FR3026635B1 - Ancillary for pre-tensioning a longiline element for attaching an implant to a bone member - Google Patents

Ancillary for pre-tensioning a longiline element for attaching an implant to a bone member Download PDF

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Publication number
FR3026635B1
FR3026635B1 FR1459365A FR1459365A FR3026635B1 FR 3026635 B1 FR3026635 B1 FR 3026635B1 FR 1459365 A FR1459365 A FR 1459365A FR 1459365 A FR1459365 A FR 1459365A FR 3026635 B1 FR3026635 B1 FR 3026635B1
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Prior art keywords
ancillary
element
comprises
device
guiding
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French (fr)
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FR3026635A1 (en
Inventor
Guy Deneuvillers
Jules PRANDI
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COUSIN BIOTECH
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COUSIN BIOTECH
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Priority to FR1459365A priority patent/FR3026635B1/en
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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8869Tensioning devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/842Flexible wires, bands or straps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8861Apparatus for manipulating flexible wires or straps

Abstract

The present invention relates to an ancillary pre-tensioning (5) of an elongated element for fixing an implant on a bone element by at least partially surrounding said bone element, said ancillary (5) comprising a rod (6) having proximal (6a) and distal (6b) ends, the distal end (6b) being provided with a support device (7) on said implant, said shaft (6) extending along an axis longitudinal (L). Advantageously, the rod (6) comprises a device for guiding and locking (8) the elongated element along the longitudinal axis (L) and the guiding and locking device (8) comprises a non-return blocking device (9). ) allowing longitudinal movement of the elongated member in said guiding and locking device (8) towards the proximal end (6a) of the shank (6) and preventing longitudinal movement of the elongate member towards the distal end (6b) of the rod (6).

Description

The present invention relates to the technical field of ancillaries for tensioning an elongated element, in particular a flat element, for attaching an implant to a bone element, in particular at least a portion of a vertebral body.

Background of the invention

It is known to correct the abnormal spinal curvatures and / or the pathological inclinations of the vertebrae to each other by the use of longitudinal bars arranged on either side of the spine and secured to the vertebrae by means of inserted screws. in the vertebrae themselves or hooks, introduced for example along the spinal canal.

However, these screws and hooks have the disadvantages of being aggressive for the spine.

To overcome these drawbacks, it has been proposed a flexible elongate fixing element combined with an implant capable of being secured to a longitudinal bar, the elongate element being fixed to the implant and engaging with at least one vertebral portion in forming a loop around the latter.

Longitudinal bars can be used in the treatment of scoliosis or the treatment of degenerative diseases. There are different levels of degeneration, for example on a vertebral level such as discopathy or on two vertebral levels such as spondylolisthesis or several levels such as scoliosis in C or S.

In these treatments, the longitudinal bar can be connected to the vertebral level to be corrected by means of an elongated element, which passes around at least a portion of a vertebral body and around said bar and the ends said elongate element can be held by means of a suture, a knot or with an implantable fastening means. Said securing means may for example comprise a housing receiving the longitudinal bar and the elongated element in the wound state around the latter, and clamping means for locking the bar and said elongate member in said housing. Generally, the clamping means comprise means for clamping said elongate element preventing any movement of the latter. One of the problems that the present invention seeks to solve is to tension the elongate member when it forms a loop on at least a portion of a vertebral body, and is engaged with an implant and / or a bar longitudinal. EP 1,933,743 B1 relates to an ancillary for tensioning an elongated element comprising a movable cylindrical piece able to move in translation around a rod, said rod comprising at its distal end means for bearing on a longitudinal bar. The movable cylindrical part also comprises a lug for fixing the elongate element. The dynamometric tightening system is operable via a handle. The tensioning of the elongated element is performed by the surgeon by pressing the handle without limit of the voltage that can be applied. The surgeon can thus apply too much tension on the elongated element, which may affect the adjustment of the longitudinal bar or bars placed on the vertebral level (s) (s) to be corrected. see even moving vertebrae. In addition, the tension is applied on a loop in the extension of the two free ends of the elongate element secured with a passer. The applied voltage will therefore not be the same on each of the free ends since it is applied directly to a single free end of the elongate element in the extension of the other free end via the loop. The application of the voltage is unbalanced on each free end of the elongate element and may cause erosion of the vertebral portion on which the tension is applied and / or sliding of the elongate element on said vertebral portion . FR 2.981.841 A1 relates to an ancillary tensioning trying to avoid compared to EP 1.933.743 B1 that the elongate member is twisted when it is tensioned. The ancillary thus includes a return so that the elongated element forms an angle of 90 °. The ends of the elongate element provided with securing means are fixed to a compensation wheel according to two diametrically opposite points. The voltage applied to each of the ends of the elongate element is therefore not balanced. In addition, the return at an angle of 90 ° of the elongate member and the means for fixing an end in a groove generate significant friction on the elongate member may weaken it. In addition, because of the return member, the ancillary is bulky. However, during surgery, multiple implants and longitudinal bars are placed on the vertebral level (es) to be corrected so that it is important for the surgeon once an elongated element tensioned to be able to easily access to the implant to complete the tightening and fixing of the latter on the elongated element but also to be able to access the other implants and / or longitudinal bars.

