EP3188694A1 - Endoprothèse pour la vertébroplastie percutanée - Google Patents

Endoprothèse pour la vertébroplastie percutanée

Info

Publication number
EP3188694A1
EP3188694A1 EP15778957.9A EP15778957A EP3188694A1 EP 3188694 A1 EP3188694 A1 EP 3188694A1 EP 15778957 A EP15778957 A EP 15778957A EP 3188694 A1 EP3188694 A1 EP 3188694A1
Authority
EP
European Patent Office
Prior art keywords
stent
cross
expanded state
sectional shape
shape
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Withdrawn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
EP15778957.9A
Other languages
German (de)
English (en)
Inventor
Harald Fischer
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.)
OPTIMED MEDIZINISCHE INSTRUMENTE GmbH
Original Assignee
Variomed AG
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 Variomed AG filed Critical Variomed AG
Publication of EP3188694A1 publication Critical patent/EP3188694A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • 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
    • A61F2/28—Bones
    • A61F2/2846—Support means for bone substitute or for bone graft implants, e.g. membranes or plates for covering bone defects
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7097—Stabilisers comprising fluid filler in an implant, e.g. balloon; devices for inserting or filling such implants
    • 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
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/885—Tools for expanding or compacting bones or discs or cavities therein
    • A61B17/8852—Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc
    • A61B17/8858—Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc laterally or radially expansible
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30092—Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
    • A61F2002/30115—Rounded shapes, e.g. with rounded corners circular circular-O-shaped
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30125—Rounded shapes, e.g. with rounded corners elliptical or oval
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30138—Convex polygonal shapes
    • A61F2002/30153—Convex polygonal shapes rectangular
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30138—Convex polygonal shapes
    • A61F2002/30154—Convex polygonal shapes square
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30205—Three-dimensional shapes conical
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30273—Three-dimensional shapes pyramidal
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30317—The prosthesis having different structural features at different locations within the same prosthesis
    • A61F2002/30327—The prosthesis having different structural features at different locations within the same prosthesis differing in diameter

