EP3522805A1 - Instrument de repositionnement chirurgical - Google Patents

Instrument de repositionnement chirurgical

Info

Publication number
EP3522805A1
EP3522805A1 EP17790967.8A EP17790967A EP3522805A1 EP 3522805 A1 EP3522805 A1 EP 3522805A1 EP 17790967 A EP17790967 A EP 17790967A EP 3522805 A1 EP3522805 A1 EP 3522805A1
Authority
EP
European Patent Office
Prior art keywords
coupling point
surgical instrument
adapter
instrument according
bearing shell
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Withdrawn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
EP17790967.8A
Other languages
German (de)
English (en)
Inventor
Zbiginiew Combrowski
Alexander Henninger
Christel Paroth
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.)
Individual
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 EP3522805A1 publication Critical patent/EP3522805A1/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Withdrawn legal-status Critical Current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, 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
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A61B17/7077—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for moving bone anchors attached to vertebrae, thereby displacing the vertebrae
    • A61B17/708—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for moving bone anchors attached to vertebrae, thereby displacing the vertebrae with tubular extensions coaxially mounted on the bone anchors
    • 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
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine

Definitions

  • the invention relates to a surgical instrument according to the preamble of claim 1.
  • fixators such as pedicle screws, rods, cages (cage is an intervertebral implant) are used.
  • pedicle screw for example, polyaxial, uniplanar or monoaxial and, depending on which spine region (lumbar or thoracic, for example), different rod shapes are also used, for example, straight, lordotic or kyphotic. So the repositioning of the screws must be parallel or at an angle. For this purpose, a tension-free reduction and prefixing of the construct should be possible during the reduction. Even with the final fixation, the instrument (s) of, for example, pedicle screws should leave as much axial freedom of movement as possible so that the pedicle screws can be fixed with the rods as tension-free as possible. Otherwise tensions lead to premature failure of the construct, as well as a loss of reduction. Depending on the indication and surgical technique, one manufacturer uses different types of screws with different tulips, introducer sheaths, extension instruments and the associated reduction instrument sets.
  • retractor instruments to provide access for the insertion of a Cages are offered in various designs. These often have the disadvantage that created with the retractor tissue and muscle access for setting the cage and kept open during the operation. At the same time, the disc space was to be spread and held open with a reduction instrument until the disc space for the cage was cleared and the cage was inserted. Here, the instruments often stand in the way. Disadvantageously, these retractor and reduction instruments consist of a variety of individual instruments and are of a complex design, so that only experienced surgeons and surgical assistants can use this instrument without suppliers' product specialists. In US Pat. Nos. 8,535,320, 8,906,034 and 8,100,828 pedicle-based retractor and reduction instruments are shown.
  • the object of the present invention is to overcome the disadvantages of the prior art.
  • a simple pedicle-based surgical device consisting of a surgical instrument, ie the adapter for a pedicle screw unit, reduction instrument and retractor blade is to be made available, which can be used openly and minimally invasively as a retractor as well as a reduction device and for For example, cages and their access in screws and rod systems allows a tension-free prefixing and / or final fixation without Repositionsmann.
  • the surgical instrument consists of a reduction instrument and an adapter for a pedicle screw unit.
  • the pedicle screw unit typically includes a pedicle screw, a tulip, and an introducer sheath.
  • the reduction instrument in this embodiment is basically a spindle instrument which adjusts or adjusts the adapter to another adapter.
  • the spindle instrument is manually operated via a tool or a drive wheel.
  • the reduction instrument has a first coupling point and the adapter via a second coupling point, wherein the first coupling point and the second coupling point non-positively and / or positively with each other are connected.
  • the first coupling point of the reduction instrument has a first corrugation and the second coupling point of the adapter has a second corrugation.
  • the first coupling point is cylindrically shaped and the first corrugation is arranged on an outer side of the coupling point.
  • the second coupling point is sleeve-shaped and the second corrugation is arranged on an inner side of the second coupling point.
  • An outer diameter of the first coupling point is smaller than an inner diameter of the second coupling point.
  • the adapter has at one end the second coupling point and at the other end comprises a bearing shell.
  • the bearing shell is preferably annular, wherein the ring shape can be fully closed or partially open. In this case, the bearing shell, viewed from above or from below, has a U-profile.