Object and summary of the invention

The present invention thus relates to a pretensioning ancillary device for putting in tension an elongated element forming a loop on a bone element without damaging said bone element, which is progressive and easily adjustable by the surgeon.

The present invention also relates to a pre-tensioning ancillary device for exerting an equal tension on each of the two ends of the elongate element.

The present invention also relates to a pretensioning ancillary device allowing the surgeon to quickly release the tension exerted on the elongate member if necessary, and to apply a tension on the controlled elongated element, in particular not exceeding a determined value.

The subject of the present invention is therefore, in a first aspect, an ancillary for pre-tensioning an elongated element, in particular a flat element, for fixing an implant on a bone element, in particular at least a portion of a vertebral body, at least partially surrounding said bone element, said ancillary including a shaft having proximal and distal ends, the distal end being provided with a support device on said implant, said shaft extending along a longitudinal axis . Advantageously, the rod comprises a device for guiding and locking the elongate element along the longitudinal axis and said guiding and locking device comprises a non-return stopper enabling the longitudinal displacement of the elongated element in said guiding device. and blocking toward the proximal end of the shaft and preventing longitudinal movement of the elongate member toward the distal end of the shaft.

Advantageously, the anti-return blocker prevents any displacement of the elongated element along the longitudinal axis towards the distal end of the rod when no tension is exerted on the elongated element which facilitates the work of the surgeon and he allows to wait for the elongated element to proceed to other acts. The surgeon can resume the tensioning of the elongated element without having to exert other prior action on the ancillary.

The tension on the elongated element can be exerted manually or with the aid of a tensioning instrument involving a dynamometric clamping device, such as that described below.

Advantageously, the elongated element is tensioned along a path parallel to the longitudinal axis of the rod between the distal end of the rod-and therefore the support device-and the guiding and locking device. The elongate member according to the invention is preferably a textile element, which can be braided, knitted or woven, preferably braided. Still preferably, the elongated member is flat in order to generate significant frictional forces with the surfaces against which it moves, facilitating in particular the design and implementation of the anti-return blocker for example. In addition, a flat elongate element limits the risk of erosion of the bone element. The elongate element comprises first and second ends, optionally free (s). Indeed, depending on the type of implant, in particular connector, a first free end of the elongated element can be secured to said implant.

Preferably, the guiding and locking device is configured to receive at least two superimposed linear element portions, said portions being in the extension respectively of the first and second free ends of the elongate element.

The support device bears on the implant which may comprise a connector and / or an implantable fastening means of the elongate element to a longitudinal bar and / or a longitudinal bar, preferably the support device comes into support on a connector or an implantable fastening means.

The connector may be that described in the international patent application PCT / FR2014 / 051801 filed in the name of the applicant.

The implantable fastening means may be that described in patents EP 2,555,698 B1 and EP 2,609,882 A1.

In a variant, the anti-return blocker comprises an unlocking member allowing, when it is actuated, the longitudinal displacement of the elongated element towards the distal end of the rod.

Advantageously, the unlocking member automatically releases the tension exerted on the elongate member which is a safety for the surgeon.

Preferably, the anti-return blocker comprises a cam mounted on a return spring and engaging at least a portion of the elongate element, preferably at least two superimposed portions of the elongate element, against a bearing surface, in particular, in order to block the displacement of the elongate element towards the distal end of the rod.

Preferably, the unlocking member is a lever which acts on the cam and the disengagement of the elongate member.

In a variant, the anti-return blocker comprises a longitudinal passage having an upper bearing surface constituting a guide portion for the longitudinal displacement of the elongated element.

Advantageously, when the elongated element is flat, the friction with the bearing surface is amplified and improves the guiding and locking of the elongate element against said upper bearing surface.