Definitions

  • the present invention relates to a stent for percutaneous vertebroplasty having a substantially tubular body which is convertible from a compressed state to an expanded state, the wall of the tubular body providing a plurality of expansion in both the longitudinal and circumferential directions of the stent Has openings.
  • Such stents are used in percutaneous vertebroplasty for the treatment of vertebral body fractures.
  • the stents are introduced percutaneously in a minimally invasive manner via an application cannula into the vertebral body to be treated, wherein the stent is in its compressed state. After the stent has been placed within the collapsed vertebral body, which is usually done by X-ray observation, the stent is transferred from its compressed state to its expanded state.
  • the stent is placed inside the vertebral body so that when the stent is expanded, the collapsed vertebral body expands accordingly until its original vertebral body height is restored. At the same time a cavity for the subsequent injection of bone cement in the vertebral body is created by the expansion of the stent, whereby a final stabilization of the reconstructed vertebral body occurs.
  • a problem with the known stents is that, in some cases, further fractures of the vertebral body may occur due to the forces occurring during expansion of the stent. It is an object of the present invention to provide a stent with which the occurrence of additional fractures during introduction and expansion of the stent can at least be reduced. Based on a stent of the type mentioned above, this object is achieved in that the stent, at least in the expanded state has a deviating from the circular cross-sectional shape.
  • stents for percutaneous vertebroplasty usually have a circular cross-sectional shape both in the compressed and in the expanded state.
  • the stent is made for example of a tubular body with a small diameter (for example, 0.5 to 3 mm), are cut in the closed body wall openings, for example in slot or other shapes. Upon expansion of the stent, these openings are widened to form a stent of increased diameter (e.g., 0.5 to 3 cm). Due to the originally tubular shape of the basic body with a circular cross-section, the circular cross section usually remains in the expanded state, whereby only the diameter of the circular cross section increases.
  • stents which consist of interwoven, welded or otherwise interconnected wire elements, so that here the openings are not formed by appropriate cutting operations, but by existing between individual wire loops clearances. When expanding, these free spaces are also widened, so that the stent can be transferred from its compressed state to its expanded state.
  • Such stents also usually have a circular cross-section, both in the compressed state and in the expanded state, since stents have always been developed for vessels with a circular cross-section. According to the invention, it has been found that the observed additional fractures during expansion of the stent are often caused by the fact that the contact area between the stent and the vertebral body during expansion or after expansion is essentially limited to two linear contact areas.
  • the stent at least in the expanded state, has a cross-sectional shape deviating from the circular shape, it is possible to provide a stent in which the bearing surface of the vertebral bodies is enlarged upon expansion of the stent or at least after expansion has taken place.
  • the force acting on the vertebral body during and after expansion of the stent is distributed over a larger area, so that the risk of additional fractures of the vertebral body can be significantly reduced.
  • the stent in the compressed state has a circular cross-section, which is changed only upon expansion of the stent in an enlarged, non-circular cross-section.
  • This embodiment has the advantage that the stent can be applied in the compressed state with a circular cross section on a Ein 1500katheter, which usually also has a circular cross-section, whereby on the one hand, the total diameter of the delivery catheter with attached stent can be minimized and on the other with no special catheter non-circular cross section is needed.
  • the insertion through usually a circular inner lumen owning Application needles is simplified in such a configuration.
  • the application needles may have a minimum inner lumen adapted to the circular cross-section of the compressed stent.
  • the stent has at least one flattened longitudinal side, in particular two, three, four or more flattened longitudinal sides, at least in the expanded state.
  • the stent has two flattened longitudinal sides, which are arranged opposite one another. The flattened longitudinal sides produce the desired enlarged bearing surface between the stent and the inner surfaces of the vertebral body during expansion of the stent.
  • the flattened longitudinal sides can be formed essentially flat or slightly curved.
  • the curvature must not be so strong that the support surface between the stent and the vertebral body, as in the known stents with a circular cross section, is reduced to a linear support area.
  • the stent has a cross-sectional shape deviating from the circular shape even in the compressed state, it can have flattened longitudinal sides in the compressed state which correspond to the flattened longitudinal sides in the expanded state.
  • the stent at least in the expanded state, has a substantially polygonal, rectangular, substantially square or oval cross-sectional shape.
