FR2801194A1 - An implant for restoring articulated movement to the thumb comprises a rigid barrel shaped core of polyethylene and a fibrous polyester envelope, both non resorbable, and attachment sutures. - Google Patents

An implant for restoring articulated movement to the thumb comprises a rigid barrel shaped core of polyethylene and a fibrous polyester envelope, both non resorbable, and attachment sutures. Download PDF

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Publication number
FR2801194A1
FR2801194A1 FR9914609A FR9914609A FR2801194A1 FR 2801194 A1 FR2801194 A1 FR 2801194A1 FR 9914609 A FR9914609 A FR 9914609A FR 9914609 A FR9914609 A FR 9914609A FR 2801194 A1 FR2801194 A1 FR 2801194A1
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France
Prior art keywords
implant
envelope
core
implant according
casing
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Granted
Application number
FR9914609A
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French (fr)
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FR2801194B1 (en
Inventor
Emmanuel Favreul
Jean Jacques Martin
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Stryker European Holdings I LLC
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Fixano SA
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/14—Macromolecular materials
    • A61L27/16—Macromolecular materials obtained by reactions only involving carbon-to-carbon unsaturated bonds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/14—Macromolecular materials
    • A61L27/18—Macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166—Sutures
    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06057—Double-armed sutures, i.e. sutures having a needle attached to each end
    • 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
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    • 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
    • A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30011—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in porosity
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    • 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
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    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/3008—Properties of materials and coating materials radio-opaque, e.g. radio-opaque markers
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    • 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
    • A61F2002/30286—Three-dimensional shapes barrel-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
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30291—Three-dimensional shapes spirally-coiled, i.e. having a 2D spiral cross-section
    • A61F2002/30293—Cylindrical body made by spirally rolling up a sheet or a strip around itself
    • 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
    • A61F2/30721—Accessories
    • A61F2002/30733—Inserts placed into an endoprosthetic cavity, e.g. for modifying a material property
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30907—Nets or sleeves applied to surface of prostheses or in cement
    • A61F2002/30909—Nets
    • A—HUMAN NECESSITIES
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    • 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
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    • A61F2002/3092—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth having an open-celled or open-pored structure
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
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    • A61F2002/4271—Carpal bones
    • A61F2002/4274—Distal carpal row, i.e. bones adjacent the metacarpal bones
    • A61F2002/4276—Trapezium
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    • 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
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    • A61F2230/0091—Three-dimensional shapes helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
    • A—HUMAN NECESSITIES
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    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0023—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in porosity
    • A61F2250/0024—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in porosity made from both porous and non-porous parts, e.g. adjacent parts
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    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers

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  • Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Public Health (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Epidemiology (AREA)
  • Dermatology (AREA)
  • Medicinal Chemistry (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)

Abstract

A total or partial implant replacement for a cuboid bone which permits articulated movement comprises a rigid non-resorbable core and an envelope of a non- resorbable fibrous material with a porous structure suitable to promote integration of the implant by invasion by neighboring fibrous or fibrocartillagenous cells. The core has the shape of a small barrel (Fig 2).

Description

présente invention concerne un implant de remplacement total ou partiel d'un os cuboïforme qui permet un mouvement articulé d'un segment osseux par rapport à un autre. Cet implant permet en particulier le remplacement du trapèze. The present invention relates to a total or partial replacement implant of a cuboidal bone that allows articulated movement of one bone segment relative to another. This implant allows in particular the replacement of the trapezium.

lésions de destructions articulaire peuvent obliger à une ablation totale ou partielle du trapèze. II est alors nécessaire d'insérer un implant entre premier métacarpien et la partie subsistante du trapèze, ou entre ce premier métacarpien et le scaphoïde. Cet implant joue le rôle d'une entretoise espaceur et permet de restituer la position anatomique du premier métacarpien par rapport au scaphoïde, afin d'assurer des tensions musculaires ligamentaires correctes. Joint destruction lesions may require total or partial removal of the trapezium. It is then necessary to insert an implant between the first metacarpal and the remaining part of the trapezium, or between this first metacarpal and the scaphoid. This implant plays the role of a spacer spacer and allows to restore the anatomical position of the first metacarpal in relation to the scaphoid, to ensure correct ligamentous muscle tension.