Alternatively, the guiding and locking device further comprises a locking member configured to lock the elongate member against the upper bearing surface while preventing longitudinal movement of the elongate member toward the distal end of the elongate member. rod.

Preferably, the locking element comprises a return member in its initial position corresponding to its engagement and thus the locking of the elongate member against said bearing surface. When the elongate element is tensioned causing its longitudinal displacement towards the proximal end of the rod, the locking element under the effect of the elongate element, disengages from the latter and thus from the bearing surface higher.

Preferably, this upper bearing surface is inclined with respect to the longitudinal axis of the rod to prevent the locking element, in particular a cam mounted on a return spring, from disengaging said elongate element under the effect of the elongate element itself according to the angle of application of the tension on the latter. For example, the spring may be cylindrical or flat, and preferably cylindrical.

In particular, the return member is mounted between the unlocking member comprising an actuating lever and the locking element, preferably around a rod connecting said lever and the locking element.

When the guiding and locking device receives two superimposed elongate element portions, blocked by the locking element against the upper bearing surface, a first portion is disposed between the upper bearing surface and the second portion while the second portion is disposed between the first portion and the locking member.

In a variant, the locking element is rotatably mounted about an axis transverse to the longitudinal direction of the rod.

Preferably, the locking member has a curved contact portion with the elongate member to prevent abrasion damage thereof.

In a variant, the guiding and locking device is configured to be traversed by two superimposed portions of the elongated element.

Advantageously, each of the portions is in the extension of one of the two free ends of the elongate element so that the tension exerted on the elongate element is uniformly applied to the entire loop at least partially surrounding said vertebral body. which avoids any risk of sliding of said elongated element but also any risk of erosion of said vertebral body.

Preferably, the guiding and locking device comprises a lateral opening facilitating the introduction of said superimposed portions of elongate element.

In a variant, the unlocking member comprises a lever configured to actuate the locking element.

Advantageously, the lever is in connection with the locking element and able to pivot said locking element towards the proximal end of the rod in order to allow the displacement of the elongated element (in particular of the two superimposed portions) towards said distal end of the stem.

In a variant, the distal end of the stem comprises a head which comprises the support device, the head is provided with a housing configured to receive at least a portion of the implant, this housing comprises an opening for the passage and guiding the elongate member.

Preferably, the housing is configured to receive a connector or an implantable fastening means of the elongate element to a longitudinal bar.

Preferably, the opening is a duct leading to a window or a groove.

In a variant, the opening comprises a bottom wall which is inclined with respect to the longitudinal axis of the rod, for guiding the elongated element towards the guiding and locking device.

Advantageously, during the surgical procedure, the implant, in particular the connector or the implantable securing means, is thus released and allows the surgeon to access the latter easily with a screwdriver for example to complete the fixation of the implant. elongated element without being disturbed by the thorny to access the implantation area.

In a variant, the head is inclined relative to the longitudinal axis of the rod and forms a bearing zone on the inclined implant relative to a plane passing perpendicular to the longitudinal axis.

We find the technical effect described above.

In a variant, the opening forms a duct opening onto a window, said duct having an inlet orifice and an outlet orifice of the elongate element spaced a distance apart.

Advantageously, when the elongate member exits the connector or the implantable securing means, it is guided by the window to be tensioned not directly at the output of the implant but at the exit of the window so as not to interfere with the setting implementation of the implant fixation member for fixing the elongate member to said implant, in particular to the connector.

In a variant, the duct comprises upper and lower walls, the lower wall being the inclined bottom wall.

In a variant, the opening comprises a coupling member with the implant for releasably securing the head with the implant.

Preferably, the coupling member comprises weights mounted on a return member, for example a flat spring, adapted to cooperate with corresponding coupling member on the implant, for example through lateral openings.

Alternatively, the proximal end of the rod is provided with a coupling member with a tensioning ancillary.

In another variant, the proximal end of the rod may receive a handle. In this case, the proximal end of the rod comprises a coupling member for its removable attachment to said handle. Still preferably, the proximal end of the rod and a portion of said handle are configured in the form of a square male or female for their removable attachment.

The subject of the present invention is, according to a second aspect, an assembly comprising an ancillary for pre-tensioning according to any one of the preceding embodiments, and an ancillary for putting in tension, in particular actuable with the aid of a dynamometric device configured to be coupled to the proximal end of the pre-tensioning ancillary rod.

Preferably, the dynamometric device is a trigger key according to a given torque (newtons / cm).

