of the axis 379 (FIG. 8), which allows the rods 35 and 36 to translate freely in both directions.
  • the device 5 is then disengaged. This feature is used to set up the distraction device.
  • the toothed wheel 311 unlike the previous versions has no connection with the double pawl 376, it only has the function of driving the rods 35 and 36. while the pawl 376 allows the translation of the rods 35 and 36 in one direction when he is engaged, and in both directions when he is disengaged.
  • the viscoelastic blocks 378a and b are housed in rigid compartments 382 and 383 located inside the casing 411.
  • compartments 382 and 383 also serve as a stop for the ratchet 376.
  • the clutch is as follows:
  • the teeth of the pawl 376a and b are each pressed against at least one of the teeth of the fluted portions 350 and 360 of the rods 35 and 36 which, moving in the direction of elongation will compress the viscoelastic blocks 378a and b, until at least one tooth 376a or b pawl 376 comes to press against one of the following teeth or grooves 350 and 360 of the rods 35 and 36 which can to advance step by step in one direction.
  • the teeth 376a and b drive the pawl 376 to the stops 382 and 383 (FIG. 11).
  • the device 5 automatically prevents the rods from moving in this direction.
  • the toothed wheel 311 has no action on the teeth 376a and b of the double pawl 376.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Neurology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
EP06808232A 2005-10-06 2006-10-04 Dispositif antiretour debrayable pour distracteur costal Withdrawn EP1942818A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR0510207A FR2891727B1 (fr) 2005-10-06 2005-10-06 Dispositif d'autoblocage perfectionne pour dispositif de distraction costal
PCT/FR2006/002225 WO2007042638A2 (fr) 2005-10-06 2006-10-04 Dispositif antiretour debrayable pour distracteur costal

Publications (1)

Publication Number Publication Date
EP1942818A2 true EP1942818A2 (fr) 2008-07-16

Family

ID=36676476

Family Applications (1)

Application Number Title Priority Date Filing Date
EP06808232A Withdrawn EP1942818A2 (fr) 2005-10-06 2006-10-04 Dispositif antiretour debrayable pour distracteur costal

Country Status (10)

Country Link
US (1) US20100004697A1 (https=)
EP (1) EP1942818A2 (https=)
JP (1) JP2009511101A (https=)
KR (1) KR20080091080A (https=)
CN (1) CN101312693A (https=)
AU (1) AU2006301135A1 (https=)
CA (1) CA2624888A1 (https=)
FR (1) FR2891727B1 (https=)
IL (1) IL190638A0 (https=)
WO (1) WO2007042638A2 (https=)

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WO2007042638A3 (fr) 2007-05-31
KR20080091080A (ko) 2008-10-09
WO2007042638A2 (fr) 2007-04-19
CN101312693A (zh) 2008-11-26
FR2891727B1 (fr) 2008-09-26
IL190638A0 (en) 2008-11-03
US20100004697A1 (en) 2010-01-07
JP2009511101A (ja) 2009-03-19
FR2891727A1 (fr) 2007-04-13
AU2006301135A1 (en) 2007-04-19
AU2006301135A2 (en) 2008-06-05
CA2624888A1 (fr) 2007-04-19

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