  • the connecting web is channel-shaped and has a bending of 70 ° to 100 °, preferably 80 ° to 95 ° and more preferably 90 °.
  • the bearing shell forms an expansion towards the connecting web, which is suitable for receiving the tulip of the pedicle screw unit in a polyaxially movable manner.
  • the bearing shell has at the other end of the connecting web two arranged in a straight line recesses. These recesses are shaped such that they complete an unspecified slot of the tulip towards the pedicle screw.
  • bars can be added.
  • a slightly curved first rod is kyphotisch used.
  • a second slightly bent rod is used lordotically and a third non-bent rod is used as needed.
  • a not-shown retractor blade can be provided, which can be arranged between the adapter and another adapter.
  • the surgical instrument mentioned in the context of the invention may be for use with any type of fixators, a cage, a pedicle screw, in particular a bone screw or other implants or extracorporeal extensions of these implants.
  • the surgical instrument consists of the adapter for the pedicle screw unit, if necessary a retractor blade and the reduction instrument. This is intended both as a retractor spreader system to provide access and distraction of the intervertebral disc space, for inserting a cage, as well as compression, distraction instrument, Aufrichtinstrument for the reduction bspw. Pedicle screws are used.
  • the reduction instrument allows the length of the rod to be determined via an integrated measuring scale prior to insertion of the rod, via the L + R spindle for uniform travel and force transmission when turning the spindle, and control of the reduction path during surgical instrument or adapter engagement ,
  • the thread is self-locking so that it holds the power and there can be no Repositionsmann.
  • the surgical instrument should be simple if possible.
  • the surgical instrument can be used for both open and minimally invasive surgery and allows simultaneous reduction on both sides of the spinal column, which, for example, enables bilateral parallel reduction in a fracture and is also very important here.
  • the surgical instrument can be repositioned parallel or at any angle over any number of vertebral segments.
  • the surgical instrument or the adapter of the surgical instrument is provided at one end with the coupling point and the other end with the annular bearing shell for example.
  • a tulip or a pedicle screw On the annular bearing shell, the additional two arranged in a straight line recesses are present. These allow the user depending on the application, the placement of the respective rod at the desired position, but also at other locations, for example, along the pedicle screw. This affects the position of the bearing / fulcrum for the introduction of force.
  • To reposition the screws must be able to slide easily with a minimum clearance to the rod, eg. Along the rod, ie axially, radially. The farther the fulcrum is from the rod axis, the larger the lever arm, thus leading to jamming and tensions.
  • the adapter or the connecting web is slightly cupped and angled so that it does not hinder the surgical field in connection with the repositioning instrument.
  • the bowl-shaped design is very wide open and allows for repositioning a fixing that, for example, the pedicle screw can be aligned polyaxially outside the axis of the connecting web.
  • the bearing shell is preferably closed annularly and has an expansion on an inner side, which serves as a bearing and pivot point. In this, the pedicle screw can move freely polyaxially.
  • a pedicle screw is received from the outside.
  • pedicle screw for example, polyaxial, uniplanar or monoaxial and, depending on in which spine area (lumbar or thoracic, for example), different rod shapes are also used (for example straight, lordotic or kyphotic).
  • rod shapes for example straight, lordotic or kyphotic.
  • the surgical instrument should allow the pedicle screws so much additional polyaxial range of motion that the pedicle screws can be fixed as tension-free as possible with the / rod / rods. Otherwise tensions lead to premature failure of the construct as well as loss of reduction and associated revisions.
  • the annular bearing shell of the adapter of the surgical instrument is preferably introduced via the pedicle screws and to the tulip rod area. The tulip is used to hold a rod, which connects various pedicle screws intracorporeally and is fixed in the tulip with an ini.
  • the coupling point in the adapter is shown as an example. Cylindrical bore with a fine toothing or fine ribbing and the coupling point of Repositions instrument as a mandrel with a fine toothing or corrugation, which interact with each other in the game.
  • the coupling point can also have, for example, either a frontal toothing or corrugation, it can be conical or formed as a ball head with a kind of toothing, which can transmit large forces.
  • the retractor blade should preferably be produced as a simple sheet metal part and is preferably pedicle screws based adaptable.
  • the retractor blade has a handle portion and at the other end a receptacle with which it can be fixed in the pedicle screw and an angled tongue, which serves to keep away muscle mass.
  • a receptacle with which it can be fixed in the pedicle screw and an angled tongue, which serves to keep away muscle mass.