II est connu d'utiliser un tendon situé à proximité de l'articulation trapézo-métacarpienne pour constituer cet implant ; le tendon est libéré et sectionné à une extrémité, puis est roulé sur lui-même en spirale à manière d'un "anchois" et est inséré entre le premier métacarpien et la partie subsistante du trapèze ou le scaphoïde. It is known to use a tendon located near the trapezio-metacarpal joint to form this implant; the tendon is released and severed at one end, then rolled on itself in an "anchovy" spiral fashion and inserted between the first metacarpal and the remaining part of the trapezius or scaphoid.

Cette technique ne donne toutefois pas satisfaction. En effet, l'implant ainsi constitué ne permet pas de restituer les mouvements anatomiques du pouce. Ses dimensions sont déterminées par la longueur de tendon enroulée, donc de manière relativement empirique, peuvent ne pas être optimales en ce qui concerne les tensions musculaires et ligamentaires obtenues. En outre et surtout, cet implant a pour inconvénient de s'écraser au cours du temps, compte tenu desdites tensions. This technique does not give satisfaction, however. Indeed, the implant thus formed does not make it possible to restore the anatomical movements of the thumb. Its dimensions are determined by the length of tendon wound, so in a relatively empirical way, may not be optimal with respect to muscle and ligament tensions obtained. In addition and above all, this implant has the disadvantage of crashing over time, given said tensions.

est par ailleurs connu de réaliser un implant de prothèse de trapèze présentant un noyau en matériau non résorbable et enveloppe en matériau résorbable. is also known to provide a trapezium prosthesis implant having a core of non-absorbable material and envelope absorbable material.

La dégradation de l'enveloppe conduit à absence de maintien noyau entre les os, ce qui induit un risque d'échappement de ce noyau. outre, la forme de ce noyau n'est pas optimale, et la résorbtion matériau conduit à une réduction de longueur. The degradation of the envelope leads to lack of kernel maintenance between the bones, which induces a risk of escape of this core. in addition, the shape of this nucleus is not optimal, and the material resorption leads to a reduction in length.

existe également des prothèses non résorbables en matériau dit "silastic", qui sont solidaires du premier métacarpien par une grille diaphysaire dont on connaît à long terme la possibilité de dégradation et de fragmentation, qui conduit à la création d'une siliconite inflammatoire. La présente invention vise à remédier à l'ensemble de ces inconvénients essentiels, en fournissant un implant qui permet de restituer un mouvement anatomique du pouce, sans risque d'écrasement au cours temps et avec une parfaite intégration à l'articulation. there are also non-resorbable prostheses in so-called "silastic" material, which are integral with the first metacarpal by a diaphyseal grid whose long-term possibility of degradation and fragmentation, which leads to the creation of an inflammatory siliconite, is known. The present invention aims to remedy all of these essential disadvantages by providing an implant that allows to restore an anatomical movement of the thumb, without risk of crushing over time and with perfect integration into the joint.

L'implant qu'elle concerne comprend, de manière connue en soi noyau en matériau rigide non résorbable et une enveloppe. The implant that it concerns comprises, in a manner known per se, a core of non-resorbable rigid material and an envelope.

Selon l'invention, - le noyau présente une forme de révolution, à paroi latérale arrondie et convexe, et à extrémités longitudinales tronquées, ce qui confère la forme d'un "petit tonneau", et - l'enveloppe est constituée en un matériau fibreux resorbable, à structure poreuse, dont les pores sont propres à être envahis par les cellules des tissus voisins, de nature fibreuse ou fibrocartillagineuse, afin d'assurer l'intégration de l'implant à ces tissus. According to the invention, the core has a shape of revolution, with a rounded and convex lateral wall, and truncated longitudinal ends, which gives the shape of a "small barrel", and the envelope is made of a material fibrous resorbable, porous structure, whose pores are adapted to be invaded by the cells of neighboring tissues, of fibrous or fibrocartillaginous nature, to ensure the integration of the implant to these tissues.