  • the cross-section in the compressed state is preferably circular, but in principle may also correspond to the polygonal, rectangular, square or oval cross-section of the expanded state.
  • the polygonal, rectangular, square or oval cross-sectional shape is not to be understood mathematically exact.
  • the sides of the polygonal, rectangular or square cross-sectional shape need not be exactly rectilinear, but may also be slightly curved, so that correspondingly slightly curved bearing surfaces are formed, as already described in the preceding paragraph.
  • This also applies to the corners of the polygonal, rectangular or square cross-sectional shape, which need not be formed exactly at right angles, but may also include a slightly different angle of 90 ° and / or in particular may also be rounded.
  • the stent in the expanded state has a substantially rectangular, in particular substantially square, cross-sectional shape and four flattened longitudinal sides, of which two in each case substantially parallel to each other, are arranged opposite one another.
  • the two opposite longitudinal sides which come into contact with the upper and lower inner surfaces of the vertebral body during expansion, thus form surface-optimized, pressure-minimized abutment surfaces of the stent.
  • the two perpendicular sides form force-optimized erection sides of the stent.
  • the stent has the cross-sectional shape deviating from the circular shape at least over a partial region of its longitudinal extension, in particular in a central region.
  • the deviating from the circular shape cross-sectional shape is to be present in particular in the portion of the stent, which comes in supportive contact with the vertebral body during expansion of the stent to form the required contact surface between stent and vertebral body.
  • the stent may in particular have a circular cross-sectional shape at one or both ends of the stent, as long as the substantial force transmission between the stent and the vertebral body takes place over the partial region with a cross-sectional shape deviating from the circular shape.
  • the stent comprises, at least in the expanded state, an end which tapers in the axial direction.
  • the other end of the stent can advantageously also be designed to be tapered.
  • the configuration of the taper ie, for example, the corresponding cone angle and the length of the tapered region, at both ends the same or, as needed, be different.
  • the tapered ends or the tapered end of the stent may be substantially conical, frusto-conical, pyramidal or pyramidal-truncated.
  • the formation of an end which tapers in the axial direction ensures that the stent, in the expanded state, is provided with a substantially "closed" end at the end is.
  • the tapered end prevents or at least reduces undesired lateral flow of the bone cement introduced into the stent after expansion of the stent.
  • the taper can be designed such that one or both ends of the stent are substantially closed after expansion of the stent or are formed only with a relatively small opening in order to prevent or reduce the undesired flow of the bone cement.
  • the other end of the stent has substantially the same cross-sectional shape and / or the same cross-sectional area as the middle region of the stent.
  • a stent according to the invention may thus have a tapered end, which causes a closed or almost closed configuration of this end of the stent, while the other end is provided with an end opening which either corresponds to the clear width of the stent in its central region or only slightly smaller is.
  • both ends of the stent have substantially the same cross-sectional shape and / or the same cross-sectional area as the middle region of the stent.
  • the stent can thus have a uniform width and height or a uniform cross-sectional shape in the expanded state, so that the body of the stent in the expanded state is substantially parallelepiped-shaped with open end faces.
  • the stent can be designed as a balloon-expandable stent.
  • the stent made of stainless steel, titanium or other biocompatible material, in particular metal or plastic. It is also possible to use a biodegradable material, in particular a biodegradable metal or polymer.
  • Such a balloon expandable stent is introduced with a balloon catheter into the vertebral body and expanded by appropriate dilation of the balloon from its compressed to its expanded state with simultaneous expansion of the buried vertebral body. After restoration of the original vertebral body height, the balloon catheter is removed and the stent filled with bone cement so that the stability of the stent and thus of the vertebral body is enhanced in addition to the stability introduced by the stent.
  • the stent is designed as a self-expanding stent.
  • the material of the stent comprises a shape memory material, for example a shape memory alloy (memory metal), in particular nitinol, or a shape memory plastic (shape memory polymer).
  • shape memory material for example a shape memory alloy (memory metal), in particular nitinol, or a shape memory plastic (shape memory polymer).
  • shape memory material for example a shape memory alloy (memory metal), in particular nitinol, or a shape memory plastic (shape memory polymer).
  • the stent may consist entirely of a corresponding shape-memory material or only substantially of such a shape-memory material. Even with a self-expanding stent, the use of a biodegradable dierbaren material, in particular a biodegradable metal or polymer, as a stent material possible.