In a variant, said ancillary for tensioning an elongated element, in particular a flat element, for fixing an implant on a bone element, in particular at least a portion of a vertebral body, at least partially surrounding said bone element , comprises a body having proximal and distal ends, the distal end being provided with a device for bearing on the implant, said body extending along a longitudinal axis. The ancillary further comprises a carriage movable along the longitudinal axis and a fastening device to the elongate element. Advantageously, the ancillary further comprises a rotating shaft about the longitudinal axis of the body, this shaft is configured to cooperate with the carriage so that a rotation of the shaft causes the displacement in translation of the carriage along the longitudinal axis of the body. longitudinal axis and correlatively the removal of the carriage from the distal end of the body and the tensioning of the elongate member.

Advantageously, the elongated element is tensioned along the longitudinal axis of the body receiving the movable carriage which reduces the size of the ancillary operating and facilitates its tensioning.

In addition, the carriage being mounted according to a rotary shaft, the ancillary according to the invention does not need a non-return system. Indeed, when the voltage applied to the elongated element is released, the carriage does not move and remains stationary because it is retained by the rotary shaft.

The definitions concerning the elongate element (free ends, portions) according to a first aspect of the invention also apply to the second aspect of the invention.

In a sub-variant, the pre-tensioning ancillary acts as a support device for the tensioning ancillary.

In a sub-variant, the support device of the tensioning ancillary device comprises the coupling member described above with reference to the first aspect according to the invention for releasably securing the proximal end of the pre-tensioning ancillary shaft with tensioning ancillary.

Preferably, the carriage is configured to receive at least two superimposed segments of elongate element which improves the distribution of the tension in the elongated element and avoids the risk of erosion and / or sliding of the elongated element around the portion of the vertebral body.

Preferably, the rotating shaft is a threaded shaft, further preferably the shaft comprises a helical thread.

Alternatively, the shaft has a portion extending beyond the proximal end of the body configured to couple with a torque clamp.

Advantageously, it is possible to choose precisely the torque (newtons / cm) that one wishes to apply for the tensioning of the elongated element instead of exerting an approximate tension whose torque is not known which is more sure for the patient.

In a variant, the fixing device comprises a jaw assembly extending in two inclined planes relative to each other and inclined with respect to the longitudinal axis of the body.

This jaw assembly is a device for attaching the elongate member to the carriage.

The surgeon does not need to have special means on the free ends of the elongate element to make them cooperate with a fastening system on the ancillary or form a loop as is the case in the state of the technique. Simply simply superpose the first and / or second end (s) free (s) of the elongate element in the jaw assembly after spreading the jaws of one another with the help of a gripping member described hereinafter.

Preferably, the inclination of the jaw assembly makes it possible to apply a progressive tension to the elongated element, which improves the fixing force of the elongate element to the fixing device. More preferably, both planes converge towards the distal end of the body, which further enhances the aforementioned effects. The jaw assembly is also inclined with respect to the longitudinal axis of the body so that the elongated member adopts a corresponding inclination between said assembly and the distal end of the body.

This arrangement also prevents the elongate element from de-actuating the blocking element of the device for guiding and locking the pre-tensioning ancillary device according to the invention.

Alternatively, the jaws are configured to be movable and operable by a gripper for the placement of the elongated member between said jaws.

Preferably, the jaw assembly includes a locking member for locking said jaws in an open position. Still preferably, the locking member comprises two lugs vis-à-vis arranged in said gripping member, including a link, adapted to abut against the carriage to lock the jaw assembly in the open position.

In a variant, the ancillary comprises a fast unlocking device for decoupling the carriage from the rotary shaft.

This arrangement advantageously makes it possible to automatically release the tension on the elongated element, and thus forms a safety for the surgeon when adjusting the elongated element.

In a variant, the carriage has a disengaged position in which the carriage is free to slide longitudinally with respect to the longitudinal axis of the rotary shaft and an engaged position in which the carriage is coupled with the rotary shaft.

Preferably, the ancillary comprises a device for clutching and disengaging the carriage of the rotary shaft, further preferably the clutch and disengaging device comprises the quick release device for actuating the clutch and the clutch. of the carriage with the rotating shaft.

Preferably, the clutch and disengagement device comprises a cam mounted on a return member in connection with the quick release device for moving the carriage from the engaged position to the disengaged position and vice versa.

In a sub-variant, the clutch and disengagement device comprises a housing adapted to receive the rotary shaft, said housing having a window adapted to let a fork in connection with the carriage to engage or disengage the rotary shaft under the effect of the cam mounted on said return member.

In a variant, the body comprises a spring mounted on the rotating shaft and extending longitudinally between the proximal end of the body and the carriage.