Le noyau, de par sa forme en "tonneau", présente une courbure tant dans un plan perpendiculaire à son axe de révolution que dans un plan parallèle à cet axe. Cette double courbure permet le jeu du premier métacarpien par rapport à l'implant dans deux plans perpendiculaires, ce permet de parfaitement restituer le mouvement anatomique du pouce. L'enveloppe permet quant à elle une intégration de l'implant aux tissus environnant l'articulation, pour assurer un parfait maintien de l'implant en position. The core, in its "barrel" shape, has a curvature both in a plane perpendicular to its axis of revolution and in a plane parallel to this axis. This double curvature allows the play of the first metacarpal with respect to the implant in two perpendicular planes, it allows to perfectly restore the anatomical movement of the thumb. The envelope allows for an integration of the implant to the tissues surrounding the joint, to ensure a perfect fit of the implant in position.

Ce dernier peut être maintenu en position dans l'articulation par ou plusieurs sutures le temps que son intégration au corps par croissance tissulaire soit réalisée. Ces sutures réalisent un effet dit "de ligamentoplastie". The latter can be maintained in position in the joint by or more sutures the time that its integration into the body by tissue growth is achieved. These sutures achieve an effect called "ligamentoplasty".

De préférence, ladite enveloppe est formée par bobinage d'un fil autour du noyau. Preferably, said envelope is formed by winding a wire around the core.

Ce bobinage permet une parfaite cohésion du noyau et de l'enveloppe, et l'obtention d'une structure poreuse optimale pour l'intégration de l'implant. This winding allows a perfect cohesion of the core and the envelope, and obtaining an optimal porous structure for the integration of the implant.

L'enveloppe peut également avoir une structure tissée, lui conférant ladite structure poreuse. The envelope may also have a woven structure, conferring on it said porous structure.

De préférence, l'implant comprend au moins un fil pour sa suture à au moins un des os contre lequel il est placé. Selon une forme de réalisation préférée de l'invention, l'implant comprend quatre fils de suture solidaires de l'enveloppe, dont deux sont situés près de l'une des extrémités longitudinales de l'enveloppe et dont les deux autres sont situés près de l'autre extrémité longitudinale de l'enveloppe, ces fils débouchant de l'enveloppe sur un même côte latéral de l'implant. Preferably, the implant comprises at least one wire for suturing at least one of the bones against which it is placed. According to a preferred embodiment of the invention, the implant comprises four integral suture son of the envelope, two of which are located near one of the longitudinal ends of the envelope and the other two are located near the other longitudinal end of the envelope, these son emerging from the envelope on the same lateral side of the implant.

Ces fils sont destinés à être engagés au travers tissus environnant l'articulation ou au niveau des extrémités des os entre lesquels l'implant est inséré. Leur disposition permet un parfait maintien l'implant entre les os, et en particulier d'assurer la fixation du premier métacarpien, empêchant tout effet de glissement-raccourcissement (ligamentoplastie). These threads are intended to be engaged through tissues surrounding the joint or at the ends of the bones between which the implant is inserted. Their arrangement allows a perfect maintenance of the implant between the bones, and in particular to ensure the fixation of the first metacarpal, preventing any effect of sliding-shortening (ligamentoplasty).

Avantageusement, deux fils situés sur un même côté de l'implant sont en fait constitués par les deux brins d'un même fil, ce fil étant engagé au travers de l'enveloppe et lesdits brins étant noués à cette enveloppe niveau de leurs bases. Advantageously, two son located on the same side of the implant are in fact constituted by the two strands of the same wire, this wire being engaged through the envelope and said strands being tied to this envelope level of their bases.

parfaite liaison de ces fils et de l'enveloppe est ainsi obtenue. perfect connection of these son and the envelope is thus obtained.

noyau peut avantageusement comprendre des repères radio- opaques afin de permettre de visualiser par radiologie la position du noyau de l'implant rapport à l'articulation. The nucleus may advantageously comprise radiopaque markers in order to make it possible to visualize by radiology the position of the nucleus of the implant relative to the joint.