  • both a balloon expanding stent and a self-expanding stent may have an additional biocompatible coating.
  • the coating may be formed so that only the material of the tubular body is encased, so that when expanding the stent, the expansion ensuring openings remain free.
  • the tubular body is covered with a flexible coating, such as a foil, which expands as the stent expands, thereby covering the openings in the wall of the tubular body. In this way, a dense stent, i. a stent with a tight outer wall, are formed.
  • FIG. 1 is a perspective view of a stent for percutaneous vertebroplasty according to the prior art
  • FIG. 2 is a simplified perspective view of the stent of FIG. 1,
  • FIG. 3 shows a cross section along the section line AA of Fig. 2nd 1 in the compressed state, a vertebral body according to FIG. 4 with an expanded stent, another compressed vertebral body with two inserted stents according to FIG. 1 in the compressed state, the vertebral body according to claim 6 with expanded Stents, a schematic perspective view of a stent according to the invention with a square cross section, a cross section through the stent of FIG. 8, a slightly modified cross-sectional shape, a schematic representation of a compressed vertebral body with inserted stent of FIG. 8 in the compressed state, the vertebral body of FIG. 1 1 with expanded stent, a schematic view of a compressed vertebral body with two inserted stents of FIG. 8 in the compressed state,
  • FIG. 14 shows the vertebral body of FIG. 13 in the expanded state
  • FIG. FIG. 15 shows a schematic side view of the stent according to FIG. 8.
  • 19 to 21 are schematic representations of various cross-sectional shapes of a stent according to the invention.
  • stent 1 shows a stent 1 with a tubular body 2 having a lattice structure, so that in the wall of the body 2 a multiplicity of openings 3 which are repeated both in the longitudinal direction and in the circumferential direction of the stent 1 are formed.
  • Fig. 2 shows the same stent 1 in a simplified perspective view, from which it can be seen more clearly that the stent 1 has a circular cross-section.
  • the circular cross section of the stent 1 is identical over the entire length of the stent 1, so that the body 2 forms a cylinder jacket with openings 3.
  • the openings 3 are diamond-shaped and formed by the stent 1 is transferred from a not shown compressed state with significantly reduced diameter in the expanded state shown in Fig. 1 and Fig.
  • the openings 3 are widened to the expansion to enable.
  • the openings 3 may be formed, for example, as slit-shaped openings which extend parallel to each other in parallel in the axial direction, wherein adjacent slot-shaped openings are arranged alternately offset from each other in the circumferential direction.
  • the circular cross-section of the stent 1 is shown in Fig. 3 again in a simplified form.
  • the stent according to FIGS. 1 to 3 is a stent for percutaneous vertebroplasty known from the prior art.
  • FIG. 4 such a stent 1 in the illustrated compressed state, ie, with a reduced diameter, is inserted into the vertebral body cavity 4 of a collapsed vertebral body 5.
  • the insertion takes place in a known manner by means of a Ein Fabric Sciencekatheters.
  • the stent 1 is expanded after successful placement, for example via a balloon catheter in its expanded state shown in Fig. 5. Due to the circular cross-section of the stent 1, this comes into contact with the inner sides 6, 7 of the vertebral body 5 only via line-shaped support points 8, 9, via which the entire erection force is introduced into the vertebral body 5 as the stent expands further. Therefore, in the region of the linear support points 8, 9, an additional break point may arise during the expansion of the stent 1, as indicated by dashed lines 10, 11.
  • Fig. 8 shows a stent 12 according to the invention in a likewise simplified perspective view, which, in contrast to the previously described stent 1 has a square cross section, as shown schematically in Fig. 9.
  • the stent 12 according to the invention has a cross-sectional shape deviating from the circular shape, and in particular two opposite, flattened longitudinal sides 13, 14, which have enlarged contact surfaces form, as will be explained in more detail below.
  • the other two opposite longitudinal sides 25 of the stent 12 are also formed corresponding flattened.
  • the cross-section of the stent 12 does not have to be exactly mathematically quadratic, but the side faces may be slightly curved in cross-section and the corners may be rounded, as long as the flattened longitudinal sides 13, 14, Form support surfaces that are not only in linear contact with the inner sides 6, 7 of the vertebral body 5, but form with this flat contact areas.
  • Fig. 1 the stent 12 according to the invention is used in its compressed state in the vertebral body cavity 4 of the collapsed vertebral body 5. If the stent 12 is transferred from its compressed state into the expanded state shown in FIG. 12, then the two flattened longitudinal sides 13, 14 are pressed flat against the inner sides 6, 7 of the vertebral body 5, so that when expanding the stent 12 the vertebral body transmitted force is distributed over a larger area and thus the vertebral body 5 is not loaded linear as in conventional stents. This minimizes the risk of an additional fracture of the vertebral body 5 occurring during expansion of the stent 12 and expansion of the vertebral body 5.