The spring is supported at the proximal end of the body and against the carriage, which accelerates the release of the tension on the elongate member when the quick release device is actuated to decouple the carriage from the rotating shaft as the spring pushes the carriage towards the distal end of the body.

In a variant, the carriage comprises a longitudinal slot for receiving the elongated element, in particular two portions of said elongate element superimposed.

Advantageously, the tension is applied homogeneously on the elongate element forming a loop around a portion of the vertebral body and the longitudinal bar.

In a sub-variant, the slot is disposed above the jaw assembly.

This arrangement facilitates access to the jaw assembly and thus the arrangement of the elongate member in said assembly.

Alternatively, the quick lock comprises a lever that is configured when actuated to decouple the carriage from the rotating shaft.

Alternatively, the proximal end of the body comprises a coupling member adapted to be coupled with a removable handle and configured to allow the pivoting of the handle about the longitudinal axis of the body.

Preferably, the coupling member is also configured to lock the handle in a predetermined position around the longitudinal axis of the body.

Advantageously, the surgeon can thus modify the position of the handle by rotating the latter around the body along the longitudinal axis of the body. Preferably, the removable handle comprises a ring having on its periphery at least one tooth adapted to cooperate with a notch of a toothed ring mounted on the proximal end of the body. Still more preferably, the coupling member comprises a clamping ring that grips the ring comprising at least one tooth and the notched ring in order to block the coupling between said rings. In particular, the proximal end of the body comprises a threaded portion on which can be screwed the clamping ring.

The present invention will be better understood on reading the exemplary embodiments described below, given by way of non-limiting example and illustrated by the drawings described hereinafter appended to this text.

DETAILED DESCRIPTION OF THE DRAWINGS FIG. 1 is a diagrammatic and perspective representation of an implantable connector fixing an elongated element disposed around a portion of a vertebral body and of a longitudinal bar; FIG. 2 is a diagrammatic and partially exploded perspective representation of a first variant of a pre-tensioning ancillary device according to the invention; FIG. 3 is a diagrammatic and perspective representation of the tensioning ancillary shown in FIG. 2; - Figure 4 is a side view of the ancillary shown in Figures 2 and 3; - Figure 5 is a top view of the ancillary shown in Figures 2,3 and 4; FIG. 6 is an exploded representation in part of the non-return stopper shown in FIGS. 2 to 5; FIG. 7 is a diagrammatic and perspective representation of a second variant of the pre-tensioning ancillary device according to the invention; FIG. 8 is a diagrammatic and perspective representation of a handle adapted to be coupled with the proximal end of the ancillary rod represented in FIGS. 2 to 5; FIG. 9 is a diagrammatic and perspective representation of the first variant of pre-tensioning ancillary device according to the invention in operation; FIG. 10 is a diagrammatic and perspective representation of the head of the stem of the first variant of ancillary pretensioning in operation; FIG. 11 is a diagrammatic and perspective representation of an assembly according to the present invention comprising the first pre-tensioning ancillary variant represented in FIGS. 2 to 5 and a first variant of a tensioning ancillary operable by means of a dynamometric device.

Detailed description of the examples of embodiment

FIG. 1 represents an implantable connector 1 fixing an elongate element 2 flat of width 11 disposed around a portion of a vertebral body 3 and a longitudinal bar 4. Said elongate element 2 prior to its fixation in its wound state around of the portion of the vertebral body 3 has been tensioned using an ancillary pretensioning device according to the invention, possibly combined with an ancillary tensioning according to the invention, in particular activated with the aid of 'a dynamometric device.

FIGS. 2 to 5 show a first example of pre-tensioning ancillary device 5 according to the invention comprising a rod 6 having proximal end 6a and distal end 6b, the distal end 6b being provided with a support device 7 on an implant, in this specific example on an implantable connector, such as the connector 1 shown in Figure 1. The rod 6 extends along a longitudinal axis L and comprises a device for guiding and locking 8 a l elongate element, such as the elongated element 2, along the longitudinal axis L. The guiding and locking device 8 comprises a non-return stopper 9 allowing the longitudinal displacement along the longitudinal axis L of the elongate element in the guiding and locking device 9 towards the proximal end 6a of the rod 6 and preventing the longitudinal displacement along the longitudinal axis L of the elongate element towards the distal end 6b of the rod 6. In this specific example, the 6 co stem comprises a first 10 and second 11 rod portions comprising at their ends 10a and 11a, shoulders 12 and 13 adapted to be received in a housing 14 formed in the guide and locking device 8 for securing the rod 6 to the device guiding and blocking 8.