Pour sa bonne compréhension, l'invention est à nouveau décrite ci-dessous en référence au dessin schématique annexé représentant, à titre d'exemple non limitatif, une forme de réalisation préférée de l'implant qu'elle concerne. For a good understanding, the invention is again described below with reference to the attached schematic drawing showing, by way of non-limiting example, a preferred embodiment of the implant it relates.

figure 1 est une vue à plat des os d'une main, avec trapézectomie partielle, l'implant ayant été mis en place entre la partie subsistante trapèze et le premier métacarpien ; figure 2 est une vue en perspective de l'implant, à échelle agrandie ; figure 3 en est une vue en coupe selon la ligne 111-11I de la figure 2 ; figure 4 en est une vue en perspective après mise en place entre la partie subsistante du trapèze et le premier métacarpien, figure 5 en est une vue de côté dans cette même position. Figure 1 is a plan view of the bones of one hand, with partial trapezectomy, the implant having been placed between the remaining trapezium and the first metacarpal; Figure 2 is a perspective view of the implant, on an enlarged scale; Figure 3 is a sectional view along the line 111-11I of Figure 2; Figure 4 is a perspective view after placement between the remaining part of the trapezium and the first metacarpal, Figure 5 is a side view in the same position.

La figure 1 représente les os d'une main droite, laquelle a été pratiquée une ablation partielle du trapèze 1 et sur laquelle a été mis en place un implant 2, entre la partie de ce trapèze 1 qui subsiste et le premier métacarpien 3. FIG. 1 represents the bones of a right hand, which has been partially removed from the trapezium 1 and on which an implant 2 has been placed between the part of this trapezium 1 which remains and the first metacarpal 3.

En référence aux figures 2 et 3, il apparaît que l'implant 2 présente une partie articulaire 5 et quatre fils 6 pour sa fixation à la partie du trapèze 1 qui subsiste et au premier métacarpien 3, en de trapézectomie partielle, ou pour sa fixation au scaphoïde 7 et au premier métacarpien 3 en cas de trapézectomie totale. Referring to Figures 2 and 3, it appears that the implant 2 has a joint 5 and four son 6 for attachment to the part of the trapezium 1 which remains and the first metacarpal 3, in partial trapeziectomy, or for its fixation scaphoid 7 and first metacarpal 3 in case of total trapeziectomy.

La partie articulaire 5 comprend un noyau 10 en matériau rigide résorbable et une enveloppe<B>11.</B> The articular part 5 comprises a core 10 of absorbable rigid material and an envelope <B> 11. </ B>

Le noyau 10 présente une forme de révolution, à paroi latérale arrondie et convexe, et à extrémités longitudinales tronquées, ce lui confère la forme d'un "petit tonneau". Ce noyau présente par conséquent une courbure tant dans un plan perpendiculaire à son axe de révolution que dans un plan parallèle à cet axe, de sorte qu'il permet le mouvement du premier métacarpien 3 dans deux plans perpendiculaires. The core 10 has a shape of revolution, rounded side wall and convex, and truncated longitudinal ends, it gives it the shape of a "small barrel". This core therefore has a curvature both in a plane perpendicular to its axis of revolution and in a plane parallel to this axis, so that it allows the movement of the first metacarpal 3 in two perpendicular planes.

Ce noyau 10 peut notamment être réalisé en polyéthylène. L'enveloppe 11 est formée par bobinage autour du noyau 10 d'un fil en un matériau fibreux, non résorbable. Elle présente ainsi une structure poreuse, et ses pores sont propres à être envahis par les cellules des tissus voisins afin d'assurer l'intégration de l'implant 2 à ces tissus. This core 10 may in particular be made of polyethylene. The casing 11 is formed by winding around the core 10 of a wire made of fibrous, non-resorbable material. It thus has a porous structure, and its pores are adapted to be invaded by the cells of neighboring tissues to ensure the integration of the implant 2 to these tissues.