  • a stent which has a circular cross-section in the compressed state
  • the cross-sectional shape during expansion relatively early from the circular shape in a deviating from the circular cross-sectional shape, in particular with opposite, flattened Long sides, changes. This ensures that the force transferred to the vertebral body during expansion is distributed over a larger area during the entire expansion process or at least during most of the expansion process.
  • the cross-sectional shape of the stent changes only shortly before or when reaching the expanded state in a shape deviating from the circular shape, so that substantially only the final support of the expanded vertebral body takes place over enlarged surfaces.
  • the total contact area and thus the total area for transmitting force from the stents 12 to the vertebral body 5 is further increased, so that the risk of an additional fracture of the vertebral body 5 can be further reduced.
  • the stents 12, deviating from the view of FIG. 13, in the compressed state have a circular cross-section.
  • the stents 12 in the compressed state of FIG. 6 and in the expanded state shown in FIGS. 8 to 10 and 14 may be formed.
  • the expansion of the stent 12 can take place via a balloon dilatation.
  • the stent 12 is a self-expanding stent that is automatically transferred from its compressed state to its expanded state due to its formation from a shape memory material, such as nitinol, upon withdrawal from body temperature.
  • the self-expanding stent in its manufacture in the compressed state circular cross-section and in the expanded Condition be impressed at least partially rectangular or square cross-section.
  • FIGS. 15 to 18 show diagrammatic side views of differently designed stents according to the invention.
  • FIG. 15 shows a side view of the stent 12 from FIG. 8, wherein, as in the following figures, only the outline of the side view is shown. Since the stent 12 of FIG. 8 has a cuboid body, the outline of the side view forms only the rectangle shown in FIG. Both the cross-sectional shape and the cross-sectional size are therefore identical for this stent over the entire length of the stent.
  • FIG. 16 shows the outline of a side view of a modified stent 15.
  • the main part 15 is adjoined by a conically tapered end 17, which opens into an end opening 18 of the stent 15.
  • the opposite end opening 19 of the stent 15, however, has a clear width, which corresponds to the inner lumen of the stent 15 in its main part 16.
  • the introducer for inserting and depositing the stent 15 can be guided through the larger end opening 19, so that after the stent has been deposited, the introducer catheter can be pulled out of the stent 15 without problems. Furthermore, bone cement can be injected into the interior of the stent 15 in a simple manner via the larger end opening 19 in order to improve the stability of the stent 15 and thus of the expanded vertebral body 5.
  • the tapered end 17 of the stent with the reduced frontal opening 18 prevents the bone cement introduced into the interior of the stent 15 from escaping from the distal side of the stent 15 again.
  • the tapered end 17 can for example, truncated pyramidal or frusto-conical, ie be formed with a square or rectangular cross-section, with a polygonal cross-section or with a circular cross-section. This also applies to the below-described tapered sections of the subsequent stents.
  • the stent 20 shown in a side view in Fig. 17 differs from the stent 15 of Fig. 16 only in that the tapered end 17 forms not an open but a closed end of the stent 20. This completely or at least largely prevents leakage of the bone cement injected into the stent 20.
  • a stent 21 according to the invention can have two tapered ends 17, 22.
  • the two tapered ends 17, 22 may form different end openings 18, 19 of the stent and also have different cone angles.
  • the two tapered ends 17, 22 may also be identical.
  • the stent can be retracted back into the insertion catheter if necessary, for example in the case of incorrect positioning, and then repositioned.
  • stents shown have in common that, at least in the expanded state, they have a cross section deviating from the circular shape and, for example, have a square cross section, as shown in FIGS. 9 and 10. Deviating from the square cross section, stents according to the invention may also have, for example, cross-sectional shapes, as shown in FIGS. 19 to 21.
  • Fig. 19 for example, a hexagonal cross section of a stent is shown, which in turn two opposite, flattened longitudinal sides 13, 14 are realized. The same applies to the cross-sectional shape in Fig. 20, in which the opposite, flattened longitudinal sides 13, 14 are interconnected by curved side surfaces 23, 24.
  • Fig. 21 it is shown that the cross section of a stent according to the invention can also be formed as an elongated rectangle, so that, for example, as shown in Fig. 14, two juxtaposed stents 12 can be replaced by a single stent according to the invention with a larger width.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
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  • Surgery (AREA)
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  • Heart & Thoracic Surgery (AREA)
  • General Health & Medical Sciences (AREA)
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  • Molecular Biology (AREA)
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  • Materials For Medical Uses (AREA)

