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
  • A61F2/28—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
  • A61B17/68—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
  • A61B17/7098—Stabilisers comprising fluid filler in an implant, e.g. balloon; devices for inserting or filling such implants wherein the implant is permeable or has openings, e.g. fenestrated screw
• • 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
  • 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
  • A61F2/30—Joints
  • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
  • A61F2/4601—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• • 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
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
  • A61F2/88—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure the wire-like elements formed as helical or spiral coils
• • 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
  • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol

Definitions

• the invention relates to a system for injecting surgical cement intra-osseous, especially at low pressure.
• the system according to the invention is particularly suitable for the consolidation of a weakened bone, in particular a vertebral body or a pathological lachrymal lesion (malignant or benign) whatever the location.
• cementoplasty is performed by percutaneous injection of cement through a needle, or trocar, introduced directly into the affected vertebral body or bone.
• Cementoplasty is particularly used in the treatment of osteoporotic fractures or, in some tumors, for the reinforcement of the affected vertebrae.
• the risks of leakage of cement to the outside of the bone body are high because of the absence of stress during the injection.
• the cement can quickly be found in the patient's venous system, with high risks of migration to the epidural and / or prevertebral veins, which can lead to pulmonary embolism.
• kyphoplasty or kyphoplasty
• kyphoplasty is very widely used in patients with more than one vertebral fracture, a collapse of the vertebra.
• This technique is particularly suitable for the treatment of bone fractures with vertebral crush, especially in young adults after trauma, since it allows the patient to recover a larger vertebral height.
• Kyphoplasty involves introducing a balloon through the trocar into the fractured vertebral body. Once in place, the balloon is inflated to gradually recover the vertebral height. The pressure used is then high. The balloon is then removed and cement is injected in its place, without resistance. However, after deflation and removal of the balloon, and before injection of the cement, there is frequently a partial loss of height, and therefore an insufficient correction resulting in persistent spinal pain.
• these systems are particularly dedicated to the treatment of traumatic vertebral fractures and can not be easily transposed to the treatment of other bone lesions, caused in particular by metastatic bone cancers.
• the pressure used is unacceptable, the risk of associated tumor migration being too high.
• the osteolytic nature of the lesions does not allow the deployment of this material in a healthy zone.
• the object of the invention is to at least partially solve the problem stated above, by proposing a single device that allows not only the placement of a stent in a bone body, but also the injection, advantageously directed, after the placing said stent in the bone body, bone cement in the volume of said stent.
• the system according to the invention does not require the use of an extrinsic mechanism for expanding the stent, and advantageously allows the establishment of a stent / cement assembly having synergistic biomechanical properties.
• the device according to the invention comprises in particular means for inserting a stent, able to bring the stent to the fracture or bone lesion to be treated and to allow its deployment once in position.
• a system of concentric tubes that can be movable relative to each other successively enables the stent to be held in a constrained state, to bring it to the zone to be treated, and then to release it in order to that it deploys simultaneously or before injecting cement into the internal volume of said stent.
• the means for placing the stent according to the invention are also used for the injection of the cement, which makes it possible to limit the number of manipulations and simplifies the surgical procedure as a whole, allowing a quick and simple realization.
• the system further has a sharp end facilitating perforation and progression in the bone.
• the invention therefore relates to a system for injecting intraosseous surgical cement comprising: - an outer sleeve;
• an inner cannula mounted coaxially in the outer sleeve, said cannula being able to be displaced along a longitudinal axis in the outer sleeve, the cannula being provided with a tapered distal tip;
• distal refers to a portion of an element that is furthest from the preemption zone of said element, as opposed to the "proximal” portion.
• distal portion of a system member refers to a portion of said member for penetrating the body of a patient as opposed to the proximal portion.
• the outer sleeve and the cannula advantageously have a generally cylindrical hollow or tubular shape. The sleeve and the cannula are coaxial, or concentric.
• the outer diameter of the cannula is strictly less than the internal diameter of the sleeve, so that said cannula, mounted in said sleeve, can move axially in the sleeve.
• the distal end of the cannula has a tapered tip, intended to facilitate the insertion of the system into the bone body.