Le fil bobiné peut notamment être formé de fibres de polyester tressées. The wound wire may in particular be formed of braided polyester fibers.

Les fils 6 sont solidaires de l'enveloppe 11. Deux d'entre eux sont situés près de l'une des extrémités longitudinales de la partie 5 et les deux autres sont situés près de l'autre extrémité longitudinale de cette partie 5. The son 6 are integral with the envelope 11. Two of them are located near one of the longitudinal ends of the portion 5 and the other two are located near the other longitudinal end of this portion 5.

Ces fils 6 débouchent de l'enveloppe 11 sur un même côté latéral de la partie 5. Ainsi que cela apparaît à la figure 3, deux fils 6 situés sur un même côté de cette partie 5 sont en fait constitués par deux brins d'un même fil, ce fil étant engagé au travers de l'enveloppe 11 et lesdits brins étant noués à cette enveloppe 1 1 au niveau de leur base. These wires 6 open out of the envelope 11 on the same lateral side of the part 5. As it appears in FIG. 3, two wires 6 situated on one and the same side of this portion 5 are in fact constituted by two strands of a same wire, this wire being engaged through the casing 11 and said strands being tied to this casing January 1 at their base.

Ces fils 6 peuvent notamment être constitués par des fibres de polyester tressées et être d'une nature similaire ou identique à celle fil constituant l'enveloppe. These son 6 may in particular be constituted by braided polyester fibers and be of a nature similar or identical to that wire constituting the envelope.

Chaque fil 6 comprend une aiguille courbe 13 sertie son extrémité libre. En pratique, ainsi que le montrent les figures 4 et 5, l'implant 2 est engagé entre la partie du trapèze 1 qui subsiste et le premier métacarpien 3, en cas de trapézectomie partielle, ou entre le scaphoïde 7 et le premier métacarpien 3, en cas de trapézectomie totale. L'implant est ensuite fixé à chacun de ces os par engagement des fils 6 au travers des tissus avoisinant l'extrémité des os, puis les fils de chaque paire de fils située sur un même coté de l'implant sont suturés l'un à l'autre. Each wire 6 comprises a curved needle 13 set with its free end. In practice, as shown in FIGS. 4 and 5, the implant 2 is engaged between the part of the trapezium 1 which remains and the first metacarpal 3, in the case of partial trapezectomy, or between the scaphoid 7 and the first metacarpal 3, in case of total trapeziectomy. The implant is then attached to each of these bones by engagement of the threads 6 through the tissues adjacent to the ends of the bones, and then the threads of each pair of threads on the same side of the implant are sutured one to the other.

Les fils 6 permettent ainsi un parfait maintien de l'implant 2 en position entre les 1, 3, 7, nonobstant les mouvements du premier métacarpien par rapport au trapèze ou au scaphoïde, le temps que la croissance des tissus s'opère au travers des pores de l'enveloppe 11, cette croissance assurant parfaite intégration de l'implant à l'articulation. The son 6 thus allow a perfect maintenance of the implant 2 in position between the 1, 3, 7, notwithstanding the movements of the first metacarpal with respect to the trapezius or scaphoid, the time that tissue growth takes place through the pores of the envelope 11, this growth ensuring perfect integration of the implant to the joint.

Le noyau 10, de par sa forme en "tonneau", présente une courbure tant dans plan perpendiculaire à son axe de révolution que dans un plan parallèle à cet axe. Cette double courbure permet le jeu du premier métacarpien 3 par rapport à l'implant 2 dans deux plans perpendiculaires, ce permet de parfaitement restituer le jeu anatomique du pouce. The core 10, in its "barrel" shape, has a curvature both in plane perpendicular to its axis of revolution and in a plane parallel to this axis. This double curvature allows the play of the first metacarpal 3 relative to the implant 2 in two perpendicular planes, it allows to perfectly restore the anatomical play of the thumb.

Le bobinage permet une parfaite cohésion du noyau 10 et de l'enveloppe 11, et l'obtention d'une structure poreuse optimale pour l'intégration de l'implant 2. The winding allows a perfect cohesion of the core 10 and the envelope 11, and obtaining an optimal porous structure for the integration of the implant 2.