The non-return blocking device 9 comprises an unlocking member 15 allowing, when it is actuated, the longitudinal displacement of the elongated element towards the distal end 6b of the rod 6. The non-return blocking device 9 comprises a longitudinal passage 16 having an upper bearing surface 16a forming a guide portion for longitudinal movement of the elongate member. The guiding and locking device 8 further comprises a locking element 17 configured to lock the elongate member against the upper bearing surface 16a while preventing the longitudinal displacement of the elongated member towards the distal end 6b of the rod 6. The locking element 17 is rotatably mounted about an axis T transverse to the longitudinal direction L of the rod 6. The unlocking member 15 comprises a lever 18 configured to actuate the locking element 17. The guide and blocking device 8 is configured to be traversed by two superimposed portions of the elongated element, each of said portions being in the extension of a first or second free end of the elongate element.

A part of the non-return blocking device 9 is shown in FIG. 6. The non-return blocking device 9 comprises in this example a support 19 receiving a cam 21, forming the locking element 17, the cam 21 is in connection with a cylinder 23, itself in conjunction with the lever 18 forming the unlocking member 15. A return member 24 shown in Figure 5, is mounted around the cylinder 23, and has a first end 24a secured to the support 19 and a second 24b end secured to the unlocking member 15, that is to say the lever 18. In this example, this return member 24 is a cylindrical spring. In this example, the cylinder 23 is mounted on the support 19 by means of two pins 26,27. The distal end 6b of the rod 6 comprises a head 29 which comprises the support device 7, the head 29 is provided with a housing 31 configured to receive at least a portion of the implant, in particular at least partially the connector 1. This housing 31 comprises an opening 33 for the passage and guiding of the elongate element. The opening 33 comprises a bottom wall 35 inclined with respect to the longitudinal axis L of the rod 6, for guiding the elongated element towards the guiding and locking device 8. The opening 33 forms a duct 37 opening onto a window 39, said duct 37 having an inlet orifice 37a and an outlet orifice 37b of the elongate element distant by a determined distance d. The duct 37 comprises upper and lower walls, the lower wall being the inclined bottom wall 35. The opening 33 comprises a coupling member 41 with the implant, in particular the connector 1, for releasably securing the head 29 with the implant. In this example, the coupling member 41 - shown in detail in FIG. 2 - is arranged in each side wall of the head 29 and comprises a fixing member 43, a spring blade 44 and a flyweight 45. This coupling member 41 is thus arranged to be coupled with the lateral grooves 1a of the connector 1 shown in FIG. 1. The proximal end 6a of the rod 6 is provided with a coupling member 47 (in particular in the form of a female square) with an ancillary tensioning which will be described below or with a handle, such as the handle 46 shown in Figure 8. The handle 46 comprises a male-shaped portion 46a adapted to cooperate with the coupling member 47 for its removable connection with the pre-tensioning ancillary 5.

FIG. 7 represents a second variant of a pre-tensioning ancillary device 49 which differs from the pre-tensioning ancillary device 5 in that the head 51 comprises a groove 53 having an inclined bottom wall 55. Like the head 29, the head 51 comprises a coupling member 57 similar to the coupling member 41.

Figures 9 and 10 show the pre-tensioning ancillary 5 in operation. Once the elongated element 2 disposed around a portion of a vertebral body 3 and a longitudinal bar 4, its first and second free ends being passed through the connector 1, the connector 1 being secured to the head 29 by through the coupling member 41, the first and second free ends of the elongated element 2 are then passed through the longitudinal passage 16 of the guiding and locking device 8 by unlocking the unlocking member 15 and thereby forming two portions of elongate element 2 superimposed and locked in the device 8. These two elongate element portions 2 are locked in the non-return blocker 9, and in particular by the locking element 17 formed of the cam 21 now said portions against the upper bearing surface 16a. When the practitioner exerts a tension on the free ends of the elongate element 2, the locking member 17 pivots along an axis T transverse to the longitudinal axis L towards the proximal end 6a of the rod 6 and thus allows the displacement from the elongate member 2 to said proximal end 6a. When the practitioner releases the tension, the locking element 17 under the effect of the return member 24 returns in its position against the upper bearing surface 16a and clamps the two elongate element portions 2 against said surface upper support 16a thus preventing any displacement of the elongated element 2 towards the distal end 6b of the rod 6. When the practitioner considers that the elongate element 2 has sufficiently been tensioned, using a tool clamping device, such as the torque screwdriver 60, it actuates the fastening member of the elongated element 2 to the connector 1.