• said tip opens at the distal end of the outer sleeve. The tip thus forms the distal end of the system, which comes first into contact with the body of the patient in which the stent is to be housed, so as to pierce the various parts of said body, to the target bone body.
• the distal tip of the cannula can thus protrude from the distal end of the sleeve, or simply flush with the mouth of the distal end of the sleeve.
• the distal end of the sleeve has a beveled tip, intended to facilitate insertion of the system into the body of the patient.
• the distal end of the sleeve has a cross section.
• the proximal end of the cannula is provided with coupling means adapted to be connected to surgical cement injection means.
• the coupling means may for example consist of a thread formed on the proximal end of the cannula, said thread, external or internal, then being complementary to a thread formed on the injection means.
• the coupling means may also consist of interlocking means, clips, etc.
• the coupling means allow a sealed coupling with the cement injection means.
• the cannula comprises a lateral orifice, able to let out surgical cement out of the cannula when it is injected into the internal volume of said cannula.
• the lateral orifice is formed in a distal portion of said cannula, intended to be inserted into the bone body to be treated, so that the cement can be released into said bone body.
• the stent in a configuration before use, is mounted in a constrained state in the internal volume of the distal portion of the sleeve.
• a distal portion of the cannula is in contact with the stent so that the outlet of the distal portion of the cannula out of the sleeve also forces the stent out of said sleeve.
• the stent is mounted around the outer wall of the distal portion of the cannula. So, the stent is kept in the internal volume of the sleeve, between the inner wall of said sleeve and the outer wall of the cannula.
• the stent is a self-expanding stent.
• the stent is wrapped around the distal portion of the cannula, so as to be constrained between the outer wall of the cannula and the inner wall of the sleeve.
• the stent is released, and no longer constrained by the wall of the sleeve, it deploys in the bone body around the distal part of the cannula. It is then possible to remove the cannula from the bone without moving the stent.
• the system is provided with reversible blocking means capable of preventing any involuntary displacement of the cannula with respect to the sleeve, or vice versa.
• the locking means are used to maintain the position of the tapered tip of the cannula relative to the sleeve during the insertion of the system to the target bone body.
• the locking means can then be unlocked to allow movement of the sleeve and / or the cannula relative to each other.
• the locking means may for example consist of complementary threads on the cannula and the sleeve.
• an inner wall of the proximal portion of the sleeve comprises a complementary thread of a thread formed on the outer wall of the proximal portion of the cannula. It is then not possible to accidentally change the position of the cannula in the sleeve. A rotation of one relative to the other is necessary to allow any displacement.
• the locking means may consist of one or more retractable lugs on the outer wall of the cannula and housed in a first configuration in one or more complementary orifices in the wall of the sleeve. To allow the displacement of the cannula in the sleeve, it is then necessary to retract the lug or pins, for example by exerting pressure.
• the system for injecting cement may be provided with control means making it possible to ensure the total release of the stent.
• control means for example, a marking is provided on the cannula, indicating to the user the maximum and / or minimum displacement distance of the sleeve in a proximal direction and / or the cannula in a distal direction, to ensure release of the stent.
• the blocking means also serve as a means of control to ensure axial displacement of the cannula in the sufficient sleeve and / or limit this displacement.
• the thread pitch of the threads on the cannula and the sleeve is calculated to allow movement of one relative to the other over a distance sufficient to ensure complete release of the stent from the inner volume of the sleeve.
• the displacement of the cannula in the sleeve is thus limited to the distance between the two series of orifices.
• the terms "upstream” and "downstream” refer to the direction of penetration of the system into a target bone body, the upstream designating the nearest part of said target bone body.
• a simple visual marking for example at the proximal portions of the cannula and / or the sleeve can be used as control means.
• the stent is a self-expanding stent made of shape memory material, so that once released from the outer sleeve, the stent deploys to at least partially recover the desired initial shape. Injection of the cement can also participate in the complete deployment of the stent in the bone.
• the shape memory stent is made of nikel / titanium (Nitinol), cobalt-chromium or platinum-chromium alloy.
• the stent is based on polymers, such as polylactic acid (PLA).
• the stent is covered with an outer casing intended to prevent or limit cement leaks.
• an outer envelope is of stretchable material, or elastic, at least partially sealed.
• the outer envelope matches an outer contour of the stent.