L'enveloppe 11 permet quant à elle une intégration de l'implant 2 aux tissus environnant l'articulation, pour assurer un parfait maintien de cet implant en position. The envelope 11 allows for it an integration of the implant 2 to the tissues surrounding the joint, to ensure a perfect maintenance of this implant in position.

L'invention fournit ainsi un implant de remplacement total ou partiel d'un os cuboïforme permettant un mouvement articulé entre deux autres os, en particulier du trapèze, qui permet de remédier aux inconvénients des implants homologues de la technique antérieure. En effet, cet implant permet de restituer un mouvement anatomique du pouce, sans risque d'écrasement au cours du temps et avec une parfaite intégration à l'articulation. The invention thus provides a total or partial replacement implant of a cuboidal bone allowing articulated movement between two other bones, in particular the trapezium, which makes it possible to overcome the disadvantages of homologous implants of the prior art. Indeed, this implant makes it possible to restore an anatomical movement of the thumb, without risk of crushing over time and with a perfect integration with the joint.

II va de soi que l'invention n'est pas limitée à la forme de réalisation décrite ci-dessus à titre d'exemple mais qu'elle en embrasse, au contraire, toutes les variantes de réalisation. Ainsi, l'enveloppe 1 1 peut être réalisée autrement que par le bobinage d'un fil, et notamment par l'enroulement serré d'une nappe sous forme de treillis ; le noyau 10 peut comprendre des repères radio-opaques permettant vision de sa position par radiographie. It goes without saying that the invention is not limited to the embodiment described above by way of example but embraces, on the contrary, all the variants. Thus, the envelope 1 1 can be made other than by the winding of a wire, and in particular by the tight winding of a web in the form of a lattice; the core 10 may comprise radiopaque markers allowing vision of its position by radiography.

En outre, il va de soi que les dimensions l'implant 2 varient, essentiellement pour ce qui est du diamètre du noyau, selon qu'une ablation totale ou seulement partielle de l'os 1 a été realisée. In addition, it goes without saying that the dimensions of the implant 2 vary, essentially as regards the diameter of the core, according to whether a total or only partial removal of the bone 1 has been achieved.

Claims (1)