FIG. 10 represents the passage of the elongate element 2 at the outlet of the connector 1 and of the head 29, in particular of the outlet orifice 7b of the duct 37 corresponding to the window 39. The window 39 thus makes it possible to shift about the distance d, the output of the elongate element 2 of the connector 1. This arrangement allows to shift the application of the voltage on the window 39 and not to apply directly to the connector 1 thus limiting the risk of decoupling the connector 1 to the head 29. Note that the support device 7 bears on the connector 1 and not on the longitudinal bar 4.

FIG. 11 represents, in operation, an assembly 61 comprising a pre-tensioning ancillary device, such as ancillary device 5, and a tensioning ancillary device 62 operable by means of a dynamometric clamping device 64, configured to be coupled or coupled to the proximal end 6a of the shank 6 of the pre-tensioning ancillary 5. The tensioning ancillary 62 of the elongate member 2 comprises a body 66 having proximal ends 66a and distal 66b, the distal end 66b being provided with a device for bearing on the implant, said body 66 extending along a longitudinal axis L. The device for resting on the implant is formed here by ancillary pretensioning 5. The ancillary 62 further comprises a movable carriage 68 along the longitudinal axis L and a fastening device 70 to the elongated element 2. Advantageously, the ancillary 62 also comprises a rotary shaft 71 around the longitudinal axis L of the body 66, this shaft 71 is configured to cooperate with the carriage 68 so that a rotation of the shaft 71 causes the displacement in translation of the carriage 68 along the longitudinal axis L and correlatively the distance of the carriage 68 of the distal end 66b of the body 66 and the tensioning of the elongate member 2. The shaft 71 has a portion 72 extending beyond the proximal end 66a of the body 66 and configured to be coupled with the dynamometric clamping device 64, in particular triggering according to a given torque (newtons / cm), for example of the order of 2 to 6 newtons / cm. The fastener 70 has a jaw assembly extending in two planes pl, p2 inclined with respect to each other and inclined with respect to the longitudinal axis of the body L. The jaw assembly is also inclined relative to the longitudinal axis L of the body 66 so that the elongated element 2 adopts a corresponding inclination between said jaw assembly and the distal end 66b of the body 66, and in particular the guiding and locking device 8. This In particular, this arrangement avoids that the elongate element 2 disengages the non-return blocking device 9 from the pre-tensioning ancillary device 5. The jaws are configured to be movable and actuable by a gripping member 74 for the placement of the elongated element 2 between them. Preferably, the jaw assembly includes a locking member for locking said jaws in an open position. The carriage 68 comprises a quick release device 73 for decoupling the carriage 68 from the rotary shaft 71.

Preferably, the body 66 comprises a spring mounted on the rotary shaft 71 and extending longitudinally between the proximal end 66a of the body 66 and the carriage 68. The spring 66 is supported at the proximal end 66a of the body 66 and against the carriage 68, which accelerates the release of the tension on the elongated element 2 when the quick release device 73 is actuated to decouple the carriage 68 from the rotary shaft 71 since the spring pushes the carriage 68 towards the The distal end 66b of the body 66. The carriage 68 has a longitudinal slot 78 for receiving two superimposed portions of the elongate member 2 disposed above the jaw assembly.

Advantageously, the tension is applied homogeneously on the elongate element forming a loop around the portion of the vertebral body 3 and the longitudinal bar 4.

The surgeon thus has a modular assembly. Once the elongated element 2 has been put in tension, the voltage-setting ancillary 61 can be decoupled from the pre-tensioning ancillary device 5 and used to complete the adjustment of the voltage of elongated elements engaged on the other pre-tensioning ancillaries according to the invention.

Claims (12)