  • only one retractor blade is used, but it can also be two. This is not shown in detail. This would be a mirrored variant the other pedicle screw, thus forming the access channel between the pedicle screws. It is conceivable that the two retractor blades can then be adjusted fan-shaped and are each provided with a detent, which allows a better fixation.
  • retractor blades are used as retractor spreader system to provide access and distraction, the disc space, to the onset of a Cages.
  • the two retractor blades are fixed in the pedicle screws.
  • the adapters are additionally secured against removal, so that they can not slip during repositioning and there would be no repositioning loss.
  • the retractor blade may be of any shape, such as a tube nearly round, cylindrical or tapered, nor does it need to be closed (eg, half open like a gutter) and depicted in the present embodiment as a retractor blade.
  • the pedicle screws have certain axialities. This allows the retractor blade to be placed in the desired position.
  • the receptacle is cylindrical as a rod and formed in the diameter of the rod.
  • it is shown as a stable sheet, the surfaces to which it is fixed, are preferably rounded. Cylindrical like a rod and shaped in the diameter of the rod.
  • the fixation is preferably done with the Ini.
  • a stop or coupling to the surgical instrument for the retractor is possible
  • the surgical instrument can be used in open and MIS surgery and preferably consists of several parts to tension as possible and preferably introduced through a same access of the pedicle screws tissue preserving, so that the Pedicle screw remains polyaxially mobile even during very high forces during reduction.
  • the adapter is available in various lengths, preferably from 50 to 200 mm long and more preferably from 60 to 130 mm.
  • the second coupling point of the adapter has a groove which cooperates with a detent at the coupling point of the reduction instrument such that a solution of the two coupling points is possible only by a targeted pulling. This serves to prevent unwanted falling out.
  • the coupling point of the adapter is, as already mentioned above, preferably arranged on the inside and the coupling point of the reduction instrument on the outside. But this can also be the other way around.
  • the corrugations or the teeth can vary in fineness and spacing and are usually arranged in a 360 ° orbit.
  • Figure 1 is a perspective view of a surgical instrument according to the invention
  • Figure 2 is a front view of the surgical instrument of Figure 1;
  • Figure 3 is a side view of the surgical instrument of Figure 1;
  • Figure 4 is a perspective view of an adapter for use in the surgical instrument of Figure 1;
  • Figure 5 is a side view of the adapter of Figure 4.
  • Figure 6 is a rear view of the adapter of Figure 4.
  • FIG. 7 shows a further perspective view of the adapter according to FIG. 4.
  • FIG. 1 shows a perspective view of a surgical instrument 1.
  • the surgical instrument 1 consists of a reduction instrument 2 and an adapter 3 for a pedicle screw unit 4.
  • the pedicle screw unit 4 comprises a pedicle screw 5, a tulip 6 and an insertion sleeve 7.
  • the reduction instrument 2 in this embodiment is basically a spindle instrument, which the adapter 3 to another adapter adjusted or adjusted.
  • the spindle instrument is manually operated via a tool or a drive wheel.
  • the reduction instrument 2 has a first coupling point 8 and the adapter 3 via a second coupling point 9, wherein the first coupling point 8 and the second coupling point 9 are non-positively and / or positively connected to each other.
  • the adapter 3 has at one end the second coupling point 9 and at the other end comprises a bearing shell 10.
  • the bearing shell 10 is preferably annular, wherein the ring shape can be fully closed or partially open. In this case, the bearing shell 10 viewed from above or from below, more or less have a U-profile.
  • the first coupling point 8 of the reduction instrument 2 has a first corrugation 11 and the second coupling point 9 of the adapter 3 has a second corrugation 12.
  • the first coupling point 8 is cylindrically shaped and the first corrugation 1 1 is arranged on an outer side 13 of the coupling point 8.
  • the second coupling point 9 is sleeve-shaped and the second corrugation 12 is arranged on an inner side 14 of the second coupling point 9.
  • An outer diameter di of the first coupling point 8 is smaller than an inner diameter d 2 of the second coupling point 9.
  • the connecting web 15 is channel-shaped and has a bending of 70 ° to 100 °, preferably 80 ° to 95 ° and more preferably 90 °.
  • the bearing shell 10 forms towards the connecting web 15 out a widening 16, which is adapted to receive the tulip 6 of the pedicle screw unit 4 movable in a polyaxial manner.
  • the bearing shell 10 has at the other end of the connecting web 15 two arranged in a straight line recesses 17. These recesses 17 are formed such that they complete a not shown in detail oblong hole of the tulip 6 to the pedicle screw 5 out.
  • a slightly curved first rod 18 is kyphotisch used.
  • a second slightly bent rod 19 is used lordotically and a third non-bent rod 20 is used as needed.
  • a retractor blade not shown in detail can be provided, which can be arranged between the adapter 3 and a further adapter.