• the outer casing is made of polytetrafluoroethylene (PTFE).
• the distal portion of the system and more particularly the distal portion of the outer sleeve and the cannula has a straight profile.
• profile is meant the external contour of the element under consideration.
• the distal portion of the outer sleeve and the cannula has a curved profile, the curvature of the sleeve and the cannula being identical. This latter configuration is particularly suitable for the treatment of bones of the pelvis or ribs.
• the outer sleeve has an external diameter of between 0.2 and 0.5 cm (ie between about 7 and 15 gauges), preferably between 0.3 and 0.4 cm, and a length between 10 and 15 cm.
• the cannula can then have a diameter of between 0.1 and 0.4 cm (ie between about 6 and 18 gauges), and preferably between 0.2 and 0.35 cm.
• the dimensions of the outer sleeve and the cannula are adapted to the body of the patient to be treated, to the position of the target bone body in said body and to the nature of the bone lesion to be treated.
• the stent may have dimensions (and in particular length and diameter) that vary depending on the nature and extent of the bone lesion to be treated.
• the stent does not generally fill the entire lesion, but must at least make it possible to form a pillar in said lesion to distribute the stresses between the regions of the bone body around the lesion.
• the stent has a diameter of between 0.8 and 1.6 cm, for a length (or greater dimension) of between 4 and 6 cm.
• the subject of the invention is also an intraosseous surgical cement injection kit comprising, in addition to the system for the cement injection described above, means for injecting the cement capable of being connected to the cement. proximal end of the cannula, and possibly surgical cement.
• the injection means consist of a syringe whose injection end is coupled to the proximal end of the cannula.
• the end for injection optionally provided with a needle, can thus be inserted into the proximal portion of the cannula.
• the insertion of the piston into the body of the syringe, previously filled with surgical cement makes it possible to inject the cement into the cannula.
• any surgical cement adapted for intraosseous use can be used.
• PMMA polymethacrylate
• the kit may comprise the elements of the injection system already mounted, that is to say the cannula and the stent housed in the outer sleeve, or on the contrary said elements ready to be mounted.
• the injection means comprise pushing means for penetrating the cement into the interior of the cannula and forcing it to the stent.
• the injection means comprise a piston intended to be inserted into the cannula, from the proximal end and adapted to slide axially in said cannula, towards the distal end.
• the system according to the invention wherein the stent is mounted around the distal portion of the cannula, can be used in a method of injecting surgical cement into a target bone body of a patient comprising the steps of:
• the cannula can be used to inject the cement into the internal volume of said stent.
• FIG. 1 a partial schematic representation in longitudinal section of the system for injecting intraosseous surgical cement according to one embodiment of the invention, before use
• Figure 2 a schematic representation of the system for injection of intraosseous surgical cement of Figure 1, in use
• Figure 3 is a schematic representation in longitudinal section of the distal end of the system for intraosseous surgical cement injection according to one embodiment of the invention
• FIGS. 4A and 4B two examples of stents that can be used in the system for injecting bone cement according to the invention
• 5A-5G schematic representations of the system for the injection of intraosseous surgical cement according to one embodiment of the invention, at different stages of a stentoplasty method;
• Figure 1 a partial view of a cement injection system 10 according to one embodiment of the invention. More specifically, the system 10 comprises an outer sleeve 11 of generally cylindrical shape with a right circular section. A distal end 12 of the sleeve 11 has a cross section.
• the outer sleeve 11 is hollow, and a cannula 13 extends along a longitudinal axis A in an internal volume 14 of said outer sleeve 11.
• the cannula 13, also hollow, has a generally cylindrical shape with a straight circular section, concentric with the outer sleeve 11.
• the internal diameter d of the cannula 13 is strictly smaller than the internal diameter D of the outer sleeve 11, so that a displacement along the axis A of the cannula 13 relative to the outer sleeve 11, or vice versa, is possible without friction.
• the cannula 13 has a tapered distal tip 15.
• the distal tip 15 of the cannula 13 opens projecting from the distal end 12 of the outer sleeve 11.
• the distal end 12 of the sleeve 11 of constant diameter, is beveled, and the distal tip 15 of the cannula 13 is flush with the mouth of the distal end. 12.