1. Ancillary pre-tensioning (5) of an elongated element (2) for fixing an implant (1) on a bone element, in particular at least a portion of a vertebral body (3), in at least partially surrounding said bone element, said ancillary device (5) comprising a shaft (6) having proximal (6a) and distal (6b) ends, the distal end (6b) being provided with a support device (7) ) on said implant (1), said rod (6) extending along a longitudinal axis (L), characterized in that the rod (6) comprises a device for guiding and locking (8) the elongated element ( 2) along the longitudinal axis (L), in that said guiding and locking device (8) comprises a nonreturn blocking device (9) allowing the longitudinal displacement of the elongate element (2) in said guiding device and blocking (8) towards the proximal end (6a) of the shank (6) and preventing longitudinal movement of the elongate member (2) towards the end distal (6b) of the shaft (6), and in that the distal end (6b) of the shaft (6) comprises a head (29) which comprises the support device (7), the feast (29) being provided with a housing (31) configured to receive at least a part of the Implant (1), this housing (31) comprising an opening (33) for the passage and guiding of the elongated element (2), and in that the opening (33) comprises a coupling member (41) with the implant (1) for releasably securing the head (29 with the implant (1),
2. Ancillary (5) according to claim 1, characterized in that the anti-return blocker (9) comprises an unlocking member (15) allowing, when actuated, the longitudinal displacement of the elongate member (2) towards the distal end (6b) of the stem (6),
3. Ancillary (5) according to either of claims 1 and 2, characterized in that the anti-return blocker (9) comprises a longitudinal passage (16) having an upper bearing surface (16a) constituting a guide portion for the longitudinal movement of the elongate member (2).
4. Ancillary (5) according to claim 3, characterized in that the guiding and locking device (8) further comprises a locking element (17,21) configured to lock the elongated element (2) against the surface upper support (16a) while preventing the longitudinal displacement of the elongated element (2) towards the distal end (6b) of the rod (6).
5. Ancillary (5) according to claim 4, characterized in that the locking element (17,21) is rotatably mounted about an axis (T) transverse to the longitudinal axis (L) of the rod (6). )
6. Ancillary (5) according to claim 4, characterized in that the unlocking member (15) comprises a lever (18) configured to actuate the locking element (17,21).
7. Ancillary (5) according to any one of claims 1 to 6, characterized in that the guiding and locking device (8) is configured to be traversed by two superimposed portions of the elongate element (2),
8. Ancillary (5) according to any one of claims 1 to 7, characterized in that the opening (33) comprises a bottom wall (35) which is inclined relative to the longitudinal axis (L) of the rod (6) for guiding the elongated element (2) towards the guiding and locking device (8).
9. Ancillary (5) according to any one of claims 1 to 8, characterized in that the opening (33) forms a duct (37) opening on a window (39), said duct (37) having a hole d an inlet (37a) and an outlet (37b) of the elongate member (2) spaced a predetermined distance (d).
10. Ancillary (5) according to claim 9, characterized in that the duct (37) comprises upper and lower walls, the bottom wall being the inclined bottom wall (35).
11. Ancillary (5) according to any one of claims 1 to 10, characterized in that the proximal end (6a) of the rod (6) is provided with a coupling member (47) with an ancillary setting in tension.
12. Assembly (61) comprising a pre-tensioning ancillary (5) according to any one of claims 1 to 11, and a tensioning ancillary (62), in particular actuable by means of a clamping device load cell (64) configured to be coupled to the proximal end (6a) of the stem (6) of the pre-tensioning ancillary (5).
FR1459365A 2014-10-01 2014-10-01 Ancillary for pre-tensioning a longiline element for attaching an implant to a bone member Active FR3026635B1 (en)

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Application Number Priority Date Filing Date Title
FR1459365 2014-10-01
FR1459365A FR3026635B1 (en) 2014-10-01 2014-10-01 Ancillary for pre-tensioning a longiline element for attaching an implant to a bone member

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR1459365A FR3026635B1 (en) 2014-10-01 2014-10-01 Ancillary for pre-tensioning a longiline element for attaching an implant to a bone member
PCT/FR2015/052618 WO2016051089A1 (en) 2014-10-01 2015-09-30 Accessory for pre-tensioning an elongate element

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FR3026635A1 FR3026635A1 (en) 2016-04-08
FR3026635B1 true FR3026635B1 (en) 2019-06-28

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US8291545B2 (en) 2005-06-24 2012-10-23 Royal Appliance Mfg., Co. Twin cyclone vacuum cleaner
FR2890851B1 (en) * 2005-09-21 2008-06-20 Abbott Spine Sa Ancillary to tension a flexible link.
FR2961687B1 (en) 2010-06-23 2015-05-22 Cousin Biotech Longiline element retention device suitable for maintaining determined intervertebral clearance
AU2012308347C1 (en) * 2011-09-14 2018-07-19 Band-Lok, Llc Tether clamp and implantation system
FR2981841B1 (en) 2011-10-28 2013-12-20 Implanet Device for tensioning a soft band and comprising assembly such device with flexible band
FR2985165B1 (en) 2011-12-29 2014-01-17 Cousin Biotech Device for fixing vertebral

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FR3026635A1 (en) 2016-04-08

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