<B>REVENDICATIONS</B> 1 Implant de remplacement total ou partiel os cuboïforme (1) qui permet un mouvement articulé d'un segment osseux (3) par rapport à un autre, comprenant un noyau en matériau rigide non resorbable et une enveloppe ; implant (2) caractérisé en ce que - noyau (10) présente une forme de révolution, à paroi latérale arrondie et convexe, et à extrémités longitudinales tronquées, ce qui lui confère la forme d'un "petit tonneau", et - l'enveloppe (11) est constituée en un matériau fibreux non résorbable, structure poreuse, dont les pores sont propres à être envahis par les cellules des tissus voisins, de nature fibreuse ou fibrocartillagineuse, afin d'assurer l'intégration de l'implant (2) à ces tissus. 2 - Implant selon la revendication 1, caractérisé en ce que le noyau (10) est en polyéthylène. 3 - Implant selon la revendication 1 ou revendication 2, caractérisé en ce que l'enveloppe (11) est formée bobinage d'un fil autour du noyau. 4 Implant selon la revendication 3, caractérisé en ce que le fil bobiné est formé de fibres de polyester tressées. 5 Implant selon la revendication 1 ou revendication 2, caractérisé en ce que l'enveloppe a une structure tissée. 6 - Implant selon l'une des revendications 1 a caractérisé en ce qu'il comprend au moins un fil (6) pour sa suture à au moins un des os (1, 3, 7) contre lequel il est placé. 7 Implant selon la revendication 6, caractérisé en ce qu'il comprend quatre fils de suture (6) solidaires de l'enveloppe 1), dont deux sont situés près de l'une des extrémités longitudinales de l'enveloppe (11) et dont les deux autres sont situés prés de l'autre extrémité longitudinale de l'enveloppe (11), ces fils (6) débouchant de l'enveloppe (11) sur un même côté latéral de l'implant (2). 8 Implant selon l'une des revendications 1 à 7, caractérisé en ce que deux fils (6) situés sur un même côté de l'implant (2) sont constitués par les deux brins d'un même fil, ce fil étant engagé au travers de l'enveloppe (11) et lesdits brins étant noués à cette enveloppe au niveau de leurs bases. 9 - Implant selon la revendication 8, caractérisé en ce chaque (6) est formé de fibres de polyester tressées. 10 - Implant selon l'une des revendications 1 à 9, caractérisé en ce que noyau (10) comprend des repères radio-opaques.A total or partial cuboidal replacement implant (1) which allows an articulated movement of one bone segment (3) relative to another, comprising a core of non-resorbable rigid material and an envelope ; implant (2) characterized in that - core (10) has a shape of revolution, rounded and convex side wall, and truncated longitudinal ends, which gives it the shape of a "small barrel", and - the casing (11) consists of a non-resorbable fibrous material, porous structure, whose pores are adapted to be invaded by cells of neighboring tissues, fibrous or fibrocartillaginous nature, to ensure the integration of the implant (2 ) to these tissues. 2 - Implant according to claim 1, characterized in that the core (10) is polyethylene. 3 - Implant according to claim 1 or claim 2, characterized in that the casing (11) is formed winding a wire around the core. Implant according to claim 3, characterized in that the wound wire is formed of braided polyester fibers. Implant according to claim 1 or claim 2, characterized in that the envelope has a woven structure. 6 - Implant according to one of claims 1 a characterized in that it comprises at least one wire (6) for suturing to at least one of the bones (1, 3, 7) against which it is placed. 7 Implant according to claim 6, characterized in that it comprises four suture son (6) integral with the casing 1), two of which are located near one of the longitudinal ends of the casing (11) and the other two are located near the other longitudinal end of the casing (11), these son (6) opening out of the casing (11) on the same lateral side of the implant (2). 8 implant according to one of claims 1 to 7, characterized in that two son (6) located on the same side of the implant (2) are constituted by the two strands of the same wire, the wire being engaged in through the envelope (11) and said strands being tied to this envelope at their bases. 9 - Implant according to claim 8, characterized in that each (6) is formed of braided polyester fibers. 10 - Implant according to one of claims 1 to 9, characterized in that core (10) comprises radiopaque markers.
FR9914609A 1999-11-19 1999-11-19 TOTAL OR PARTIAL REPLACEMENT IMPLANT OF A CUBOIFORM BONE Expired - Fee Related FR2801194B1 (en)

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FR2838956A1 (en) * 2002-04-25 2003-10-31 Xavier Renard Prosthetic implant for replacing small bone comprises spiral-rolled strip of biocompatible material of greater diameter than bone
FR2899095A1 (en) * 2006-03-31 2007-10-05 Small Bone Innovations Interna Trapezium bone replacement implant for allowing articulated movement of metacarpal, has inserts made of stainless steel and fixed to body such that inserts are arranged opposite to bone surfaces when implant is inserted in space
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EP2460492A1 (en) * 2010-12-02 2012-06-06 Lazic, Voja Wrist prosthesis
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FR2838956A1 (en) * 2002-04-25 2003-10-31 Xavier Renard Prosthetic implant for replacing small bone comprises spiral-rolled strip of biocompatible material of greater diameter than bone
FR2899095A1 (en) * 2006-03-31 2007-10-05 Small Bone Innovations Interna Trapezium bone replacement implant for allowing articulated movement of metacarpal, has inserts made of stainless steel and fixed to body such that inserts are arranged opposite to bone surfaces when implant is inserted in space
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EP2460492A1 (en) * 2010-12-02 2012-06-06 Lazic, Voja Wrist prosthesis
WO2016166641A1 (en) * 2015-04-13 2016-10-20 Marco Lanzetta Prosthesis for the trapeze-metacarpal joint of the thumb
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US10231841B2 (en) 2015-04-13 2019-03-19 Marco LANZETTA Prosthesis for the trapeze-metacarpal joint of the thumb

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