• an orifice 17 is provided on a distal portion 16 of the cannula 13.
• the orifice 17 must be of sufficient size to allow cement to flow through the cannula 13.
• a stent 18 is wound around the distal portion 16 of the cannula 13.
• the stent 18 is positioned on the cannula 13, so as to be fully housed in the internal volume 14 of the outer sleeve 11, and maintained in the space between the cannula and the sleeve.
• the stent is advantageously a self-expanding stent with shape memory.
• the stent 18 is maintained in a constrained, i.e., undeployed state, in the inner volume 14 of the sleeve 11.
• Figures 4A and 4B show two examples of stent 18 that can be used in the system
• the mesh of the stent 18 is such that leakage of cements out of said stent are limited.
• the stent 18 is completely covered with a film 19.
• the film 19 further reduces the risk of leakage of cement.
• the film 19 is made of elastic waterproof material, for example PTFE.
• Locking means advantageously make it possible to reversibly hold the cannula 13 in this first position, or penetration position, in the outer sleeve 11.
• the proximal ends of the outer sleeve 11 and the cannula 13 are provided with complementary threads, preventing any sliding of the cannula 13 in the outer sleeve 11.
• the displacement of the cannula 13 relative to the outer sleeve 11, and vice versa, is then possible only by rotating the relative to the other, in the direction to allow by the step of screws.
• Figure 2 shows the system 10 in use. Specifically, the outer sleeve
• the cannula 13 and / or the sleeve 11 may be provided with visual cues (not shown) making it possible to inform the user of the sufficient or insufficient displacement of the sleeve with respect to the cannula, and therefore the complete release of the stent 18.
• the visual means are advantageously located at the proximal portions of the cannula 13 and / or the sleeve 11 so as to be outside the body of the patient during the use of the system 10.
• the orifice 17 of the cannula 13 is entirely in the internal volume of the stent 18. If necessary, it is conceivable to move the cannula 13 along the axis A, so as to position the orifice 17 at the desired location relative to the stent 18, and allow during the cement injection a homogeneous distribution of the cement throughout the volume of the stent 18.
• FIGS. 5A-5G An intraosseous surgical cement injection method will now be described using FIGS. 5A-5G.
• Such a method is advantageously implemented during the treatment of a patient, in particular a human patient, who has a bone trauma.
• such a method can be implemented to achieve stentoplasty at an injured vertebra.
• the system 10 for the surgical cement injection according to the invention is brought into the body 100 of a patient by the tapered distal end of the cannula 13, which first pierces and crosses the body 100 of the patient.
• the cannula 13 / outer sleeve assembly 11 is pressed into the body 100 of the patient to the target bone body 101 (FIG. 5B).
• the outer sleeve 11 is then removed at least partially from the body 100 of the patient. Only the cannula 13, on which the stent 18 is mounted, remains in position in the bone body 101 ( Figure 5C). The stent 18 can then be deployed in the bone body 101 (FIG. 5D).
• Cement injection means (not shown), coupled to the proximal end 19 of the cannula 13 allow cement to be injected through the cannula 13 into stent 18 (Figure 5E).
• a syringe filled with surgical cement is inserted into the cannula 13, by its proximal end.
• the piston of the syringe is pressed into said syringe to penetrate the cement into the cannula.
• the cement flows out of the cannula 13 through the lateral orifice (not visible) and fills the internal volume of the stent 18.
• the cannula 13 is gradually removed from the bone body 101 (FIG. 5F ), the outer sleeve 11 can be held in position.

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• Health & Medical Sciences (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Surgery (AREA)
• General Health & Medical Sciences (AREA)
• Heart & Thoracic Surgery (AREA)
• Veterinary Medicine (AREA)
• Public Health (AREA)
• Animal Behavior & Ethology (AREA)
• Neurology (AREA)
• Transplantation (AREA)
• Molecular Biology (AREA)
• Medical Informatics (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Cardiology (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Vascular Medicine (AREA)
• Physical Education & Sports Medicine (AREA)
• Prostheses (AREA)

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• 2016
  • 2016-05-06 FR FR1654105A patent/FR3050925B1/fr active Active
• 2017
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  • 2017-05-04 WO PCT/FR2017/051077 patent/WO2017191419A1/fr unknown
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