Abstract

L'invention concerne une endoprothèse destinée à la vertébroplastie percutanée. L'endoprothèse comprend un corps sensiblement tubulaire qui peut passer d'un état comprimé à un état déployé. La paroi du corps tubulaire comporte, tant dans le sens longitudinal que dans le sens circonférentiel de l'endoprothèse, une pluralité d'orifices qui assurent le déploiement. L'endoprothèse présente au moins à l'état déployé une forme en section transversale qui diffère de la forme circulaire.
EP15778957.9A 2014-10-14 2015-10-13 Endoprothèse pour la vertébroplastie percutanée Withdrawn EP3188694A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102014114888.6A DE102014114888A1 (de) 2014-10-14 2014-10-14 Stent für die perkutane Vertebroplastie
PCT/EP2015/073633 WO2016059026A1 (fr) 2014-10-14 2015-10-13 Endoprothèse pour la vertébroplastie percutanée

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EP3188694A1 true EP3188694A1 (fr) 2017-07-12

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US (1) US20170266006A1 (fr)
EP (1) EP3188694A1 (fr)
JP (1) JP2017532137A (fr)
CN (1) CN107106303A (fr)
DE (1) DE102014114888A1 (fr)
WO (1) WO2016059026A1 (fr)

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FR3054430B1 (fr) 2016-07-27 2018-07-27 Centre Hospitalier Universitaire De Bordeaux Stent intra-osseux
CN108670394B (zh) * 2018-06-14 2024-04-19 谢少鹏 一种骨扩张结构

Citations (1)

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Publication number Priority date Publication date Assignee Title
WO2006034436A2 (fr) * 2004-09-21 2006-03-30 Stout Medical Group, L.P. Dispositif de support expansible et procede d'utilisation

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Publication number Priority date Publication date Assignee Title
DE60022891T2 (de) * 1999-10-20 2006-06-29 SDGI Holdings, Inc., Wilmington Eingeschlagenes orthopädisches knochenstützimplantat
US7507241B2 (en) * 2004-04-05 2009-03-24 Expanding Orthopedics Inc. Expandable bone device
US20060100706A1 (en) * 2004-11-10 2006-05-11 Shadduck John H Stent systems and methods for spine treatment
JP5112295B2 (ja) * 2005-04-27 2013-01-09 スタウト メディカル グループ，エル．ピー． 拡張型支持具およびその使用方法
CN101291633A (zh) * 2005-08-31 2008-10-22 斯巴尼沃克斯医学公司 治疗骨组织微结构损伤的可植入装置和方法
US20070093899A1 (en) * 2005-09-28 2007-04-26 Christof Dutoit Apparatus and methods for treating bone
WO2007076374A2 (fr) * 2005-12-19 2007-07-05 Stout Medical Group, L.P. Dispositif de support dilatable et son procede d’utilisation
DE102005061932A1 (de) * 2005-12-23 2007-07-05 Biedermann Motech Gmbh Mehrwandiger Platzhalter
ES2390482T3 (es) * 2007-12-28 2012-11-13 Biedermann Technologies Gmbh & Co. Kg Implante para estabilizar vértebras o huesos
DE102012003247A1 (de) * 2012-02-20 2013-08-22 Bentley Surgical Gmbh Vertebralstent

Patent Citations (1)

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Publication number Priority date Publication date Assignee Title
WO2006034436A2 (fr) * 2004-09-21 2006-03-30 Stout Medical Group, L.P. Dispositif de support expansible et procede d'utilisation

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WO2016059026A1 (fr) 2016-04-21
US20170266006A1 (en) 2017-09-21
JP2017532137A (ja) 2017-11-02
CN107106303A (zh) 2017-08-29
DE102014114888A1 (de) 2016-04-14

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