Landscapes

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

Abstract

L'invention concerne un instrument chirurgical constitué d'un instrument de repositionnement (2) et d'un adaptateur (3) pour une unité à vis pédiculaire (4), cette unité à vis pédiculaire (4) comprenant une vis pédiculaire (5), une tulipe (6), et un manchon d'insertion (7). Selon l'invention, l'instrument de repositionnement (2) comporte un premier point d'accouplement (8) et l'adaptateur (3) comporte un deuxième point d'accouplement (9), le premier point d'accouplement (8) et le deuxième point d'accouplement (9) pouvant être reliés à force et/ou par complémentarité de forme.
EP17790967.8A 2016-10-04 2017-10-04 Instrument de repositionnement chirurgical Withdrawn EP3522805A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102016118718.6A DE102016118718A1 (de) 2016-10-04 2016-10-04 Chirurgisches Instrument
PCT/EP2017/075121 WO2018065436A1 (fr) 2016-10-04 2017-10-04 Instrument de repositionnement chirurgical

Publications (1)

Publication Number Publication Date
EP3522805A1 true EP3522805A1 (fr) 2019-08-14

Family

ID=60186228

Family Applications (1)

Application Number Title Priority Date Filing Date
EP17790967.8A Withdrawn EP3522805A1 (fr) 2016-10-04 2017-10-04 Instrument de repositionnement chirurgical

Country Status (4)

Country Link
US (1) US20190290330A1 (fr)
EP (1) EP3522805A1 (fr)
DE (1) DE102016118718A1 (fr)
WO (1) WO2018065436A1 (fr)

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018150215A1 (fr) * 2017-02-17 2018-08-23 Warsaw Orthopedic, Inc. Système et procédé chirurgicaux
EP3517062B1 (fr) * 2018-01-26 2021-03-17 Aesculap AG Instrument de repositionnement de la colonne vertébrale et système de repositionnement de la colonne vertébrale
JP2024500095A (ja) 2020-12-09 2024-01-04 アルファテック スパイン， インコーポレイテッド 外科用リトラクタ

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AU2003295934B2 (en) 2002-11-23 2009-02-26 Frey, George A. Distraction and retraction system for spinal surgery
CN102821673B (zh) 2009-11-10 2016-06-08 纽瓦西弗公司 牵开器系统
US9198698B1 (en) * 2011-02-10 2015-12-01 Nuvasive, Inc. Minimally invasive spinal fixation system and related methods
EP2838455B1 (fr) 2012-04-17 2020-01-08 Alphatec Spine, Inc. Instrument servant à la compression et la distraction de la moelle épinière
AU2014274626B2 (en) * 2013-12-13 2019-12-12 Stryker European Operations Holdings Llc Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion

Also Published As

Publication number Publication date
WO2018065436A1 (fr) 2018-04-12
US20190290330A1 (en) 2019-09-26
DE102016118718A1 (de) 2018-04-05

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